https://doi.org/10.4081/gc.2026.15765
14 | Malnutrition, discharge complexity and hospital outcomes in older adults
A. Cavalli, M. Ceci, E. Del Giudice, G.U. Galasso, L. Palleschi | Azienda Ospedaliera San Giovanni Addolorata, Roma.
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Published: 11 June 2026
Introduction. Malnutrition is common among hospitalized older adults and associated with adverse clinical outcomes. The extent to which clinical-social complexity — assessed by the BRASS (Blaylock Risk Assessment Screening Score) — mediates its impact on length of stay and discharge destination has not been formally evaluated.
Objectives. To evaluate the association between malnutrition and length of stay (LOS) and non-home discharge, and to assess whether discharge complexity mediates these relationships.
Materials and Methods. Retrospective observational study including 1,328 older patients admitted to a geriatric ward (Azienda Ospedaliera San Giovanni-Addolorata) between 2023 and 2025. Malnutrition was assessed using MNA (≤7). Multivariable linear and logistic regression analyses were performed. Mediation was evaluated using causal mediation analysis with nonparametric bootstrap.
Results. Malnourished patients showed higher BRASS scores (β=3.85; 95%CI 3.08–4.63; p<0.001). Malnutrition was independently associated with longer LOS (β=2.55 days; 95%CI 1.30–3.90; p=0.002) and non-home discharge (OR=1.68; 95%CI 1.26–2.23; p<0.001). Higher BRASS scores were also associated with increased LOS (β=0.17/point; 95%CI 0.07–0.27; p<0.001) and non-home discharge (OR=1.05/point; 95%CI 1.03–1.07; p<0.001). BRASS partially mediated both associations: indirect effect on LOS 0.65 days (95%CI 0.29–1.07), 20.4% of total effect (95%CI 7.6–38.2%); indirect effect on non-home discharge 3.0 percentage points (95%CI 1.7–4.5), 25.2% of total effect (95%CI 13.1–47.9%). Direct effects remained significant for both outcomes.
Conclusions. Malnutrition independently worsens hospital outcomes, acting both directly and through increased discharge complexity. Early nutritional screening combined with proactive discharge planning may reduce hospitalization burden in this vulnerable population.
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