title: Poor nutritional status of older subacute patients predicts clinical outcomes and mortality at 18 months of follow-up.
abstract: OBJECTIVE
  Older malnourished patients experience increased surgical complications and greater morbidity compared with their well-nourished counterparts. This study aimed to assess whether nutritional status at hospital admission predicted clinical outcomes at 18 months follow-up.
  
  
  METHODS
  A retrospective analysis of N=2076 patient admissions (65+ years) from two subacute hospitals, New South Wales, Australia. Analysis of outcomes at 18 months, according to nutritional status at index admission, was performed in a subsample of n = 476. Nutritional status was determined within 72 h of admission using the Mini Nutritional Assessment (MNA). Outcomes, obtained from electronic patient records, included hospital readmission rate, total Length of Stay (LOS), change in level of care at discharge and mortality. Survival analysis, using a Cox proportional hazards model, included age, sex, Major Disease Classification, mobility and LOS at index admission as covariates.
  
  
  RESULTS
  At baseline, 30% of patients were malnourished and 53% were at risk of malnutrition. LOS was higher in malnourished and at risk, compared with well-nourished patients (median (interquartile range): 34 (21, 58); 26 (15, 41); 20 (14, 26) days, respectively; P<0.001). Hazard rate for death in the malnourished group is 3.41 (95% confidence interval: 1.07-10.87; P = 0.038) times the well-nourished group. Discharge to a higher level of residential care was 33.1%, 16.9% and 4.9% for malnourished, at-risk and well-nourished patients, respectively; P ≤ 0.001).
  
  
  CONCLUSIONS
  Malnutrition in elderly subacute patients predicts adverse clinical outcomes and identifies a need to target this population for nutritional intervention following hospital discharge.
authors.affiliation: School of Health Sciences, Faculty of Health and Behavioural Sciences, University of Wollongong, Wollongong, Australia. karenc@uow.edu.au
authors.forename: K
authors.initials: K
authors.lastname: Charlton
authors.forename: C
authors.initials: C
authors.lastname: Nichols
authors.forename: S
authors.initials: S
authors.lastname: Bowden
authors.forename: M
authors.initials: M
authors.lastname: Milosavljevic
authors.forename: K
authors.initials: K
authors.lastname: Lambert
authors.forename: L
authors.initials: L
authors.lastname: Barone
authors.forename: M
authors.initials: M
authors.lastname: Mason
authors.forename: M
authors.initials: M
authors.lastname: Batterham
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment; D006801:Humans; D007902:Length of Stay; D008297:Male; D044342:Malnutrition / Q000453:epidemiology / Q000401:mortality*; D009517:New South Wales / Q000453:epidemiology; D015596:Nutrition Assessment; D009752:Nutritional Status; D010343:Patient Admission; D010351:Patient Discharge; D016016:Proportional Hazards Models; D012016:Reference Values