The identification and assessment of undernutrition in patients admitted to the age related health care unit of an acute Dublin General Hospital

  • R. Charles
  • S. Mulligan
  • D. O’Neill


Objectives: To profile those over 65 yr admitted to an acute geriatric medical service. To identify and assess their undernutrition risk and quantify the nutritional intervention they received.

Methods: Forty-nine consecutive admissions were recruited, 23 various parameters were assessed. A diagnosis of undernutrition was made according to a specifically designed flow chart.

Results: Eighty-four per cent of recruits were at risk of undernutrition on admission and 80 per cent were moderately to severely at risk. There was deterioration from baseline nutritional status in 29 per cent of previouslywell nourished patients with hospitalization. In the undernourished group, an improvement and/or stasis from baseline was achieved in 75 per cent, with intervention.

Conclusions: The risk of undernutrition on admission to hospital and during treatment is an indicator of the need for nutrition services and nutritional screening for all acute medical services for older people.


Mini Nutritional Assessment Protein Energy Malnutrition Unplanned Readmission Irish Medical Journal Inadequate Nutritional Intake 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Keller, H. H. Malnutrition in institutionalised elderly: how and why? JAGS 1993; 41: 1212–1218.Google Scholar
  2. 2.
    Mowé, M., Bøhmer, T. The prevalence of undiagnosed protein-calorie undernutrition in a population of hospitalised elderly patients. JAGS 1991; 39: 1089–1092.Google Scholar
  3. 3.
    Bianchetti, A., Rozzini, R., Carabellese, C. et al. Nutritional intake, socio-economic conditions and health status in a large elderly population. JAGS 1990; 38: 521–526.Google Scholar
  4. 4.
    Radioman, D., Feeler, E. Protein calorie undernutrition in the nursing home. JAGS 1989; 37: 173–183.Google Scholar
  5. 5.
    Abbasi, A. A., Rudman, D. Observations on the prevalence of protein calorie undernutrition in VAC nursing homes. JAGS 1993; 41: 117–121.Google Scholar
  6. 6.
    Fogarty, J., Nolan, G. Assessment of the nutritional status of rural and urban elderly living at home. Irish Medical Journal 1992; 85: 14–16.PubMedGoogle Scholar
  7. 7.
    Incalzi, R. A., Landi, F., Cipriana, L. et al. Nutritional assessment: a primary component of multidimensional geriatric assessment in the acute care setting. JAGS 1996; 44: 166–174.Google Scholar
  8. 8.
    Dávalos, A., Ricart, W., Gonzalez-Hiux, F. et al. Effect of malnutrition after acute stroke on clinical outcome. Stroke 1996; 27: 1028–1032.PubMedGoogle Scholar
  9. 9.
    Health Services Development Unit, Institute of Public Administration, Dublin 6, Ireland. Health Fact Sheet 4/96.Google Scholar
  10. 10.
    The Years Ahead.…A Policy for the Elderly. Report of the Working Party on Services for the Elderly, Government Publications, Dublin Stationary Office, October 1988.Google Scholar
  11. 11.
    Sullivan, D. H., Patch, G. A., Walls, R. C. et al. Impact of nutrition status on morbidity and mortality in a select population of geriatric rehabilitation patients. Am. J. Clin. Nutr. 1990; 51: 749–758.PubMedGoogle Scholar
  12. 12.
    Larsson, F., Unosson, M. Effect of dietary supplement on nutritional status and clinical outcome in 501 geriatric patients — a randomised study. Clin. Nutr. 1990; 9: 179–184.PubMedCrossRefGoogle Scholar
  13. 13.
    Lewis, B. K. Wound care management and the place of nutrition in the assessment of risk. Clin. Nutr. Update 1995; 5: 1–2.Google Scholar
  14. 14.
    Sullivan, D. H. Risk factors for early hospital readmission in a select population of geriatric rehabilitation patients: the significance of nutritional status. JAGS 1992; 40: 792–798.Google Scholar
  15. 15.
    Williams, E. I., Fitton, F. Factors affecting early unplanned readmission of elderly patients to hospital. Br. Med. J. 1988; 297: 784–787.CrossRefGoogle Scholar
  16. 16.
    Pertoldi, W., Fragiacomo, C., Rapin, C. H. et al. The Mini Nutritional Assessment as predictor of Hospital Costs in Geriatric Patients. Presented as a poster at the AGS/AFAR Annual Meeting, May 1–5 1996, Chicago, USA.Google Scholar
  17. 17.
    Mahoney, F. I., Barthel, D. W. Functional evaluation: The Barthel Index. Maryland State Medical Journal 1965; 14: 61–65.PubMedGoogle Scholar
  18. 18.
    Williams, C. Comparing Norton and Medley. Nursing Times 1991; 87: 66–68.PubMedGoogle Scholar
  19. 19.
    O’Neill, D., Condren, L., O’Reilly, F. et al. Cognitive impairment in the elderly. Irish Medical Journal 1988; 88: 11–13.Google Scholar
  20. 20.
    Douglas, B. T., Watson, W. A., Biggs, H. G. Albumin standards and the measurement of serum albumin using bromocresol green. Clin. Chim. Acta. 1971; 31: 87–96.CrossRefGoogle Scholar
  21. 21.
    Lehmann, A. B., Bassey, E. J., Morgan, K. et al. Normal values for weight, skeletal size and body mass indices in 890 men and women over 65 years. Clin. Nutr. 1991; 10: 18–22.PubMedCrossRefGoogle Scholar
  22. 22.
    Kwok, T., Whitelaw, M. N. The Use of armspan in nutritional assessment of the elderly. JAGS 1991; 39: 492–496.Google Scholar
  23. 23.
    Detsky, A. S., McLaughlin, J. R., Baker, J. P. et al. What is Subjective Global Assessment of Nutritional Status? JPEN 1987; 11: 8–13.Google Scholar
  24. 24.
    Chumlea, W. C., Roche, A. F., Mukherjee, D. Nutritional Assessment of the Elderly Through Anthropometry. Ross Laboratories, Columbus, Ohio, 1987.Google Scholar
  25. 25.
    Bishop, C. W., Bowen, D. E., Ritchley, S. J. Norms for nutritional assessment of American adults by upper arm anthropometry. Am. J. Clin. Nutr. 1981; 34: 2530–2539.PubMedGoogle Scholar
  26. 26.
    Frisancho, A. R. New norms of upper limb fat and muscle area for assessment of nutritional status. Am. J. Clin. Nutr. 1981; 34: 2540–2545.PubMedGoogle Scholar
  27. 27.
    National Advisory Group for the Elderly. The Nutrition Assessment Checklist: Guidance Notes and Advice. British Dietetic Association 1990.Google Scholar
  28. 28.
    Woo, J., Ho, S. C., Mak, Y. T. et al. Nutritional status of elderly patients during recovery from chest infection and the role of nutritional supplementation assessed by a prospective randomised single-blind trial. Age and Ageing 1994; 23: 40–48.PubMedCrossRefGoogle Scholar
  29. 29.
    Burr, M. L., Phillips, K. M. Anthropometric norms in the elderly. Br. J. Nutr. 1984; 51: 165–169.PubMedCrossRefGoogle Scholar
  30. 30.
    McEvoy, A. W., James, O. F. Anthropometric indices in normal elderly subjects. Age and Ageing 1982; 11: 97–100.PubMedCrossRefGoogle Scholar
  31. 31.
    Chandra, R. K. Nutrition, immunity and infection: present knowledge and future directions. Lancet 1983; 26 March: 688–691.Google Scholar
  32. 32.
    Varma, R. N. Risk for drug-induced malnutrition is unchecked in elderly patients in nursing homes. JADA 1985; 94: 192–194.Google Scholar
  33. 33.
    Roe, D. A. Therapeutic effects of drug-nutrient interactions in the elderly. JADA 1985; 85: 174–181.Google Scholar
  34. 34.
    Euronut SENECA investigators. SENECA study on Nutrition and the Elderly: Intake of energy and nutrients. Eur. J. Clin. Nutr. 1991; 45 (Suppl. 3): 105–119.Google Scholar
  35. 35.
    McWhirter, J. P., Pennington, C. R. Incidence and recognition of malnutrition in hospital. Br. Med. J. 1994; 308: 945–948.Google Scholar
  36. 36.
    World Health Organisation. Physical status: The use and interpretation of Anthropometry. WHO Technical Report Series-854, 1995.Google Scholar
  37. 37.
    Closs, S. J. Malnutrition: the key to pressure sores? Nursing Standard 1993; 8(4): 32–36.PubMedGoogle Scholar
  38. 38.
    Doekel, R. C., Zwillich, C. W., Scoggin, C. H. et al. Clinical semi-starvation: depression of hypoxic ventilatory response. NEJM 1976; 295: 358–361.PubMedGoogle Scholar
  39. 39.
    Unosson, M., Larsson, J., Ek, A. C. et al. Effects of dietary supplement on functional condition and clinical outcome measured with a modified Norton scale. Clin. Nutr. 1992; 11: 134–139.PubMedCrossRefGoogle Scholar
  40. 40.
    Guigoz, Y., Vellas, B., Garry, P. J. Mini Nutritional Assessment; A practical assessment tool for grading the nutritional state of elderly patients. Facts Res. Gerontol. 1994: Suppl. 2: 12–59.Google Scholar
  41. 41.
    White, J. V., Ham, R. J., Lipschiz, D. A. Consensus of the Nutrition Screening Initiative; Risk factors and indicators of poor nutritional status in older Americans. JADA 1991; 91: 783–787.Google Scholar
  42. 42.
    Wolinsky, F. D., Coe, R. M., McIntosh, W. A. et al. Progress in the Development of a Nutritional Risk Index. J. Nutr. 1990; 120: 1549–1553.PubMedGoogle Scholar
  43. 43.
    Harvet, K. B., Lyle, B. S., Moldawer, B. S. et al. Biological measures for the formulation of a hospital prognostic index. Am. J. Clin. Nutr. 1981; 34: 2013–2022.Google Scholar
  44. 44.
    Reuben, D. B., Greendale, G. A., Harrison, G. G. Nutrition screening in older persons. JAGS 1995; 43: 415–425.Google Scholar
  45. 45.
    Reilly, H. M., Martineau, J. K., Moran, A. Nutritional screening — Evaluation and implementation of a simple nutritional risk score. Clin. Nutr. 1995; 14: 269–273.PubMedCrossRefGoogle Scholar
  46. 46.
    White, J. V., Dwyer, J. T., Posner, B. M. et al. Nutrition Screening Initiative: Development and implementation of the public awareness checklist and screening tools. JADA 1992; 92: 163–167.Google Scholar
  47. 47.
    Nutrition Checklist. National Dairy Council, Dublin 2, Ireland. 1995.Google Scholar
  48. 48.
    Baker, J. P., Detsky, A. S., Wesson, D.E. et al. Nutritional Assessment. A comparison of clinical judgement and objective measurements. NEJM 1992; 306: 969–972.Google Scholar
  49. 49.
    Morley, J. E. Why do physicians fail to recognise malnutrition in older persons? JAGS 1991; 39: 1139–1140.Google Scholar

Copyright information

© Springer 1999

Authors and Affiliations

  • R. Charles
    • 1
  • S. Mulligan
    • 1
  • D. O’Neill
    • 2
  1. 1.Department of Nutrition and DieteticsThe Adelaide & Meath Hospital, Dublin incorporating the National Children’s HospitalIreland
  2. 2.Age Related Health CareThe Adelaide & Meath Hospital, Dublin incorporating the National Children’s HospitalIreland

Personalised recommendations