Early Clinical Swallow Evaluation Is Associated with Lower Malnutrition Prevalence at Discharge in Neurogeriatric Rehabilitation Patients: A Prospective Study.

BACKGROUND

Malnutrition is a known outcome of dysphagia.

OBJECTIVES

To estimate the association between the timing of the Clinical Swallow Evaluation (CSE) at admission and nutrition status at hospital discharge.

METHODS

In this single-center prospective study, the electronic medical records of patients discharged from the neurogeriatric rehabilitation department at the participating hospital, who had undergone CSE by a speech pathologist per hospital bed-side evaluation protocol, were reviewed. The participants were divided into two groups: those who underwent CSE within 48 h of hospitalization per Israel Ministry of Health guidelines (early CSE, N = 31); and those who underwent CSE later than 48 h from admission (late CSE, N = 47). Nutrition status was evaluated by a registered dietitian using the Mini Nutritional Assessment Tool Short Form (MNA-SF). Nutrition status at discharge was categorized and compared between the groups.

RESULTS

Seventy-eight patients were included (mean age 80.7 ± 8.1 years); 85.9% were malnourished at admission, with no difference between groups. At discharge, malnutrition was less prevalent in the early vs. late CSE group (61.3% vs. 78.7%; p = 0.012). In multivariable logistic regression, late CSE increased odds of malnutrition at discharge by more than six-fold. Each additional year of age increased the odds of malnutrition by 13%; each additional point in baseline MNA SF score reduced the odds by 48%; and greater cognitive decline increased the odds of discharge malnutrition risk by more than 2.6-fold. Sex and the number of dietitian consultations were not associated with malnutrition at discharge.

CONCLUSIONS

Early CSE in elderly patients hospitalized for neurogeriatric rehabilitation is associated with less malnutrition at discharge.