Characteristics of undernourished older medical patients and the identification of predictors for undernutrition status.
BACKGROUND
Undernutrition among older people is a continuing source of concern, particularly among acutely hospitalized patients. The purpose of the current study is to compare malnourished elderly patients with those at nutritional risk and identify factors contributing to the variability between the groups.


METHODS
The study was carried out at the Soroka University Medical Center in the south of Israel. From September 2003 through December 2004, all patients 65 years-of-age or older admitted to any of the internal medicine departments, were screened within 72 hours of admission to determine nutritional status using the short version of the Mini Nutritional Assessment (MNA-SF). Patients at nutritional risk were entered the study and were divided into malnourished or 'at risk' based on the full version of the MNA. Data regarding medical, nutritional, functional, and emotional status were obtained by trained interviewers.


RESULTS
Two hundred fifty-nine elderly patients, 43.6% men, participated in the study; 18.5% were identified as malnourished and 81.5% were at risk for malnutrition according to the MNA. The malnourished group was less educated, had a higher depression score and lower cognitive and physical functioning. Higher prevalence of chewing problems, nausea, and vomiting was detected among malnourished patients. There was no difference between the groups in health status indicators except for subjective health evaluation which was poorer among the malnourished group. Lower dietary score indicating lower intake of vegetables fruits and fluid, poor appetite and difficulties in eating distinguished between malnourished and at-risk populations with the highest sensitivity and specificity as compare with the anthropometric, global, and self-assessment of nutritional status parts of the MNA. In a multivariate analysis, lower cognitive function, education <12 years and chewing problems were all risk factors for malnutrition.


CONCLUSIONS
Our study indicates that low food consumption as well as poor appetite and chewing problems are associated with the development of malnutrition. Given the critical importance of nutritional status in the hospitalized elderly, further intervention trials are required to determine the best intervention strategies to overcome these problems.
Feldblum
Ilana
I
The S, Daniel Abraham International Center for Health and Nutrition, Ben-Gurion University of the Negev, Beer-Sheva, Israel. shvartzm@bgu.ac.il
German
Larisa
L
Castel
Hana
H
Harman-Boehm
Ilana
I
Bilenko
Natalya
N
Eisinger
Miruna
M
Fraser
Drora
D
Shahar
Danit R
DR
D000368:Aged; D001066:Appetite / Q000502:physiology; D004522:Educational Status; D002149:Energy Intake / Q000502:physiology*; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000175:diagnosis*; D008409:Mastication / Q000502:physiology; D015999:Multivariate Analysis; D015596:Nutrition Assessment; D009752:Nutritional Status; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index