Standard health surveys administered to elderly people to predict their risk for future hospitalization have not traditionally included questions on nutritional status, despite the importance of nutritional assessment and intervention in this age group.
Jensen et al. compared the effectiveness of two screening approaches--one specifically to identify risk for hospitalization and one to detect warning signs of poor nutritional health. They found that that the two procedures were comparable in recognizing elderly at risk for hospitalization. The analogous results of the two approaches confirm the extent of health endangerment to the elderly posed by poor nutritional status.
The 386 participants, aged 65-85 years, were enrolled in a Medicare managed-risk health plan and were screened at numerous clinic sites as part of a health plan enrollment packet. The Probability of Repeated Admission (PRA) is a screening instrument specifically developed to identify older persons most likely to be hospitalized. The Level II Nutrition Screen (LII) is a 10-item questionnaire designed to find warning signs of poor nutritional health in the elderly. Questions on the PRA focus on age, sex, self-rated health, prior hospital admissions, physician contacts, chronic disease processes, and caregiver status. The LII assesses factors such as recent weight change, living and eating habits, alcohol and medication use, depression, dentition, and functional limitations.
In the year following the assessment, 50 (13%) of the subjects were hospitalized at least once. The LLII forecasted future hospitalization of the subjects with a positive predictive value of 17.9%, which was comparable to the 21.3% positive predictive value derived using the PRA.
An important correlation between the two methods was that the PRA-identified high-risk patients were also more likely to report risk factors associated with the LLII, such as weight loss, special diets, multiple medication use, or functional limitation.
The authors suggest that answers to questions about eating problems, weight loss, and special diets should be part of the screening process to predict future hospital admissions in the elderly, regardless of the screening method chosen. An accompanying editorial by Bales points out that "nutritional and hydration concerns often rank far too low on the list of evaluation and treatment priorities" in hospitals, nursing homes and the community.
Jensen, Gordon L, et al. Screening for hospitalization and nutritional risks among community-dwelling older persons. Am J Clin Nutr 2001;74:201-5.
Bales, Connie W. What does it mean to be "at nutritional risk"? Seeking clarity on behalf of the elderly. Am J Clin Nutr 2001;74:155-6.
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