September 23, 2025Open Access

Undernourished and Undertreated: The Role of Nutritional Care in Geriatric Hospital Outcomes

POP. OrlandoniIstituti di Ricovero e Cura a Carattere Scientifico NPNikolina Jukic PeladicIstituti di Ricovero e Cura a Carattere Scientifico MRMirko Di RosaIstituto Nazionale di Riposo e Cura per Anziani

Key Points

Only 11% of hospitalized older adults received a nutritional consultation, leading to a concerning in-hospital mortality rate of 35.8%.
The geriatric nutritional risk index significantly predicted mortality (HR 1.89) and was inversely associated with length of stay, indicating the frailty of these patients.
Enteral and parenteral nutrition were more often prescribed to patients who did not survive, with complications from medical nutritional therapy often increasing in these cases.
Timely nutritional interventions were not significantly linked to improved mortality or length of stay, suggesting a need for better integration of nutritional care.

Abstract

Background: Malnutrition is highly prevalent in hospitalized older adults and is associated with adverse clinical outcomes. However, the extent to which nutritional care is systematically implemented and its relationship with outcomes remains unclear. Methods: We conducted a retrospective analysis of 4963 patients aged ≥65 years who were admitted to the National Institute for Health and Scientific Research for the Elderly (IRCCS INRCA, Ancona, Italy) between 2012 and 2020 and received at least one nutritional consultation. We examined associations between timing and type of nutritional interventions, the Geriatric Nutritional Risk Index (GNRI), and clinical outcomes, including in-hospital mortality and length of hospital stay (LOS). We also analyzed the prevalence of different complications during Medical Nutritional Therapy (MNT). Results: Only 11% of hospitalized patients received a nutritional consultation. Among them, in-hospital mortality was 35.8%. The Geriatric Nutritional Risk Index was a significant predictor of mortality (HR 1.89; 95% CI: 1.55–2.31; p < 0.001) and inversely associated with LOS, reflecting a frail subset of patients with complex clinical conditions. The timing of nutritional consultation showed no significant association with mortality or LOS, possibly due to relatively prompt intervention (median 4 days). Enteral (EN) and parenteral nutrition (PN) were more frequently prescribed to non-survivors. Medical nutrition therapy-related complications were also more common in non-survivors (22.3% vs. 14%, p < 0.001). Artificial nutrition (AN) was not associated with increased mortality, but it was associated with prolonged hospital stays both in survivors and in non-survivors. Conclusions: Our findings highlight the limited use of nutritional consultations in hospitalized elderly patients despite the high prevalence of malnutrition and its prognostic relevance. The GNRI is a valuable tool for early risk stratification and clinical decision-making. Systematic screening and timely nutritional intervention, integrated with broader therapeutic goals, may improve care and optimize outcomes even in this vulnerable population.

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