Prospective audits of quality of PEM recognition and nutritional support in critically ill elderly patients.
OBJECTIVE
Undereating is a frequent concern in acute care geriatric settings and is supposed to worsen the outcomes of the underlying diseases, while the quality of nutritional support could be improved.


METHODS
Two consecutive and prospective audits (A and B) with team training over a 1 year period investigated the quality of malnutrition recognition and nutritional support and outcomes in immobilized, critically ill elderly subjects.


RESULTS
Audit A included 170 patients (86.3+/-6.1 years old) and audit B, 232 patients (86.3+/-6.3), respectively 20.6% and 31.4% of the hospitalized population. Misclassifications occurred in A in 54.0% compared to 34.05% in B (P < 0.001). 32.6% in A versus 86.9% in B adequately received oral supplements (P = 0.02). Significant risk factors for the adverse outcomes in the combined two audits were: dementia (RR: 1.8, 95%CI: 1.0 to 3.0, P= 0.04) and dehydration (RR: 2.0, 95%CI:1.0 to 4.1, P= 0.05) for pressure ulcer incidence; stroke (RR: 8.8, 95%CI: 4.8 to 16.0, P < 0.001) for pressure ulcer prevalence at discharge; neoplasms (RR: 1.1, 95%CI: 1.0 to 1.2, P = 0.02) for nosocomial infections; bladder indwelling for urinary tract infections (RR: 4.8, 95%CI: 2.9 to 7.7, P<< 0.001); swallowing problems for pulmonary infections (RR: 5.4, 95%CI: 2.8 to 10.5, P < 0.001); venous indwelling for septicaemia (RR: 5.4, 95%CI: 1.3 to 23. 3, P= 0.02). However, after adjustment on significant risk factors, the outcome rate was similar in audit B: death rate: A (15.6%), B (14.2%); length of stay: A (17.3+/-10.4 days), B (17.4+/-10.0); pressure ulcer incidence: A (26.4%), B (20.2%), (83% were erythema); pressure ulcer prevalence at discharge: A (14.7%), B (10.3%), (40% were erythema); nosocomial infections: A (26.4%), B (19.0%).


CONCLUSIONS
The improvement of malnutrition recognition and nutritional support was not followed by a perceptible decrease in adverse outcome rate, this latter being mainly related to the underlying conditions of these critically ill elderly patients.
Bourdel-Marchasson
I
I
Centre de Gériatrie Henri Choussat - CHU de Bordeaux, CHU de Bordeaux Hôpital Xavier-Arnozan, Pessac, 33604, France.
Barateau
M
M
Sourgen
C
C
Pinganaud
G
G
Salle-Montaudon
N
N
Richard-Harston
S
S
Reignier
B
B
Rainfray
M
M
Emeriau
J P
JP
D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control; D004435:Eating; D005260:Female; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D016014:Linear Models; D008297:Male; D008485:Medical Audit; D018529:Nutritional Support / Q000592:standards* / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care; D003668:Pressure Ulcer / Q000453:epidemiology / Q000517:prevention & control; D011446:Prospective Studies; D011502:Protein-Energy Malnutrition / Q000145:classification / Q000175:diagnosis / Q000628:therapy*; D012307:Risk Factors; D016896:Treatment Outcome