A longitudinal study of hospital undernutrition in the elderly: comparison of four validated methods.
BACKGROUND
Undernutrition/nutritional risk were evaluated longitudinally in 531 hospitalized elderly by four validated methods to appraise the most feasible for routine use.


METHODS
Within 48 hrs of admission and 24 hrs before discharge: the following data were collected: clinical data, nutritional status (BMI, %weight loss) and risk (MNA, MUST), energy requirements (Owen et al), diet.


RESULTS
Significant changes from admission to discharge in risk/undernutrition prevalence, were not shown by BMI (approximately 17% vs 22%), > or = 5%weight loss (approximately 53% vs approximately 56%) or MNA 83% vs approximately 81%; at admission, 93% patients were MUST high risk declining to approximately 47% (p=0.001) at discharge, alongside eating resumption. By multivariate analysis comparing all methods and differences between patient groups during hospitalization, only %weight loss clarified nutritional progression: more surgical patients had > or = 10%weight loss vs medicine, p < 0.01. Only admission > or = 5%weight loss was predictive of longer hospitalizations (OR:1.57; 95%CI 1.02-2.40; p < 0.003), though MNA and MUST undernourished/high risk had significantly longer stays. MNA and MUST were the most concordant methods, p < 0.001. Eating compromising symptoms were prevalent in surgery/medicine with > or = 5%weight loss, MNA risk/undernutrition, and MUST high risk, p < 0.005. Overall, mean energy requirements/diet were not significantly different between admission/discharge: requirements approximately 1400 kcal were always lower than on offer approximately 2128 kcal, p=0.0001.


CONCLUSIONS
Rigid diets create costly waste which do not counteract nutritional deterioration. Different nutritional risk/status prevalences were unveiled at admission and discharge: > 50% patients were at risk/undernourished by significant weight loss, MNA or MUST, all associated with longer stays. Recent weight loss is unarguably essential, comprehensive MNA and MUST similarly reliable; in this study dynamic MUST seemed easier to practise. Quality nutritional care before/during/after hospitalization is mandatory in the elderly.
Cansado
P
P
Centro Hospitalar do Baixo Alentejo S.A.-Hospital José Joaquim Fernandes, Beja, Portugal.
Ravasco
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P
Camilo
M
M
D000368:Aged; D000369:Aged, 80 and over; D004032:Diet; D004435:Eating; D005240:Feasibility Studies; D005260:Female; D006760:Hospitalization; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D044342:Malnutrition / Q000175:diagnosis* / Q000453:epidemiology; D015999:Multivariate Analysis; D009751:Nutritional Requirements; D009752:Nutritional Status; D015995:Prevalence; D012307:Risk Factors; D015431:Weight Loss