Protein-Energy Undernutrition Among Elderly Hospitalized Patients: A Prospective Study

Abstract

Context: Numerous studies have identified strong correlations between the severity of nutritional deficits and an increased risk of subsequent morbid events among the hospitalized elderly, but whether inadequate nutrient intake during hospitalization contributes to such nutritional deficits or the risk of adverse outcomes is not known. Objectives: To identify the distribution of average daily nutrient intake among the nonter–minally ill hospitalized elderly, ascertain what factors contribute to persistently low intakes, and determine whether the adequacy of nutrient intake correlates with the risk of mortality. Design: Prospective cohort study conducted from 1994 to 1997. Setting: University-affiliated Department of Veterans Affairs hospital. Patients: A total of 497 patients 65 years or older (mean [SD] age, 74 [6] years; 97% male; 86% white) with a length of stay of 4 days or more. Main Outcome Measures: Daily in-hospital nutrient intake, in-hospital mortality, and 90-day mortality. Results: A total of 102 patients (21%) had an average daily in-hospital nutrient intake of <50% of their calculated maintenance energy requirements. Admission illness severity, average length of stay, and admission albumin and prealbumin levels for this low nutrient group did not differ significantly from those of the remaining patients. However, the low nutrient group had lower mean (SD) discharge serum total cholesterol (154 [44] mg/dL [4 [1.1] mmol/L] vs 173 [42] mg/dL [4.5 [1.1] mmol/L]; p = .001), albumin (29.1 [6.7] vs 33.2 [6.1] g/L, p = .001), and prealbumin (162 [69] vs 205 [68] mg/L;p = .001) concentrations and a higher rate of in-hospital mortality (relative risk, 8.0; 95% confidence interval, 2.8 to 22.6) and 90-day mortality (relative risk, 2.9; 95% confidence interval, 1.4 to 6.1). Contributing to the problem of inadequate nutrient intake, patients were frequently ordered to have nothing by mouth and were not fed by another route. Neither canned supplements nor nutrition support were used effectively. Conclusions: Throughout their hospitalization, many elderly patients were maintained on nutrient intakes far less than their estimated maintenance energy requirements, which may contribute to an increased risk of mortality. Given the difficulties reversing established nutritional deficits in the elderly, greater efforts should be made to prevent the development of such deficits during hospitalization. (JAMA 281:2013–2019, 1999)