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QuaLife+: Screening of malnutrition in the elderly population in a university-central hospital in the North of Portugal Melim D1 & Marília-Silva S1,2, Arteiro C1, Azevedo R1, Coroas A1, Gaspar F1, Gil C1, Santos R1, Silva D1, Pinhão S1, Teixeira C1, Vasconcelos C1, Viana M1, Teixeira L1, Madureira E1 1Centro Hospitalar de São João (CHSJ), 2Coordenadora do Projeto Rationale Methods Nowadays, 20% of the portuguese population are 65 or more . years old, and this number tends to increase. The prevalence of malnutrition in elderly is 1-5% in community and 20-50% in the hospitalized, being associated with an increase in hospitalization duration, costs and mortality. The QuaLife+ Project, financed by Norway, Iceland and Liechtenstein through EEA Grants, allows the assessment and monitoring of the nutritional risk in the elderly hospitalized in CHSJ. It was evaluated the nutritional risk of the hospitalized patients in CHSJ who are 65 or more years old, between November 2015 and July 2016. The nutritional risk screening is performed by nurses on admission (first 48h) through Mini Nutritional Assessment – Short Form (MNA-SFR), generating an automatic alert to the nutrition team when risk is detected. Then, nutritional assessment and intervention take place. To become the screening practices more uniform, staff formation occured in the implementation period. The sample methodology is described in graphic 1. It was used descriptive statistics to the definition of the sample, and Chi-square to find out if there are differences on the proportion of men and women in each nutritional state, and if there are differences on the proportion of patients classified in each nutritional state between screened and assessed. Mann-Whitney test was used to verify if there are differences on the median of age. Objective To monitor the nutritional status of the elderly in CHSJ and to define the type of nutritional intervention. Preliminary results Hospitalized patients Number of non eligible screened Average delay until screening n = 34098 Screened Screening results on admission may be observed in graphic 2. Non eligible: Age <65y Hospitalization in intensive units Non screened 31,7% of the at undernutrition risk patients on screening and 46,8% of the undernourished were actually undernourished after assessment (considering patients from which was possible to obtain this classification). Eligible to screening 19,7% n = 12149 Proportion of patients screened in the first 48 hours Table 2. Agreement between MNA-SF and nutritional assessment results Non screened Nutritional assessment result Nutridos 46,5% Em risco de desnutrição Screened with incomplete MNA-SF Proportion of eligible screened Proportion of eligible with incomplete MNA-SF Nourished Undernourished1 Without classification Non appliable Non evaluated Undernutrition risk 702 (29,9) 745 (31,7) 54 (2,3) 438 (18,6) 412 (17,5) Undernourished 209 (15,1) 83 (6,0) 218 (15,7) 229 (26,5) Undernutrition risk/undernourished 911 (24,4) 137 (3,7) 656 (17,5) 641 (17,1) Desnutridos 33,8% Nourished Undernutrition risk Undernourished Screened with complete MNA-SF Average delay until nutritional assessment Number of overscreened Screened with 2 competitor items filled MNA-SF>11 Number of screened with 2 competitor items filled Non aplicable to nutritional assessment: Graphic 2 – Nutritional risk on admission (CHSJ) Death Discharge Transfer to intensive units Nutritional assessment previously done by the nutritionist of the service 1395 (37,3) ¹Includes mild, moderate and severe undernutrition The association of MNA-SF with sex and age is described in table 1. Table 2. Agreement between MNA-SF and nutritional assessment results The data concerning the nutritional intervention refers to March until July 2016. Table 1. Characterization of the patients according nutritional screening results (MNA-SF) Assessment classification: 650 (46,8) n = 7063 Eligible to nutritional assessment n = 3740 Proportion of patients assessed in the first 72 hours MNA-SF result Screening classification: Proportion of nourished patients Proportion of at risk of undernutrition patients Proportion of undernourished patients Proportion of nourished patients reassessed Proportion of nourished patients who preserve the nutritional state Normal nutritional status Undernutrition risk Undernutrition p 1368 (41.5 %) 1245 (37.8%) 680 (20.7%) <0.001 Non assessed Nourished Mild undernutrition Moderate undernutrition Severe undernutrition Non appliable Female With nutritional assessment PROPORTION GRAPHIC OF PATIENTS 3. PROPORTION BY TYPE OFOF PATIENTS INTERVENTION BY TYPE GENERATED OF GENERATED AFTER INTERVENTION ASSESSMENT AFTER NUTRITIONAL ASSESSMENT N=399 Sex n (%)* Male n = 2576 Without intervention/ prescription generated after nutritional assessment: Proportion of nourished patients – false positive Proportion of undernourished patients – true positive Kind of intervention/prescription generated after nutritional assessment: n (%) Dietary plan Hospital diet Enteral nutrition Parenteral nutrition Oral supplementation Hospital diet with supplementation Predicted discharge soon Patient in comfort measures Medical team chooses a different approach There is already an adequated intervention/ prescription Without registred justification 1917 (50.9%) 1144 (30.3%) 709 (18.8%) 0,0 DIETA 0,0 DE ALTA Age(median P25-P75)# 75 (69-80) 79 (72-85) 80 (74-86) <0.001 DIETA DE ALTA DIETA DIETA #Mann-Whitney *Chi-square, Table 1 – Proportion by sex and differences of age for each nutritional state 10,0 10,0 7,3 20,0 30,0 30,0 40,0 40,0 50,0 50,0 60,0 60,0 70,0 70,0 80,0 90,0 80,0 90,0 100,0 32,4 32,0 HOSPITALAR NUTRIÇÃO ENTÉRICA 4,1 4,5 NUTRIÇÃO PARENTÉRICA 0,8 NUTRIÇÃO PARENTÉRICA 0,8 SUPLEMENTOS ENTÉRICOS ORAIS SUPLEMENTOS ENTÉRICOS ORAIS 45,3 45,7 Non specified SUPLEMENTOS ALIMENTARES SUPLEMENTOS ALIMENTARES 7,5 Proportion of patients for each kind of intervention generated after nutritional assessment With intervention/nutritional prescription Proportion of patients with nutritional intervention generated after nutritional assessment Graphic 1 – Sample methodology, process and result indicators The probability of being at risk of undernutrition ou undernourished is higher in women comparing to men. Regarding age, older patients have higher risk of undernutrition or undernutrition. 7,1 VÁRIAS INTERVENÇÕES 1,5 VÁRIAS INTERVENÇÕES 1,8 SEM REGISTO 0,7 SEM REGISTO 0,7 Graphic 3. Type of nutritional intervention after assessment (between march and july only) Conclusion Screening results point to more than 1/3 of admitted patients at undernutrition risk and about 1/5 undernourished; after nutritional assessment, most of them were undernourished. We assessed a hospital malnutrition prevalence that matches the one described in the literature. Older elderly, in particular women, have higher risk of malnutrition. Acknowledgment 100,0 7,2 HOSPITALAR NUTRIÇÃO ENTÉRICA 20,0 To all the nurses who cooperated in this malnutrition screening in CHSJ. References XV census of the portuguese population – 2011 (Statistics National Institute)