Malnutrition in the Eldery patient - Essay Example

In a controlled study of 92 patients that underwent hip surgery, 27% of the 26 patients who had suffered from postoperative delirium were admitted to a nursing home within 3 months of discharge from hospital compared to 8% of the 66 non-delirious patients. McCusker et al .found no difference for admission rates to long-term care facilities between patients with delirium and a non-delirious control group (odds ratio 1.15; 95% confidence intervals 0.33-4.05). The odds ratio for admission to long-term care, however, increased to 3.

18 (95% CI 1.19-8.49) for demented delirious patients. Also, in a study by Edelstein et al ,the 5.1% of 921 patients who became delirious after hip-fracture surgery were less likely to recover to their pre-fracture level of ambulation than non-delirious patients. In patients newly admitted to post-acute care facilities after discharge from hospital, persistent delirium symptoms were prevalent in 23% of patients, being associated with poor functional recovery. Cognitive decline is not only a predisposing factor for delirium, but it has also been shown that delirium independently worsens cognitive function.

In both delirious and non-delirious patients who underwent hip surgery, the score on the Mini-Mental State Examination (MMSE) decreased significantly during hospital stay. In the delirious group, however, the average MMSE score decreased significantly more (from 23.06 to 20.44 points) than in the non-delirious group (from 26.74 to 25.83 points; P < 0.001) Twelve months after discharge, the reduction in MMSE score was significantly greater in pre-morbid demented patients (mean reduction 4.99 points, 95% CI 2.8-7.2) than in non-demented patients who had suffered from delirium (mean reduction 3.

36 points, 95% CI 0.58-6.15). Higher mortality rates after discharge have been reported repeatedly for patients who experienced an episode of delirium, up to 10% in the first year after delirium had occurred Thus, in both medical and surgical elderly patients, most studies show an increased hospital stay, a decline of functional and cognitive outcome, and increased mortality following delirium.DiagnosisThere is no evidence that the clinical picture of delirium in the elderly differs from that in younger patients, although symptoms of delirium may be more persistent and follow a more chronic course.

In 193 medical inpatients aged 65 and over with delirium diagnosed at admission or during the first week in hospital, symptoms of delirium persisted up to 12 months after diagnosis, in patients both with and without dementia. Diagnosing delirium in demented patients may be hard due to the overlap in symptoms of delirium and dementia. Recently, malnutrition related syndromes wereDened such as sarcopenia, i.e. loss of muscle mass, and failure to thrive (FTT), i.e. involuntary loss of weightcombined with functional decline.

Both are also highlyprevalent in geriatric patient and similarly caused bymultiple risk factors, overlapping with malnutrition [6-8]. Malnutrition is a general term for the medical condition caused by an improper or insufficient ("undernourished") diet. An individual will experience malnutrition if the appropriate amount, kind or quality of nutrients comprising a healthy diet are not consumed for an extended period of time. An extended period of malnutrition will result in starvation.Malnutrition as the