Elderly patients are frequently malnourished during hospital stays, and their chances of recovering from illnesses decline as a result. Given these findings, hospitals need to pay more attention to the food and nutrition their elderly patients receive.
These are the conclusions of a major study funded by the Department of Veterans Affairs and published this month in the Journal of the American Medical Association. The study followed 497 patients over age 65 who stayed at least four days in the Central Arkansas Veterans Healthcare System in Little Rock.
While in the hospital, 21 percent of the patients consumed less than 50 percent of the energy they needed to remain stable, the study found. Since up to 60 percent of elderly patients are estimated to be undernourished on admission to a hospital, the impact of a major weight loss while hospitalized can be severe.
"If you're an elderly person who becomes malnourished, your risk of subsequent illness and death increases dramatically," said Dennis Sullivan, a physician at the Little Rock veterans facility and an author of the study. "We don't really know whether this is because sick people don't eat well, or if people are getting sicker because they aren't well nourished. But we do know there's a connection."
Sullivan said that his study found some of the weight loss came from doctors' orders that patients not eat food, usually for medical reasons. The study found that other modes of nutrition, such as feeding tubes, were not always offered as a replacement.
"It was our impression that [hospital staff] were often unaware of the potential seriousness of a patient's developing nutrient deficits," the study concluded. As a result, the authors recommended that "nothing by mouth" orders should trigger a careful review of a patient's nutrition and daily caloric intake.
The study also found that some patients were not getting food because of persistent nausea, lack of appetite or dislike of the food.
Sullivan said the patients with the biggest nutritional deficits were likely to have been admitted in good health and for elective surgery rather than for medical services or emergency surgery.
The weight loss and nutritional deficits are of particular concern, Sullivan said, because elderly people have a much harder time returning to their normal weights than younger people. "The evidence suggests that the deficits will stick with the elderly," he said.
Many hospitals are trying to find new and better ways to insure that elderly pations are adequately nourished, but Sullivan said the job is a difficult one.
"We're not as good as we would like to be in keeping people well nourished in hospitals," Sullivan said. "One problem is that there aren't really good and clear guidelines, because the literature does not show anything is effective. But I think that if people start looking at it, they can can probably improve the care and find innovative ways to get the people fed."