| BackgroundWith the development of health care and social economy,population aging has become a serious challenge facing the whole world since the 20th century.In recent years,the incidence of chronic non-communicable Diseases(NCDs)is on the rise,and the prevalence is high among the elderly.The number of elderly patients living with diseases is gradually increasing.Chronic diseases have become the main disease burden of the elderly population in China.Chronic diseases are closely related to lifestyle and often cause and effect of malnutrition,so the use of simple and less time-consuming tools for patients at risk of malnutrition is strongly recommended in clinical practice in many countries.Nutrition screening is an economical and convenient clinical tool.However,the gold standard of nutrition screening for elderly inpatients is not clear yet,and most of the scales are from foreign countries.The use of the Chinese-based nutrition screening tools also has limitations.Except for some hospitals with strong comprehensive strength,most of the hospitals in China pay relatively little attention to nutrition problems and do not routinely carry out nutrition screening and assessment upon admission,especially in grass-roots hospitals.Medical resources and public infrastructure accessibility for people at the grass-roots level are weak,but everybody should enjoy the rights of nutrition,and health care workers have a duty to provide the specification and feasible medical technology services to the elderly,to understand the occurrence of nutritional risk/malnutrition in the patient,understand the current nutrition in the elderly,to explore the influencing factors of nutrition/malnutrition risk.More in-depth research has been carried out abroad on the influencing factors of nutritional risk/malnutrition.However,there are relatively few relevant researches in China,and a lot of researches are still needed,especially on social psychological factors.ObjectivesThe aim of this study was to investigate the new hospitalized elderly patients to find nutrition/malnutrition risk situation,especially in patients with rural household registration to determine their relevant health service demand,and to explore possible influencing factors of nutritional risk/malnutrition risk in elderly patients,in order to reduce the incidence of chronic diseases in the elderly and the incidence of nutritional risk/malnutrition risk in elderly patients,and to provide some suggestions and a reference for clinical medical staff to conduct nutritional screening in elderly patients.Methods and materialsThis study was a cross-sectional study.From June 2020 to December 2020,a continuous fixed-point sampling was conducted in a county hospital to conduct a field survey of newly admitted patients in geriatrics.The data of patients’ basic information,disease-related information,clinical laboratory indexes and so on were extracted from the inpatient medical records.Information not in the medical record is collected by the investigators using a scale or questionnaire,including Nutritional Risk Screening 2002(NRS 2002),Mini Nutritional Assessment(MNA),Mini Nutritional Assessment-Short Form(MNA-SF),Activity of Daily Living Scale(ADL),Patient Health Questionnaire Questionnaire(PHQ-9),and Food Frequency Questionnaire(FFQ).After data collection,invalid data were removed.Data was processed using EpiData 3.1,and SPSS 24.0 was used for statistical analysis.In the statistical analysis,the malnutrition group and the malnutrition risk group in the evaluation results of MNA-SF and MNA were combined into the malnutrition risk group.The demographic characteristics,anthropometric indexes and nutritional status of the subjects were described statistically.The consistency of NRS 2002,MNA-SF and MNA was analyzed by Kappa test.Cronbach’s a coefficient were calculated and exploratory factor analysis were conducted.Independent-sample t test was used to compare nutritional risk/malnutrition risk between groups,and correlation analysis was conducted for some of the study factors.Patients who were rated at nutritional risk/malnutrition risk using either NRS 2002,MNA-SF or MNA scales were categorized as risk group,and other patients were categorized as non-risk group.The combined nutritional evaluation results were the dependent variable,Pearson Chi-square test was used for univariate analysis,and the unconditioned logistic regression analysis were used for multivariate analysis to explore influncing factors of nutritional risk/malnutrition risk by calculating AOR and 95%CI.Two-sided test was used,and the test level α=0.05.Results1.A total of 389 valid questionnaires were included in this study,with a male-to-female ratio of 0.84:1.The age ranged from 60 to 93 years,with a mean age of 72.31±7.39 years and a median age of 72 years.More than half of the patients(60.7%)were over 70 years old,and the residents were mainly farmers(92.0%).Most of the patients were married(76.6%).and the proportion of them who had not gone to school was 67.1%.The average monthly income of most patients(88.9%)was less than 3000 yuan2.The average NRS 2002 score was 2.17±1.23,and 134 patients(34.4%)had nutritional risk.The average MNA-SF score was 11.60±2.04 points,the risk of malnutrition was 148 cases(38.0%),and 19 cases(4.9%)were with malnutrition.The mean MNA score was 23,36±3.77,the risk of malnutrition was 151 cases(38.8%)and 26 cases(6.7%)were with malnutrition.According to the analysis of Body Mass Index(BMI),29 patients(7.5%)were obese.97 patients(24.9%)were overweight,224 patients(57.6%)were normal weight,and 39 patients(10.0%)were low weight.94.9%of the patients had comorbidities,with an average of 3.93±1.64 kinds of comorbidities,and 32.1%had≥5 kinds of comorbidities.3.The average CDGI(2018)-E of the elderly patients before admission was 54.31 ±11.08 points,54.2%of the elderly were lower than 55 points,and 83.5%,54.2%,45.2%.42.2%and 32.1%of the elderly had no aquatic products,milk and dairy products,livestock meat fruits and eggs in their diets,respectively4.The evaluation results of NRS 2002 and MNA showed moderate consistency(Kappa=0.582,P<0.001).and the evaluation results of MNA-SF and MNA showed strong consistency(Kappa=0.781,P<0.001).The overall Cronbach’s a coefficient of the MNA scale used for nutrition assessment of elderly patients was 0.708.Factor analysis extracted 6 common factors,and the cumulative variance contribution rate was 56.709%.The factor load of two items was less than 0.5,indicating that their structural validity was not ideal.The overall Cronbach’s a coefficient of the MNA-SF scale for screening the risk of malnutrition in elderly patients was 0.518.Factor analysis extracted two common factors,the cumulative variance contribution rate was 56.415%,the factor load was>0.5,and its structural validity was not ideal.5.When NRS 2002,MNA-SF,and MNA were used,the scores of elderly patients were correlated with continuous variables such as mid arm circumference(MAC),calf circumference(CC),BMI,total protein(TP),albumin(ALB),prealbumin(PA),hemoglobin(Hb).total lymphocyte count(TLC),and CDGI(2018)-E respectively,and all are related to the education level and the monthly average income.The score of NRS 2002 and MNA was related to the total number of comorbidities.MAC,CC,BMI,CDGI(2018)-E,TP,ALB,PA,Hb,TLC in the nutritional risk/malnutrition risk group were lower than those in the no-nutritional risk/well-nourished group.Hospitalization costs and length of stay were higher in the nutritional risk group than in the no-nutritional risk group when using NRS 2002.6.Univariate analysis found that age,marital status,education level,monthly average income,ability to move,depression,number of comorbidities,gastrointestinal disease,CC,BMI,CDGI(2018)-E,ALB were related to the nutritional risk/malnutrition risk of elderly patients.Multivariate analysis of the unconditional Logistic regression model found that depression(AOR=2.799,95%CI:1.399-5.601,P=0.004),CDGI(2018)-E(AOR=0.755,95%CI:0.577-0.988,P=0.041),gastrointestinal disease(AOR=1.904,95%CI:1.061-3.415,P=0.031),BMI(AOR=0.408,95%CI:0.264-0.632,P<0.001)and CC(AOR=0.202,95%CI:0.107-0.382,P<0.001)may be the influencing factors of nutritional risk/malnutrition risk in elderly patients.Conclusions1.The detection rate of nutritional risk and malnutrition risk in geriatric patients at admission was high,and CDGI(2018)-E was low.2.The results of NRS 2002 and MNA-SF were basically consistent with MNA,and both of them could be used as nutritional screening tools for elderly internal medicine patients.MNA-SF is more suitable for nutritional screening in general elderly internal medicine patients.3.Demographic characteristics(age,marital status,education level,monthly average income),physical measurement indexes(CC,BMI),some clinical laboratory indicators(ALB,PA,Hb,TLC),ability to move,depression or not,presence or absence of gastrointestinal diseases,and the number of comorbidities,CDGI(2018)-E can be used as auxiliary indexes for nutritional screening or nutritional assessment.Depression or not,CDGI(2018)-E,presence or absence of gastrointestinal diseases,BMI,CC may be the influencing factors of nutritional risk/malnutrition risk in elderly patients. |
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