Outcomes of Older Patients with Malnutrition and Malnutrition–Sarcopenia in the Emergency Department: A 3-Month Prospective Observational Study

Abstract

Objectives Malnutrition and sarcopenia are both associated with increased risks of adverse outcomes in older people. The emergency department (ED) is a unique and crucial part of geriatric care. Clinical evaluation of malnutrition-sarcopenia syndrome (MSS) in the ED setting and its impact on prognosis after ED visits remain to be elucidated. This study aims to determine the associations of malnutrition, sarcopenia and MSS with subsequent prognoses and geriatric conditions. Design This was a prospective observational study between August 2018 and October 2021. Setting This study was conducted in the ED observation room of a medical center. Participants Patients 65 years and older who were observed or treated in the observation room of the ED for any indication were screened within the first 24 hours of ED presentation and asked to participate. Measurements Sarcopenia and nutritional status were assessed. Data were obtained through face-to-face interviews, hospital record reviews, and the CGAs. The differences in demographic characteristics and clinical variables among the groups of patients ≥65 years old with or without sarcopenia, malnutrition, or MSS were evaluated. Outcome data obtained during the 3-month period following the initial ED visit were also analyzed. Results In total, 650 enrolled older patients were divided intosix groups: normal (n=168), malnutrition-risk-without-sarcopenia (n=141), malnutrition-without-sarcopenia (n=36), sarcopenia-with-normal-nutritional status (n=71), sarcopenia-with-malnutrition-risk (n=137), and MSS (n=97). Mortality after ED visits at the 1- and 3-month follow-ups was significantly different amongthe six groups (p<0.05). The Kaplan–Meier method with the log-rank test discerned that the MSS group had the lowest survival probability (p=0.016) at 1-month follow-up, and the malnutrition without sarcopenia group had the lowest survival probability (p=0.002) and a higher revisit probability (p=0.049) at 3-month follow-up. Conclusions Older patients with malnutrition without sarcopenia have the highest mortality and ED revisit rates at a 3-month follow-up after an ED visit. Early detection of malnutrition, including MSS, in the ED could enable ED physicians to collaborate with geriatric specialists to initiate a particular nutritional modality in pursuit of improved outcomes, particularly mortality and revisit rates.