Inadequate caloric intake: a risk factor for mortality of geriatric patients in the acute-care hospital

Objectives: to compare the adequacy of nutritional support in surgical, medical and geriatric wards, and to assess correlates and prognostic implications of inadequate caloric intake. Design: prospective observational study. Setting: an acute-care university hospital. Patients: 370 patients over 70 years of age consecutively admitted to general surgery (n = 86), general medicine (n = 149) and geriatric (n = 135) wards. Method: a multidimensional assessment was performed on admission, and the average daily caloric intake was computed. The logistic regression analysis was used to characterize patients at risk of starvation, defined as a caloric intake below 40% of the estimated requirement, and of death. Results: the average daily caloric intake, expressed as mean +/- SD, was 63 +/- 40%, 63 -+ 31% and 69 +/- 34% of that required in surgical, medical and geriatric wards, respectively. Patients at risk of starvation were identified by body mass index <22 kg/cm(2) on admission [odds ratio (OR)= 1.73, 95% confidence interval (CI) = 1.33-2.24] and pre-admission dependency in activities of daily living (OR = 1.34, 95% CI = 1.03-1.73). Mortality was independently predicted by an actual/required caloric intake ratio below 40% in the first 3 days of stay (OR = 1.87, 95% CI = 1.21-2.85), pre-admission dependency in at least one activity of daily living (OR = 1.91, 95% CI = 1.24-2.34), lymphocytes <1000/mm(3) (OR = 1.71, CI= 1.11-2.64), albumin <3.5 g/dl (OR = 1.69, 95% CI=1.08-2.66). Conclusions: nutritional support to geriatric patients is frequently inadequate in both surgical and medical and geriatric wards of the acute-care hospital. Malnourished and dependent patients are at high risk of in-hospital starvation. Inadequate caloric intake is a co-contributor to the risk of hospital mortality.