A multicenter survey on changes in nutritional risk and malnutrition incidence of elderly patients in Chinese large hospitals during hospitalization

Objective To investigate the change of the nutritional status of elderly patients in Chinese major hospitals dynamically with nutritional risk screening 2002 (NRS 2002) and subjective global assessment (SGA) during hospitalization. Methods A prospective, multi-center survey was conducted on over 65 years old patients who were admitted in departments of gastroenterology, respiratory medicine, general surgery, geriatrics, thoracic surgery, neurology, orthopedics and medical oncology of 9 large hospitals in China for 7-30 days between June 2014 and September 2014. On admission and within 24 hours after discharge, the clinical data were recorded, physical indices were measured, and laboratory examination were conducted. NRS 2002 and SGA were used to make an evaluation. The nutritional supports and clinical outcomes were also recorded and then the correlation between nutritional status and clinical outcomes were analyzed. Results A total of 2558 patients above 65 years old were included into the study. Compared with their status on admission, their grip strength, upper arm circumference and crural circumference were reduced significantly at discharge (P<0.05). The total protein, albumin and hemoglobin levels were significantly lower than those on admission (P<0.05). The incidence of nutritional risk (NRS 2002 score≥3)and malnutrition (SGA B+ C) on admission were lower than those at discharge (51.1% vs 53.0%, 32.6% vs 35.6%). The hospitalization time and medical expenses were higher in patients with malnutrition on admission than in those with normal nutrition intakes. The nutritional status at discharge was negatively correlated with hospitalization time and medical expenses. 61.3% patients having nutritional risk did not take nutritional support during the hospital stay, while utilization rate of parenteral nutrition was higher than that of enteral nutrition in patients receiving nutritional support (19.6% vs 11.9%). Conclusion Elderly patients have higher possibilities of facing nutritional risk or malnutrition on admission, these are associated with poor clinical outcomes and their nutritional status will not improve significantly at discharge. Therefore, the screening and evaluation of nutritional status in elderly patients during hospitalization should be conducted and their nutritional intervention should be standardized so as to improve the clinical outcomes. Key words: Elderly patients; Dynamic nutrition survey; Nutritional status of discharged patients; Nutritional risk screening; Subjective global assessment; Length of hospital stay; Medical expenses