Nutritional assessment: a primary component of multidimensional geriatric assessment in the acute care setting.
OBJECTIVE
To test the prognostic role of nutritional variables as a component of geriatric multidimensional assessment and to study the effect of hospitalization on nutritional status.


METHODS
Validation cohort study: multidimensional assessment on admission and at discharge and a weekly nutritional assessment.


METHODS
General Medicine and Geriatrics wards in an acute-care university hospital.


METHODS
A consecutive sample of 302 patients aged 79 +/- 6 years, range 70-96 years.


METHODS
Mortality, longstay (> 29 days), loss of lean body mass as expressed by a negative change in mid-arm muscle circumference (MAMC).


RESULTS
Incidence of mortality, longstay, and decreased MAMC was 6.9%, 24.8%, and 64.2%, respectively. According to logistic regression analysis, mortality was independently predicted by preadmission dependency in at least one Activity of Daily Living (odds ratio = 2.08, confidence limits = 1.19-3.65), clinical diagnosis of malnutrition (OR = 1.89, CL = 1.11-3.21), serum albumin < 3.5 g/dL (OR = 1.82, CL = 1.06-3.14). This predictive model allowed us to recognize 75% of the patients at risk of death by targeting 23% of the population. Longstay was independently predicted by stroke (OR = 1.54, CL = 1.01-2.35), clinical diagnosis of malnutrition (OR = 1.41, CL = 1.04-1.93), and more than five comorbid diseases (OR = 1.39, CL = 1.01-1.94). Dependency in at least one ADL was the only independent predictor of decreased MAMC (OR = 1.71, CL = 1.27-2.30).


CONCLUSIONS
Nutrition variables are a cardinal component of multidimensional assessment in the acute-care setting. Nutritional status deteriorates during the hospital stay, mostly in physically dependent patients.
Antonelli Incalzi
R
R
Department of Geriatrics, Catholic University of the Sacred Heart, Rome, Italy.
Landi
F
F
Cipriani
L
L
Bruno
E
E
Pagano
F
F
Gemma
A
A
Capparella
O
O
Carbonin
P U
PU
D000203:Activities of Daily Living; D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D009026:Mortality; D015596:Nutrition Assessment; D009748:Nutrition Disorders / Q000150:complications / Q000175:diagnosis*; D009752:Nutritional Status; D015203:Reproducibility of Results