Prospective audits of quality of PEM recognition and nutritional support in critically ill elderly patients.

ABSTRACT

BACKGROUND AND AIMS: Undereating is a frequent concern in acute care geriatric settings and is supposed to worsen the outcomes of the underlying diseases, while the quality of nutritional support could be improved. METHODS: Two consecutive and prospective audits (A and B) with team training over a 1 year period investigated the quality of malnutrition recognition and nutritional support and outcomes in immobilized, critically ill elderly subjects. RESULTS: Audit A included 170 patients (86.3+/-6.1 years old) and audit B, 232 patients (86.3+/-6.3), respectively 20.6% and 31.4% of the hospitalized population. Misclassifications occurred in A in 54.0% compared to 34.05% in B (P < 0.001). 32.6% in A versus 86.9% in B adequately received oral supplements (P = 0.02). Significant risk factors for the adverse outcomes in the combined two audits were dementia (RR 1.8, 95%CI 1.0 to 3.0, P= 0.04) and dehydration (RR 2.0, 95%CI1.0 to 4.1, P= 0.05) for pressure ulcer incidence; stroke (RR 8.8, 95%CI 4.8 to 16.0, P < 0.001) for pressure ulcer prevalence at discharge; neoplasms (RR 1.1, 95%CI 1.0 to 1.2, P = 0.02) for nosocomial infections; bladder indwelling for urinary tract infections (RR 4.8, 95%CI 2.9 to 7.7, P<< 0.001); swallowing problems for pulmonary infections (RR 5.4, 95%CI 2.8 to 10.5, P < 0.001); venous indwelling for septicaemia (RR 5.4, 95%CI 1.3 to 23. 3, P= 0.02). However, after adjustment on significant risk factors, the outcome rate was similar in audit B death rate A (15.6%), B (14.2%); length of stay A (17.3+/-10.4 days), B (17.4+/-10.0); pressure ulcer incidence A (26.4%), B (20.2%), (83% were erythema); pressure ulcer prevalence at discharge A (14.7%), B (10.3%), (40% were erythema); nosocomial infections A (26.4%), B (19.0%). CONCLUSION: The improvement of malnutrition recognition and nutritional support was not followed by a perceptible decrease in adverse outcome rate, this latter being mainly related to the underlying conditions of these critically ill elderly patients.