The prevalence of malnutrition and impact on patient outcomes among older adults presenting at an Irish emergency department: a secondary analysis of the OPTI-MEND trial

Abstract

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, risk of adverse health outcomes, frailty, hospital admissions, falls history and clinical outcomes at index visit, 30-day and 6-month follow up. Aggregate anonymised participant data linked from index visit 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. Differences between the MNA SF and 6-month outcomes were similar but not statistically significant.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 a nursing home at 30 days.Trial registration: Protocol registered in ClinicalTrials.gov, ID: NCT03739515, first posted November 13, 2018. https://clinicaltrials.gov/ct2/show/NCT03739515

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

“…Upon admission, the prevalence of malnutrition and risk of malnutrition according to MNA-SF (68%) is comparable to findings from other studies reporting 48–64% of acutely admitted older medical patients to present with malnutrition or risk of malnutrition upon admission to the ED [ 3 , 4 , 5 ]. One study, however, found a prevalence of 36% [ 2 ]. This lower reported prevalence might be explained by the fact that only 21% of the population in the study by Griffin et al [ 2 ] was scored as suffering from psychological stress or acute disease within the past three months.…”

“…One study, however, found a prevalence of 36% [ 2 ]. This lower reported prevalence might be explained by the fact that only 21% of the population in the study by Griffin et al [ 2 ] was scored as suffering from psychological stress or acute disease within the past three months. This prevalence is remarkably low considering the ED setting, where one would expect a higher percentage of patients to suffer from acute disease.…”

“…Worldwide, older patients (≥65 years of age) make up 41–46% of acute admissions, and risk of malnutrition based on nutritional screening is frequent, with a reported prevalence of 35–70% [ 1 , 2 , 3 , 4 , 5 ]. The European Society of Clinical Nutrition (ESPEN) recommended a two-step approach for the diagnosis of malnutrition in 2015, i.e., first, screening for risk of malnutrition with a validated screening tool, and second, assessment for diagnosis of malnutrition [ 6 ].…”

Optimization of Nutrition And Medication (OptiNAM) for acutely admitted older patients: protocol for a randomized single-blinded controlled trial

“…Internationally, older patients (≥65 years) account for 41–46% of acute admissions [ 1 – 3 ]. Among older patients admitted to the emergency department, the prevalence of the risk of malnutrition and malnutrition ranges between 35 and 71% in acutely admitted older patients [ 4 – 8 ] and the prevalence of polypharmacy (≥5 prescribed medications) is 73–77%, while 51–85% receive at least one potentially inappropriate medication (PIM) [ 9 – 12 ]. Both malnutrition and polypharmacy are associated with decreased quality of life [ 13 – 16 ], and these risk factors are often comorbid, as 64–87% of older patients at risk of malnutrition present with polypharmacy [ 5 , 6 , 9 ].…”

“…However, interventions to address malnutrition and inappropriate medication prescribing in the ED are limited by the acute setting. The median length of stay (LOS) for acutely admitted older medical patients is 2.2–4.5 days [ 17 , 18 ], and more than half of all patients admitted to the ED are discharged without being transferred to another department [ 6 , 8 , 19 ]. Consequently, some of these patients will be discharged before initiatives to overcome malnutrition or inappropriate medication have been started.…”