The journal of nutrition, health & aging

, Volume 14, Issue 5, pp 387–392 | Cite as

Undiagnosed malnutrition and nutrition-related problems in geriatric patients

  • Dorothee Volkert
  • C. Saeglitz
  • H. Gueldenzoph
  • C. C. Sieber
  • P. Stehle
Article

Abstract

Background & aims

Malnutrition is common in geriatric patients and associated with poor outcome. If recognised, effective treatment is possible. In recent years, low nutritional awareness among health care professionals (HCPs) has been deplored with respect to the general hospital population. The aim of the present cross-sectional study was to assess to which extent malnutrition and nutrition-related problems are documented by physicians and nursing staff in geriatric patients and whether nutrition support is used in daily clinical routine.

Methods

Patient’s characteristics, nutritional status (BMI, Subjective Global Assessment, Mini Nutritional Assessment) and several nutrition-related problems (e.g. weight loss, poor appetite, chewing and swallowing problems) were assessed in 205 patients consecutively admitted to the geriatric ward of a community hospital on the first day after admission. After discharge, all documented information in the medical folders about nutritional status, nutrition-related problems and nutrition support was systematically collected.

Results

According to BMI (< 22 kg/m2) and Subjective Global Assessment (C), malnutrition was observed in 25.4 %, according to Mini Nutritional Assessment (<17 points) in 30,2 % of the patients. In daily routine, clinical judgement of nutritional status by physicians was performed in 187 patients (91.2 %) of whom 6.4 % (5.9 % of all) were classified as malnourished. Weight was documented in 54.1 %, height in 25.9 %. BMI was not calculated. Nutrition-related problems were present in up to half of the patients and only partly documented by HCPs. Seventeen patients (8.3 %) received nutrition support, mostly in the form of oral supplements (3.9 %), followed by enteral (2.9 %) and parenteral nutrition (1.5 %).

Conclusion

Despite high prevalence rates among geriatric patients, malnutrition and nutrition-related problems are rarely recognised and treated. In order to improve nutritional care, routine screening and standard protocols for nutritional therapy should be implemented in geriatric hospital wards.

Key words

Malnutrition awareness of malnutrition nutriton-related problems geriatric patients routine documentation management 

Non-standard abbreviations

ADL

activities of daily living

CJ

clinical judgement of nutritional status

GDS

Geriatric Depression Scale

HCPs

health care professionals

MMSE

Mini Mental Status Examination

MNA

Mini Nutritional Assessment

SGA

Subjective Global Assessment

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Stratton RJ, King CL, Stroud MA, Jackson AA, Elia M. ’Malnutrition Universal Screening Tool’ predicts mortality and length of hospital stay in acutely ill elderly. Br J Nutr 2006; 95: 325–330.CrossRefPubMedGoogle Scholar
  2. 2.
    Persson MD, Brismar KE, Katzarski KS, Nordenström J, Cederholm TE. Nutritional status using mini nutritional assessment and subjective global assessment predict mortality in geriatric patients. J Am Geriatr Soc 2002; 50: 1996–2002.CrossRefPubMedGoogle Scholar
  3. 3.
    Milne AC, Avenell A, Potter J. Meta-analysis: protein and energy supplementation in older people. Ann Intern Med. 2006; 144: 37–48.PubMedGoogle Scholar
  4. 4.
    Morley JE. Management of nutritional problems in subacute care. Clin Geriatr Med 2000; 16: 817–832.CrossRefPubMedGoogle Scholar
  5. 5.
    Bruun LI, Bosaeus I, Bergstad I, Nygaard K. Prevalence of malnutriton in surgical patients: evaluation of nutritional support and documentation. Clin Nutr 1999; 18: 141–147.CrossRefPubMedGoogle Scholar
  6. 6.
    Garrow J. Starvation in hospital. Br Med J 1994; 308: 934.Google Scholar
  7. 7.
    Lennard-Jones JE, Arrowsmith H, Davison C, Denham AF, Micklewright A. Screening by nurses and junior doctors to detect malnutrition when patients are first assessed in hospital. Clin Nutr 1995; 14, 336–340.CrossRefPubMedGoogle Scholar
  8. 8.
    McWhirter JP, Pennington CR. Incidence and recognition of malnutrition in hospital. Br Med J 1994; 308: 945–948.Google Scholar
  9. 9.
    Rasmussen HH, Kondrup J, Ladefoged K, Staun M. Clinical nutrition in Danish hospitals: a questionnaire-based investigation among doctors and nurses. Clin Nutr 1999; 18: 153–158.CrossRefPubMedGoogle Scholar
  10. 10.
    Rasmussen HH, Kondrup J, Staun M, Ladefoged K, Kristensen H, Wengler A. Prevalence of patients at nutritional risk in Danish hospitals. Clin Nutr 2004; 23: 1009–1015.CrossRefPubMedGoogle Scholar
  11. 11.
    Singh H, Watt K, Veitch R, Cantor M, Duerksen DR. Malnutrition is prevalent in hospitalized medical patients: are housestaff identifying the malnourished patient? Nutrition 2006; 2: 350–354.CrossRefGoogle Scholar
  12. 12.
    Thorsdóttir I, Eriksen B E, Eysteinsdóttir S. Nutritional status at submission for dietetic services and screening for malnutrition at admission to hospital. Clin Nutr 1999; 18: 15–21.CrossRefPubMedGoogle Scholar
  13. 13.
    Bavelaar JW, Otter CD, van Bodegraven AA, Thijs A, van Bokhorst-de van der Schueren MA. Diagnosis and treatment of (disease-related) in-hospital malnutrition: the performance of medical and nursing staff. Clin Nutr. 2008; 27: 431–438.CrossRefPubMedGoogle Scholar
  14. 14.
    Mahoney FI, Barthel DW: Functional Evaluation: The Barthel Index. Md State Med J 1965; 14: 61–65.PubMedGoogle Scholar
  15. 15.
    Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12: 189–198.CrossRefPubMedGoogle Scholar
  16. 16.
    Yesavage JA, Brink TL, Rose TL, Lum O, Huang V, Adey M, Leirer VO. Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res 1982; 17: 37–49.CrossRefPubMedGoogle Scholar
  17. 17.
    McDowell MA, Fryar CD, Hirsch R, Ogden CL. Anthropometric reference data for children and adults: U.S. population, 1999–2002. Adv Data 2005; 361: 1–5.PubMedGoogle Scholar
  18. 18.
    Detsky AS, McLaughlin JR, Baker JP, Johnston N, Whittaker S, Mendelson RA, Jeejeebhoy K. What is subjective global assessment of nutritional status? J Parenter Enteral Nutr 1987; 11: 8–13.CrossRefGoogle Scholar
  19. 19.
    Vellas B, Guigoz Y, Garry PJ, Nourhashemi F, Bennahum D, Lauque S, Albarede J L. The Mini Nutritional Assessment (MNA) and its use in grading the nutritional state of elderly patients. Nutrition 1999; 15: 116–122.CrossRefPubMedGoogle Scholar
  20. 20.
    Bauer JM, Vogl T, Wicklein S, Trogner J, Muhlberg W, Sieber CC: Comparison of the Mini Nutritional Assessment, Subjective Global Assessment, and Nutritional Risk Screening (NRS 2002) for nutritional screening and assessment in geriatric hospital patients. Z Gerontol Geriatr 2005; 38: 322–327.CrossRefPubMedGoogle Scholar
  21. 21.
    Incalzi RA, Landi F, Cipriani L et al. Nutritional assessment: A primary component of multidimensional geriatric assemssment in the acute care setting. J Am Geriatr Soc 1996; 44: 166–174.Google Scholar
  22. 22.
    Compan B, di Castri A, Plaze JM, Arnaud-Battandier F. Epidemiological study of malnutrition in elderly patients in acute, sub-acute and long-term care using the MNA. J Nutr Health Aging 1999; 3: 146–151.PubMedGoogle Scholar
  23. 23.
    Poulsen I, Rahm Hallberg I, Schroll M. Nutritional status and associated factors on geriatric admission. J Nutr Health Aging 2006; 10: 84–90.PubMedGoogle Scholar
  24. 24.
    Westergren A, Lindholm C, Axelsson C, Ulander K. Prevalence of eating difficulties and malnutrition among persons within hospital care and special accommodations. J Nutr Health Aging 2008; 12: 39–43.CrossRefPubMedGoogle Scholar
  25. 25.
    Lindorff-Larsen K, Hojgaard Rasmussen H, Kondrup J, Staun M, Ladefoged K; The Scandinavian Nutrition Group. Management and perception of hospital undernutrition — A positive change among Danish doctors and nurses. Clin Nutr 2007; 26: 371–378.CrossRefPubMedGoogle Scholar
  26. 26.
    Rasmussen HH, Kondrup J, Staun M, Ladefoged K, Lindorff K, Jorgensen LM, Jakobsen J, Kristensen H, Wengler A. A method for implementation of nutritional therapy in hospitals. Clin Nutr 2006; 25: 515–523.CrossRefPubMedGoogle Scholar
  27. 27.
    Mowe M, Bosaeus I, Rasmussen HH, Kondrup J, Unosson M, Rothenberg E, Irtun Ø Scandinavian Nutrition Group. Insufficient nutritional knowledge among health care workers? Clin Nutr 2008; 27: 196–202.CrossRefPubMedGoogle Scholar
  28. 28.
    Elia M. The cost of disease-related malnutrition in the UK and economic considerations for the use of oral nutritional supplements in adults. BAPEN, Perspektiv PMA, Nottingham, 2005.Google Scholar
  29. 29.
    Kondrup J, Allison SP, Elia M, Vellas B, Plauth M, Educational and Clinical Practice Committee, European Society of Parenteral and Enteral Nutrition (ESPEN). ESPEN guidelines for nutrition screening 2002. Clin Nutr 2003; 22: 415–421.CrossRefPubMedGoogle Scholar
  30. 30.
    Volkert D, Cederholm T, Coti-Bertrand P, Milne A, Palmblad J, Schneider S, Sobotka L, Stanga Z and the DGEM working group. ESPEN Guidelines Enteral Nutrition: Geriatrics. Clin Nutr 2006; 24: 330–360.CrossRefGoogle Scholar
  31. 31.
    Mowe M, Bosaeus I, Rasmussen HH, Kondrup J, Unosson M, Irtun O. Nutritional routines and attitudes among doctors and nurses in Scandinavia: a questionnaire based survey. Clin Nutr 2006; 25: 524–532.CrossRefPubMedGoogle Scholar

Copyright information

© Serdi and Springer Verlag France 2010

Authors and Affiliations

  • Dorothee Volkert
    • 1
    • 4
  • C. Saeglitz
    • 2
  • H. Gueldenzoph
    • 3
  • C. C. Sieber
    • 1
  • P. Stehle
    • 2
  1. 1.Institute for Biomedicine of AgingUniversity of Erlangen-NürnbergErlangenGermany
  2. 2.Department of Nutrition and Food Sciences (IEL) — Nutrition PhysiologyUniversity of BonnBonnGermany
  3. 3.Department of Geriatric MedicineMalteser-HospitalBonnGermany
  4. 4.Institute for Biomedicine of AgingUniversity of Erlangen-NürnbergNürnbergGermany

Personalised recommendations