Malnutrition in subacute care

Background: Dramatic weight loss and hypoalbuminemia often follow acute hospitalization. Objective: The objective was to examine the prevalence of undernutrition in a subacute-care facility. Design: We evaluated 837 patients consecutively admitted over 14 mo to a 100-bed subacute-care center. Nutritional status was assessed by anthropometric measurements, biochemical markers, and a Mini Nutritional Assessment (MNA) score. Primary outcome measures included length of stay and death. Secondary measures included readmission to an acute-care hospital and placement at discharge. Results: The subjects' mean (+/-SD) age was 76 +/- 13 y and 61% were women. Eighteen percent of the subjects had a body mass index (in kg/m(2)) < 19. With the use of 35 g/L as a cutoff, 53% of the subjects had hypoalbuminemia. Only 8% of the subjects were classified as being well nourished according to the MNA. Almost one-third (29%) of the subjects were malnourished and almost two-thirds (63%) were at risk of malnutrition. Thus, >91% of subjects admitted to subacute care were either malnourished or at risk of malnutrition. The Geriatric Depression Score was higher in malnourished subjects than in nutritionally at-risk subjects (P = 0.05). Length of stay differed by 11 d between the malnourished group and the nutritionally at-risk group (P = 0.007). In the MNA-assessed group of largely malnourished subjects, 25% of subjects required readmission to an acute-care hospital compared with 11% of the well-nourished group (P = 0.06). Mortality was not found to be related to BMI. Conclusion: Malnutrition reaches epidemic proportions in patients admitted to subacute-care facilities. Whether this reflects nutritional neglect in acute-care hospitals or is the result of profound illness is unclear. Nevertheless, strict attention to nutritional status is mandatory in subacute-care settings.