Patient characteristics associated with the provision of nutritional support to older hospitalised patients at risk of malnutrition: A cohort study

Abstract

Background and aims

There is a need for knowledge about the factors affecting nutritional support to hospitalised older patients at risk of malnutrition. We aimed to investigate whether patient characteristics are associated with the likelihood of hospitalised older patients at risk of malnutrition receiving nutritional support.

Methods

The study included 3188 hospital stays among 2739 individual somatic patients aged ≥65 years who were at risk of malnutrition according to the Nutritional Risk Screening 2002 (NRS 2002). Information on the risk of malnutrition, nutritional support (menu modification, oral nutritional supplements and enteral or parenteral nutrition) and dietitian involvement was collected from in-hospital point prevalence surveys between 2008 and 2018. Information on age, sex, diagnoses and type of hospitalisation was retrieved from the electronic patient administration systems. We applied logistic and multinomial regression models to investigate associations of patient characteristics (age, sex, number of diagnoses, BMI, type of hospitalisation and nutritional risk screening score) with the likelihoods of receiving any nutritional support and specific types of nutritional support.

Results

Nutritional support was provided in 56 % and planned in 9 % of hospital stays. Dietitians were involved in 7 % of hospital stays, and 21 % of patients at risk of malnutrition had diagnoses related to malnutrition. Older patients were less likely to have received any nutritional support as compared to the patients 65–69 years old (adjusted OR range: 0.69–0.84). Patients classified as underweight were more likely (adjusted OR (95%CI): 1.77 (1.44, 2.17)) and patients in the overweight and obese categories were less likely (adjusted OR (95%CI): 0.70 (0.57, 0.87) and 0.70 (0.52, 0.94), respectively) to receive nutritional support. The OR for receiving nutritional support substantially increased with increasing NRS 2002 score (adjusted OR range: 1.79–4.20).

Conclusions

This study showed that over one-third of older patients at risk of malnutrition did not receive nutritional support in hospital and that older patients with more diagnoses, those classified as underweight, and those with higher NRS 2002 scores were more frequently provided nutritional support. The findings suggest that healthcare professionals’ decisions regarding whether to provide nutritional support to older patients at risk of malnutrition to a large extent are affected by patient characteristics.