Malnutrition associated with increased risk of frail mechanical falls among older people presenting to an emergency department.

OBJECTIVE

To identify associations between malnutrition falls risk and hospital admission among older people presenting to ED.

METHODS

A prospective convenience sample of patients, aged 60 years or more, presenting to an Australian tertiary teaching hospital ED were included in this cross-sectional study. Malnutrition Screening Tool and Subjective Global Assessment tool were administered to 126 non-consecutive participants. Participants were categorized as non-fallers, frail mechanical or active mechanical fallers. Self-reported falls in past 6 months and hospital admission were documented.

RESULTS

Participant age and sex (median age 74, interquartile range 65-82 years; male 59%, 74/126, 95% CI 50-67%) were representative of older people presenting to the ED. Malnutrition prevalence was 15% (19/126, 95% CI 9-21%). There was an increased risk of being assessed as malnourished when a frail mechanical faller relative to: a non-faller (relative risk [RR]: 1.5, 95% CI 1.0-2.3, P= 0.001), an active mechanical faller (RR: 3.1, 95% CI 1.0-10.9, Fisher's Exact test P= 0.02) or a non-faller and active mechanical faller combined (RR: 1.5, 95% CI 1.0-2.1, P= 0.001). Malnourished participants had an increased risk of self-reported falls over 6 months (RR: 1.5, 95% CI 1.0-2.5, P= 0.03). There was over five times the risk of hospital admission if malnourished than if well-nourished (RR: 5.3, 95% CI 1.4-20.0, Fisher's exact test P= 0.001). The Malnutrition Screening Tool captured 84% (16/19, 95% CI 78-92%) of participants assessed as malnourished by Subjective Global Assessment.

CONCLUSIONS

Older people presenting to ED should be nutritionally screened. Malnutrition prevalence of 15% was documented and was associated with an increased risk of frail mechanical falls and hospital admission. The Malnutrition Screening Tool was a simple and practical screen for ED.