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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)