DALLAS – Nutritional deterioration in elderly hospitalized patients is very common, often unrecognized, and linked to negative consequences in terms of key hospital outcome measures.
“Let me say, for sure, malnutrition in elderly patients is associated with terrible outcomes in terms of length of stay, mortality, functional decline, and of course nursing home admission,” Dr. Robert M. Palmer said at the annual meeting of the Society of Hospital Medicine.
Many studies indicate that about 40% of hospitalized elderly patients are either protein-calorie undernourished upon admission or become so before discharge.
“The interesting thing is it's really unusual to see malnutrition as a diagnosis in their medical record, and it's even more unusual to see that it's being adequately treated,” observed Dr. Palmer, head of the section of geriatric medicine at the Cleveland Clinic Foundation.
The consequences of failure to address these deficits during the hospital stay were spelled out some years ago in a prospective Arkansas Veterans Affairs study.
The study involved 497 consecutive elderly, nonpalliative care, medical or surgical patients hospitalized for at least 4 days–in theory, long enough for them to undergo a nutritional assessment and have major deficiencies met. Their in-hospital nutrient intake was assessed daily. Those identified as having low energy intake were subsequently assessed more intensively at the bedside on a meal-by-meal basis.
A total of 21% of the seniors had an in-hospital average daily nutrient intake of less than 50% of their calculated maintenance energy requirement. At admission, their health status was comparable with and in some respects better than that of the other patients at the VA facility. For example, their body mass index, midarm muscle circumference, and subcutaneous fat stores were significantly greater. They were also more likely to consider their health to be good or excellent and to have been admitted electively (JAMA 1999;281:2013-9).
Nonetheless, there was a huge difference in outcomes between the two groups. (See box.) The investigators determined that the biggest contributing factor to the in-hospital malnutrition problem was attending physicians' practice of ordering patients to have nothing by mouth but not prescribing nutrients by another route.
One-quarter of patients in each group received canned nutritional supplements at some point during hospitalization. Those in the undernourished group were significantly less likely to consume theirs. Enteral and parenteral nutritional support were seldom employed.
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