Nutritional screening and risk factors in elderly hospitalized patients: association to clinical outcome?

Abstract

The aim of this study was to test the intervalidity of three different nutrition screening tools towards a broad population of elderly hospitalized patients. The association with risk factors and mortality was investigated. This is a prospective cohort study in three medical, surgical and geriatric settings, in Denmark and Sweden. Patients >65 years were consecutively included. Patients were screened by mini-nutritional assessment (MNA), malnutrition universal screening tool (MUST) and nutritional risk screening (NRS-2002). Anthropometrics, cognitive test (SPMSQ), as well as a questionnaire investigation regarding eating problems and life situation, were performed. Mortality within 12 months was investigated. In total, 233 patients mean (SD) age 81(7.64) years were included. A large variation in prevalence of nutritional risk was determined between the screening tools, MNA was 68% vs. MUST, 47% and NRS 54%, p < 0.0001. An overall agreement of 67% was seen (κ 0.52-0.55). Risk factors were associated with nutritional risk, including depressive mood. Only handgrip strength, fungus in mouth, serum albumin, CRP and cognitive function were associated with mortality. Fungus had the strongest association (OR 3.7; CI 1.19-11.30). The overall mortality rate was 27% during 12 months. However, none of the three screening tools predicted 12-month mortality. The findings show great variation in the prevalence of nutritional risk of under nutrition both between the tools and the settings. The level of agreement between the tools was moderate, and none of the three tools were capable of predicting 12-month mortality. A functional and psychological evaluation including oral health seems recommendable in elderly patients at nutritional risk.

Nutritional status predicts preterm death in older people: A prospective cohort study

“…However, after adjustment for age, sex, and Charlton comorbidity index, there is no association between malnutrition and mortality at 1-year follow-up. 21 The prospective design of the current study, the large sample size and the adjustment for several important determinants including comorbidities, contribute to clarifying the independent relationship between nutritional status defined by MNA and mortality. The finding from the present study that 65% of older people admitted to hospital were at risk of malnutrition or malnourished, and thus had an increased risk of an early death, emphasises the importance of screening and taking appropriate actions to counteract malnutrition.…”

Comparing the adequacy of the MNA-SF, NRS-2002 and MUST nutritional tools in assessing malnutrition in hip fracture operated elderly patients

“…Bauer et al examined three screening and assessment tools: the SGA, MNA-SF and NRS-2002 and also found a significant relationship between nutritional status, according to the MNA and serum albumin levels [16]. Although albumin level is associated with morbidity and mortality in the elderly [21], it is neither sensitive enough or specific as to the diagnosis of malnutrition [16]. Albumin measurement as a nutritional marker is controversial since its level might be affected by many factors such as dehydration, trauma and sepsis [5].…”

Documentation and communication of nutritional care for elderly hospitalized patients: perspectives of nurses and undergraduate nurses in hospitals and nursing homes

“…It lengthens hospital stay and expands health care costs. Furthermore, it is associated with physical and psychological burdens and reduces quality of life [3, 5, 7, 11–13]. Many elderly patients are already undernourished upon hospital admission, and nutritional status often deteriorates during hospital stay [2, 4, 11, 13–15].…”