Optimizing Clinical Nutrition Management for Elderly Hospitalized Patients: Current Practices and Insights

Introduction

The aging process encompasses numerous physical, social, and physiological changes that unfold over a person’s lifetime [1]. Globally, the percentage of elderly individuals has been steadily increasing and is expected to continue rising in the coming years. Projections suggest a significant surge in the elderly population, with estimates indicating that by 2050, the global population of older adults (aged ≥60 years) will double from 841 million in 2013 to 2 billion, accounting for roughly 21% of the world’s population [2,3]. Nutrition requires special attention as individuals age. While energy requirements typically decrease with advancing years, the need for protein and specific nutrients actually increases to support the body’s normal functions [4]. Recent evidence underscores the complex interaction between nutrition, lifestyle, and aging. A cross-sectional study comparing Malaysian and Indonesian nurses revealed a high prevalence of obesity, coupled with low physical activity levels and weak correlations between body mass index and health-promoting behaviors. These findings highlight how lifestyle and nutritional imbalances contribute to health risks even among working-age adults, reinforcing the importance of early preventive measures to maintain metabolic and physiological health in later life [5].

Heightened nutritional deficiencies significantly increase the risk of specific chronic diseases and age-related health decline. Nutritional risk refers to the likelihood of adverse clinical outcomes driven by suboptimal nutrient intake [6]. Elderly patients face heightened vulnerabilities due to physiological alterations, comorbidities, and psychosocial factors that impede adequate dietary intake [7]. Malnutrition, encompassing both undernutrition and overnutrition, remains a significant issue among older adults and is often overlooked [8]. It contributes to extended hospital stays, delayed rehabilitation, higher readmission rates, and increased mortality, underscoring an urgent need for public health and policy interventions [9].

Studies in China have revealed that the prevalence of nutritional risk among elderly hospitalized patients ranges from 40.15% to 59.93% [10]. A study involving 3122 patients in Australia and New Zealand found that 41% of participants were deemed “at risk” of malnutrition, underscoring the widespread occurrence of malnutrition and inadequate food intake among acute care patients in various hospital settings [11,12]. Furthermore, Loss et al demonstrated a correlation between malnutrition and worse outcomes, including increased infection rates, prolonged hospital stays, and increased mortality risks among elderly patients [13]. In addition to these findings, interventional studies have demonstrated that targeted nutritional and lifestyle modifications can improve physiological resilience in older adults. For example, a trial in postmenopausal women aged 50–65 years found that combining honey supplementation with regular walking exercise enhanced antioxidant enzyme activity, suggesting potential synergistic benefits of diet and moderate physical activity in mitigating oxidative stress during aging [14].

A prospective study examined the impact of dietary patterns and nutrition initiatives on the 28-day all-cause mortality rate in elderly patients, suggesting that the administration and management of nutrition emerged as an autonomous risk factor for 28-day survival, with enteral nutrition potentially enhancing this outcome. Critically ill patients in the ICU who received early parenteral nutrition, were of advanced age, exhibited rapid respiratory rates, and had elevated lactate levels were prone to poorer prognoses [15,16]. Consequently, the implementation of nutritional interventions stands as a critical approach to addressing prevailing nutritional deficiencies and fostering recovery from diseases in the elderly [17,18]. Early nutrition therapy for patients identified as being at nutritional risk plays a pivotal role in enhancing clinical outcomes, such as reducing complications and length of hospital stays [19]. With the evolving medical frameworks within hospitals and the heightened focus on clinical nutrition departments, nutrition consultation has emerged as a crucial initial step in treating hospitalized patients at nutritional risk [20,21]. As China’s population aged 60 and above reached 280.04 million individuals, constituting 19.8% of the total population in 2022, the looming threat of nutritional risk is poised to intensify [22]. Therefore, this study aimed to assess the nutritional status of elderly hospitalized patients and investigate tailored nutritional interventions to address their unique needs.

Material and Methods

PARTICIPANTS:

A retrospective study was conducted on hospitalized patients in the Department of Geriatrics at Peking University People’s Hospital who received nutrition consultations from May 2017 to September 2020. Inclusion criteria were ages 60 to 90 years, and patients who died during hospitalization were excluded. The study was reviewed by the Ethics Committee and adhered to ethical principles, following the Declaration of Helsinki and the regulations for biomedical research involving human subjects in China (NO: 220PHB225-001).

DATA COLLECTION:

This investigation utilized hospital medical records obtained from the statistical comprehensive management system. Collected data included patients’ basic information (age, sex, length of stay), nutritional status, details of nutrition consultations, compliance with clinical advice, and chronic diseases (hypertension, type 2 diabetes, coronary heart disease, cerebral apoplexy, chronic obstructive pulmonary disease, lung infections, gastrointestinal disorders, gallbladder disease, chronic kidney disease, liver disease, anemia, dementia, anxiety, and depression). Changes in blood biochemical indices (total protein, albumin, blood calcium, blood potassium, blood sodium) were also recorded.

To ensure data accuracy and integrity, a rigorous data management process was implemented using Epi Data 3.1 software. Two trained researchers independently performed double entry of all extracted variables. The datasets were then cross-checked to identify discrepancies, which were resolved through consensus review. Logical verification procedures were applied to detect outliers, inconsistencies, and missing values. Any anomalies flagged during this process were reconciled against the original source records to maintain data reliability prior to statistical analysis.

NUTRITION INTERVENTIONS:

Nutrition interventions were documented in the nutrition medical record system and included 3 main components. The first component was health education, which involved correcting patients’ improper dietary structures and habits, along with formulating personalized nutritional meal plans based on the hospital nutrition canteen’s timing and quantitative distribution. The second component was enteral nutrition, which encompassed oral nutritional supplements (ONS) and feeding via nasogastric or nasojejunal tubes. The third component was parenteral nutrition, where parenteral nutrient solutions were administered through central venous catheters or peripheral veins. Patients receiving a daily energy supply greater than 41.84 kJ (10 kcal)/(kg·d) for 3 consecutive days were classified as having received nutritional support (Table 1).

NUTRITION RISK SCREENING:

The Nutrition Risk Screening 2002 (NRS2002) scale was utilized for this study, assessing 3 aspects [23]. These aspects included an impaired nutritional status score ranging from 0 to 3 points, a disease severity score ranging from 0 to 3 points, and a score of 1 point for age ≥70 years. A total score of ≥3 points indicated nutritional risk requiring support. Anemia was defined as hemoglobin levels ≤120 mg/L for men and ≤110 mg/L for women, in conjunction with clinical symptoms.

STATISTICAL ANALYSIS:

The significance level for testing was set at a P value of 0.05. Statistical analysis was conducted using SPSS 26.0 software. Continuous variables were described using mean (±SD) or median (interquartile range), while categorical variables were presented as counts and percentages. The Pearson chi-square test and Fisher’s exact test were employed to compare the incidence of nutritional risk and the implementation rates of nutritional intervention programs. Nonparametric tests were utilized to assess the influence of hospital stay duration and to make intergroup comparisons of various biochemical indicators within the intervention modes. A paired sample t test was used to evaluate changes in biochemical indicators before and after nutritional intervention.

Results

DEMOGRAPHIC AND NUTRITIONAL RISK PROFILE OF PATIENTS:

A total of 227 patients (144 males and 83 females) participated in this study. The mean age was 79.5±11.4 years, and the median duration of hospitalization was 19.00 days. The mean BMI for male patients was 23.45±5.24 kg/m2, while for females, it was 22.45±4.86 kg/m2, with no statistically significant difference between the 2 groups (P=0.16). Analysis of nutritional risk status and influencing factors revealed that 160 of the 227 patients (70.48%) were at nutritional risk. The incidence of nutritional risk was 68.75% in men and 73.49% in women, with no significant difference between the sexes (P=0.45). Patients of different ages exhibited significantly varying proportions of nutritional risk (P=0.00), with older patients showing a higher incidence. Notably, 87.06% of patients over 85 years old were identified as at nutritional risk (Table 2). Among the diseases diagnosed upon admission, hypertension (67.84%), type 2 diabetes (46.26%), and coronary heart disease (42.73%) were the most prevalent. Furthermore, elderly individuals with type 2 diabetes, pulmonary infections, gastrointestinal diseases, chronic kidney disease (CKD), and anemia had a higher incidence of nutritional risk compared to those without these conditions (P<0.05) (Table 3).

PROPOSED SCHEME AND IMPLEMENTATION OF NUTRITION CONSULTATION:

Following consultations with clinical nutritionists, a nutrition support scheme was proposed for 160 patients identified as at nutritional risk. This included 88 cases (55.00%) receiving ONS, 28 cases (17.50%) receiving tube-fed enteral nutrition, 7 cases (4.38%) receiving parenteral nutrition, and 19 cases receiving a combination of enteral and parenteral nutrition. Additionally, 18 cases (11.25%) were not recommended for nutrition support. In contrast, among the 67 patients without nutritional risk, 5 patients (7.46%) were advised to use ONS, and 1 patient (1.49%) received tube feeding. Overall, 204 patients received the corresponding nutrition intervention plan; however, the implementation rates of different nutrition support plans varied (χ²=11.06, P=0.03). The highest implementation rate was for health education (98.73%), while the lowest was for ONS treatment alone (83.87%). This discrepancy likely reflects greater patient acceptance and understanding of educational measures versus perceived complexity, taste issues, or logistical barriers to ONS. The remaining 23 patients who did not implement the nutrition support plan were categorized as follows: 69% failed to take oral nutritional supplements, 22% had families who refused tube feeding, and 9% did not have their parenteral nutrition formula adjusted in time.

INFLUENCING FACTORS OF HOSPITAL STAY:

Patients with positive nutritional risk screening results had significantly longer hospital stays compared to those without nutritional risk (P=0.00). After nutrition consultation, the hospitalization duration for patients who adhered to the nutritionist’s advice was shorter than for those who did not follow the intervention plan, with a statistically significant difference (P=0.00). Among patients who received nutrition consultations, those who consulted within 1 week of admission had significantly shorter hospital stays compared to those who consulted after one week (P=0.00) (Table 4).

COMPARISON OF THE EFFICACY OF NUTRITIONAL SUPPORT:

Patients with nutritional risk were categorized into 2 groups based on the NRS 2002 score to mitigate the influence of confounding factors such as age and underlying diseases [24]. This allowed for a comparison of changes in nutrition-related biochemical indicators between the total enteral nutrition intervention group and the EN+PN or total parenteral nutrition group. Results indicated that among all patients with low nutritional risk (NRS 3–4), all indicators, except for blood potassium before the intervention, were below the normal range, with no significant differences between groups (P>0.05). After the intervention, all indicators improved in both groups. However, total protein, albumin, and blood calcium levels in the total enteral nutrition group were significantly higher after the intervention (P<0.01), while increases in these indicators in the EN+PN or total parenteral group were minor and not statistically significant (P>0.05). Additionally, total protein and albumin levels in the total enteral nutrition group were significantly greater than those in the EN+PN or total parenteral intervention group (Table 5). For patients with high nutritional risk (NRS 5–7), all indicators, except for blood potassium before the intervention, were also below the normal range. Notably, the total enteral nutrition group had higher blood calcium levels and lower blood potassium levels compared to the EN+PN or total parenteral group (P<0.05). After the intervention, all indicators improved in both groups; however, only total protein, albumin, and blood calcium showed significant increases in the EN+PN or total parenteral group (P<0.05). Changes in each index before and after the intervention in the total parenteral group were statistically significant (P<0.05). There were no significant differences in the increases of total protein, albumin, and blood calcium between the 2 groups, nor were there significant differences in any indicators after the intervention (P>0.05) (Table 6).

Discussion

LIMITATIONS:

This study has several limitations inherent to its retrospective design. First, the sample size of the EN+PN or TPN group was relatively small, which may reduce statistical power and limit the generalizability of the findings. Additionally, the collected data lacked comprehensive patient-reported outcomes and long-term follow-up, which restricts our ability to assess sustained benefits of nutritional interventions.

The absence of detailed dietary intake records and adherence tracking may have introduced bias in evaluating the effectiveness of specific nutrition strategies. Furthermore, as a single-center study, institutional practices and resource availability may have influenced implementation rates and outcomes, limiting the applicability of results to other settings.

To address these limitations, future research should involve larger, multicenter cohorts and use prospective study designs. Including qualitative assessments of patient and caregiver experiences could provide deeper insights into barriers to nutritional compliance. Longitudinal tracking of outcomes such as readmission rates, functional recovery, and quality of life would also help evaluate the long-term impact of tailored nutrition interventions in elderly hospitalized populations.

Conclusions

The incidence of nutritional risk among elderly hospitalized patients is notably high. This study demonstrated the importance of tailored nutritional interventions based on individual risk levels. For patients with low nutritional risk, EN was effective in improving nutritional indicators. Conversely, for patients with higher nutritional risk, combining PN with EN – while accounting for the specific clinical characteristics – proved beneficial. These targeted approaches can optimize nutritional status and enhance overall patient outcomes. To translate these findings into practice, healthcare providers should implement standardized nutrition risk screening within 48 hours of admission and initiate early nutritional interventions to reduce complications and hospital stay duration. Actively involving family members in nutrition education and care planning is essential, particularly for elderly patients with cognitive or functional limitations. These strategies not only improve compliance and recovery but also support the development of more effective and sustainable nutrition management systems in hospital settings.