Background & Aims: Malnutrition is highly prevalent in older people in hospital
and adversely affects health and recovery. However, little was known about its
association with quality of life (QoL). Therefore, this project aimed to describe the relationship between QoL and nutritional status in older people in hospital.
Methods: (1) A prospective observational study; (2) a systematic review and meta-analysis; and (3) a prospective cross-sectional study of malnutrition and QoL were carried out. The cross-sectional study involvedl49 inpatients aged 65-99 years. Exclusion criteria were terminal illness, active malignancy, lack of capacity to consent and severe communication difficulties. Nutritional measures included anthropometrics, nutrition risk scores (Malnutrition Universal Screening Tool - MUST and Short Form Mini Nutritional Assessment - MNA-SF) and biochemical markers. Scores on health related quality of life were obtained using the SF-36 and the EQ-5D questionnaires.
Results: (1) Malnutrition was identified in 44% of 126 patients over 60 surveyed
with the MUST, and this was associated with poor clinical outcomes; less than a
third received nutritional support. (2) Cohort studies reviewed suggested that
malnutrition is associated with poorer QoL and that nutritional interventions can
significantly improve both physical and mental aspects of QoL. (3) The MUST and
MNA-SF showed moderate agreement and both predict mortality. Although the
MNA-SF categorises many more older people admitted to hospital as at risk of
malnutrition, it better predicts length of stay. There were significant associations
between QoL scores and nutritional indices. Regression analysis showed nutritional scores and functional status made independent contributions to prediction of QoL. Effect on food intake, mobility and psychological stress /acute disease also had a significant influence.
Conclusion: Evidence presented in this thesis suggests that malnutrition is
associated with poorer QoL in older people. Nutrition screening methods can detect those at risk of adverse clinical outcomes, and tremendous opportunities exist for nutritional screening and provision of nutritional support for older people in hospital. Such interventions not only improve nutritional status but may also have beneficial effects on mortality and lead to significant improvements in QoL in this population.