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Clinical nutrition, enteral and parenteral nutrition

Poor nutritional status of older subacute patients predicts clinical outcomes and mortality at 18 months of follow-up

European Journal of Clinical Nutrition volume 66, pages 1224–1228 (2012)Cite this article

Subjects

Abstract

Background/Objectives:

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.

Subjects/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).

Conclusion:

Malnutrition in elderly subacute patients predicts adverse clinical outcomes and identifies a need to target this population for nutritional intervention following hospital discharge.

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Acknowledgements

No external sponsorship was received for this study. A summer scholarship from the Smart Foods Centre, University of Wollongong was provided to CN. Joanna Russell is thanked for editorial assistance.

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Authors and Affiliations

  1. School of Health Sciences, Faculty of Health and Behavioural Sciences, University of Wollongong, Wollongong, Australia

    K Charlton & C Nichols

  2. Nutrition and Dietetics Department, Illawarra and Shoalhaven Local Health District, Wollongong Hospital, Wollongong, New South Wales, Australia

    S Bowden, M Milosavljevic, K Lambert, L Barone & M Mason

  3. Centre for Statistical and Survey Methodology, University of Wollongong, Wollongong, New South Wales, Australia

    M Batterham

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  1. K Charlton
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Correspondence to K Charlton.

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Competing interests

Karen Charlton was a member of the International MNA Revision Group and attended a workshop in Switzerland in October 2008 that was fully funded by Nestle Nutrition Institute, Switzerland. She has received honoraria from Nestle Healthcare Nutrition (Australia) for participation in a Malnutrition in the Elderly Advisory Board and for educational presentations to general practitioners and geriatricians on the topic of malnutrition screening. The other authors declare no conflict of interest.

Additional information

Contributors: KEC—conceptualisation of study design, data analysis and primary responsibility for writing the article; CN—data entry, data analysis and writing the article; SB—study design, data collection, entry and cleaning and data analysis; KL and LB—data collection, data entry and writing the article; SM—data collection and writing the article; MM—study design and writing the article; MB—statistical data analysis and editing.

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Charlton, K., Nichols, C., Bowden, S. et al. Poor nutritional status of older subacute patients predicts clinical outcomes and mortality at 18 months of follow-up. Eur J Clin Nutr 66, 1224–1228 (2012). https://doi.org/10.1038/ejcn.2012.130

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