# Pre-discharge energy intake and post-discharge mortality in acutely hospitalized older adults

## TL;DR

This study shows that older adults who eat more before leaving the hospital are less likely to die within three months after discharge.

## Contribution

The study introduces pre-discharge energy intake as a clinically feasible predictor of post-discharge mortality in older hospitalized patients.

## Key findings

- 74.7% of older hospitalized patients failed to meet recommended energy intake levels before discharge.
- Higher pre-discharge energy intake was associated with a 25% lower risk of post-discharge mortality.
- Monitoring pre-discharge energy intake could improve post-discharge outcomes through timely interventions.

## Abstract

Undernutrition is a prevalent issue among hospitalized older adults. Dietary intake is a major factor in nutritional status. Although insufficient dietary intake during hospitalization has been well documented, little research has focused on dietary intake at discharge, which may reflect the patient’s true dietary intake capacity. Furthermore, it would be desirable for energy intake to be estimated in a clinically feasible way.

This study aimed to assess pre-discharge energy intake using routinely recorded dietary intake data, and to examine the association between pre-discharge energy intake and post-discharge mortality in older inpatients.

A prospective cohort study was conducted in a geriatric ward. Energy intake in the 3 days prior to discharge was estimated using visually assessed dietary intake data recorded in medical records. The primary outcome was 3-month post-discharge mortality.

A total of 257 patients (mean age 84.7 years) was included. The mean pre-discharge energy intake was 1327 ± 315 kcal/day, with 74.7% of patients failing to meet recommended energy intake levels. Within 3 months post-discharge, 18 patients (7.0%) had died. Cox regression analysis revealed that higher pre-discharge energy intake was associated with lower post-discharge mortality (per 100 kcal/day, hazard ratio 0.75, 95% confidence interval 0.65–0.86), independent of other prognostic factors such as comorbidities and functional status.

Many patients did not reach their recommended energy intake at discharge. Integrating routine monitoring of pre-discharge energy intake into discharge planning could trigger timely nutritional interventions and goal-of-care discussions, thereby improving post-discharge outcomes.

The online version contains supplementary material available at 10.1007/s40520-025-03076-7.