Post-discharge consequences of protein-energy malnutrition, sarcopenia, and frailty in older adults admitted to rehabilitation: A systematic review.

BACKGROUND & AIMS: Malnutrition, sarcopenia, and frailty are three prevalent wasting conditions among older rehabilitation patients that lead to multiple health-related negative outcomes. This systematic review and meta-analysis aimed to determine the post-discharge consequences of malnutrition, sarcopenia, and frailty in older adults admitted to inpatient rehabilitation. METHODS: MEDLINE, Embase, Web of Science, and CINAHL databases were searched on 20 April, 2021 for longitudinal studies in older adults (≥65 years) admitted for inpatient rehabilitation. This systematic review included and synthesised studies that 1) measured malnutrition, sarcopenia, and/or frailty using a validated assessment tool or guideline; and 2) reported the association with post-discharge mortality, physical function, quality of life, or discharge location. The Academy of Nutrition & Dietetics Quality Criteria Checklist and GRADE criteria were used to assess risk of bias and evidence certainty. Where possible, data were pooled using Revman. RESULTS: Twenty-six observational studies (n = 9709 participants in total) with similarly aged populations were included. Eight, seven, and eleven studies assessed malnutrition, sarcopenia, and frailty, respectively. Follow-up periods ranged from immediate to 7 years post-rehabilitation. Malnutrition was associated with discharge to a higher level of care (GRADE: very low), and worse quality of life (GRADE: very low) and physical function (GRADE: very low). Sarcopenia was associated with worse physical function (GRADE: very low) and lower rate of home discharge (OR: 0.14; 95%CI: 0.09-0.20; I2:30%; GRADE: low). Frailty was associated with increased mortality (GRADE: very low), hospital readmission (GRADE: very low), and decreased home discharge (GRADE: very low). CONCLUSION: Wasting conditions in older adults during rehabilitation admission may be associated with poorer quality of life, lower rates of home discharge, and higher rates of health service use, physical dysfunction, and mortality following discharge. Further research is needed to investigate the comparative and combined impacts, as well as the overlap of malnutrition, sarcopenia, and frailty during and after rehabilitation to guide priority screening and intervention.

NOx and O3 Trends at U.S. Non-Attainment Areas for 1995-2020: Influence of COVID-19 Reductions and Wildland Fires on Policy-Relevant Concentrations.

We analyzed NO2 and O3 data from 32 U.S. non-attainment areas (NAAs) for 1995-2020. Since 1995, all regions have shown steady reductions in NO2 and the weekend-weekday pattern indicates that the O3 production regime in most NAAs has transitioned to a NOx-limited regime, while a few NAAs remain NOx-saturated. In the eastern U.S., all NAAs have made steady progress toward meeting the current (70 ppb) O3 standard, but this is less true in midwestern and western NAAs, with most showing little improvement in peak O3 concentrations since about 2010. Due to COVID-19 restrictions, NO2 concentrations were substantially reduced in 2020. In the eastern NAAs, we see significant reductions in both NO2 and peak O3 concentrations. In the midwestern U.S., results were more variable, with both higher and lower O3 values in 2020. In the western U.S. (WUS), we see variable reductions in NO2 but substantial increases in O3 at most sites, due to the influence from huge wildland fires. The recent pattern over the past decade shows that the large amount of wildland fires has a strong influence on the policy-relevant O3 metric in the WUS, and this is making it more difficult for these regions to meet the O3 standard.