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Nutrition Status and Pressure Ulcer: What We Need for Nutrition Screening

From the Research Group on Geriatrics at "Evangelisches Geriatriezentrum Berlin," Charité-Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany

Correspondence: Ralf-Joachim Schulz, MD, PhD, Charité-Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Research Group on Geriatrics at "Evangelisches Geriatriezentrum Berlin," Reinickendorfer Strasse 61, D-13347 Berlin, Germany. Electronic mail may be sent to ralf-joachim.schulz{at}charite.de.

Background: Pressure ulcers (PU) and malnutrition exist in elderly hospitalized patients as a significant and costly problem. The aim of the study was to compare different screening tools to assess nutrition status and to verify them for usage in clinical routine. Methods: Nutrition status (body mass index [BMI], Mini Nutritional Assessment [MNA], weight loss) was determined in 484 (326 female/158 male) multimorbid elderly patients with mean age of 79.6 ± 7.6 (80.9 ± 7.4 female/76.9 ± 7.4 male) years. Bioelectrical impedance analysis (BIA; Nutrigard 2000-M) was used for evaluation of body composition. Activities of daily living (ADL) were measured with the Barthel Index. PUs were divided into stages I–IV (European Pressure Ulcer Advisory Panel [EPUAP]) and were assessed by the Norton scale. Results: The prevalence of PU was 16.7%, with a median Norton scale of 20 (range, 17–24). According to MNA, 39.5% of the PU patients were malnourished, and 2.5% were well nourished. By contrast, 16.6% of the non-PU patients were malnourished, and 23.6% were well nourished. BMI decreased significantly in PU patients (p < .008). BIA resulted in no significant resistance and reactance but in a significant reduction of phase angle in PU. According to a significantly reduced body cell mass and lean body mass in PU patients, the ADL decreased in these patients, too. Furthermore, we analyzed a significant effect of age, ADL, MNA, BMI, phase angle, and body cell mass on the Norton scale. Conclusions: The MNA as a screening and assessment tool is easy to use to determine the nutrition status in multimorbid geriatric patients with PU. Further studies are needed to show an improved outcome of PU healing if evaluation of nutrition status is part of routine clinical practice in multimorbid elderly risk patients within the first day after admission.

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