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

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 a1 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%C1:1.0 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 aperceptible decrease in adverse outcome rate, this latter being mainly related to the underlying conditions of these critically ill elderly patients.