Malnutrition in older general medical inpatients: Identification, prevalence and benefits of early nutritional intervention

Author: Yogesh Sharma

Sharma, Yogesh, 2018 Malnutrition in older general medical inpatients: Identification, prevalence and benefits of early nutritional intervention, Flinders University, College of Nursing and Health Sciences

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Malnutrition is common in hospitalized patients and is associated with adverse clinical outcomes and is costly for the public health system. Although hospitals have established nutrition screening protocols, still patients miss nutrition screening because of unknown reasons. The malnutrition universal screening tool (MUST) is commonly used in hospitalized patients but has not been validated in older general medical patients. With an ageing population it is possible that the prevalence of malnutrition is increasing and this needs further verification. Clinicians need to be informed about the clinical consequences of malnutrition and whether malnutrition influences the risk for readmission and can be used in readmission prediction models. The clinical and economic benefits of nutrition intervention in general medical patients needs further clarification because recent research has suggested inconsistent benefits of nutrition intervention in older medical patients.

This research investigated factors responsible for a missed nutritional screening and determined the prevalence and clinical consequences of malnutrition in older general medical inpatients. In addition, a randomized controlled trial (RCT) tested clinical and economic benefits of an early and extended nutritional intervention in older medical inpatients.

This study found that over 50% of older general medical patients were malnourished and a similar number missed nutrition screening. Factors such as patients’ outward appearance and location in the hospital were more likely to be associated with a missed nutrition screening. The MUST was confirmed as a valid nutrition screening tool when compared against a reference standard in older medical patients. Malnourished patients were found to have poor clinical outcomes manifesting as a longer length of hospital stay (LOS), a higher number of nosocomial complications, higher mortality and more frequent readmissions following hospital discharge. An RCT, comparing an early and extended nutrition intervention in 148 older general medical patients over a period of 3-months, found that nutrition intervention was associated with an improvement in nutritional status and also resulted in a significant shortening of LOS in the intervention group. Economic evaluation conducted alongside the clinical trial found that nutrition intervention was cost-effective in terms of both an improvement in costs per unit improvement in nutrition score and costs per quality adjusted life years (QALY) gained and resulted in net cost savings of AU$907 per patient.

This research suggests that there are clinical and economic benefits of treating older malnourished patients. The findings of this study provide compelling evidence to clinicians to incorporate nutrition screening in their practice and for the policy makers to justify greater allocation of resources to improve the nutrition status of hospitalized patients.

Keywords: Malnutrition, Hospitalized patients, Malnutrition screening, Nutritional intervention, Health economics

Subject: Nutrition thesis

Thesis type: Doctor of Philosophy
Completed: 2018
School: College of Nursing and Health Sciences
Supervisor: Prof Michelle Miller