Improving the efficacy of nutritional supplementation in the hospitalised elderly

Background: Protein-energy malnutrition delays wound healing, extends length of stay, and increases complication rates. Identification of patients at risk of malnutrition, together with early intervention, may prevent further deterioration of nutritional status. Objectives: Through the use of nutrition screening and assessment, prioritise nutrition intervention to those at greatest nutritional risk. To improve the consumption rate of nutritional supplements, using a 'nutrition as medication' program. Methods: We assessed 200 acute aged care patients for malnutrition risk using the Mini Nutritional Assessment (MNA) tool (Nestle SA, Vevey, Switzerland) within 72 h of hospital admission. Patients 'at risk' or malnourished, received either mid meal supplements (control group) or 60 mL of a 2 kcal per ml supplement, given four times daily (trial group). Outcome measures included comparison of supplement consumption changes in MNA scores on fortnightly reassessment or discharge. Results: Thirty per cent of patients were malnourished on admission, with a further 42% 'at risk'. Patient compliance with the 'nutrition as medication' program was excellent (95%) compared with current practice (48%). On reassessment patients in the trial group showed a trend towards a greater improvement in score for appetite (P = 0.065), number of meals consumed (P = 0.01) and protein intake (P = 0.007). Improvement in score for weight was significant in the trial group (P = 0.027). Length of stay was shorter in the trial group (P = 0.044). Conclusion: Routine use of a validated assessment tool is essential for early identification of malnutrition risk. A 'nutrition as medication' program is effective in attenuating deterioration in nutritional status.