For older people recovering from a debilitating illness, getting back on their feet can take longer if they are malnourished

A new research study by Singapore General Hospital’s (SGH) Department of Dietetics suggests that malnourishment in elderly patients is linked to longer hospital stays and a poorer ability to regain functional independence. Functional independence is a measure of physical and cognitive disability, and uses 18 items of ability such as walking, feeding and dressing.

The research is significant because more than half of the 109 SGH rehabilitation patients under study were found to be malnourished to some extent. The men and women in the study had an average age of 69 years, and were admitted to the SGH rehabilitation ward at Bright Vision Hospital (BVH) for continuing care after being treated at SGH in Outram Road for conditions such as stroke, hip fracture, or brain or spinal injuries. Many were elderly; the oldest patient in the study was 94, although the youngest was 20.

These patients who were under acute care for a serious illness at SGH might not have eaten as well as they should because of their condition. So by the time their condition had stabilised and they were ready to be transferred to a rehabilitation ward for longer term convalescence, they might have become undernourished.

Dietitian Yang Jie, the lead investigator of the study, known as the Nutritional Status of Hospitalised Rehab Patients, said the findings supported the observations that she and her colleagues had made about these patients.

Others behind the study include Dr Loh Yet Hua, Head, Department of Dietetics; Mr Tan Lee Boo, Senior Principal Dietitian; and Dr Ng Yee Sien, Senior Consultant and Head, Department of Rehabilitation Medicine, Singapore General Hospital (SGH), a member of the SingHealth group.

“In general, a patient who comes in with normal nutrition does better. They are usually not as sick as those who are severely malnourished and tend to recover and improve faster,” Ms Yang said. Ms Yang presented the team’s findings from the study at the 7th World Congress of the International Society of Physical and Rehabilitation Medicine (ISPRM) in Beijing in 2013.

44 per cent of patients in study found to be well-nourished

To determine if the patients were malnourished, and if they were, whether they were mildly or moderately malnourished, the researchers used a standard tool to gauge their nutritional status. Known as the Subjective Global Assessment, the tool looked at factors such as the patients’ weight, oral intake, gastrointestinal symptoms, physical signs of malnutrition, and whether they had lost significant amounts of weight recently.

Only about 44 per cent of the patients were found to be well-nourished.

This finding was supported by the results of a second, similar tool known as the Mini Nutritional Assessment. This tool was only used on patients who were at least 65 years of age. Of the 71 patients in this age group, 68 per cent were malnourished or at risk of malnourishment.

Each patient’s functional independence measure was rated weekly by the rehab team. The researchers found statistically significant differences between the score improvements of the well nourished and severely malnourished patients. This means that severely malnourished patients fared worse in performing daily tasks ranging from eating to walking.

In fact, the severely malnourished patients remained in hospital for an average of 51 days, while the well nourished ones went home on average about 20 days earlier. Ms Yang said that there are many possible reasons for the patients’ malnourished state, which does not happen “overnight”. For example, suffering a stroke can mean that a patient has difficulty eating.

As more than half the patients were already malnourished when they started rehab, one recommendation is to screen them earlier so that their nutrition levels can be improved at an earlier stage.

“We would like to be able to see the patients once they show that they are not eating well and have lost their appetite. We can assess if what they are eating is nutritionally enough, and then recommend a suitable diet and/or nutritional supplements to help them recover faster,” she said.

Family members can also do their part by watching the eating habits of the elderly, who may not have a balanced diet or eat enough of the food placed before them. Ms Yang said: “As people age, their sense of taste and smell can become impaired. If they feel the food is not tasty, they may not eat as well. Loss of vision and hearing can affect their ability to prepare and buy food. Dentures can make it hard for a wearer to chew food.

“Family members need to be able to recognise signs that the patient is not eating well, losing muscle, or losing weight. And they should take action to help them to maintain their weight. Otherwise, if disease attacks, they will be sicker.”

Ref. R14