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Nutritional screening in a case management program for community-living older individuals at high risk of hospital admission

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Abstract

Background

The prevalence of malnutrition in older persons depends on the healthcare setting. In recent years, hospital-based case management programs (CM Programs) targeting individuals in the community with chronic multimorbidity and high use of hospital resources (admissions or emergency visits) have been developed in many countries to reduce the need for complex health care. The objective of this study was to assess the prevalence of risk of malnutrition, using the Short Form of the Mini-Nutritional assessment, of community dwelling patients included in a chronic CM Program. Factors associated with malnutrition risk were also explored.

Methods

Patients included in a hospital-based integrated CM Program for older persons at high risk for hospital readmission after an index admission were studied. MNA-SF was used at program inclusion to assess the risk of malnutrition. An array of factors potentially associated with malnutrition were explored (including feeding route, use of dental prosthesis, dysphagia, consistency of foods, specific therapeutic diets, use of oral nutritional supplements, polypharmacy, falls, and other diseases and geriatric syndromes).

Results

791 participants were included, mean age 79.8 years, 50.1% females. Risk of malnutrition was present in 44.9%. Participants at risk of malnutrition were more frequently female, had a lower BMI, were less likely to be fed orally and used more nutritional supplements. They also had a higher prevalence of dysphagia, needing changes in food consistency or using specific therapeutic diets, and had dementia or cancer more frequently. They also showed a higher need for palliative care.

Conclusions

Risk of malnutrition in patients included in a CM Program is higher than in non-selected community dwelling older individuals. This information may help inform screening policies in similar populations at risk of hospital readmission.

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Abbreviations

BMI:

Body mass index

CM Program:

Case management program

ESPEN:

European Society for Parenteral and Enteral Nutrition

HaH:

Hospital at Home

MNA-SF:

Mini-Nutritional Assessment—Short Form

MMSE:

Mini-Mental State Examination

NECPAL:

Instrument for the identification of palliative needs

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Authors and Affiliations

  1. Hospital Universitario y Politécnico La Fe, Avenida Fernando Abril Martorell 106, UHD Torre C Planta 1, 46026, Valencia, Spain

    S. Forcano-Sanjuan, E. Soriano-Melchor, B. Valdivieso-Martinez, V. Ruiz-García & J. F. Merino-Torres

  2. Hospital Ramón y Cajal, Ctra. De Colmenar Viejo, Km 9, 100, 28034, Madrid, Spain

    A. J. Cruz-Jentoft

Authors
  1. S. Forcano-Sanjuan
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  2. E. Soriano-Melchor
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  3. B. Valdivieso-Martinez
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  4. V. Ruiz-García
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  5. J. F. Merino-Torres
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  6. A. J. Cruz-Jentoft
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Corresponding author

Correspondence to S. Forcano-Sanjuan.

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Conflict of interest

All the authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the Clinical Research Ethics Committee of the Hospital La Fe of Valencia. All procedures performed in studies involving human participants were in accordance with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Forcano-Sanjuan, S., Soriano-Melchor, E., Valdivieso-Martinez, B. et al. Nutritional screening in a case management program for community-living older individuals at high risk of hospital admission. Eur Geriatr Med 9, 691–696 (2018). https://doi.org/10.1007/s41999-018-0083-x

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  • DOI: https://doi.org/10.1007/s41999-018-0083-x

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