Emergency department malnutrition screening and support model improves outcomes in a pilot randomised controlled trial

Vivanti, Angela; Isenring, Elisabeth; Baumann, Sophie; Powrie, Duncan; O’Neill, Melanie L.; Clark, Daniel O.; Courtice, Sally; Campbell, Katrina L.; Ferguson, Maree

doi:10.1136/emermed-2013-202965

Cited by 25 publications

(38 citation statements)

References 34 publications

(28 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Implementation of oral nutritional supplementation is inexpensive and may result in overall cost savings by accelerating recovery from illness and reducing readmissions. 49,50 A recent pilot study (N=19) has demonstrated the feasibility of an ED-based intervention to treat malnutrition in older adults; 21 further research is needed to characterize the costs and benefits of such a program and, if helpful, develop a scalable version.…”

Section: Discussionmentioning

confidence: 99%

“…15–18 Although there is growing awareness of the potential value of screening for health conditions among older adults in the ED, including non-medical conditions, malnutrition was not identified as a screening target in recently published guidelines. 19,20 A 2013 study in Australia demonstrated the feasibility of interventions to treat malnutrition among older ED patients, 21 but in order to determine the potential impact of such interventions, a better understanding of the epidemiology of malnutrition among older ED patients is needed. We sought to estimate the prevalence of malnutrition and risk for malnutrition among older adults presenting to a single ED and identify subgroups at increased risk.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Malnutrition Among Cognitively Intact, Noncritically Ill Older Adults in the Emergency Department

Pereira¹,

Bulik

Weaver

et al. 2015

Annals of Emergency Medicine

View full text Add to dashboard Cite

Objectives We estimate the prevalence of malnutrition among older patients presenting to an emergency department (ED) in the southeastern United States and identify subgroups at increased risk. Methods We conducted a cross-sectional study with random time block sampling of cognitively intact patients aged 65 years and older. Nutrition was assessed using the Mini Nutritional Assessment Short-Form (0–14 scale) with malnutrition defined as a score of 7 or less and at-risk for malnutrition defined as a score of 8–11. The presence of depressive symptoms was defined as a Center for Epidemiological Studies Depression-10 score of 4 or more (0–10 scale). Results Among 138 older adults, 16% (95% Confidence Interval [CI], 10%–22%) were malnourished and 60% (95% CI, 52%–69%) were either malnourished or at-risk for malnutrition. Seventeen of the 22 malnourished patients (77%) denied previously being diagnosed with malnutrition. The prevalence of malnutrition was not appreciably different between males and females, across levels of patient education, or between those living in urban and rural areas. However, the prevalence of malnutrition was higher among patients with depressive symptoms 52%, those residing in assisted living 50%, those with difficulty eating 38%, and those reporting difficulty buying groceries 33%. Conclusion Among a random sample of cognitively intact older ED patients, more than half were malnourished or at-risk for malnutrition, and the majority of malnourished patients had not previously been diagnosed. Higher rates of malnutrition among those with depression, difficulty eating, and difficulty buying groceries suggest the need to explore multifaceted interventions.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Malnutrition Among Cognitively Intact, Noncritically Ill Older Adults in the Emergency Department

Pereira¹,

Bulik

Weaver

et al. 2015

Annals of Emergency Medicine

View full text Add to dashboard Cite

show abstract

“…As such, the ED is a potentially important setting for identifying and addressing malnutrition. Prior research has found that the burden of malnutrition is high among older adults presenting to the ED, with prevalence point estimates ranging from 12% to 16% . Only one clinical trial has examined the value of identifying and treating malnutrition in older ED patients .…”

mentioning

confidence: 99%

“…5,8,9 Only one clinical trial has examined the value of identifying and treating malnutrition in older ED patients. 8 This pilot study provided patients with individualized dietary counseling over a period of 12 weeks and observed clinically important but non-statistically significant improvements in quality of life and reductions in healthcare utilization. Although these results support the need for a large trial, much remains unknown about the optimal strategy to improve nutritional health among malnourished older ED patients.…”

mentioning

confidence: 99%

Risk Factors for Malnutrition among Older Adults in the Emergency Department: A Multicenter Study

Burks

Jones

Braz

et al. 2017

J American Geriatrics Society

View full text Add to dashboard Cite

Background Among older adults, malnutrition is common, often missed by healthcare providers, and influences recovery from illness or injury. Objective To identify modifiable risk factors associated with malnutrition in older patients. Design Prospective cross-sectional multicenter study Setting 3 EDs in the South, Northeast, and Midwest Participants Non-critically ill, English-speaking adults aged ≥65 years Measurements Random time block sampling was used to enroll patients. The ED interview assessed malnutrition using the Mini Nutritional Assessment Short-Form. Food insecurity and poor oral health were assessed using validated measures. Other risk factors examined included depressive symptoms, limited mobility, lack of transportation, loneliness, and medication side effects, qualified by whether the patient reported the risk factor affected their diet. The population attributable risk proportion (PARP) for malnutrition was estimated for each risk factor. Results In our sample (n=252), the prevalence of malnutrition was 12%. Patient characteristics associated with malnutrition included not having a college degree, being admitted to the hospital, and residence in an assisted living facility. Of the risk factors examined, the PARPs for malnutrition were highest for poor oral health (54%; 95% CI 16%, 78%), food insecurity (14%; 95% CI 3%, 31%), and lack of transportation affecting diet (12%; 95% CI 3%, 28%). Conclusion Results of this observational study identify multiple modifiable factors associated with the problem of malnutrition in older adults.

show abstract

“…<15 and < 17 kg/m 2 in females and males, respectively) (25). Malnutrition often remains unrecognized and hence untreated (9,20,(26)(27)(28). Clinical staff can miss malnutrition in older adults due to barriers that affect nutritional screening including a lack of routine nutritional screening in many hospitals (9,29), and a belief by clinical staff that individual judgement of nutritional status is more superior (30,31).…”

mentioning

confidence: 99%

The Prevalence and Impact on Patient Outcomes of Malnutrition Among Older Adults Presenting at an Irish Emergency Department: A Secondary Analysis of the OPTIMEND Trial

Griffin

́Neill

́Connor

et al. 2020

Preprint

View full text Add to dashboard Cite

BackgroundMalnutrition is common among older adults and is associated with adverse outcomes but remains undiagnosed on healthcare admissions. Older adults use emergency departments (EDs) more than any other age group. This study aimed to determine the prevalence and factors associated with malnutrition on admission and with adverse outcomes post-admission among older adults attending an Irish ED. MethodsSecondary analysis of data collected from a randomised trial exploring the impact of a dedicated team of health and social care professionals on the care of older adults in the ED. Nutritional status was determined using the Mini Nutritional Assessment- short form. Patient parameters and outcomes included health related quality of life, functional ability, frailty, hospital admissions, falls history and clinical outcomes at index visit, 30-day and 6-month follow up. Aggregate anonymised participant data linked from baseline to 30-days and 6-month follow-up were used for statistical analysis.ResultsAmong 353 older adults (mean age 79.6 years (SD=7.0); 59.2% (n=209) female) the prevalence of malnutrition was 7.6% (n=27) and ‘risk of malnutrition’ was 28% (n=99). At baseline, those who were malnourished had poorer quality of life scores, functional ability, were more frail, more likely to have been hospitalised or had a fall recently, had longer waiting times and were more likely to be discharged home from the ED than those who had normal nutrition status. At 30-days, those who were malnourished were more likely to have reported another hospital admission, a nursing home admission, reduced quality of life and functional decline than older adults who had normal nutrition status at the baseline ED visit. At 6-months, a reported further decline in functional ability was more likely among those who were malnourished compared to those who had normal nutritional status. ConclusionOver one-third of older adults admitted to an Irish ED are either malnourished or at risk of malnourishment. Malnutrition was associated with a longer stay in the ED, functional decline, poorer quality of life, increased risk of hospital admissions and a greater likelihood of admission to long-term care at 30 days. Trial registration: Protocol registered in ClinicalTrials.gov, ID: NCT03739515, first posted November 13, 2018. https://clinicaltrials.gov/ct2/show/NCT03739515

show abstract

Emergency department malnutrition screening and support model improves outcomes in a pilot randomised controlled trial

Cited by 25 publications

References 34 publications

Malnutrition Among Cognitively Intact, Noncritically Ill Older Adults in the Emergency Department

Malnutrition Among Cognitively Intact, Noncritically Ill Older Adults in the Emergency Department

Risk Factors for Malnutrition among Older Adults in the Emergency Department: A Multicenter Study

The Prevalence and Impact on Patient Outcomes of Malnutrition Among Older Adults Presenting at an Irish Emergency Department: A Secondary Analysis of the OPTIMEND Trial

Contact Info

Product

Resources

About