Inadequate caloric intake: a risk factor for mortality of geriatric patients in the acute-care hospital

Abstract

to compare the adequacy of nutritional support in surgical, medical and geriatric wards, and to assess correlates and prognostic implications of inadequate caloric intake. prospective observational study. an acute-care university hospital. 370 patients over 70 years of age consecutively admitted to general surgery (n= 86), general medicine (n7=149) and geriatric (n=135) wards. a multidimensional assessment was performed on admission, and the average daily caloric intake was computed. The logistic regression analysis was used to characterize patients at risk of starvation, defined as a caloric intake below 40% of the estimated requirement, and of death. the average daily caloric intake, expressed as mean ± SD, was 63 ± 40%, 63 ± 31% and 69 ± 34% of that required in surgical, medical and geriatric wards, respectively. Patients at risk of starvation were identified by body mass index <22 kg/cm2 on admission [odds ratio (OR)=1.73, 95% confidence interval (CI)=1.33−2.24] and pre-admission dependency in activities of dairy living (OR=1.34, 95% CI=1.03−1.73). Mortality was independently predicted by an actual/required caloric intake ratio below 40% in the first 3 days of stay (OR=1.87, 95% CI=1.21−2.85), pre-admission dependency in at least one activity of daily living (OR=1.91, 95% CI=1.24−2.94), lymphocytes <1000/mm3 (OR=1.71, CI=1.11−2.64), albumin <3.5 g/dl (OR= 1.69, 95% CI=1.08−2.66). nutritional support to geriatric patients is frequently inadequate in both surgical and medical and geriatric wards of the acute-care hospital. Malnourished and dependent patients are at high risk of in-hospital starvation. Inadequate caloric intake is a co-contributor to the risk of hospital mortality.