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© 1998 Oxford University Press
research-article |
Inadequate caloric intake: a risk factor for mortality of geriatric patients in the acute-care hospital
Istituto di Medicina e Geriatria dell'Universita' Cattolica Policlinico A. Gemelli, Largo A Gemelli 8, 00168 Roma, Italy
1Teaching Nursing Home ‘Cittadella della Carita’ Taranto,Italy
Address correspondence to: R. Antonelli Incalzi. Fax: (+39) 6 3051911
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 (n7=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/cm2 on admission [odds ratio (OR)=1.73, 95% confidence interval (CI)=1.33–2.24] and pre-admission dependency in activities of dairy 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=1.24–2.94), lymphocytes <1000/mm3 (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.
Keywords: dependency, malnutrition, mortality, old age, surgery, dependency
Received March 13, 1997;
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