Energy and nutrient intake of elderly hospitalized patients in a steady metabolic status versus catabolic status.

Protein undernutrition enhances frailty and aggravates intercurrent diseases generally observed in elderly patients. Undernutrition results from insufficient food intake and catabolic status. Daily nutrient intakes were explored for hospitalized geriatric patients. Nutrient intake (carbohydrates, lipids, proteins, and calcium) was determined in randomly selected geriatric patients (n=49) over five consecutive days by weighting food in the plate before and after meals. For each geriatric patient, catabolic status and risk factors of undernutrition were considered. Results were compared between patients in a steady status or catabolic status. In steady status patients, protein, lipid and carbohydrate intake but not calcium intake, met recommended dietary allowances (total caloric intake:1535 +/- 370 Cal/day ; protein:1+/- 0.4 g/kg/day ; carbohydrates:55 +/- 7.7 % ; lipids: 30 +/- 6.3 % ; calcium:918 +/- 341 mg/day) . Patients in catabolic status (cardiopulmonary deficiency , neurologic disease , inflammatory process) had lower total caloric intake, lower protein intake and dramatically lower calcium intake (total caloric intake : 1375 +/- 500 Cal/day ; protein :0.9 +/- 0.4 g/kg/day ; carbohydrates : 54 +/- 8.3 % ; lipids : 31 +/-6.2 % ; calcium : 866 +/- 379 mg/day). Nutrient intake was lower in elderly patients hospitalized in short stay care units, perhaps due to failure to recognize suitable nutrient requirements. Protein-caloric undernutrition should be diagnosed early during hospitalization in order to allow appropriate dietary supplementation. However the incidence of protein undernutrition among elderly patients as a cause or a consequence of adverse pathophysiological processes remains a cause of debate.

[Factors contributing to falls in elderly subjects leading to acute-care hospitalization]. / Facteurs explicatifs de la chute du sujet âgé, motif d'admission en médecine aiguë.

OBJECTIVE: Falls are a frequent reason for hospitalization in short-stay geriatric units. Paradoxically, the factors determining such hospitalization remain unknown. The objective of our study was to identify the explanatory factors of falls leading to acute-care hospitalization of elderly subjects. PATIENTS AND METHODS: We prospectively compared patients hospitalized for falls and those hospitalized for another reason in a short-stay geriatric unit. Data were collected over a 6-month period starting with a questionnaire and a physical examination. RESULTS: Patients admitted for falls were predominantly women (76.9%) living alone (76.9%). Falls depended mainly on intrinsic factors. The precipitating factor was a medical condition (84%) and acute (96%). The pattern of multiple disease conditions was not specific for patients who fell. Inversely, osteoarthritis and visual and auditory deficits with direct effects on motor functions were correlated with falls. The environment played a determining role, but was primarily a predisposing and not a precipitating factor as is was directly the cause of falls in only 4% of cases. The loss of self-sufficiency for daily activities was also significantly more frequent in patients who fell. DISCUSSION: The explanatory factors of falls as the reason for hospitalization of elderly subjects in short-stay geriatric units are intrinsic factors. They are associated with a precipitating factor which is usually an acute medical condition and a chronic multiple disease state having an effect on postural balance leading to the fall. These factors are combined in a context of social and environmental isolation.