Malnutrition in Elderly Australians



A ground breaking Australian study has revealed alarming levels of malnutrition in the elderly with close to 80 per cent malnourished or at risk when first admitted to hospital.

However early intervention with a dietitian proved doctors could dramatically reduce length of hospital stay and health costs.

The findings follow a one-year study by a team of gastroenterologists, geriatricians and dietitians at Sydneys Prince of Wales Hospital - the results to be presented at Digestive Diseases Week in Washington on May 19th.

The study, led by President of the Gut Foundation, Professor Terry Bolin together with the Prince of Wales Department of Geriatric Medicine and Department of Nutrition and Dietetics, showed that when arriving for admission to hospital 80 per cent of elderly patients were malnourished or 'at risk' but their hospital stay could be halved by implementing a nutritional care program.

Prof Bolin, a conjoint Associate Professor of Medicine at the University of New South Wales, said, "Malnutrition is not simply caused by lack of access to food - we believe other factors such as malabsorption play a key role. Elderly patients may appear to be a healthy weight but in fact be malnourished so Body Mass Index (BMI) alone is a poor indicator."

What this study has shown is that the prevalence of malnutrition among the elderly in the community is high but we have simple and effective remedies. "Malnutrition has significant impact on mortality, morbidity, length of hospital stay and readmission. The benefit of early action could potentially save our health system hundreds of millions of dollars. The team at Prince of Wales Hospital is helping to bring a better understanding of how to address the critical issue of malnutrition." The study is believed to be the first randomised study of its kind examining malnutrition in a clinical setting with control and intervention groups.

The study participants were screened using a Mini Nutritional Assessment which included examination of recent decline in food intake, weight loss, mobility and morbidity, neuropsychological problems and BMI. The screened patients were then randomly assigned to a control or intervention group. The intervention patients were immediately put under the care of a dietitian with an individualised diet plan together with protein and energy supplements.

Manager, Department of Nutrition and Dietetics at Prince of Wales Hospital Margaret Holyday said, "It is clear from our study that timely intervention was very effective. When people are under nourished they are more likely to develop infections, getting pressure sores and be unable to undertake rehabilitation. Their recovery is slower and they are more likely to be readmitted to hospital. This is exacerbated in the elderly. Dietitians understand this but we need a broader level of appreciation."

An extension of the study will look at malabsorption rates in the community by using a dual sugar absorption test - which assesses mucosal permeability and intestinal absorption- along with a simple rice breathe hydrogen test*.

"Unfortunately nutrition and malnutrition are not priorities for physicians and surgeons and only come to notice when a patients recovery is not progressing. Often this is too late. This study highlights the need for a new approach from health care professionals and government", Professor Bolin said.


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