Undernutrition, hypothermia, and injury in elderly women with fractured femur: an injury response to altered metabolism?

Abstract

On the basis of triceps skinfold thickness and arm muscle circumference measurements, 744 elderly women with fractured neck of femur were divided into three groups--well nourished, thin, and very thin. The mortality in the three groups was 4.4%, 8%, and 18%, respectively. Differences were not explained by age, associated disease, dementia, or marital status. Food intake after injury was related to initial nutritional state. There was a midwinter peak in fracture incidence and also a pronounced seasonal variation in the type of patient admitted; a much higher proportion of thin patients presented in winter after accidents indoors. The hypothesis that thinness or under-nutrition may impair thermoregulation and predispose to hypothermia, lack of coordination, and accident was supported by core temperature measurements on admission: those in most very thin patients were less than 35 degrees C, whereas in most well-nourished patients they were greater than 36 degrees C.