Prospective audits of quality of PEM recognition and nutritional support in critically ill elderly patients

Background and aims: Undereating is a frequent concern in acute care geriat ric settings and is supposed to worsen the outcomes of the underlying disea ses, while the quality of nutritional support could be improved. Methods: T wo consecutive and prospective audits (A and B) with team training over a 1 year period investigated the quality of malnutrition recognition and nutri tional support and outcomes in immobilized, critically ill elderly subjects . Results: Audit A included 170 patients (86.3+/-6.1 years old) and audit B , 232 patients (86.3+/-6.3), respectively 20.6% and 31.4% of the hospitaliz ed population. Misclassifications occurred in A in 54.0% compared to 34.05% in 8 (P < 0.001). 32.6% in A versus 86.9% in B adequately received oral su pplements (P = 0.02). Significant risk factors for the adverse outcomes in the combined two audits were: dementia (RR: 1.8, 95%Cl: 1.0 to 3.0, P = 0.0 4) and dehydration (RR: 2.0, 95%Cl:1.0 to 4.1, P = 0.05) for pressure ulcer incidence; stroke (RR: 8.8, 95%Cl: 4.8 to 16.0, P < 0.001) for pressure ul cer prevalence at discharge; neoplasms (RR: 1.1, 95%Cl: 1.0 to 1.2, P = 0.0 2) for nosocomial infections; bladder indwelling for urinary tract infectio ns (RR: 4.8, 95%Cl: 2.9 to 7.7, P < 0.001); swallowing problems for pulmona ry infections (RR: 5.4, 95%Cl: 2.8 to 10.5, P < 0.001); venous indwelling f or septicaemia (RR: 5.4, 95%Cl: 1.3 to 23.3, P = 0.02). However, after adju stment on significant risk factors, the outcome rate was similar in audit B : death rate: A (15.6%), B (14.2%); length of stay: A (17.3+/-10.4 days), B (17.4+/-10.0); pressure ulcer incidence: A (26.4%), B (20.2%), (83% were e rythema); pressure ulcer prevalence at discharge: A (14.7%), B (10.3%), (40 % were erythema); nosocomial infections: A (26.4%), B (19.0%). Conclusion: The improvement of malnutrition recognition and nutritional sup port was not followed by a perceptible decrease in adverse outcome rate, th is latter being mainly related to the underlying conditions of these critic ally ill elderly patients.