Poor Diet Hinders Recovery of Hospitalized Seniors

Source: Tufts University
September 7, 2000 (Reviewed: January 15, 2003)

Being hospitalized could cause more harm than good to elderly patients whose illness keeps them from meeting their nutrient needs. This troubling issue was the focus of an article in a recent issue of Nutrition Reviews.

An important study published last year in the Journal of the American Medical Association found that elderly patients who did not consume enough calories and protein left the hospital sicker and were more likely to die than patients who were better able to maintain adequate nutrition. In that study, researchers monitored almost 500 elderly patients for at least 90 days from the time they entered the hospital. They measured the amount of protein and calories that each patient consumed while in the hospital, and calculated how closely each one of them came to meeting their daily requirements for both.

The patients categorized as having a "low nutrient intake" had lower levels of serum albumin (a measure of protein that correlates with health and recovery) and greater weight losses at time of discharge than those categorized as having "adequate nutrient intake." Of those in the "low intake group," 16% died within 90 days of entering the hospital, compared with 6% of those who were in better nutritional shape.

One might assume that the "low nutrient intake" patients were sicker to begin with, which led to worse outcomes. But actually, all study participants were in similar states of health when they entered the hospital. To determine what had interfered with the ability to consume an adequate diet, the researchers explored factors that commonly contribute to low nutrient intakes in hospitalized patients. For example, patients are often ordered to consume "nothing by mouth" (NPO) in preparation for a procedure or diagnostic test. In a number of cases, the researchers could find no clear explanation of why a person was NPO. They further suggest that delays in writing medical orders may have kept patients from eating for longer periods than necessary. Other factors leading to poor food intake were dislike of the food, lack of appetite, and persistent nausea.

Hospitals should have a system in place to identify and monitor those patients who are malnourished or at risk for becoming so. As this study illustrates, though, people with poor nutrition status can "slip through the cracks," consuming too little food while in the hospital and putting themselves at increased medical risk. Since declines in health can occur quickly in the elderly--the average length of hospital stay in this study was only eight days--it is essential that nutrition be part of every elderly patient's medical care plan. If illness prevents a person from eating normally, there are other feeding options, such as tube feeding products and intravenous nutrient support, which can help fill the nutrition gap. Health care providers should keep these options in mind when caring for a hospitalized older person. Concerned family members should feel comfortable in raising questions about the adequacy of the diet when they believe that the patient cannot communicate effectively on their own behalf.

Sources

• Low nutrient intake contributes to adverse clinical outcomes in hospitalized elderly patients. DH. Sullivan,  et al., Nutrition Reviews., 2000, vol. 58, pp. 214--217



• Protein-energy undernutrition among elderly hospitalized patients. DH. Sullivan,  et al., Journal of the American Medical Association., 1999, vol. 218, pp. 2013--2019

Related Links
The Warning Signs, New York State Office for the Aging
Tufts University's Nutrition

Please take a moment to give us your comments. For questions about Health matters you may check our "Questions & Answers" Portal and Service.