Increased Need for High Levels of Care in Patients with Delirium Superimposed on Dementia and Risk of Malnutrition

We examined the impact of a malnutrition risk (Malnutrition Universal Screening Tool (MUST) score ≥1) in patients with delirium superimposed on dementia (DSD) on the need for higher levels of care on discharge. The associations of risk categories (defined as: i, well-nourished patients with delirium but without dementia and; ii, DSD or malnutrition risk; and iii, DSD & malnutrition risk) with care needs were evaluated by multivariable logistic regression. These were expressed as odds ratios (OR) and 95% confidence intervals (95% CI), adjusted for age, sex, polypharmacy and anticholinergic burden. In total, 554 consecutive patients admitted to a single UK secondary hospital, aged 61.3-105.3 years (mean = 85.5 ± 7.6 years), were enrolled for whom: 75.1% were from their own home; 36.3% exhibited underlying DSD; and 47.5% had malnutrition at admission. Compared to well-nourished patients with delirium but without dementia, those with both DSD and a malnutrition risk had greater needs for new care-home placement [OR = 2.75, 95%CI 1.46-5.20], and a discharge delay due to waiting for a package of care, a suitable placement, or equipment [OR = 2.54, 95%CI 1.46-4.41], and were proportionally less functionally independent. Malnutrition risk amongst patients with DSD who were admitted to hospital increased the need for higher levels of care at discharge. Prevention of malnutrition for patients with underlying dementia is essential to reduce hospitalization and improve care needs.