Abstract
BACKGROUND: Undernutrition/nutritional risk were evaluated longitudinally in 531 hospitalized elderly by four validated methods to appraise the most feasible for routine use. DESIGN: Within 48 hrs of admission and 24 hrs before discharge: the following data were collected: clinical data, nutritional status (BMI, %weight loss) and risk (MNA, MUST), energy requirements (Owen et al), diet. RESULTS: Significant changes from admission to discharge in risk/undernutrition prevalence, were not shown by BMI (approximately 17% vs 22%), > or = 5%weight loss (approximately 53% vs approximately 56%) or MNA 83% vs approximately 81%; at admission, 93% patients were MUST high risk declining to approximately 47% (p=0.001) at discharge, alongside eating resumption. By multivariate analysis comparing all methods and differences between patient groups during hospitalization, only %weight loss clarified nutritional progression: more surgical patients had > or = 10%weight loss vs medicine, p < 0.01. Only admission > or = 5%weight loss was predictive of longer hospitalizations (OR:1.57; 95%CI 1.02-2.40; p < 0.003), though MNA and MUST undernourished/high risk had significantly longer stays. MNA and MUST were the most concordant methods, p < 0.001. Eating compromising symptoms were prevalent in surgery/medicine with > or = 5%weight loss, MNA risk/undernutrition, and MUST high risk, p < 0.005. Overall, mean energy requirements/diet were not significantly different between admission/discharge: requirements approximately 1400 kcal were always lower than on offer approximately 2128 kcal, p=0.0001. CONCLUSIONS: Rigid diets create costly waste which do not counteract nutritional deterioration. Different nutritional risk/status prevalences were unveiled at admission and discharge: > 50% patients were at risk/undernourished by significant weight loss, MNA or MUST, all associated with longer stays. Recent weight loss is unarguably essential, comprehensive MNA and MUST similarly reliable; in this study dynamic MUST seemed easier to practise. Quality nutritional care before/during/after hospitalization is mandatory in the elderly.