Malnutrition in subacute care.
BACKGROUND
Dramatic weight loss and hypoalbuminemia often follow acute hospitalization.


OBJECTIVE
The objective was to examine the prevalence of undernutrition in a subacute-care facility.


METHODS
We evaluated 837 patients consecutively admitted over 14 mo to a 100-bed subacute-care center. Nutritional status was assessed by anthropometric measurements, biochemical markers, and a Mini Nutritional Assessment (MNA) score. Primary outcome measures included length of stay and death. Secondary measures included readmission to an acute-care hospital and placement at discharge.


RESULTS
The subjects' mean (+/- SD) age was 76 +/- 13 y and 61% were women. Eighteen percent of the subjects had a body mass index (in kg/m(2)) <19. With the use of 35 g/L as a cutoff, 53% of the subjects had hypoalbuminemia. Only 8% of the subjects were classified as being well nourished according to the MNA. Almost one-third (29%) of the subjects were malnourished and almost two-thirds (63%) were at risk of malnutrition. Thus, >91% of subjects admitted to subacute care were either malnourished or at risk of malnutrition. The Geriatric Depression Score was higher in malnourished subjects than in nutritionally at-risk subjects (P = 0.05). Length of stay differed by 11 d between the malnourished group and the nutritionally at-risk group (P = 0.007). In the MNA-assessed group of largely malnourished subjects, 25% of subjects required readmission to an acute-care hospital compared with 11% of the well-nourished group (P = 0.06). Mortality was not found to be related to BMI.


CONCLUSIONS
Malnutrition reaches epidemic proportions in patients admitted to subacute-care facilities. Whether this reflects nutritional neglect in acute-care hospitals or is the result of profound illness is unclear. Nevertheless, strict attention to nutritional status is mandatory in subacute-care settings.
Thomas
David R
DR
Division of Geriatric Medicine, St Louis Health Sciences Center and The Geriatric Research, Education, and Clinical Center, St Louis Veterans Administration Medical Center, MO 63104, USA. thomasdr@slu.edu
Zdrowski
Carolyn D
CD
Wilson
Margaret-Mary
MM
Conright
Kelly C
KC
Lewis
Cecelia
C
Tariq
Syed
S
Morley
John E
JE
D000368:Aged; D015992:Body Mass Index; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D007902:Length of Stay; D008297:Male; D008923:Missouri / Q000453:epidemiology; D009748:Nutrition Disorders / Q000453:epidemiology*; D009752:Nutritional Status; D019467:Subacute Care; D015431:Weight Loss