Assessment of nutritional status and its impact on outcome in elderly admitted with respiratory diseases in critical care unit

Abstract

Need for the study Abstract As the ageing population is growing world-wide, so is the risk of malnutrition in elderly population1. There is a high prevalence of malnutrition in elderly population, and the prevalence increases manifold in hospitalized elderly patients2. The reason for high prevalence of malnutrition are many and includes-multi- morbidity, atypical disease presentation, delay in seeking medical consultation due to various psycho-socio-economic factors and also includes the fear of hospital admission in elderly age group. Disease and illness in itself is a risk factor of malnutrition and eating fewer than two meals a day adds to this problem. The frail elderly adult may be requiring assistance for self-care and for his activities of daily living. He may be suffering from tooth loss or mouth pain, chewing difficulty, economic hardships to buy food stuff, reduced social contact or may be facing involuntary weigh loss. Patients with COPD are mostly severely undernourished for proteins. The main mechanism is hyper-metabolism, which is responsible for increased oxygen consumption by the malnourished respiratory muscles. One of the most important cause of the atrophy and decreased strength of respiratory muscles decreased exercise performance, decreased quality of life and increased risk of hospital acquired or community-acquired Pneumonia is malnutrition3. Mini Nutritional Assessment-short form (MNA-SF®) is an easy and reliable screening tool for physician, dietician, medical students or nurses to quickly evaluate the nutritional status of elderly adults. A low MNA-SF® score (0-7) represents malnutrition; a high score (12-14) represents normal nutrition status and an intermediate score (8-11) represents risk of malnutrition. MNA-SF® is an ideal tool for the evaluation of older adults with high specificity, sensitivity, negative and positive predictive values and a high validity. Materials and method The present study is a hospital-based cross-sectional study conducted on 100 elderly patients admitted with various respiratory diseases in the critical care unit (ICU) of Shri B M Patil Medical College and Research Centre, Vijayapura, after obtaining due approval from the institutional ethical committee. Results The study population of this study consists of 53% males and 47% females with mean age of 69.11± 7.82 years. Majority (74%) of patients fall in the age group of 60-74 years (young-old) and 65% were on mixed diet with 52% elderly patients reported a normal dietary intake. In our study, 17% of patients were screened by MNA-SF® to be malnourished, 40% were found to be to risk of malnutrition, and 43% were normally nourished. 58% of the patients stayed below ten days in the hospital, and only 18% stayed for more than 20 days. 32% of the study population required mechanical ventilation, 28% were on non-invasive ventilation, and 26% elderly patients were given Oxygen via mask. Considering the haematological and biochemical parameters, 72% elderly had haemoglobin less than 13 g/dL, total leukocytes counts were more than 11,000 per cu mm in 38%, mean corpuscular volume was less than 80 fL in 30% and more than 100 fL 13%. Serum Creatinine was more than 1.3 mg/dL in 34% of patients. In our study, mortality was seen in 10% of patients and 71% patients were discharged with follow-up advice. 8% of patients who died had breathlessness as the presenting complaint, 7% had three co-morbidities, 4% died due to lower respiratory tract infection as their diagnosis and 6% of them had mid-arm circumference less than 22.5 cm which was statistically significant. 6% elderly patients died due to malnutrition based on MNA-SF® finding, which is a statistically significant finding of this study. Conclusion Malnourished patients face heightened risks of mortality and morbidity, which can exacerbate existing conditions like chronic lung disease, sepsis, trauma, and cardiovascular dysfunction. Addressing malnutrition through systematic nutritional screening is crucial as it allows healthcare providers to identify patients at risk early on. This approach not only highlights the problem but also integrates nutritional correction as a fundamental part of patient therapy. Importantly, many of the adverse effects of malnutrition can be partially reversed with appropriate re- feeding strategies. More research is needed in this domain in the future and time will see that ―clinical nutrition‖ will be considered as ―fundamental human right‖ in the future, by the governments.