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Nutritional Assessment: A Primary Component of Multidimensional Geriatric Assessment in the Acute Care Setting
Author(s) -
Incalzi Raffaele Antonelli,
Landi Francesco,
Cipriani Luca,
Bruno Elvira,
Pagano Francesco,
Gemma Antonella,
Capparella Oliviero,
Carbonin PierUgo
Publication year - 1996
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.1996.tb02434.x
Subject(s) - medicine , malnutrition , odds ratio , logistic regression , geriatrics , polypharmacy , confidence interval , incidence (geometry) , population , acute care , cohort , health care , physics , environmental health , psychiatry , optics , economics , economic growth
OBJECTIVE : To test the prognostic role of nutritional variables as a component of geriatric multidimensional assessment and to study the effect of hospitalization on nutritional status. DESIGN : Validation cohort study: multidimensional assessment on admission and at discharge and a weekly nutritional assessment. SETTING : General Medicine and Geriatrics wards in an acute‐care university hospital. PATIENTS : A consecutive sample of 302 patients aged 79 ± 6 years, range 70–96 years. MAIN OUTCOME MEASURES : Mortality, longstay (>29 days), loss of lean body mass as expressed by a negative change in mid‐arm muscle circumference (MAMC). RESULTS : Incidence of mortality, longstay, and decreased MAMC was 6.9%, 24.8%, and 64.2%, respectively. According to logistic regression analysis, mortality was independently predicted by preadmission dependency in at least one Activity of Daily Living (odds ratio = 2.08, confidence limits = 1.19–3.65), clinical diagnosis of malnutrition (OR = 1.89, CL= 1.11–3.21), serum albumin < 3.5 g/dL (OR = 1.82, CL = 1.06–3.14). This predictive model allowed us to recognize 75% of the patients at risk of death by targeting 23% of the population. Longstay was independently predicted by stroke (OR = 1.54, CL = 1.01–2.35), clinical diagnosis of malnutrition (OR = 1.41, CL = 1.04–1.93), and more than five comorbid diseases (OR = 1.39, CL = 1.01–1.94). Dependency in at least one ADL was the only independent predictor of decreased MAMC (OR = 1.71, CL = 1.27–2.30). CONCLUSIONS : Nutrition variables are a cardinal component of multidimensional assessment in the acute‐care setting. Nutritional status deteriorates during the hospital stay, mostly in physically dependent patients. J Am Geriatr Soc 44:166–174, 1996 .