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Malnutrition in hospitalised older adults: A multi-centre observational study of prevalence, associations and outcomes

Published online by Cambridge University Press:  03 February 2017

Emma O’ Shea
Affiliation:
Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, Ireland
Steven Trawley
Affiliation:
Centre for Health and Social Research, Australian Catholic University, Melbourne, Australia
Edmund Manning
Affiliation:
Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, Ireland
Aoife Barrett
Affiliation:
Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, Ireland
Vanessa Browne
Affiliation:
Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, Ireland
Suzanne Timmons
Affiliation:
Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, Ireland
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Abstract

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Abstract
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Copyright © The Authors 2017 

Malnutrition is common in older adults, and is associated with high healthcare costs and adverse outcomes, particularly in hospital settings(Reference Rice and Normand1,Reference Rasheed and Woods2) . The prevalence and correlates of malnutrition in hospitalised older adults are currently not clear; much of the existing research in this area is limited methodologically; studies are typically based on small samples and/or narrow populations(Reference Chen, Bai and Huang3,Reference Vanderwee, Clays and Bocquaert4) , exclude people with dementia(Reference Chen, Bai and Huang3,Reference Vanderwee, Clays and Bocquaert4) , are uni-centre(Reference Eide, Halvorsen and Almendingen5), and/or use tools not designed for use with older adults(Reference Eide, Halvorsen and Almendingen5). The present study addresses this gap, investigating the prevalence, correlates and outcomes of malnutrition in older adults on admission to hospital.

In total, 606 (70+ years) older adults were included in a prospective cohort study across six hospitals in the Republic of Ireland. All elective and acute admissions to any speciality were eligible. Day-case admissions and those moribund on admission were excluded. All participants were clinically assessed for dementia on admission (see Timmons et al.(Reference Timmons, Manning and Barrett6)). Socio-demographic and clinical data, including nutritional status (Mini-Nutritional Assessment – short form(Reference Kaiser, Bauer and Ramsch7), was collected within 36 hours of admission. Outcome data was collected prospectively on length of stay, in-hospital mortality and institutionalisation.

The mean age was 79·7; 51 % were female; 29 % were elective admissions; 67 % were admitted to a medical specialty. Nutrition scores were available for 602/606; 37 % had a ‘normal’ status, 45 % were ‘at-risk’, and 18 % were ‘malnourished’. Malnutrition was more common in females, acute admissions, older patients and those who were widowed/ separated. Dementia, functional dependency, comorbidity and frailty independently predicted a) malnutrition and b) being at-risk of malnutrition (p < ·001). Malnutrition was also associated with an increased length of stay (p < ·001), institutionalisation (p < 0·001) and in-hospital mortality (p < ·001).

These findings support the prioritisation of nutritional screening in clinical practice and public health policy, for all ≥70 on admission to hospital, and in particular for people with dementia, increased functional dependency and/or multi-morbidity, and those who are frail.

References

1. Rice, N, Normand, C (2012) The cost associated with disease-related malnutrition in Ireland. Public Health Nutr 15(10): 1966.CrossRefGoogle ScholarPubMed
2. Rasheed, S, Woods, RT (2013) Malnutrition and associated clinical outcomes in hospitalized patients aged 60 and older: An observational study in rural Wales. J Nutr Gerontol Geriatr 32(1): 7180.CrossRefGoogle ScholarPubMed
3. Chen, CC, Bai, YY, Huang, GH et al. (2007) Revisiting the concept of malnutrition in older people. J Clin Nurs 16(11): 2015–26.CrossRefGoogle ScholarPubMed
4. Vanderwee, K, Clays, E, Bocquaert, I et al. (2011) Malnutrition and nutritional care practices in hospital wards for older people. J Adv Nurs 67(4): 736–46.CrossRefGoogle ScholarPubMed
5. Eide, HD, Halvorsen, K, Almendingen, K (2015) Barriers to nutritional care for the undernourished hospitalised elderly: Perspectives of nurses. J Clin Nurs 24(5–6): 696706.CrossRefGoogle Scholar
6. Timmons, S, Manning, E, Barrett, A et al. (2015) Dementia in older people admitted to hospital: A regional multi-hospital observational study of prevalence, associations and case recognition. Age Ageing 44(6): 993.CrossRefGoogle ScholarPubMed
7. Kaiser, M, Bauer, JM, Ramsch, C et al. (2009) Validation of the mini nutritional assessment short-form (MNA®-SF): A practical tool for identification of nutritional status. J Nutr Health Aging 13(9): 782–8.CrossRefGoogle ScholarPubMed

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