Nutrition status and pressure ulcer: what we need for nutrition screening.
BACKGROUND
Pressure ulcers (PU) and malnutrition exist in elderly hospitalized patients as a significant and costly problem. The aim of the study was to compare different screening tools to assess nutrition status and to verify them for usage in clinical routine.


METHODS
Nutrition status (body mass index [BMI], Mini Nutritional Assessment [MNA], weight loss) was determined in 484 (326 female/158 male) multimorbid elderly patients with mean age of 79.6 +/- 7.6 (80.9 +/- 7.4 female/76.9 +/- 7.4 male) years. Bioelectrical impedance analysis (BIA; Nutrigard 2,000-M) was used for evaluation of body composition. Activities of daily living (ADL) were measured with the Barthel Index. PUs were divided into stages I-IV (European Pressure Ulcer Advisory Panel [EPUAP]) and were assessed by the Norton scale.


RESULTS
The prevalence of PU was 16.7%, with a median Norton scale of 20 (range, 17-24). According to MNA, 39.5% of the PU patients were malnourished, and 2.5% were well nourished. By contrast, 16.6% of the non-PU patients were malnourished, and 23.6% were well nourished. BMI decreased significantly in PU patients (p < .008). BIA resulted in no significant resistance and reactance but in a significant reduction of phase angle in PU. According to a significantly reduced body cell mass and lean body mass in PU patients, the ADL decreased in these patients, too. Furthermore, we analyzed a significant effect of age, ADL, MNA, BMI, phase angle, and body cell mass on the Norton scale.


CONCLUSIONS
The MNA as a screening and assessment tool is easy to use to determine the nutrition status in multimorbid geriatric patients with PU. Further studies are needed to show an improved outcome of PU healing if evaluation of nutrition status is part of routine clinical practice in multimorbid elderly risk patients within the first day after admission.
Hengstermann
Susanne
S
Research Group on Geriatrics, Evangelisches Geriatriezentrum Berlin, Charité-Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany.
Fischer
Andreas
A
Steinhagen-Thiessen
Elisabeth
E
Schulz
Ralf-Joachim
RJ
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D001823:Body Composition; D015992:Body Mass Index; D017097:Electric Impedance; D005260:Female; D015577:Geriatric Assessment; D005858:Germany; D006707:Homes for the Aged; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000150:complications* / Q000175:diagnosis*; D008403:Mass Screening; D009735:Nursing Homes; D015596:Nutrition Assessment; D009752:Nutritional Status; D003668:Pressure Ulcer / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control