Preventing Malnourishment in Elderly Hospital Patients: Prevalence & Consequences, Slides of Geriatrics

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Hungry in Hospital

Malnourishment among elderly inpatients

Objectives

Define malnourishment

Describe the burden and consequences of malnourishment in hospital

Understand the utility of the “Subjective Global Assessment” tool

Identify strategies to prevent a person from becoming malnourished in hospital

Definition

A state of nutrition in which a deficiency of energy, protein and/or other nutrients causes measurable adverse effects on tissue/body form, composition, function, or clinical outcome

Measuring malnutrition

Hospitalized patients:  Dietary intake <50% of estimated needs  Hypoalbuminemia <35 g/L  Hypocholesterolemia <1.6 g/L

NICE guidelines: BMI<18.5kg/m 2 or, Unintentional weight loss>10% within previous 6 months or, BMI<20kg/m 2 and unintentional weight loss >5%

Consequences of malnutrition

Vulnerability to infection

Delayed wound healing

Impaired respiratory function

Decreased muscle strength

Depression

Longer admissions

Increased overall healthcare costs

Higher complication rates

Increased mortality rates

Burden of malnutrition

Inpatients >80yo have a 5x higher prevalence of malnutrition than those <50yo

40% of elderly patients are malnourished on admission

Up to 75% of elderly patients will have lost weight by the time of discharge

Nutrition in Medical Training

Despite integration into medical school curriculum, only 28% of medical residents and senior medical students had heard of the SGA; only one of 25 could perform it

Nutritional status is an important predictor of health outcomes

Nutritional training in the current medical curriculum is poor and needs improvement

SGA

 Weight change  Dietary change  GI symptoms  Functional capacity  Presence of disease  Physical signs of malnutrition

 Overall score derived from subjective combination of above findings  A: well nourished  B: moderately malnourished  C: severely malnourished Docsity.com

How accurate is the SGA?

Detsky et al.

SGA scores predicted post-op complications (sepsis, abscess, wound infection) SGA-C: LR 4.0 (more post-op complications) SGA-B: LR 0.96 (negligible) SGA-A: LR 0.66 (better post-op outcomes) SGA scores performed with higher accuracy than percentage of ideal body weight and body fat % in predicting post-op complications

 The SGA correlates with objective measures of nutrition (albumin, total protein, body composition, physical measurements), and with better sensitivity (82%) and specificity (72%) Docsity.com

Can the SGA be used in the elderly?

Sacks et al.

53 nursing home residents >65 yo assessed with SGA Major infections, decubitus ulcers, nutrition- related re-admissions, and mortality followed over 3 months SGA was significantly associated with mortality (p<0.05, sensitivity 75%, specificity 84%) SGA composite score (numerical conversion) significantly associated with nutrition-related re- admissions, infection, and mortality Docsity.com

Remove physical limitations

Ensure tray is within reach with food covers off Ensure patient is positioned appropriately and has glasses on/dentures in if necessary

Provide assistance

Encourage family members to assist with meals and selecting items from menu Involve volunteers Enhance socialization at mealtimes between patients Encourage pts to ask for snacks if hungry

System policies

Implementation of alert when pt NPO for longer than 24hrs for diagnostic imaging Schedule RN breaks around patient mealtimes to maximize staffing during meals Protected mealtimes if possible for patients at risk of malnourishment (e.g. no tests, etc.) Specialized utensils available