Malnutrition Screening and Support in the ED Advised for Older Adults

November 26, 2013

By Lorraine L. Janeczko

NEW YORK (Reuters Health) Nov 26 - Older adults who visit the Emergency Department (ED) may benefit from screening for malnutrition, a new study from Australia suggests.

Emergency Departments are key access points for unwell older people, and because not all ED patients are admitted to the hospital, malnutrition screening there can capture an at-risk population that might otherwise slip through the cracks, the authors wrote in a paper online November 5 in Emergency Medicine Journal.

"Introducing two Malnutrition Screening Tool (MST) questions or other valid screening tools can ensure that vulnerable people are identified and steps can be taken to improve their nutritional status," said principal investigator Dr. Angela Vivanti, research and development dietitian and senior lecturer in the School of Human Movement Studies of the University of Queensland in an email to Reuters Health.

The study, she added, suggests that screening and interventions can ultimately help prevent falls and pressure ulcers, limit the length of hospital admissions, and improve older patients' quality of life.

"Malnutrition amongst older people was more common than those working in the ED would have anticipated," Dr. Vivanti said. "In our study, one in eight older people presenting to our major hospital's emergency department were confirmed as being malnourished."

"This plan should be widely adopted. With many people visiting Emergency Departments each year, they are an important capture point and can play a key role in identifying people quietly living in their communities who are at risk or who are currently malnourished," she said.

In a randomized controlled intervention trial, the researchers screened ED patients over age 60 for malnutrition and compared the effect of two service delivery models of nutritional support on nutritional status, quality of life, falls and unplanned hospital admissions.

Patients were excluded if they were in the highest-priority triage category; were already receiving dietetic care; were admitted from a nursing home or other health care facility, or if they visited the ED outside normal business hours.

Of 3,028 people who visited the ED, 1,508 entered between 9:00am and 5:00pm, Monday through Friday. The research team screened 703 patients, and, using the MST, identified 84 (12%) as being at risk for malnutrition.

Of the 24 patients who consented to participate in the intervention study, 88% (21/24) were confirmed to be malnourished. Participants' mean age was 79 years. Their body weight, quality of life, depression, history of falls and days admitted to the hospital were recorded at baseline and at 12 weeks.

During the 12-week trial, the control group received the standard ED care from the hospital's nursing staff. The intervention group received the usual care plus individual dietary counseling at baseline to set nutrition goals and strategies in collaboration with the ED dietitian. Follow-up was performed at a minimum of weeks 4 and 8, by telephone review, a home visit or both, and data for both groups was collected at 12 weeks.

Ten of 14 controls and nine of 10 intervention patients completed the study.

The intervention group showed improvements in both quality of life and depression compared with the control group. Mean quality of life scores on the EQ-5D health survey questionnaire improved by an average of 14.4 points (on a scale of 1 to 100) in the intervention group but fell by an average of 0.1 points among those receiving standard care.

The median total hospitalization was 4.5 days in the intervention group vs six days in the standard care group. Depression scores improved among the intervention cohort but worsened in the standard care group.

The researchers found clinically important but not statistically significant differences over the 12-week trial. The intervention group gained an average of 0.8 kg (1.76 lb), while the control group lost an average of 1.1 kg (2.42 lb). The intervention group also had better quality of life, less depression and shorter hospital admissions.

The authors wrote that malnutrition among older people visiting the ED has been documented at 15%, increasing to 24% among those admitted to the hospital.

They added that, to their knowledge, this is the first nutrition intervention study conducted within the real world setting of the ED, and they recommended that, because it was not adequately powered to show statistical significance of the results, further research with larger samples be conducted.

"Our population is aging - including us!" Dr. Vivanti said in an email. "Maintaining optimal nutritional status benefits both the health services by reducing the length of stay and infections, and the individuals involved by improving their quality of life."


Emerg Med J 2013.


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