Abstract
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.
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Keller, H. H. Malnutrition in institutionalised elderly: how and why? JAGS 1993; 41: 1212–1218.
Mowé, M., Bøhmer, T. The prevalence of undiagnosed protein-calorie undernutrition in a population of hospitalised elderly patients. JAGS 1991; 39: 1089–1092.
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.
Radioman, D., Feeler, E. Protein calorie undernutrition in the nursing home. JAGS 1989; 37: 173–183.
Abbasi, A. A., Rudman, D. Observations on the prevalence of protein calorie undernutrition in VAC nursing homes. JAGS 1993; 41: 117–121.
Fogarty, J., Nolan, G. Assessment of the nutritional status of rural and urban elderly living at home. Irish Medical Journal 1992; 85: 14–16.
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.
Dávalos, A., Ricart, W., Gonzalez-Hiux, F. et al. Effect of malnutrition after acute stroke on clinical outcome. Stroke 1996; 27: 1028–1032.
Health Services Development Unit, Institute of Public Administration, Dublin 6, Ireland. Health Fact Sheet 4/96.
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.
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.
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.
Lewis, B. K. Wound care management and the place of nutrition in the assessment of risk. Clin. Nutr. Update 1995; 5: 1–2.
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.
Williams, E. I., Fitton, F. Factors affecting early unplanned readmission of elderly patients to hospital. Br. Med. J. 1988; 297: 784–787.
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.
Mahoney, F. I., Barthel, D. W. Functional evaluation: The Barthel Index. Maryland State Medical Journal 1965; 14: 61–65.
Williams, C. Comparing Norton and Medley. Nursing Times 1991; 87: 66–68.
O’Neill, D., Condren, L., O’Reilly, F. et al. Cognitive impairment in the elderly. Irish Medical Journal 1988; 88: 11–13.
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.
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.
Kwok, T., Whitelaw, M. N. The Use of armspan in nutritional assessment of the elderly. JAGS 1991; 39: 492–496.
Detsky, A. S., McLaughlin, J. R., Baker, J. P. et al. What is Subjective Global Assessment of Nutritional Status? JPEN 1987; 11: 8–13.
Chumlea, W. C., Roche, A. F., Mukherjee, D. Nutritional Assessment of the Elderly Through Anthropometry. Ross Laboratories, Columbus, Ohio, 1987.
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.
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.
National Advisory Group for the Elderly. The Nutrition Assessment Checklist: Guidance Notes and Advice. British Dietetic Association 1990.
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.
Burr, M. L., Phillips, K. M. Anthropometric norms in the elderly. Br. J. Nutr. 1984; 51: 165–169.
McEvoy, A. W., James, O. F. Anthropometric indices in normal elderly subjects. Age and Ageing 1982; 11: 97–100.
Chandra, R. K. Nutrition, immunity and infection: present knowledge and future directions. Lancet 1983; 26 March: 688–691.
Varma, R. N. Risk for drug-induced malnutrition is unchecked in elderly patients in nursing homes. JADA 1985; 94: 192–194.
Roe, D. A. Therapeutic effects of drug-nutrient interactions in the elderly. JADA 1985; 85: 174–181.
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.
McWhirter, J. P., Pennington, C. R. Incidence and recognition of malnutrition in hospital. Br. Med. J. 1994; 308: 945–948.
World Health Organisation. Physical status: The use and interpretation of Anthropometry. WHO Technical Report Series-854, 1995.
Closs, S. J. Malnutrition: the key to pressure sores? Nursing Standard 1993; 8(4): 32–36.
Doekel, R. C., Zwillich, C. W., Scoggin, C. H. et al. Clinical semi-starvation: depression of hypoxic ventilatory response. NEJM 1976; 295: 358–361.
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.
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.
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.
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.
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.
Reuben, D. B., Greendale, G. A., Harrison, G. G. Nutrition screening in older persons. JAGS 1995; 43: 415–425.
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.
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.
Nutrition Checklist. National Dairy Council, Dublin 2, Ireland. 1995.
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.
Morley, J. E. Why do physicians fail to recognise malnutrition in older persons? JAGS 1991; 39: 1139–1140.
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Charles, R., Mulligan, S. & O’Neill, D. The identification and assessment of undernutrition in patients admitted to the age related health care unit of an acute Dublin General Hospital. Ir. J. Med. Sc. 168, 180–185 (1999). https://doi.org/10.1007/BF02945849
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DOI: https://doi.org/10.1007/BF02945849