Factors related to home discharge in malnourished community-dwelling older adults: A retrospective longitudinal cohort study

Abstract

Patients who become malnourished during hospitalization because of illness or treatment often receive intervention from a nutrition support team (NST). The NST intervention not only enhances the nutritional status but also decreases medical expenses and catheter-related complications. However, the impact of the NST intervention on the home discharge of hospitalized community-dwelling older adults remains unclear. Hence, this study aims to investigate factors related to home discharge in malnourished community-dwelling older adults.In this retrospective longitudinal cohort study, examined 191 community-dwelling older adults aged ≥65 years (108 males; mean age: 80.9 ± 7.8 years) who received the NST intervention. All participants were categorized into two groups based on whether they were home discharged or not (home discharge group and non-home discharge group). We performed intergroup comparisons using serum albumin (Alb) as an index of the nutritional status and functional independence measure (FIM: motor and cognitive items) as an index of activities of daily living (ADL). Furthermore, we constructed a prognostic model of home discharge using the logistic regression analysis.The home discharge group had 94 participants, with a home discharge rate of 50.8%. Baseline body mass index (BMI), motor-FIM score, and cognitive-FIM score were significantly higher in the home discharge group compared with the non-home discharge group (P = .002, P < .001, P < .001, respectively). In the home discharge group, BMI declined significantly, Alb elevated significantly, and both motor-FIM and cognitive-FIM score enhanced significantly by the completion of the NST intervention (P < .001, P < .001, P < .001, P = .005, respectively). The adjusted logistic regression analysis extracted the baseline BMI (odds ratio [OR], 1.146; 95% confidence interval [CI]: 1.034-1.270), baseline motor-FIM score (OR, 1.070; 95% CI: 1.036-1.105), and extent of change in the motor-FIM score (OR, 1.061; 95% CI: 1.026-1.098) as independent factors that predict home discharge.This study highlights the significance of higher baseline BMI, higher baseline ADL level, ADL enhancements, and improvements in the nutritional status by the NST intervention in malnourished community-dwelling older adults considering home discharge.