Pre-discharge energy intake and post-discharge mortality in acutely hospitalized older adults.

BACKGROUND

Undernutrition is a prevalent issue among hospitalized older adults. Dietary intake is a major factor in nutritional status. Although insufficient dietary intake during hospitalization has been well documented, little research has focused on dietary intake at discharge, which may reflect the patient's true dietary intake capacity. Furthermore, it would be desirable for energy intake to be estimated in a clinically feasible way.

OBJECTIVE

This study aimed to assess pre-discharge energy intake using routinely recorded dietary intake data, and to examine the association between pre-discharge energy intake and post-discharge mortality in older inpatients.

METHODS

A prospective cohort study was conducted in a geriatric ward. Energy intake in the 3 days prior to discharge was estimated using visually assessed dietary intake data recorded in medical records. The primary outcome was 3-month post-discharge mortality.

RESULTS

A total of 257 patients (mean age 84.7 years) was included. The mean pre-discharge energy intake was 1327 ± 315 kcal/day, with 74.7% of patients failing to meet recommended energy intake levels. Within 3 months post-discharge, 18 patients (7.0%) had died. Cox regression analysis revealed that higher pre-discharge energy intake was associated with lower post-discharge mortality (per 100 kcal/day, hazard ratio 0.75, 95% confidence interval 0.65-0.86), independent of other prognostic factors such as comorbidities and functional status.

CONCLUSION

Many patients did not reach their recommended energy intake at discharge. Integrating routine monitoring of pre-discharge energy intake into discharge planning could trigger timely nutritional interventions and goal-of-care discussions, thereby improving post-discharge outcomes.