The inability to care for yourself puts you at greatest risk of death in a hospital

Underweight elderly patients who have difficulty performing routine daily activities such as eating and bathing are at greatest risk to die in the hospital, new Saint Louis University research shows.

The findings are published in the May/June issue of the Journal of Health, Nutrition, and Aging, and are adjusted to factor in the severity of an illness and a patient's nutritional status.

The study examined the medical records of more than 1,700 elderly patients who were hospitalized during a one-year period at a university teaching hospital.

"The inability to care for yourself puts you at greatest risk of death in a hospital," said David R. Thomas, M.D., professor of geriatrics at Saint Louis University School of Medicine and principal investigator for the study. "But that's wonderful news because you can improve your ability to function with good physical therapy and intensive rehabilitation."

Dr. Thomas says his is the first study that examines connections between the many factors that influence death in the hospital.

"Previous reports have examined individual factors that influence hospital outcomes. Functional status, how sick the person is, and his or her nutritional status have all been shown to be important individually. We thought it was important to look at the interaction among these different variables."

Functional status is a person's ability to take care of his own basic needs, such as feeding and dressing himself, bathing, using the restroom, moving from a bed to a chair or walking.

"We discovered that the combination of functional status and low body mass index best predict death in the hospital," Thomas said.

"This is good news because functional status can potentially be corrected. We already are working on this at our specialized ACE (Acute Care of the Elderly) Unit that encourages hospitalized elderly patients to do as much as they can to care for themselves as they recover from an illness. We want our patients to get out of bed, join others in a dining area for meals, and walk to the bathroom. We want to prevent their functional decline when they are in the hospital."

The study found that a body mass index of less than 20 coupled with a person's inability to independently perform routine daily activities is a marker of death during hospitalization.

Body mass index (BMI) is an indicator of body fat based height and weight measurements. A BMI of between 18.5 and 24.9 is considered normal.

The more unable a person is to perform independent daily activities, the more likely the patient is to die in the hospital, researchers found.

Thomas found that a declining body mass index and difficulties caring for oneself are closely connected. As an elderly person who has problems performing some daily activities loses weight, he becomes increasingly unable to care for himself.