Health issues and nutrition in the elderly

Prevalence and consequences of malnutrition and malnourishment in older individuals admitted to hospital with a hip fracture

Abstract

Background/objectives

Major causes of hip fractures are osteoporosis and falls, both of which are determined by nutrition. Information on the nutritional status of patients admitted to hospital with a hip fracture is lacking. In this study, we assessed determinants and adverse outcomes associated with malnutrition and malnourishment.

Methods

Nutritional status, assessed using the Malnutrition Universal Screening Tool protocol, was compared to age and residency prior to admission, and outcomes during hospital stay and at discharge.

Results

A total of 1239 patients admitted with a hip fracture (349 men, 890 women), aged 60–100 years. Compared with well-nourished individuals, the prevalences of malnutrition risk or malnourishment were higher in older age groups and those from residential or nursing care. Those with risk of malnutrition or malnourishment stayed in hospital longer by 3.0 days (95% confidence interval (CI), 1.5–4.5 days; p < 0.001) and 3.1 days (95% CI, 0.7–5.5 days; p = 0.011), respectively. Compared with the well-nourished group, malnourished individuals had increased: (1) risk for failure to mobilise within 1 day of surgery (rates = 17.9 versus 27.0%; odds ratio (OR) = 1.6 (95% CI, 1.0–2.7), p = 0.045); (2) pressure ulcers (rates = 1.0% versus 5.0%; OR = 5.5 (95% CI, 1.8–17.1), p = 0.006); (3) in-patient mortality (rates = 4.5% versus 10.1%; OR = 2.3 (95% CI, 1.1–4.8) p = 0.033) and (4) discharge to residential/nursing care: rates = 4.3% versus 11.1%; OR = 2.8 (95% CI, 1.2–6.6), p = 0.022.

Conclusions

Inadequate nutrition is common in patients admitted to hospital with a hip fracture, which in turn predisposes them to a number of complications. More research on nutritional support should be directed to this group to prevent or minimise hip fractures.

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Fig. 1: Distribution of patients throughout the study.
Fig. 2: Nutritional status in relation to age and pre-admission residency.
Fig. 3: Nutritional status in relation outcomes.
Fig. 4: Nutritional status in relation to length of stay.

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Acknowledgements

We are grateful to all patients who participated in this NHFD Audit Programme and hospital staff who provided clinical care and support to patients throughout their hospital stay.

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TSH reviewed the topic related literature and conceived the original idea. KY and RL performed the study coordination and data collection. TSH wrote the first draft, analysed, interpreted the data and revised the paper. CHF and DF edited the paper. All authors checked, interpreted the results and approved the final version.

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Correspondence to Thang S. Han.

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Han, T.S., Yeong, K., Lisk, R. et al. Prevalence and consequences of malnutrition and malnourishment in older individuals admitted to hospital with a hip fracture. Eur J Clin Nutr (2020). https://doi.org/10.1038/s41430-020-00774-5

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