American Journal of Food and Nutrition
ISSN (Print): 2374-1155 ISSN (Online): 2374-1163 Website: https://www.sciepub.com/journal/ajfn Editor-in-chief: Mihalis Panagiotidis
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American Journal of Food and Nutrition. 2015, 3(3), 84-89
DOI: 10.12691/ajfn-3-3-4
Open AccessArticle

Nutritional Risk in Acutely Admitted Older Medical Patients

Louise Lawson-Smith1, , Janne Petersen1, 2, Pia Søe Jensen1, Ditte Maria Sivertsen1, Mette Merete Pedersen1, Gertrude Ellekilde3, Tove Lindhardt4 and Ove Andersen1

1Optimed, Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark

2Department of Biostatics, University of Copenhagen, Copenhagen, Denmark

3Emergency Department, Copenhagen University Hospital, Hvidovre, Denmark

4Department of Internal Medicine, Copenhagen University Hospital, Herlev, Denmark

Pub. Date: September 01, 2015

Cite this paper:
Louise Lawson-Smith, Janne Petersen, Pia Søe Jensen, Ditte Maria Sivertsen, Mette Merete Pedersen, Gertrude Ellekilde, Tove Lindhardt and Ove Andersen. Nutritional Risk in Acutely Admitted Older Medical Patients. American Journal of Food and Nutrition. 2015; 3(3):84-89. doi: 10.12691/ajfn-3-3-4

Abstract

Nutritional risk among older medical patients admitted to hospitals is high. More knowledge is needed of the association between nutritional risk when hospitalised and that after full recovery. This is the first step towards determining a more comprehensive cross-sectional nutritional risk. Our aim was to examine the association between nutritional risk at admission versus six months after discharge in acutely admitted older patients. We also examined the nutritional risk of patients who died or were lost to follow-up. This descriptive follow-up study included 90 older patients. Nutritional risk was determined by the Nutritional Risk Screening (NRS). The associations between nutritional risk measures determined at admission and six months after discharge and between nutritional risk measures and the reason for being lost to follow-up were analysed by Chi-square or Fisher’s exact test, as appropriate. At admission, 74% of the patients were at nutritional risk. Of the patients who were not at nutritional risk at admission and who completed the six-month follow-up, five (31%) reported weight loss at follow-up. Furthermore, 12 (46%) of the patients who did not report weight loss at admission reported weight loss at follow-up. Forty-six (49%) patients were lost to follow-up: eight died, all of whom were at nutritional risk; seven had decreased appetite at admission; and ten were too exhausted to continue due to illness, including eight at nutritional risk and seven with decreased appetite. Being an acutely admitted older medical patient seems to be a risk factor for developing nutritional risk within six months, independent of nutritional risk status at admission. In addition, poor nutritional status was predictive of being lost to follow-up.

Keywords:
nutritional risk older medical patient acutely admitted hospital

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References:

[1]  Van Bokhorst-de van der Schueren, M.A.E., Lonterman-Monasch, S., de Vries, O.J., Danner, S.A., Kramer, M.H.H., and Muller, M., “Prevalence and determinants for malnutrition in geriatric outpatients,” Clin Nutr., 32(6). 1007-11. Dec. 2013.
 
[2]  Rasmussen HH, Kondrup J, Staun M, Ladefoged K, Kristensen H, Wengler A. Prevalence of patients at nutritional risk in Danish hospitals. Clin Nutr Edinb Scotl., 23(5):1009-15. Oct 2004.
 
[3]  Kaiser MJ, Bauer JM, Rämsch C, Uter W, Guigoz Y, Cederholm T, et al. Frequency of malnutrition in older adults: a multinational perspective using the mini nutritional assessment. J Am Geriatr Soc., 58(9):1734-8. Sep 2010.
 
[4]  Milne AC, Potter J, Vivanti A, Avenell A. Protein and energy supplementation in elderly people at risk from malnutrition. Cochrane Database of Systematic Reviews [Internet]. John Wiley & Sons, Ltd; [cited 2013 Sep 16]. 1996.
 
[5]  Akner G, Cederholm T. Treatment of protein-energy malnutrition in chronic nonmalignant disorders. Am J Clin Nutr., 74(1):6-24. 2001.
 
[6]  Morley JE. Undernutrition in older adults. Fam Pract., 1;29(suppl 1):i89-i93 Apr. 2012.
 
[7]  Waitzberg DL, Baxter YC. Costs of patients under nutritional therapy: from prescription to discharge. Curr Opin Clin Nutr Metab Care., 7(2):189-98. Mar 2004.
 
[8]  Guigoz Y. The Mini Nutritional Assessment (MNA®) review of the literature-what does it tell us? J Nutr Health Aging., 10(6):466. 2006.
 
[9]  Brantervik ÅM, Jacobsson IE, Grimby A, Wallén TCE, Bosaeus IG. Older hospitalised patients at risk of malnutrition: correlation with quality of life, aid from the social welfare system and length of stay? Age Ageing., 1;34(5):444-9. Sep 2005.
 
[10]  Brownie S. Why are elderly individuals at risk of nutritional deficiency? Int J Nurs Pract., 12(2):110-8. Apr 2006.
 
[11]  Noel M, Reddy M. Nutrition and aging. Prim Care., 32(3):659-69. Sep. 2005.
 
[12]  Lee JS, Kritchevsky SB, Harris TB, Tylavsky F, Rubin SM, Newman AB. Short-term weight changes in community-dwelling older adults: the Health, Aging, and Body Composition Weight Change Substudy. Am J Clin Nutr., 82(3):644-50. Sep 2005.
 
[13]  Wallace JI, Schwartz RS. Epidemiology of weight loss in humans with special reference to wasting in the elderly. Int J Cardiol., 85(1):15-21. Sep. 2002.
 
[14]  Beck AM, Ovesen L. At which body mass index and degree of weight loss should hospitalized elderly patients be considered at nutritional risk? Clin Nutr Edinb Scotl., 17(5):195-8. Oct. 1998.
 
[15]  Alley DE, Koster A, Mackey D, Cawthon P, Ferrucci L, Simonsick EM, et al. Hospitalization and change in body composition and strength in a population-based cohort of older persons. J Am Geriatr Soc., 58(11):2085-91. Nov. 2010.
 
[16]  Gordon BS, Kelleher AR, Kimball SR. Regulation of muscle protein synthesis and the effects of catabolic states. Int J Biochem Cell Biol., 45(10):2147-57. Oct. 2013.
 
[17]  Kondrup J. Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clin Nutr. 2003 Jun;22(3):321-36.
 
[18]  Kondrup J. ESPEN Guidelines for Nutrition Screening 2002. Clin Nutr. 2003 Aug;22(4):415-21.
 
[19]  Rasmussen HH, Holst M, Kondrup J. Measuring nutritional risk in hospitals. Clin Epidemiol. 2010 Oct 21;2:209-16.
 
[20]  Dolan P. Modeling valuations for EuroQol health states. Med Care., 35(11):1095-108. Nov 1997.
 
[21]  Brooks R. EuroQol: the current state of play. Health Policy., 37(1):53-72. Jul. 1996.
 
[22]  Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”: A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res., 12(3):189-98. Nov 1975.
 
[23]  Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic dis, 40(5):373-383, 1987.
 
[24]  Bodilsen AC, Pedersen MM, Petersen J, Beyer N, Andersen O, Smith LL, et al. Acute Hospitalization of the Older Patient: Changes in Muscle Strength and Functional Performance During Hospitalization and 30 Days After Discharge. Am J Phys Med Rehabil Assoc Acad Physiatr., 92 (9):789-96. Sep. 2013.
 
[25]  Pedersen MM, Bodilsen AC, Petersen J, Beyer N, Andersen O, Lawson-Smith L, et al. Twenty-four-hour mobility during acute hospitalization in older medical patients. J Gerontol A Biol Sci Med Sci., 68(3):331-7. Mar 2013.
 
[26]  Holst M. Undernutrition in hospitals: An evaluation of risk factors concerning the nutritional care process [Internet]. Videnbasen for Aalborg UniversitetVBN, Aalborg UniversitetAalborg University, Det Teknisk-Naturvidenskabelige Fakultet The Faculty of Engineering and Science, Institut for PlanlægningDepartment of Development and Planning; [cited 2013 Nov 8]. Availablefrom: http://vbn.aau.dk/ws/files/34058348/PhDThesis_MetteHolst.pdf 2010.
 
[27]  Landi F, Lattanzio F, Dell’Aquila G, Eusebi P, Gasperini B, Liperoti R, et al. Prevalence and Potentially Reversible Factors Associated With Anorexia Among Older Nursing Home Residents: Results from the ULISSE Project. J Am Med Dir Assoc., 14(2): 119-24. Feb. 2013.
 
[28]  Diekmann R, Winning K, Uter W, Kaiser MJ, Sieber CC, Volkert D, et al. Screening for malnutrition among nursing home residents - a comparative analysis of the mini nutritional assessment, the nutritional risk screening, and the malnutrition universal screening tool. J Nutr Health Aging., 17(4):326-31. Apr. 2013.
 
[29]  Buys DR, Roth DL, Ritchie CS, Sawyer P, Allman RM, Funkhouser EM, et al. Nutritional Risk and Body Mass Index Predict Hospitalization, Nursing Home Admis si ons, and Mortality in Community-Dwelling Older Adults: Results From the UAB Study of Aging With 8.5 Years of Follow-Up. J Gerontol A Biol Sci Med Sci. 3; Mar. 2014.