July 27, 2001

Study: Nutrition affects risk of hospitalization

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Dr. Gordon L. Jensen

Study: Nutrition affects risk of hospitalization

Lists of serious health risk factors that plague older persons don’t normally include nutrition, but a Vanderbilt University Medical Center study published in the August issue of the American Journal of Clinical Nutrition shows that nutrition plays a large role in predicting the older population’s risk for hospitalization.

Nutritional risk factors such as eating problems, weight loss or even consumption of special diets should be considered in the management of older persons at risk of hospitalization, said Dr. Gordon L. Jensen, associate professor of Medicine at VUMC, director of the Vanderbilt Center for Human Nutrition and principal author of the study. The collaborative study between VUMC, the Geisinger Medical Center, and Pennsylvania State University looked at 386 participants, ages 65 to 85, who were enrolled in a Medicare managed risk health plan and screened at numerous clinic sites as part of a health plan enrollment packet.

The patients were from Penn State Geisinger Health System, a nonprofit group practice serving a predominantly rural population in central and northeastern Pennsylvania. This service area has one of the largest concentrations of rural older persons in the United States.

Two screening methods were compared – the Probability of Repeated Admission (PRA), a screening instrument specifically developed to identify older persons most likely to be hospitalized and the Level II Nutrition Screen (LII), a 34-item check box questionnaire designed to identify risk factors of poor nutritional health in older persons.

Questions on the PRA focus on age, sex and self-rated health, prior hospital admissions, physician contacts, chronic disease processes and caregiver status. The LII questionnaire, “a fairly robust questionnaire,” Jensen said, assesses factors such as recent weight change, living and eating habits, alcohol and medication use, depression, oral health and functional limitations.

During the year following the assessment, 50 (13 percent) of the subjects were hospitalized at least once. The LII items (eating problems and multiple medications) that predicted future hospitalization of the subjects had a positive predictive value of 17.9 percent. The PRA items (self-reported health, hospitalization in the past year and greater than six doctor visits in the past year) that predicted future hospitalization had a predictive value of 20 percent.

Jensen said that the high-risk patients identified through the PRA were also more likely to report risk factors typically associated with the LII such as weight loss, special diets, multiple medication use or functional limitation.

“What the findings of this study mean is that nutritional risk factors should be considered in the management of older persons at risk for hospitalization, irrespective of the screening approach selected. We need a way to identify who is at risk before they get to the hospital,” Jensen said. “Interventions, nutritional or otherwise, may be able to alter hospitalization outcomes.”