A high prevalence of malnutrition in acute geriatric patients predicts adverse clinical outcomes and mortality within 12 months

Abstract

Background & aims Older malnourished patients experience increased length of hospital stay and greater morbidity compared to their well nourished counterparts. This study aimed to assess whether nutritional status at hospital admission predicted clinical outcomes at 12 months follow-up. Methods Secondary data analysis of 2602 consecutive patient admissions to an acute tertiary hospital in New South Wales, Australia on or before 1st June 2009. Twelve-month data was analysed in a sub-sample of 774 patients. Nutritional status was determined within 72 h of admission using the Mini Nutritional Assessment (MNA). Outcomes, obtained from electronic patient records included hospital readmission rate, total length of stay (LOS), change in level of care at discharge, and in-hospital mortality. Results A third (34%) of patients were malnourished and 55% at risk of malnutrition. Using a Cox proportional hazards regression model, controlling for underlying illness and age, patients at risk of malnutrition were 2.46 (95% CI: 1.36, 4.45; p = 0.003) times more likely to have a poor clinical outcome (mortality/discharge to higher level of care), while malnourished patients had a 3.57 (95% CI: 1.94, 6.59; p = 0.000) times higher risk. Conclusions A poor nutritional status carries a substantially greater risk of death and/or loss of dependency in older adults. Interventions to improve the nutritional status of patients during their hospital stay, and following discharge back to the community, are needed to lower the risk of adverse outcomes.

Can the mini nutritional assessment (MNA®) be used as a nutrition evaluation tool for subacute inpatients over an average length of stay?

“…Malnutrition has been shown to cause increased length of hospital stay and increased morbidity and mortality (1)(2)(3)(4)(5).…”

“It could probably help someone else but not me”: A feasibility study of a snack programme offered to meals on wheels clients

“…An additional 35-39 % have been categorised as at risk of malnutrition. Malnutrition increases the risk of falls, osteoporosis, fractures, chronic disease, prolonged hospitalisation, and increased complications, all of which heighten the risk of mortality (5)(6)(7). Meals on Wheels (MOW), Australia, is a non-for-profit organization that provides both hot and frozen meals to frail older people, as well as younger people living with disabilities.…”

Trends in uptake of the 75+ health assessment in Australia: a decade of evaluation

“…For example, nutrition-related problems in older adults is one of the commonly identified non-medical problems that may be identified within the screen (Cheffins et al 2010). Malnutrition often remains undetected in older adults despite being a strong predictor of unfavourable health outcomes (Visvanathan et al 2004;Charlton et al 2013) and the GP is in a unique position to identify problems related to nutritional risk, for referral to a dietitian for further evaluation, if necessary (Sampson 2009). Various authors have advocated for inclusion of a validated nutrition screening instrument within the 75+ HA (Flanagan et al 2012).…”