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Article Excerpt
Abstract
Aim: To determine the prevalence of malnutrition in Queensland public acute and residential aged care facilities, and explore effects of variables associated with malnutrition in these populations.
Methods: A multicentre, cross-sectional audit of a convenience sample of subjects was carried out as part of a larger audit of pressure ulcers in Queensland public acute and residential aged care facilities in 2002 and again in 2003. Dietitians in 20 hospitals and six aged care facilities conducted single-day nutritional status audits of 2208 acute and 839 aged care subjects using the Subjective Global Assessment, in either or both audits. Subjects excluded were obstetric, same-day, paediatric and mental health patients. Weighted average proportions of nutritional status categories for acute and residential aged care facilities across the two audits were determined and compared. The effects of gender, age, facility location and medical specialty on malnutrition were determined via logistic regression.
Results: A mean of 34.7 [+ or -] 4.0% and 31.4 [+ or -] 9.5% of acute subjects and a median of 50.0% and 49.2% of residents of aged care facilities were found to be malnourished in Audits 1 and 2, respectively. Variables found to be significantly associated with an increased odds risk of malnutrition included: older age groups, male (in residential aged care facilities), metropolitan location of facility and medical specialty, in particular, oncology and critical care.
Conclusion: Malnutrition is significant in public acute and residential aged care facilities in Queensland. Action must be taken to increase the recognition, prevention and treatment of malnutrition especially in high-risk groups.
Key words: aged, hospitalisation, malnutrition, Subjective Global Assessment.
INTRODUCTION
In Australia, disorders related to 'overnutrition' are now a national health priority. (1) There is, however, limited awareness of the existence and extent of malnutrition. Numerous studies investigating the prevalence of malnutrition and its consequences have been published. (2-25) The majority of studies have been undertaken in hospital settings, with relatively few in the community or residential care facilities. Stratton et al. (26) provided an international review of the prevalence of malnutrition in patients with different disease groups, mixed diagnoses, across different age groups and settings. They concluded that malnutrition was common in hospitals (10-60%), in residential aged care facilities ([greater than or equal to]50%), and in free-living individuals with severe or multiple diseases (>10%). The reported prevalence of malnutrition in Australian studies is 12-42% in acute settings, (15-22) 6-49% in rehabilitation settings, (20,23,24) 5% in community domiciliary care setting, (25) and no studies conducted in residential aged care settings. The wide variation in the reported prevalence of malnutrition is due to variation in the methodology and criteria used to assess nutritional status, diagnoses of patients and setting (e.g. hospital or community). This makes it difficult to compare studies and to ascertain the actual prevalence of malnutrition in hospitals, residential care facilities or the community, (27) or to apply these findings to the Australian setting in general.
The purpose of the present study was to determine the prevalence of malnutrition in Queensland public acute and residential aged care facilities, and identify variables which may be associated with malnutrition in these populations.
METHODS
The study involved the collection of nutritional status data of subjects participating in a larger study investigating the prevalence of pressure ulcers. The multicentre audits were conducted initially in 2002 (Audit 1) and repeated 12 months later (Audit 2), after the implementation of pressure ulcer guidelines in 20 hospitals and six residential aged care facilities. Facility involvement in the nutritional status audits was determined by whether a facility employed dietitians and whether the dietitians nominated to participate. Four of the 20 hospitals and four of the six residential aged care facilities participated in both nutritional status audits, with other facilities being involved in either Audit 1 or Audit 2 only. A larger number of acute facilities were able to participate in Audit 2.
Nutritional status sample
Audits were conducted on a single day for each facility involved, with all available subjects potentially eligible for inclusion. Exclusions included: obstetric, paediatric, mental health and same-day patients. The project was approved by Queensland Health as a quality improvement project, and as such, no formal ethics approval was required, although subjects or their next of kin provided informed written consent to be included in the audits. Participation in the study was dependent on whether dietitians could undertake the audits; thus the sample for acute facilities was biased towards larger facilities in which patient acuity is greater.
Variables
A data set was extracted from the larger study database for the purposes of the present study program. Variables were collected by trained audit staff, usually nurses, and were limited to those collected for the larger study and included: audit number/year, facility, age, gender and medical specialty (acute only). Nutritional status data were independently collected by dietitians.
Nutritional status of subjects was assessed using the Subjective Global Assessment (SGA), (28) which determines nutritional status based upon a medical assessment and physical examination. It has a...
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