Identification of wrong or inadequate nutrition of elderly patients in an acute-admissions hospital

Background and objective: Wrong or inadequate nutrition can lead to an increased morbidity and mortality as well as a raised perioperative rate of complications. Endangered patients should be identified quickly, reliably and cost-effectively on admission. This study aimed at developing a 3-step assessment, using a previously evaluated questionnaire. Patients and methods: Between February and July 2001, the nutritional state was prospectively obtained, in the first three days after admission, by questionnaire (based on a questionnaire developed at the Bethanien Hospital, Heidelberg) and objective measurements of 408 hospitalized patients aged over 70 years (139 men, 269 women, average age 82.2 years). Body mass index (BMI) was calculated for each patient and in those in whom it was over 25, concentrations of albumin, calcium, vitamin D and lymphocyte count as well as triceps skin fold thickness were also obtained. Results: 22 of the 408 patients (5.4%) had a BMI of less than or equal to 18.5 (step 1). 191 patients (46.8%) answered afirmatively four or more of the questions, placing them in the group of "in danger of malnutrition". The,objective" parameters were present in all patients with a BMI < 25. Abnormal levels were found only in patients who had already been identified through their questionnaire (four or more positive answers). 310 answered positively to question 8 and 11 (step 2). When additionally answers to questions 1, 2, 6, 7 and 10 were included (at least four additional positive answers in the Bethanian questionnaire, step 3) 175 patients in danger of malnutrition (91.6%) were identified. Conclusion: The 3-step assessment (BMI and questions answered positively) correctly identified 90% of elderly patients in danger of malnutrition. This assessment thus ensured effective provision of nutritional care in an acute-admissions hospital.