Malnutrition and Geriatric Vulnerability Are Independently Associated With Short-Term Mortality in Older Emergency Department Patients in Taiwan.

BACKGROUND

Malnutrition is common among older adults and is associated with adverse outcomes, yet its impact and relationship with geriatric vulnerability in emergency department (ED) patients remain underrecognized.

OBJECTIVES

To determine the prevalence, associated factors, and prognostic impact of malnutrition in noncritically ill older adults in the ED.

METHODS

We conducted an observational study of patients aged ≥ 65 years presenting to the ED. Nutritional status was assessed using the Mini Nutritional Assessment-Short Form (MNA-SF) and categorized as normal, at risk of malnutrition, or malnourished. Comprehensive geriatric assessment included functional status (activities of daily living (ADL)), frailty, cognitive function, and handgrip strength. Multivariable logistic regression identified factors associated with malnutrition. Kaplan-Meier survival analysis and multivariable Cox proportional hazards regression were performed to evaluate the association between nutritional status and 30- and 90-day all-cause mortality.

RESULTS

Among 1487 patients, 23.3% were malnourished and 46.4% were at risk, with 59.7% overall having impaired nutritional status. Malnourished patients had significantly worse functional status, cognition, and physical performance. Independent factors associated with malnutrition included lower ADL, frailty, and decreased handgrip strength. Malnutrition was associated with significantly lower 30- and 90-day survival (both log-rank p < 0.001) and remained independently associated with both 30-day mortality (adjusted HR, 5.32; 95% CI, 1.36-20.73) and 90-day mortality (adjusted HR, 6.92; 95% CI, 2.16-22.13) after multivariable adjustment.

CONCLUSIONS

Malnutrition is highly prevalent among older ED patients and is independently associated with increased short-term mortality. Functional decline, frailty, and reduced muscle strength are closely linked to both malnutrition and nutritional risk. Integrating nutritional screening with functional and physical assessment in the ED may improve early identification of high-risk patients and support timely interventions.