Risk of Malnutrition upon Admission and after Discharge in Acutely Admitted Older Medical Patients: A Prospective Observational Study

Abstract

There is a lack of knowledge about malnutrition and risk of malnutrition upon admission and after discharge in older medical patients. This study aimed to describe prevalence, risk factors, and screening tools for malnutrition in older medical patients. In a prospective observational study, malnutrition was evaluated in 128 older medical patients (≥65 years) using the Nutritional Risk Screening 2002 (NRS-2002), the Mini Nutritional Assessment-Short Form (MNA-SF) and the Eating Validation Scheme (EVS). The European Society of Clinical Nutrition (ESPEN) diagnostic criteria from 2015 were applied for diagnosis. Agreement between the screening tools was evaluated by kappa statistics. Risk factors for malnutrition included polypharmacy, dysphagia, depression, low functional capacity, eating-related problems and lowered cognitive function. Malnutrition or risk of malnutrition were prevalent at baseline (59–98%) and follow-up (30–88%). The baseline, follow-up and transitional agreements ranged from slight to moderate. NRS-2002 and MNA-SF yielded the highest agreement (kappa: 0.31 (95% Confidence Interval (CI) 0.18–0.44) to 0.57 (95%CI 0.42–0.72)). Prevalence of risk factors ranged from 17–68%. Applying ESPEN 2015 diagnostic criteria, 15% had malnutrition at baseline and 13% at follow-up. In conclusion, malnutrition, risk of malnutrition and risk factors hereof are prevalent in older medical patients. MNA-SF and NRS-2002 showed the highest agreement at baseline, follow-up, and transitionally.

Immunonutrition in Orthopedic and Traumatic Patients

“…Over the last twenty years, the role of nutrition has gained relevance in many surgical fields. Several studies have shown that up to 40–50% of patients present in both surgical and medical departments are malnourished already at admission to the hospital [ 39 , 40 ]. However, malnutrition is associated with increased morbidity and a longer length of hospital stay [ 41 ], especially among trauma and elective orthopedic patients [ 42 ].…”

Mild Cognitive Impairment Is Associated with Poorer Nutritional Status on Hospital Admission and after Discharge in Acutely Hospitalized Older Patients

“…Participants in STAND-Cph and FAM-Cph were eligible if they were aged ≥65 years and admitted to the ED for an acute medical illness, and further, in FAM-Cph, were Caucasian. In STAND-Cph and FAM-Cph, eligible patients were excluded if they were: unable to understand and speak Danish, unable to cooperate, terminally ill or in isolation room stay, and further, in STAND-Cph, were transferred to another hospital or the intensive care unit, receiving treatment for cancer or unable to stand (for further details please see Pedersen et al [ 27 ] and Andersen et al [ 29 ]). All participants in STAND-Cph were randomized to either a strength training intervention or standard care.…”

“…To address data collection as a potential source of bias, clinical in-service training and supervision were provided by the same qualified person in both studies during data collection to enhance the quality of the measurements. Blood samples were routinely collected upon admission to the ED and the results from the blood samples were entered in Microsoft Excel before FI-OutRef was calculated (for further details please see Pedersen et al [ 27 ] and Andersen et al [ 29 ]).…”

Nutritional Care Practices in Geriatric Rehabilitation Facilities across Europe: A Cross-Sectional Study

“…Malnutrition and the risk of malnutrition are very common in older hospitalized patients. The global prevalence depends on the diagnostic instrument used and the hospital population studied, and it varies from 59 to 98% at admission and from 30 to 88% at discharge [8,9]. There is also a high prevalence of malnutrition risk (47%) and malnutrition (13–43%) upon admission to GR [2,10].…”