Malnutrition in elderly ambulatory medical patients

Elderly ambulatory persons may be especially susceptible to malnutrition, particularly those who are poor and socially isolated or have commorbid chronic medical diseases. We found that 98 of 2,986 persons age 60 years or older attending a hospital-based medical practice between 1979 and 1989 weighed less than 45.4 kg (100 lbs). All but 1 of these subjects met criteria for malnutrition as judged against age-specific norms for weight. Thus the prevalence of malnutrition in this sample was 3.25% (95% CI 2.61, 3.89%). Interviews and physical examinations of a subsample (n = 16) revealed that all 16 subjects either met anthropometric-based criteria for malnutrition or were being treated for malnutrition. Of the 98 subjects who weighted less than 45.4 kg, 62 (63.3%; 95% CI 53.8, 72.8%) had comorbid conditions that could have contributed to malnutrition. Physicians did not record a diagnosis of malnutrition or weight loss in 47.9% of subjects (95% CI 38.0, 57.8%) and did not prescribe a nutrition supplement for 76.5% of subjects (95% CI 68.1, 84.9%). Subjects treated with nutrition supplement were more likely to have cancer. These findings suggest that malnutrition, both with and without concomitant major comorbid disease, is releatively frequent among elderly ambulatory patients and that a specific nutritional diagnosis is not made in many cases. We suggest that weight under 45.4 kg in an elderly person is a useful criterion for identifying elderly patients at nutritional risk.