Nutrition Screening And Application Of Nutrition Supports In Elderly Hospitalized Patients

BackgroundAs the number of older people continues to rise, nutrition in elderly patients was receiving increasing concerns. Malnutrition is a common problem in this age group when admitted to the hospital. Malnutrition screening is the recommended first step in the nutrition care process as it allows the early identification of nutritional concerns. The patients with nutritional risk should promptly get nutrition support treatment. Rational application of nutritional support can improve the prognosis effectively.Parenteral nutrition-associated liver disease(PNALD) is a common complication of Parenteral nutrition. Disorders of bile acid’s enterohepatic circulation, flora caused by intestinal dysfunction, cholestasis caused by biliary obstruction, entral venous catheter-related sepsis, nutritional deficiencies or excess are risk factors of PNALD. It is recommend the prevention and treatment of PNALD on the basis of the above risk factors. Ursodeoxycholic acid (UDCA), is used in reducing the cholestasis and improving liver function which maybe he helpful in the prevention and treatment of PNALD in infants and children, but nearly no study was performed in adults and geriatrics.Objective1. To determine the nutrition risk rate, nutritional support rate in elderly patients and identify risk factors for malnutrition.2. To analyze the impact of patients’ nutritional status and nutritional supports on clinical outcomes and to propose better clinical strategies on the evidences of nutritional treatment.3. To analyze the preventive effect of UDCA on PNALD and to propose better clinical strategies on the evidences of UDCA treatment.MethodsThe statistical study was carried out on the data of 745 cases of patients(age≥65years) in the geriatric medicine department of Qilu hospital of Shandong University from Mar.2012 to Mar.2015. Nutrition Risk Screening 2002(NRS 2002) and Mini Nutritional Assessment—short form(MNA-SF) were applied for the nutritional risk screening at admission. Anthropometrics and co-morbidities were registered. Several comparisons were performed to analysis the impact on clinical outcomes and prognosis from different incidence rate of nutritional risk, different nutritional support rate and different ways to get supported. PNALD incidence and influencing factors were analyzed. The preventive effect of UDCA on PNALD were identified to find whether UDCA can effectively prevent the occurrence of PNALD.Results1. The incidence of nutritional riskNRS 2002 and MNA-SF were applied for the nutritional risk screening at admission and the incidence of nutritional risk was 39.81%,44.10%. The incidence of malnutrition risk result from MNA-SF was 33.38% and malnutrition was 5.50%.The incidence of nutritional risk in Gastroenterology, Hematology, Respiratory was 51.72%,46.88%,43.33%, higher than other sections.2. Comparison of MNA-SF and NRS 2002Compared to the standard of malnutrtion(BMI<18.5 kg/m2), Sensitivity of NRS 2002 and MNA-SF was 100% and specificity was 63.69% and 59.15%. The accuracy of the two methods were moderate.NRS 2002 and MNA-SF had the unaimous correlation with classical nutritional markers(ALB, PAB, TP, Hb, CC, AC)(P<0.05).3. Nutritional risk and length of hospital stayNutritional risk of patients increased the length of hospital stay(P<0.05).4. Nutritional supportThe nutritional support rate of patients was 16.49%, PN:EN was 5.13:1. The nutritional support rate of patients with nutritional risk screening by NRS 2002 and MNA-SF was 29.63% and 28.57%. Patients in Gastroenterology, Hematology got higher nutritional support than other sections.5. Nutritional support and clinical outcomesNutritional support decreased the length of hospital stay(P<0.05).The patients with nutrition support had lower incidence of infectious complications than the patients without nutrition support(NRS 2002 was 6.82%: 18.18% and MNA-SF was 9.57%:20.23%)(P<0.05).6. The incidence of PNALD and preventive effect of UDCA on PNALDThe incidence of PNALD in 54 patients was 24.07%, the patients with PNALD had higher total calories and non-protein calories than the patients without PNALD(P <0.05).The patients with treatment of UDCA had lower incidence of PNALD than the patients without treatment of UDCA(8.00%:37.93%, P<0.05).Conclusions1. Undernourishment and nutritional risk of elderly patients at hospital admission is frequent. Nutritional risk rate in Gastroenterology is higher than other sections. Nutritional supports need better application in clinical treatment.2. Both NRS 2002 and MNA-SF can be applied for the nutritional risk screening in geriatric patients. The two methods show a high accuracy and can predict clinical outcomes.3. Nutritional support can decreased the length of hospital stay and incidence of infectious complications.4. The incidence of PNALD in geriatric patients is high and related with total calories and non-protein calories.5. Combined with UDCA in TPN can effectively prevent the occurrence of PNALD.