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A. Hussain, D.H. Barer, Department of Geriatrics, New Castle General Hospital, Newcastle upon Tyne (UK) Dear Sir, We read with interest the article by Lansey et al. [1] on the assessment of malnutrition in the hospitalised frail elderly, and strongly support the suggestion that improved physician education is needed to identify patients at risk. This applies particularly to patients admitted to hospital with proximal femoral fractures, whose incidence continues to rise [2, 3]. Malnutrition is especially common in this group of patients [4], and is associated with markedly increased mortality, morbidity, and length of stay [5, 6]. Indeed nutritional supplements have clearly been shown to improve outcome [7, 8], so we decided to assess current attitudes and measures taken to detect and manage malnutrition in such patients. A standard questionnaire was circulated to all 61 orthopaedic surgeons in the North of England, of whom 44 have so far replied (response rate to first mailing 72%). On average, they each treated 100 patients/year with proximal femoral fractures. Two-thirds did not do any form of nutritional assessment and indeed one-third of the surgeons did not feel that malnutrition was a significant problem in their patients with proximal femoral fractures. Clearly there is a great need to increase the awareness of medical staff about nutritional problems, and the development of standard guidelines for assessment of malnutrition in elderly patients in hospital is an important first step. References Lansey S, Waslien C, Mulvihill M, Fillit H: The role of anthropometry in the assessment of malnutrition in the hospitalized frail elderly. Gerontology 1993;39:346-353. Royal College of Physicians: Fractured neck of femur: Prevention and management. London, Royal College of Physicians, 1989. Keene GS, Parker MJ, Pryor GA: Mortality and morbidity after hip fractures. BrMed J 1993;307:1248-1250. Older MWJ, Delyth E, Dickenson JWT: A nutrient survey in elderly women with femoral neck fracture. BrJSurg 1980;67:884-886. Bastow MD, Rawlings J, Allison SP: Undernutrition, hypothermia and injury in elderly women with fractured femur: An injury response to altered metabolism? Lancet 1983;1: 143-146. Anderson MA, Collins G, Davis G, Bivins BA: Malnutrition and length of stay. A relationship? Henry Ford HospMed J 1985;4:190-193. Bastow MD, Rawlings J, Allison SP: Benefits of supplementary tube feeding after fractured neck of femur: A randomized controlled trial. BrMed J 1983;287:1589-1592. Delmi M, Rapin C-H, Bengou J-M, Delmas PD, Vasey H, Bonjour JP: Dietary supplementation in elderly patients with fractured neck of femur. Lancet 1990;335:10131016.

Nutritional Assessment in Patients Admitted with Proximal Femoral Fractures