Survival of cognitively impaired older hospitalized patients at risk of malnutrition

Introduction: In our society offering extra nutritional support is a standard for malnourished patients at admission to hospital. Whether cognitively impaired, older, hospitalized patients at risk of malnutrition would also benefit from this regimen is unknown. This study assesses their 3-months and 1-year survival. Prognostic characteristics predicting life expectancy are also studied. Methods: This prospective cohort included cognitively impaired, older, hospitalized patients at risk of malnutrition (group 1: dementia, 2: delirium and 3: combination dementia/delirium) newly admitted to an acute hospital and receiving usual nutritional care. Data on survival was completed until 1 year after patients' admission to the hospital. Possible prognostic characteristics predicting life expectancy data were collected. Results: A cohort of 116 cognitively impaired, older, hospitalized patients at risk of malnutrition is described. Forty-nine patients were described to have dementia, 48 delirium and 19 a combination of dementia and delirium. Mean age was 81.6 years (SD 8.3, range 60-99 years). Fifty-five patients (47.4%) died within 1 year after hospital admission, 36 of them (31%) died within 3 months after hospital admission. There were no significant differences in survival between the three groups (P = 0.672). Patients with a malignancy or vascular disease were more likely to die within 3 months after discharge. Multivariate analysis showed malignant neoplasm, vascular disease and age as prognostic factors for mortality. Conclusion: Almost half of a cohort of malnourished, cognitive impaired, older, hospitalized patients died within 1 year after hospital admission. Patients with a malignancy or vascular disease were more likely to die early after discharge. It could be defended that in these patients, extra-nutritional support should no longer be offered as a standard. (C) 2012 Elsevier Masson SAS and European Union Geriatric Medicine Society. All rights reserved.