Nutrition survey in an elderly population following admission to a tertiary care hospital

Background: Malnutrition in elderly patients in institutions has become an issue of clinical concern, but it remains largely unrecognized in acute car e hospitals. The demonstrated benefits of intervention emphasize the need f or routine nutritional assessment. The objectives of this study were to det ermine the prevalence of malnutrition in elderly patients admitted to a ter tiary care centre and to test the sensitivity and specificity of 3 nutritio n screening tools. Methods: Between July and November 1996 patients 65 years and older were co nsecutively recruited from the general medicine, orthopedics, general surge ry and neurosciences services of The Ottawa Hospital - General Campus withi n 72 hours of admission. They were interviewed using 3 nutritional screenin g tools: one developed by Chandra and colleagues (Chandra), the Nutrition S creening initiative (NSI) and the Mini Nutritional Assessment (MNA). A deta iled nutrition assessment was then undertaken, which included anthropometri c assessment, laboratory tests, determination of risk factors and assessmen t of dietary intake. A dietitian blinded to the screening results classifie d each patient as being well nourished, at risk for malnutrition or malnour ished. The prevalence of malnutrition was assessed, and screening results w ere compared with the results of the detailed nutrition assessment for sens itivity and specificity. Results: In total, 160 patients (86 women) were recruited. Derailed nutriti on assessments were completed for 152 patients, of which 62 (40.8%) were fo und to be well nourished, 67 (44.1%) at moderate risk for malnutrition and 23 (15.1%) malnourished. Matched comparisons showed that, of the 23 malnour ished patients, 1 was found to be at high risk for malnutrition using the C handra screening tool, 9 using the NSI and 4 using the MNA, giving sensitiv ities of 32%, 54% and 57%, and specificities of 85%, 61% and 69%, respectiv ely. Interpretation: Given the high rate of malnutrition or risk of malnutrition in this study, admitting physicians need to be aware of this problem and i ts scope. The 3 screening tools tested performed poorly in comparison with the detailed nutrition assessment. This may have been because the score thr esholds for the screening tools were set for screening purposes and because the screening tools were designed for different settings and a wider popul ation.