Nutritional Status in Hospitalized Patients Over 65 Years of Age With Mental Disorders

The prevalence of predefined nutrition disorders and nutrition-related conditions will be assessed in hospitalized patients aged 65 years and older with mental disorders using validated diagnostic criteria. Predefined conditions include malnutrition, cachexia, sarcopenia, frailty, overweight, obesity (including sarcopenic obesity and central obesity), and micronutrient abnormalities.

Nutritional status will be assessed using the Mini Nutritional Assessment (MNA®; score range 0-30). Higher MNA scores indicate better nutritional status.

Appendicular skeletal muscle mass index (ASMI, kg/m²) will be assessed by bioelectrical impedance analysis and calculated as appendicular skeletal muscle mass in kilograms divided by height in meters squared. Higher ASMI values indicate greater appendicular skeletal muscle mass relative to height.

Dysphagia will be assessed using the Gugging Swallowing Screen (GUSS). The total score ranges from 0 to 20 points, with higher scores indicating better swallowing function. Established score ranges will be used to describe dysphagia severity.

Phase angle, expressed in degrees, will be assessed using bioelectrical impedance analysis. Higher phase angle values generally indicate greater cell membrane integrity and body cell mass.

Activities of daily living will be assessed using the Barthel Index. The total Barthel Index score (0-100 points) will be recorded. Higher scores indicate greater independence in activities of daily living.

Handgrip strength will be assessed using a calibrated hand dynamometer. One maximal grip strength measurement will be obtained from the dominant hand and recorded in kilograms (kg). Higher values indicate greater handgrip strength.

Cognitive function will be assessed using the Mini-Mental State Examination (MMSE). The total score ranges from 0 to 30 points, with higher scores indicating better cognitive function.

Depressive symptoms will be assessed using the 15-item Geriatric Depression Scale (GDS-15). The total score ranges from 0 to 15 points, with higher scores indicating more severe depressive symptoms.

Hospital length of stay will be calculated as the number of calendar days from hospital admission to hospital discharge, based on the hospital medical record.

The number of participants experiencing at least one predefined adverse event during hospitalization will be recorded. Predefined adverse events include falls, fractures, delirium, aspiration, pneumonia, urinary tract infection, gastrointestinal infection, sepsis, gastrointestinal bleeding, pressure ulcer, deep vein thrombosis, pulmonary embolism, arrhythmia, stroke, myocardial infarction, cardiopulmonary arrest, or death. Each participant will be counted once, irrespective of the number of adverse events experienced.

Mobility will be assessed using the de Morton Mobility Index (DEMMI). The DEMMI total score (0-100 points) will be recorded. Higher scores indicate better mobility.

Gait speed will be assessed over a 4-meter walking distance. Walking speed will be calculated as distance in meters divided by walking time in seconds and expressed in meters per second. Higher values indicate faster gait speed.

Lower extremity muscle function will be assessed using the Five Times Sit-to-Stand Test (5STS). The time (seconds) required to complete five consecutive sit-to-stand repetitions will be recorded. Shorter completion time indicates better lower extremity strength.

Functional mobility will be assessed using the Timed Up and Go (TUG) test. The time (seconds) required to stand up from a chair, walk around a marker, return, and sit down will be recorded. Shorter completion time indicates better function.

Frailty will be assessed using the Clinical Frailty Scale (CFS), ranging from 1 to 9 points. Higher scores indicate greater frailty.

Comorbidity burden will be assessed using the Age-adjusted Charlson Comorbidity Index. The total ACCI score will be recorded.

The number of regularly prescribed systemic medications documented in the participant's medication list at baseline will be recorded. Medications prescribed only as needed will not be included.

GNRI will be calculated from serum albumin concentration and the ratio of actual to ideal body weight using the prespecified GNRI equation (Bouillanne et al, 2005). The GNRI is a unitless score, with higher scores indicating lower nutrition-related risk.

Serum brain-derived neurotrophic factor (BDNF) concentration will be measured in serum obtained from venous blood using a validated enzyme-linked immunosorbent assay and expressed in ng/ml.

Serum interleukin-6 (IL-6) concentration will be measured in serum obtained from venous blood using a validated laboratory assay and expressed in pg/ml.

Serum interleukin-1 beta (IL-1β) concentration (pg/ml) will be measured in serum obtained from venous blood using a validated laboratory assay.

Total antioxidant capacity, assessed using the DPPH radical scavenging assay, will be expressed as percentage inhibition of the DPPH radical. Higher values indicate greater antioxidant capacity.

Serum tumor necrosis factor-alpha (TNF-α) concentration (pg/ml) will be measured in serum obtained from venous blood using a validated laboratory assay.

Serum C-reactive protein (CRP) concentration (mg/l) will be measured in serum obtained from venous blood using routine laboratory methods.

PhenoAge, expressed in years, will be calculated using the validated equation described by Ruan et al. (2023), based on chronological age, serum albumin, creatinine, glucose, lymphocyte percentage, mean corpuscular volume, red cell distribution width, alkaline phosphatase, and white blood cell count. Lower values indicate lower biological age.

Skeletal muscle mass percentage will be assessed by bioelectrical impedance analysis and expressed as the percentage of total body mass classified as skeletal muscle mass.

Fat mass percentage will be assessed by bioelectrical impedance analysis and expressed as the percentage of total body mass classified as fat mass. Higher values indicate a greater proportion of body fat.

Calf circumference will be measured in centimeters at the prespecified anatomical site using a non-stretch measuring tape and standardized anthropometric procedures.

Body mass index (BMI) will be calculated as body weight in kilograms divided by height in meters squared and expressed in kg/m².