Why don't elderly hospital inpatients eat adequately?

Background: Malnutrition is common among older hospital patients and contributes to poor clinical outcomes. Poor intake among this group of patients could be due to a variety of factors.Objective: To better understand the causes and consequences of inadequate food intake among hospitalised elderly patients, specifically: to determine (i) the prevalence of factors contributory to inadequate food intake, (ii) the relationship of these factors to nutritional status and course of hospital stay.Design: A longitudinal observational study of a convenience sample.Setting: Inpatients of an inner city elderly care unit in the UK.Methods: One hundred patients (mean 81.7 years (sd 7.2); 27 male, 73 female) were observed twice weekly, from admission to discharge/maximum of 4 weeks. Anthropometric assessments of nutritional status were made on admission and discharge. At each visit, adequacy of intake in the preceding 24-hour period, and reasons for inadequate intake, were determined using nurse observations, food-charts, case-notes, and interviews of patients/carers. With all available information, adequacy was estimated whether the subject had consumed at least three-quarters of their standard diet along with any prescribed food supplements. Inadequate nutritional intake was defined as completing less than this amount.Results: On admission, 21 patients were malnourished [below the 10th percentile for demiquet (weight/demispan2) for males or mindex (weight/demispan) for females. Three patients became malnourished during their stay. At 285/425 assessments (67%), patients were judged to be eating inadequately. Acute illness, anorexia, catering limitations and oral problems were the most prevalent reasons for inadequate intake during the earlier part of patients' hospital stay. Confusion, low mood and dysphagia remained prevalent throughout. Compared to well-nourished patients (n=67), malnourished patients (n=24) had higher prevalence of oral problems (22%v6%;p < 0.001), mood/anxiety disturbances (33%v19%;p=0.02), anorexia (38%v23%;p=0.02) and catering limitations (34%v12%;p < 0.001), but lower prevalence of dysphagia (4%v13%,p=0.015). Of 51 patients in hospital for less than 10days, 36 were eating inadequately.Conclusion: Reasons for inadequate intake vary according to stage of hospital stay and nutritional status. Inadequate intake in the early stage after admission is mainly due to self-limiting temporary factors associated with acute illness.