Quality of Life, Malnutrition and Cognitive Function in Preoperative Elderly Participants with Periampullary Disease

Background: Quality-of-life (QOL) is an important reference for healthcare decision making and the quality of care, and an important criterion in aging research. Nutritional status is compromised among elderly people in general, and the risk of malnutrition is prevalent in an aging population. Also, malnutrition is a common problem in hospitalized patients and is related to decreased cognitive function and impaired QOL. Objective: The purpose of this study was to investigate nutritional status, cognitive function and QOL in preoperative participants with periampullary disease, and to evaluate the relationship between them. Method: Data were prospectively collected from 154 elderly participants (more than 65 years) with periampullary disease between 2009 and 2015. Nutritional status was evaluated with Mini Nutrition Assessment. Nutritional status was classified by the following scores: well-nourished if greater than 22, at-risk-of malnutrition if between 15 and 21.5, and malnourished if less than 15. Cognitive function was measured the cognitive function questionnaires using the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30. QOL was measured the global health status and QOL questionnaires using the EORTC QLQ-C30. Result: Preoperatively, 20 (13.0%) participants were well-nourished, 92 (59.7%) were at-risk-of malnutrition, and 71(27.3%) were malnourished. Preoperative BMI and preoperative QOL were lower in malnourished group compared to well-nourished and at-risk-of malnutrition group (P<0.001, P<0.001). Advanced old age was significantly higher postoperative complication rates and longer hospital stay (P=0.047, P=0.043). QOL was higher in high cognitive function group than in low cognitive function group (P<0.001). There was significant positive relationship between “nutritional status and QOL” (r=0.531, p<0.001), “cognitive function and QOL” (r=0.455, p< 0.00). Factors associated with preoperative QOL were low cognitive function (OR 0.219, 95% CI 0.109-0.439, P<0.001) and malnutrition (OR 0.156, 95% CI 0.063-0.389, P<0.001). Conclusion: Cognitive function and nutritional status were positively associated with QOL. Early detection of malnutrition and cognitive troubles is important in elderly participants with periampullary disease before surgery. Vigorous efforts are needed to improve nutritional status and cognitive function through intensive nutritional support before surgery, which ultimately may improve QOL.