Energy and protein intake in 330 geriatric orthopaedic patients: Are the current nutrition guidelines applicable?

BACKGROUND AND AIMS: Elderly orthopaedic patients are potentially at a high nutritional risk. The reasons for this are numerous as i.e. reduced appetite, sensation of satiety after eating small amounts of food, multi-medication or immobility. This is in contrast to the increased energy and protein recommendations for geriatric orthopaedic patients.

METHODS: Oral intake during hospitalization of more than 1000 geriatric orthopaedic patients aged over 80, with or without fracture, was recorded, calculated and then compared to energy and protein requirements by clinical dietitians according to international guidelines.

RESULTS: 330 patients were included in the sample of which 76.7% were female (n = 253) and 23.3% male (n = 77). The mean age was 87.4 (+/-4.7) years. Most patients (204 = 61.8%) had lived at home prior to hospital admission. 72 patients (21.8%) lived in a retirement home, 54 (16.4%) lived in a nursing home. 98.5% of the included patients were unable to cover their energy needs and 99% were unable to achieve their protein needs. Only five patients (1.5%) were able to achieve their energy needs and one single patient (0.3%) achieved his recommended protein intake.

CONCLUSION: Orthogeriatric patients are at high risk of malnutrition. Very few of these patients were able to cover their estimated energy and protein needs through dietary intake. This suggests that there is a high need of dietetic interventions in this multimorbid elderly patient group. The aim of the nutritional therapy and its interventions should be its continuity, especially after hospital discharge so that long-term optimization of the nutritional status can occur. Future research should further investigate if current recommendations are applicable and the best way to achieve a better nutritional status in this population risk group.