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

Abstract

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.