Nutritional status of nursing home patients.

Nutritional surveys were conducted on all 115 patients of a Medicare-approved nursing home. The techniques of nutritional assessment used included anthropometric measurements (weight/height, triceps skinfold, arm-muscle and arm circumference), biochemical and hematologic tests (serum albumin, serum transferrin, total lymphocyte count, hemoglobin, and hematocrit), and an intradermal skin test for cell mediated immunity. The prevalence of protein-calorie malnutrition (PCM) of moderate to severe degree was very high by currently used standards (weight/height, 43%; triceps skinfold, 37%; arm-muscle circumference, 85%; serum albumin, 32%; serum transferrin, 38%; and total lymphocyte counts, 22%). Anemia was found in 52% of the men and 14% of the women by normal adult standards; in addition, 19% of the patients had negative cell-mediated immunity (CMI) tests. The mortality rate during the 6 months after surveying was 13% for the immunocompetent (CMI-positive) patients and 48% for the anergic (CMI-negative). These findings confirm that PCM is prevalent in 85% of nursing home patients according to currently accepted nutritional assessment standards. In this nursing home population, 485 had marasmus, 35% had marasmus-kwashiorkor mixed syndrome, and 2% had kwashiorkor. Perhaps new standards need to be derived for such specific age groups as the elderly.