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To test the hypothesis that individualized nutritional treatment during and after discharge from acute hospitalization will reduce mortality and improve nutritional outcomes. Randomized, controlled trial. Internal medicine departments. Two hundred fifty-nine hospitalized adults aged 65 and older at nutritional risk were recruited and randomized according to hospitalization ward into one intervention and two control groups during hospitalization. Group 1 (intervention group) received individualized nutritional treatment from a dietitian in the hospital and three home visits after discharge. Group 2 received one meeting with a dietitian in the hospital. Group 3 received standard care. Groups 2 and 3 were combined into a single group that served as the control group in the analysis. Mortality, health status, nutritional outcomes, blood tests, cognition, emotional, and functional parameters were assessed at baseline and after 6 months. All participants were contacted monthly. The overall dropout rate was 25.8%. After 6 months, rise in Mini Nutritional Assessment score, adjusted for education and hospitalization ward, was significantly higher in the intervention group than in the control groups (3.01 ± 2.65 vs 1.81 ± 2.97, P=.004) mainly on the subjective assessment part (0.34 ± 0.86 vs. −0.04 ± 0.87, P=.004). The only laboratory parameter for which a difference was observed between the groups was albumin; 9.7% of the intervention group had serum albumin levels of less than 3.5 g/dL, versus 22.9% of the control group ( P=.03). Mortality was significantly lower in the intervention group (3.8%) than in the control group (11.6%, P=.046). Lower mortality and moderate improvement in nutritional status were found in patients receiving individualized nutritional treatment during and after acute hospitalization. [ABSTRACT FROM AUTHOR]

Background: Aging is associated with increased prevalence of depression and with increased use of medications. The aims of this study were to determine the rate of recognition of depressive symptoms and the prevalence of depressed mood among aged inpatients, as well as to assess the use of medications known to enhance depression in this population. Methods: A cross-sectional study of cognitively intact patients aged 65 and over, in a general medical ward, was undertaken. Depressed mood was identified using the Geriatric Depression Screening Scale. Data on diagnoses, prescribed medications, psychiatry consultations and medication changes were abstracted from medical charts. Two years following the index hospitalization, data on diagnoses during subsequent admissions were abstracted from computerized records. Results: The study sample comprised 183 elderly patients. 27.3% of them displayed depressed mood. None were diagnosed as suffering from depression, referred to psychiatric consultation, or prescribed antidepressant medication. All patients but one received depression-enhancing medications. Only in four cases were these medications stopped, without attributing the cessation to awareness of the mood disturbance and the potential association with the stopped medication. During the subsequent two years, a state of depression was recorded in only three additional patients. Conclusion: Under-recognition of depressed mood leads to inappropriate management of aged inpatients. Initiation or continuation of depression-associated medications, resulting from under-recognition of depression, may contribute to the prevalence and augment the severity of this disorder. [ABSTRACT FROM AUTHOR]