Malnutrition often missed in hospitalized elderly
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Many doctors and nurses may fail to recognize certain key signs of malnutrition in older hospital patients, according to a study conducted at a hospital in Australia.
Researchers found that of 100 elderly patients at a major Melbourne hospital, 30 percent were malnourished, while 61 percent were at risk of becoming so. However, their doctors and nurses often failed to recognize two major risk factors for malnutrition—recent weight loss and waning appetite.
While 59 patients had recently lost weight, only 19 percent of these cases had been recognized by the hospital staff. Of 57 patients with appetite loss, staff recognized 53 percent of cases.
Rates of referral to a dietitian were even lower, according to the researchers, led by Naomi E. Adams of Deakin University in Burwood, Australia. Only 9 percent of patients with appetite loss, and 7 percent of those with weight loss, were referred to a dietitian, the researchers report in the journal Nutrition and Dietetics.
The findings may reflect a lack of knowledge about certain malnutrition risk factors, according to the researchers.
On one hand, doctors and nurses were well aware of medical indicators of malnourishment—the appearance of the skin, for instance, and blood levels of a protein called albumin. On the other, they tended to put greater stock in patients’ current weight as a measure of their nutritional well-being, rather than recent weight loss.
If hospital staff focus on elderly patients’ current weight—which may technically be in the “healthy” range—rather than the fact that they are losing pounds, many patients at risk of malnourishment could go unrecognized, the researchers point out.
“Nutrition as part of essential care often becomes overlooked in our high-tech health care environment,” Natalie Simmance, chief dietitian at St. Vincent’s Hospital in Fitzroy and a co-researcher on the study, told Reuters Health.
Staff may overlook the nutritional needs of the elderly because other complex medical problems are given priority, she added.
Moreover, Simmance explained, hospital menus are often designed to meet the needs of healthy people, and not those with poor appetites and difficulty feeding themselves—which describes many hospitalized elderly. So many may miss meals and lose weight.
A potential way to combat the problem would be to do routine nutritional screening when older patients are admitted to the hospital, and then periodically during their stay, the researchers say.
At-risk patients could then be referred for special care from a dietitian.
It would also help, the researchers point out, for all older patients to routinely get “nutritional support,” like calorie- and nutrient- packed small meals and drinks, and more help with feeding themselves.
SOURCE: Nutrition & Dietetics, June 2008.
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