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Risk of malnutrition in retirement homes elderly persons measured by the 'Mini-Nutritional Assessment'
Abstract
The combined influence of age-associated factors such as general health, degree of dependency, diminished odor perception, and poor oral health on the risk for malnutrition was explored.
A total of 81 persons living in retirement homes took part in the study (mean age 83.4 years, SD = 6.6, range 61-98). The Mini-Nutritional Assessment (MNA) was used to evaluate the risk of malnutrition. Odor perception was measured by the detection threshold for isoamylacetate. The number of drugs taken by each person was counted. General health status was determined by the Medical Outcome Study (MOS) scores. Oral examinations were carried out to count the number of natural teeth and type of dentures.
On average, women had slightly, but significantly, lower MNA scores than men (respectively, 23.4, SD = 2.8; and 24.6, SD = 2.6; p = .048). The correlations between age and MNA score and between odor perception and MNA score were not significant. Significant correlations were found between age and number of natural teeth (r = -.26, p = .001) and between MNA score and number of natural teeth (r = .27, p = .001). The mean MNA score of complete denture wearers (22.8, SD = 2.9) was significantly lower than that of partial denture wearers (25.8, SD = 2.9; p = .0005). The total MOS and MNA scores were not correlated, but a significant correlation was found with the subscales mental functioning (r = .29, p = .003), social functioning (r = . 19, p = .045), and perceived health (r = .19, p = .047). No relation was found between the activities of daily living (ADL) and MNA scores. A significant negative correlation was observed between number of drugs taken and the MNA score (r = -.34, p = .001). When participants without risk of malnutrition (MNA > or = 24) were compared with those at risk (MNA = 17-23.5), again, the number of drugs taken was significantly different (on average, respectively, 4.5, SD = 2.9; and 7.0, SD = 2.6; p < .0005). Using multiple regression to test the separate effects of the different independent variables, the number of drugs taken showed a significant negative regression coefficient (beta = -.31, p = .008), as did the mental health score (beta = .27, p =.02), giving a total R2 = .32. The other parameters did not contribute significantly.
Among the elderly in retirement homes, the health state (as measured by the MOS subscale mental health and by the medication use) appears to be the most clinically relevant parameter to explain the risk for malnutrition. Loss of natural teeth and perceived health are less independently contributing, whereas no contribution derives from decline of odor perception, degree of dependency, and age itself.
... However, two studies defined polypharmacy as the use of six or more drugs [29,30]. Two studies did not provide a definition based on the number of drugs used, but a mean and standard deviation that corresponded to the minimum of 5 drugs [31,32]. In their analysis, Jyrkka et al. (2011) distinguished between polypharmacy (five or more drugs) and excessive polypharmacy (ten or more drugs) [33]. ...
... Two studies reported a Beta coefficient. Both univariate and multivariate analysis by Griep et al. (2000) demonstrated a significant correlation between higher number of drugs taken and lower MNA score (respectively r ¼ À0.34, p ¼ 0.001 and b ¼ À0.31, [31]. In addition, Jyrkka et al. (2011) demonstrated lower mean scores for MNA-SF (p < 0.001) compared to the nonpolypharmacy group at baseline. ...
... Two studies reported a Beta coefficient. Both univariate and multivariate analysis by Griep et al. (2000) demonstrated a significant correlation between higher number of drugs taken and lower MNA score (respectively r ¼ À0.34, p ¼ 0.001 and b ¼ À0.31, [31]. In addition, Jyrkka et al. (2011) demonstrated lower mean scores for MNA-SF (p < 0.001) compared to the nonpolypharmacy group at baseline. ...
Background & Aim
Malnutrition adversely influences a broad range of physical and psychological symptoms. Although polypharmacy is often mentioned to be associated with malnutrition, especially in older people it is unclear to what extent. The aim of this systematic review was to investigate the extent of the association between polypharmacy and malnutrition in older people.
Methods
The methodology followed the guidelines of the Cochrane Collaboration. Literature search was performed in PubMed, CINAHL and Embase. The population of interest for this systematic review were people of 65 years and older with polypharmacy. Because there is ambiguity with regard to the actual definition of malnutrition and polypharmacy, in this systematic review all articles describing malnutrition prevalence rates were included, regardless of the criteria used. Both observational and intervention studies were screened for eligibility. Selection and quality assessment of the included full text studies was assessed by two reviewers independently. A level of evidence and methodological quality score was adjudged to each article based on this assessment.
Results
A total of 3126 studies were retrieved by the literature search, of which seven studies were included in this systematic review. There was considerable variation in the definition of polypharmacy between studies. Two studies defined polypharmacy as the use of five or more drugs, two studies as the use of six or more drugs, two studies provided a mean and standard deviation that corresponded to the minimum of five drugs, and one study distinguished between polypharmacy (five or more drugs) and excessive polypharmacy (ten or more drugs). However, all studies showed a statistically significant association between (the risk) of becoming malnourished and polypharmacy regardless the instrument or criterion used to define risk of malnutrition. Studies presented the associations respectively as OR ≥ 1.177, p-value ≤ 0.028, β≥ -0.62 and r≥ -0.31.
Conclusion
This review demonstrated a statistically significant association between polypharmacy and malnutrition. Further research is required to determine the magnitude of the effect by increased number of drugs in combination with the type of drugs, on the risk of malnutrition.
... Three separated meta-analyses were conducted in order to account for different oral parameters evaluated in the studies. The meta-analysis for edentulism was performed with eight studies [15,23,24,28,32,35,38,42], the use of prosthesis was composed with 4 studies [32,33,35,36] and mean number of present teeth included 5 studies [10,15,32,35,42]. ...
... Three separated meta-analyses were conducted in order to account for different oral parameters evaluated in the studies. The meta-analysis for edentulism was performed with eight studies [15,23,24,28,32,35,38,42], the use of prosthesis was composed with 4 studies [32,33,35,36] and mean number of present teeth included 5 studies [10,15,32,35,42]. ...
... Three separated meta-analyses were conducted in order to account for different oral parameters evaluated in the studies. The meta-analysis for edentulism was performed with eight studies [15,23,24,28,32,35,38,42], the use of prosthesis was composed with 4 studies [32,33,35,36] and mean number of present teeth included 5 studies [10,15,32,35,42]. ...
This systematic review aimed to compare the nutritional status and oral health in older adults individuals. Three databases (Medline-Pubmed, Scopus and EMBASE) were searched up to October 28th 2016 for studies that performed the Subjective Global Assessment (SGA) or the Mini Nutritional Assessment (MNA) and an oral examination performed by a dental professional, either dental hygienist or a dentist. Both observational and interventional studies were screened for eligibility. Meta-analyses were performed comparing the malnourished/at risk of malnutrition and the normal nutrition subjects with three oral health parameters (edentulism, use of prosthesis and mean number of present teeth). Twenty-six studies were included in the systematic review, of which 23 were cross-sectional. It was showed that well-nourished subjects had a significantly higher number of pairs of teeth/Functional Teeth Units (FTU) in comparison to individuals with risk of malnutrition or malnutrition. The meta-analyses showed no statistically significant association between edentulism and use of prosthesis, as the pooled Relative Risk were, respectively, 1.072 (95% CI 0.957-1.200, p = 0.230) and 0.874 (95% CI 0.710-1.075, p = 0.202). On the other hand, the pooled Standard Mean Difference of mean number of present teeth were -0.141 (95% CI -0.278 to -0.005, p = 0.042) in subjects with at risk of malnutrition/malnourished. FTU and mean number of teeth present were significantly associated with nutritional status. Furthermore, more longitudinal studies in this field are needed.
... The MNA has been used in multiple studies evaluating nutritional status in the older adult in different living situations; those who live independently in the community, those who are hospitalized, those who live in nursing homes, and those who live in retirement homes (eldercare facilities). These studies have corroborated the MNA's operative validity [16][17][18]. ...
... Using the same MNA instrument, they classified nutritional status in OAEF in their respective studies as follows: malnourished 8.3% and 15.3%, at risk of malnutrition 45.7% and 55.6%, and normal nutritional status 36% and 29.1%. However, a study carried out by Griep et al (2000) reported different results. Using the MNA on 81 hospital patients, they found that 37% of patients were at risk of malnutrition, 2% were malnourished, and 61% had normal nutritional status [18]. ...
... However, a study carried out by Griep et al (2000) reported different results. Using the MNA on 81 hospital patients, they found that 37% of patients were at risk of malnutrition, 2% were malnourished, and 61% had normal nutritional status [18]. ...
Malnutrition in the older adult is an ongoing situation in Mexico and is most apparent in individuals that reside in hospitals, nursing homes, and retirement homes. For that reason, it is necessary to evaluate the nutritional status of these adults by means of the Mini Nutritional Assessment (MNA) and levels of three serum indicators that are commonly ordered when making malnutrition diagnosis. An analytical cross-sectional study was carried out on 100 older adults residing in eldercare facilities. Nutritional status was evaluated by means of the MNA and three serum indicators (albumin, ferritin, and hemoglobin). Descriptive statistics were used to analyze sociodemographic characteristics, and a Student’s t test, based on gender and reference values, was used to compare mean values of the three serum indicators. A Chi-square test was used to compare proportions in individuals, based on gender, who had normal nutritional status or were malnourished, and who were at-risk of malnutrition. A One-way ANOVA with Scheffé post hoc test was used to identify the association between serum indicators and nutritional status of older adults. Of the 100 older adults studied, 53% were men and 47% were women. The mean age was 85±0.7 years. According to the MNA, 20% had normal nutritional status, 55% were at-risk of malnutrition, and 25% were malnourished. The mean indicator values were: albumin 4.7±0.04 g/dL, ferritin 74.2±8.7 ng/mL, and hemoglobin 13.0±0.1 g/dL. No significant association was found between serum indicators and each MNA classification; however, when the same indicators were compared between the sexes, hemoglobin showed a significant difference (P=0.037). Women had lower values but those values did not extend beyond the established physiological range for this population. There was a 55% prevalence of risk of malnutrition in the nutritional status of older adults living in Mexican eldercare facilities in a Mexican province and it was even more frequent in women.
... Griep studies the number of drugs depending on the MNA nutritional statuson 81 elderly people living in nursing homes. Its population is lightly younger than ours (83.4 vs 86.4yearsold), less dependent (29.6% totally or partially dependent vs 86.7%), less malnourished (> 50% well-nourished vs 1.35% and 2% malnourished vs 27%) and taking less drugs (average number of drugs at 5.5 vs 8.3) [46]. He finds a malnutrition risk factor with the polypharmacy but knowing that people with malnutrition are significantly younger and the sample is small. ...
... Even though our results showed no correlation between polypharmacy and malnutrition, such relation may exist for different elderly populations. Indeed relationships between those two factors have been shown for elderly living in their homes or living in nursing home in the younger people [27,28,46]. ...
... The relationship between gender and nutritional status according to the MNA was not statistically significant. Other studies support the current study results (12)(13)(14). ...
... The current study demonstrated that the BMI was significantly higher in well-nourished patients. Other studies showed that the percentage of malnutrition was related to the decreased BMI (12)(13)(14). The BMI has a direct relationship with the MNA score: the higher the BMI, the better the patient's Nova Scotia (NS) (17). ...
Background: Malnutrition is a common problem among elderly patients, especially those with heart failure, and is known to increase mortality rates.
Objectives: The current study evaluated nutritional status to identify changes in the elderly patients with congestive heart failure (CHF) during hospital stay.
Patients and Methods: This cross-sectional study recruited 225 CHF hospitalized elderly patients, comprised of 154 males (68.4%) and 71 females (31.6%) at ameanage of 71.1±7.35 years. The mini nutritional assessment (MNA) was performed to estimate functional, cognitive and nutritional status. The MNA, an18-item tool to evaluate subjective and objective findings, including anthropometric measurements for nutritional risk, is found to be sensitive, specific and accurate in identifying elderly people at nutritional risk.
Results: According to the MNA questionnaire, 9.8% of the elderly were malnourished, 80.9% at risk of malnutrition and 9.3% well nourished.Weight loss, bedsore, and level of knowledge and income had a significant relationship with nutritional status based on the MNA (P value < 0.05).
Conclusions: Considering the high percentage of elderly patients with malnutrition or at risk of malnutrition, the need for nutritional intervention is obvious. The MNA seems to be a reliable tool to identify individuals at risk of malnutrition. To decrease hospital stay duration and cost, application of the MNA is suggested.
... Moreover, the population structure in the older population, living in nursing homes were in ranges of age 57-89 and prevalence rates of malnutrition and risk of malnutrition were also high (55.9% and 9% respectively). These findings are the same as those reported recently in some countries [27][28][29][30] including Spain and Sweden studies which showed prevalence rates of 61.8% and 51%, respectively [27][28][29][30]. Values are presented as frequency (percentage) In accordance with previous reports [31], even though the score of MNA was lower in women, no significant difference observed between gender subgroups. ...
... Moreover, the population structure in the older population, living in nursing homes were in ranges of age 57-89 and prevalence rates of malnutrition and risk of malnutrition were also high (55.9% and 9% respectively). These findings are the same as those reported recently in some countries [27][28][29][30] including Spain and Sweden studies which showed prevalence rates of 61.8% and 51%, respectively [27][28][29][30]. Values are presented as frequency (percentage) In accordance with previous reports [31], even though the score of MNA was lower in women, no significant difference observed between gender subgroups. ...
Background: Nutrition status is an important constituent of health in an elderly and evaluation of these groups are necessary for development of treatment protocols. The study aimed to estimate the prevalence of malnutrition with mini nutritional assessment (MNA) tool in the elderly living in nursing homes. In addition, the association of MNA results and functional status was investigated. Methods: 245 of elderly residents in nursing homes in Tehran (90 men and 155 women) were studied. Data were collected using the MNA, anthropometric measurement, and functional evaluations by Katz Index. Results: 35.1% showed normal status while 55.9% have been classified at risk malnutrition and 9% suffered from severe malnutrition based on MNA scores. Katz score showed that 20.4% older people absolutely depended on others for all of activities for daily living. There was significant difference in score of Katz index according to gender (p < 0.050). A positive correlation was found between MNA scale and Katz index (r = 0.251, n = 245, and p = 0.001). Analysis of logistic regression controlled for age and gender showed in those at risk of malnutrition a higher MNA score significantly lowered the risk of being dependent based on Katz index (odds ratio: 2.14, confidence interval: 1.15-3.98 and p = 0.016), however this relationship was not observed elderly subjects who were malnourished [2.53 (0.92-6.95) and p = 0.070).
... 18 Although MNA has been efficacious in geriatric nutrition evaluation studies, its dependence on neuropsychiatric stability and consciousness and lack of serum data has proven to be a weakness for the assessment, particularly in its short form. 17,18,39 The development of GNRI aimed to consider both serum and anthropometric values and is an objective measurement unaffected by the consciousness level of elderly adults. 5 GNRI has displayed reliability and validity comparable to established nutritional assessments; notably, poor prognosis following orthopedic surgeries was most effectively predicted by GNRI scores. ...
Background
This study investigates the association between the Geriatric Nutritional Risk Index (GNRI), a simple readily available measure of malnutrition risk, and 30-day postoperative complications following total shoulder arthroplasty (TSA).
Methods
The American College of Surgeons National Surgical Quality Improvement Program database was queried for all patients who underwent TSA between 2015 and 2021. The study population was divided into 3 groups based on preoperative GNRI: normal/reference (GNRI > 98), moderate malnutrition (92 ≤ GNRI ≤ 98), and severe malnutrition (GNRI < 92). Logistic regression analysis was conducted to investigate the connection between preoperative GNRI and postoperative complications.
Results
Compared to normal nutrition, moderate malnutrition was independently significantly associated with a greater likelihood of any complications (odds ratio [OR]: 1.74, 95% confidence interval [CI]: 1.54-1.96; P < .001), blood transfusions (OR: 1.52, 95% CI: 1.09-2.11; P = .013), failure to wean off a ventilator within 48 hours (OR: 3.84, 95% CI: 1.26-11.72; P = .018), wound dehiscence (OR: 15.80, 95% CI: 1.61-155.28; P = .018), nonhome discharge (OR: 1.90, 95% CI: 1.63-2.22; P < .001), readmission (OR: 1.54, 95% CI: 1.19-1.99; P = .001), unplanned reoperation (OR: 1.87, 95% CI: 1.27-2.74; P = .001), length of stay > 2 days (OR: 1.85, 95% CI: 1.63-2.12; P < .001), and mortality (OR: 3.38, 95% CI: 1.32-8.71; P = .011). Severe malnutrition was independently significantly associated with a greater likelihood of any complication (OR: 3.33, 95% CI: 2.80-3.97; P < .001), sepsis (OR: 9.83, 95% CI: 2.94-32.85; P < .001), pneumonia (OR: 3.30, 95% CI: 1.71-6.38; P < .001), unplanned reintubation (OR: 5.77, 95% CI: 2.47-13.51; P < .001), urinary tract infection (OR: 2.15, 95% CI: 1.19-3.87; P = .011), stroke (OR: 3.57, 95% CI: 1.18-10.84; P = .024), blood transfusions (OR: 5.27, 95% CI: 3.86-7.20; P < .001), failure to wean off a ventilator within 48 hours (OR: 7.64, 95% CI: 2.29-25.55; P < .001), Clostridioides difficile infection (OR: 4.17, 95% CI: 1.21-14.32; P = .023), nonhome discharge (OR: 3.56, 95% CI: 2.92-4.34; P < .001), readmission (OR: 2.05, 95% CI: 1.46-2.89; P < .001), length of stay > 2 days (OR: 3.27, 95% CI: 2.73-3.92; P < .001), and mortality (OR: 4.61, 95% CI: 1.51-14.04; P = .007).
Conclusion
Malnutrition based on GNRI is a strong predictor of complications following TSA, with increasing severity related to an increased rate of complications.
... Several studies in different regions are in line with female older adults being more likely to be malnourished [28,[31][32][33]. Women have higher rates of depression and widowhood and a lower subjective health status, which are known risk factors for malnutrition [31]. ...
Malnutrition is widespread among older adults, and its determinants may differ between countries. We compared Portuguese and Turkish non-institutionalized older adults regarding nutritional status, sociodemographic, health and anthropometric characteristics and studied the relationships between nutritional status and those characteristics. This cross-sectional study analyzed data from 430 Portuguese and 162 Turkish non-institutionalized older adults regarding sociodemographics, health conditions, the Mini-Nutritional Assessment (MNA-FF) and anthropometry. Turkish older adults were more likely to be malnourished or at risk of malnutrition and had lower average BMI but a higher calf circumference. A higher proportion of the Portuguese sample had tooth loss, diabetes, hypertension, oncologic diseases, kidney diseases, osteoarticular problems or eye problems, while less had anemia. A better nutritional status (higher MNA-FF score) was found among the Portuguese, males, people using dentures, those without tooth loss, hypertension, cardiovascular diseases, anemia or oncological diseases and was related to younger age, higher BMI and a higher calf circumference. Malnutrition and its risk were higher among older adults from Turkey, despite Portuguese older adults presenting a higher prevalence of chronic diseases. Being female, older age, tooth loss, hypertension, anemia, CVD or oncological disorders and having a lower BMI or CC were associated with higher rates of malnutrition among older adults from Portugal and Turkey.
... Aside from that, dietary changes have a significant impact as risk factors throughout a person's life, and they may have an even greater impact on the elderly. The gradual deterioration of health conditions and body function caused by aging often referred to as frailty, is thought to be a major cause of malnutrition in older people, rather than age [20]. Additionally, there are other factors like physical activity, constipation, cognitive decline, dementia, poor appetite, eating dependencies, and loss of interest in life that affect the nutritional status of the elderly [21]. ...
p>With changing demography, developing countries will be outnumbered by the elderly and their associated chronic diseases. The geriatric population is at increased risk of malnutrition with multiple factors, especially depression. This study explored potential linkages between malnutrition and depression in the geriatric population. A cross-sectional study was conducted at tertiary healthcare facilities at Western Rajasthan, India from April to June 2018. After consent from 310 elderly patients attending out patient department, a pre-tested questionnaire was used to collect data. Assessment of malnutrition status using mini nutritional assessment (MNA), depression using geriatric depression scale (GDS), physical frailty using activities of daily living (ADL), and instrumental activities of daily living (IADL) was done. Chi-square, Fischer test, and unpaired t-test were employed for inferential statistics. Multiple logistic regression was used to compute the adjusted odds ratio. Out of 310 elderlies, 192 (61.9%) participants were categorized as having poor nutrition and 99 (31.9%) were likely to suffer from depression. The elderly at risk of malnutrition among depressed was 75.8% (n=99) with a preponderance for females, and minor disabilities. Multivariate analysis suggested higher odds of malnutrition in the elderly with lower socioeconomic status and rural residence. Depression and malnutrition are linked in a destructive cycle but the causality remains elusive.</p
... 8 Several studies have demonstrated an association between polymedication and adverse events in the elderly population, such as increased interaction between drugs, 9 poor adherence to therapeutic regimens, 10,11 and declining nutritional status. [12][13][14] They have also found a higher risk of functional impairment, 13,15,16 frailty, 17 sarcopenia, 18 falls, 19 cognitive dysfunction, 13,15,20 and high rates of hospitalization 21 and mortality. 22 In Portugal, data on the factors associated with polymedication are scarce. ...
Population aging is a reality resulting in polymedication and its harmful consequences. Therefore, determining polymedication state in Portugal and identifying its associated characteristics is vital.
Methods:
Among the cross-sectional study Nutrition UP 65, information on socio-demographic data, cognitive performance, lifestyle, health, and nutritional status was collected in the Portuguese older population. Frequency of polymedication (self-reported concomitant administration of ≥5 medications and/or supplements) was calculated. Associated factors were determined.
Results:
A total of 1317 individuals were included in the sample and the frequency of polymedication was 37.1%. Characteristics associated with higher odds of polymedication were living in an institution (OR: 1.97; CI: 1.04-3.73); being overweight (OR: 1.52; CI: 1.03-2.25) or obese (OR: 1.57; CI: 1.06-2.34); perceiving health status as reasonable (OR: 1.68; CI: 1.25-2.27) or bad/very bad (OR: 2.04; CI: 1.37-3.03); having illnesses of the circulatory system (OR: 2.91; CI: 2.14-3.94) or endocrine, metabolic, and nutritional diseases (OR: 1.79; CI: 1.38-2.31).
Conclusions:
A 3 to 4 out of 10 Portuguese older adults are polymedicated. Intervention in modifiable factors and the monitorization of others is an important strategy in the care of the elderly.
... The prevalence rates in our study are very comparable with the found results in literature in community dwelling elderly. One should expect a higher prevalence rate of sarcopenia in nursing home elderly due to the higher age, higher malnutrition rate (15,16) and higher functional dependency compared with community dwelling elderly (17,18). This can be due to the relatively healthy elderly population in our study (as stated above). ...
... The association between xerostomia and malnutrition has been investigated mainly in the elderly; however, studies show contradicting results. [16][17][18] To our knowledge, the association between nutritional status and the number of prescribed medications or their nutritional-related side-effects has not yet been investigated in patients with CKD. The study aimed to describe the prescribed medications in patients at different stages of treatment of CKD and to investigate the association of prescribed medications and nutritional status. ...
Background
Chronic kidney disease (CKD) is associated with metabolic, nutritional, and extra-renal changes, as well as a high rate of comorbidities, which necessitates the prescription of numerous medications. Patients with CKD often experience poor nutritional status related to disease severity and prescribed medication; however, this association has not been investigated in depth. Therefore, this study aimed at investigating the association between prescribed medication and the nutritional status in patients with CKD.
Methods
Assessment of nutritional status was performed using anthropometric and functional measurements and by biochemical measures. Patient history, the number and type of currently prescribed medications were collected from patients’ records. We evaluated the total number and the number of specific medicines with common or very common side-effects of nausea or xerostomia.
Results
217 patients with CKD were included in this cross-sectional study (n=112 pre-dialysis CKD stages 3-5, n=33 hemodialysis, n=72 kidney transplant). On average, patients were prescribed nine medications concurrently. The number of prescribed medications was inversely associated with mid-upper arm circumference, skinfold thickness triceps, handgrip strength, serum albumin, and hemoglobin after adjustment for age, sex, and kidney function. Prescription of medications with nausea as a side-effect showed similar associations, while medications with xerostomia as a side-effect was associated with lower handgrip strength.
Conclusion
Medication prescription was associated with poor nutritional status in CKD patients, and monitoring of nutritional status in CKD patients with long medication lists is warranted to identify and treat patients with poor nutritional status.
... Another study showed that BMI, hemoglobin, blood sugar, serum albumin, and vitamin B 12 levels were significantly lower among older people compared to their middle-aged counterparts [49]. Malnutrition in older people is reported to be a consequence of inadequate food intake, underlying diseases, and economic vulnerability [56][57][58]. A variety of psychological and social factors are also responsible for malnutrition in older people [59]. ...
Background:
Bangladesh has experienced remarkable transformation in demographic, health and nutritional status of the population. The changes have exposed the population to a number of challenges the detrimental effect of which on health and nutrition of the people is likely to be increased by the COVID-19 pandemic.
Objective:
To provide an overview of health and nutritional challenges in Bangladesh in relation to demographic transition and COVID-19 pandemic.
Methods:
We identified and reviewed recent reports, published articles and pertinent grey literature on nutrition and food security in Bangladesh to provide historical and contextual information.
Results:
The review identifies the progress as well as existing burden regarding nutrition and food security in Bangladesh and highlights the challenges in coming days in regard to population growth and COVID-19 pandemic. The country is on track in reducing all forms of childhood undernutrition, while the proportion of nutrition related non-communicable diseases are on a rise owing to changes in dietary intake, low physical activity and sedentary lifestyle.
Conclusion:
Despite remarkable progress, health and nutritional status of the population in Bangladesh faces challenges, particularly in relation to demographic transition and compounded by the COVID-19 pandemic which require concerted attention from the policymakers as well as stakeholders.
... Kronik hastalıkların artışı beraberinde ilaç kullanımının artışını getirir, bu da pek çok yan etki nedeniyle malnutrisyon riskinin artışına katkıda bulunur (19). Griep ve arkadaşlarının, 61 yaş ve üzerinde, 81 kişiyi dâhil ettikleri çalışmalarında, kullanılan ilaç sayısı ile MNA skoru arasında negatif korelasyon olduğunu ve kullanılan ilaç sayısının, MNA skorunun kestiricisi olduğu gözlenmiştir (20). Bizim çalışmamızda MNA skoru ile kullanılan ilaç sayısı arasında anlamlı bir korelasyon bulunmadı. ...
... A pesar de no haberse incluido un índice de pobreza en el estudio, para conocer los ingresos de los adultos mayores, sí pudimos corroborar que la percepción de no tener suficiente dinero para vivir se correlacionó con riesgo nutricional, factor ya descrito por otros autores (13). La presencia de comorbilidades predispone a riesgo nutricional (10,12,(14)(15)(16), sin embargo, en este estudio no se pudo establecer dicha asociación, como tampoco lo fue la presencia de polifarmacia en nuestros adultos mayores. No hubo diferencias en el sexo que predispusieran a riesgo, a diferencia de lo encontrado por otros autores (17)(18)(19). ...
RESUMEN El riesgo nutricional es la potencialidad de desarrollar desnutrición por déficit de alimentación, debido a diversos factores. La prevalencia del riesgo nutricional en adultos mayores utilizando la Valoración Nutricional Mínima (MNA®) en Europa y Estados Unidos es de un 15 % y 20 %. El estudio SABE-México, determinó un 31,8 %. Objetivo: Conocer la prevalencia de riesgo nutricional y sus principales factores asociados en los adultos mayores que asisten a un primer nivel de atención en Costa Rica. Metodología: Diseño transversal, descriptivo, de tipo prevalencia. Se realizó muestreo al azar de 100 pacientes. Se llevó a cabo una entrevista, historia geriátrica completa, mediciones antropométricas, y la Valoración Mínima Nutricional (MNA). La información se procesó en el programa SPSS v17.Se utilizó la prueba de t Student para comparar las diferencias entre variables y una regresión logística con todas las variables.. Resultados: Total de 100 pacientes, el 39 % fueron hombres, y el 61% restante mujeres. La edad promedio fue 76,4 años, con una máxima de 97 años. La prevalencia de riesgo nutricional fue 34 % (IC 95 %: 24,2-43,8). Los resultados de la regresión logística mostraron que la pérdida de apetito, el riesgo de depresión y un IMC igual o menor a 23, mostraron fuerte asociación con riesgo nutricional. Conclusiones: La prevalencia de riesgo nutricional fue inferior a lo reportado en estudios europeos, pero similar a lo documentado en estudios latinoamericanos. Los factores relacionados encontrados podrían ser variables utilizables en instrumentos de detección de riesgo nutricional para ser aplicables a nivel nacional. ABSTRACT Nutritional risk is the potential of developing malnutrition by the lack of food, due to various factors. The prevalence of nutritional risk in older adults using the minimum nutritional assessment (MNA®) in Europe and the United States is 15 % and 20 %. The SABE study in Mexico, determined a 31,8 % Objective: to know the prevalence of nutritional risk and its main factors in older adults who attend a first level of care in Costa Rica. Methodology: Study design is transverse, descriptive, prevalence type. 100 patients obtained by random sampling. An interview was conducted; complete geriatric history, anthropometric measurements, and the minimum nutritional assessment (MNA). Statistical package (SPSS v. 17). T Student to compare the differences in the variables. Logistic regression with all the variables. Results: Total of 100 patients, 39 % were men, and the remaining 61% women. The average age was 76,4 years, with a high of 97 years. The prevalence of nutritional risk was 34 % (95 % C.I.: 24,2-43,8). The results of logistic regression showed that loss of appetite, the risk of depression and a BMI equal to or less than 23, showed strong association with nutritional risk. Conclusions: The prevalence of nutritional risk was lower than reported in European studies, but similar as documented in the Latin American studies. The related factors obtain in this study could served as usable variables in nutritional risk detection instruments to be applicable at the national level.
... Scientific evidence is showing that the use of multiple drugs is one of the clearest evidence of malnutrition in the elderly [96,97]. ...
Advances in medicine and lifestyle changes have had positive effects on the life expectancy of the population, therefore it is important to achieve healthy aging by reducing the risk factors that cause age-related damage and diseases. With a healthy diet we are able to modify these factors by modulating the intestinal microbiota. A diet rich in antioxidants, fiber, minerals and low in fat, provides beneficial effects on the body by interacting with intestinal bacteria and contributing to the maintenance of good health, moreover, with the prevention of age-related diseases such as diabetes and cardiovascular diseases .
... Similar to our study, they also used the MNA form in their study, which involved 294 older people. A study made with the elderly living in retirement homes found that as the number of drugs used increased the scores obtained from the MNA test decreased (Griep, Mets, Collys, Ponjaert-Kristoffersen, & Massart, 2000). Heuberger et al. found in their survey study that medications used more frequently and in larger quantities had a statistically significant negative effect on nutritional status (Heuberger & Caudell, 2011). ...
Background: To investigate the association of polypharmacy with physical function, nutritional status, and depression in the elderly.
Method: The study included 675 people aged over 65 years from 8 centers in various geographical regions. The polypharmacy status was categorized as non-polypharmacy (0–4 drugs), polypharmacy (≥5 drugs). The subjects’ physical function was assessed based on their “physical activity levels, Holden ambulation scores, gait speeds, and hand grip strengths”; their nutritional status based on the “Mini Nutritional Assessment (MNA)”; and their psychological status based on the “Center for Epidemiologic Studies Depression Scale -CES-D”.
Results: The presence of polypharmacy in this population was found to be 30% (n = 203). A statistically significant difference was found between the groups on the level of physical activity, Holden ambulation score, and nutrition status (p < .05). There was a statistically significant difference between the groups also on hand grip strength, MNA score, Charlson score (p < .05).
Conclusion: Polypharmacy was observed to have a significant association with physical function, nutrition, and depression in the elderly aged ≥ 65 years.
... Consuming fruits and vegetables that can be bought at reasonable prices in their respective season and then dried, particularly in the winter, can be recommended as an alternative solution to the economic vulnerability among the elderly. Many older adults have financial problems when they retire, which negatively affects their eating habits (70,71). Fresh fruits and vegetables or most of the foods that we consume daily are wasted because we cannot store them for long. ...
Several studies have shown that dietary factors play a role in the development and course of chronic diseases. In modern societies, we now observe a transition from a diet mainly comprising fruits and vegetables that are rich in fibres, micronutrients and antioxidants by way of which we have survived due to the adaptation mechanisms we have developed for centuries to a diet that is high in calories but poor in fibres and vitamins. Finding rational solutions to the problem of expanding elderly population would only be possible with a holistic and proactive approach. In this review, we aimed to investigate the positive effect of the long-term use of dried fruits and vegetables, which are as old as the history of mankind, on various pathologic processes that occur as a result of ageing in conjunction with the available studies.Keywords: Aged, vegetables, fruit, diet, vitamins, micronutrient
(DOI: 10.4274/ejgg.galenos.2020.280)
... Being far from family can provide ground for physical and mental diseases, so that married people compared to divorced people, and also those elderly living with their families compared to those living alone visited physicians and/or were hospitalized less; this finding indicates the positive impact of family members relationship on quality of life (48). Elderly residing in elderly homes compared to those living in their own homes are more vulnerable in terms of nutritional disorders (46,49,50). By entering elderhood the rate of disabilities is gradually increasing, therefore, the prevalence of movement restrictions at 76 yr of age and above reach even to 50% which these restrictions, in turn, cause the dependency of elderly (31) and them with increasing movement disabilities, the likelihood of transferring elderly to elderly homes and care centers increases (51). ...
Background
The elderly population following the improvement in health status and life expectancy in developing countries is increasing. Malnutrition causes decreased quality of life and increased mortality in elderly. This study aimed to review systematically and meta-analysis of studies assessing the prevalence of malnutrition among Iranian elderly people over 60 yr of age using Mini Nutritional Assessment (MNA).
Methods
This systematic review and meta-analysis was conducted in 2016 to estimate the overall malnutrition prevalence. Data were collected using the following keywords: prevalence, elderly, aging, malnutrition, nutrition, nutritional assessment, nutritional status, health status, mini nutritional assessment, MNA and Iran in PubMed, Scopus, Google Scholar, Iranmedex, Magiran, and SID. Computer software CMA: Two were applied to estimate the overall prevalence of malnutrition.
Results
Seventeen of 811 articles were included in our analyses. The overall estimated prevalence of malnutrition among elderly based on the random effect model was 12.2% (95% CI 8–18.5). In subgroups, the prevalence of malnutrition among elderly living in home based on the fixed effect model was 9.2% (95% CI 7.1–11.9) and prevalence of malnutrition among elderly residents of nursing homes based on the random effect model was 21.6% (95% CI 12–38.6).
Conclusion
Given the increase in the elderly population in future and the prevalence rate of malnutrition among them as well as the higher prevalence of malnutrition in elderly care centers, more attention to this population group is a matter of necessity.
... Additionally, in most of these studies subjects were institutionalized older adults. Similar with this study our data support the hypothesis that existing number of natural, non-decayed teeth are not determinants of nutritional status (17,18). The finding that more than onethird of older adults in our study was edentulous supports the consideration that oral health status may be related with malnutrition but tremendous number of older adults with worst oral health condition prevented us to make this discrimination. ...
... The ability to eat certain foods is related to the presence and distribution of natural teeth that affects nutrient intakes and nutritional status of elderly [30]. A study illustrated that the loss of natural teeth and wearing of dentures are associated with the increased risk of malnutrition [31]. These oral problems consequently affect nutritional status and cause involuntary weight loss among community dwelling elderly [22] and also increases the risk of general health problems [32]. ...
... Several studies reported independent relationships between excessive polypharmacy and declined nutritional status, functionality, and cognitive capacity [41][42][43]. Griep et al. [44] found an independent association between polypharmacy and malnutrition (using the MNA-SF) in older retirement home residents. Weight loss which is one component of the MNA-SF, has also been reported to be related with polypharmacy [45]. ...
Background/aim
Polypharmacy and inappropriate medication use in older adults is a major public health problem associated with morbidity and mortality. Aging is associated with metabolic changes and decreased drug clearance, increased drug–drug interactions, prescribing cascades, and potentially inappropriate medication (PIM) use. The purpose of this study was to evaluate the association between a common geriatric syndromes and PIM use among older adults.
Methods
Study participants were recruited among patients admitted to Istanbul Medical School Geriatrics outpatient clinic between June 2000 and June 2014 and were evaluated retrospectively by a geriatrician using the patients’ records according to Beers 2012 criteria.
Results
Among the 667 enrolled patients, 421 (63.1%) were women and 246 (36.9%) were men. The use of PIM was not associated with age or sex. Polypharmacy (OR 4.86, 95% CI 3.25–7.27, p < 0.001), malnutrition (OR 2.69, 95% CI 1.52–4.76, p = 0.001), depression (OR 2.61, 95% CI 1.7–3.95, p < 0.001), presence of fall in the previous year (OR 2.24, 95% CI 1.51–3.32, p < 0.001), and dementia (OR 1.69, 95% CI 1.08–2.65, p = 0.021) were independently associated with the use of PIM.
Discussion/conclusions
The results of our study suggest that PIM use is independently associated with presence of polypharmacy, malnutrition, depression, falls and dementia in older outpatients. Identifying the association of inappropriate medication use with common geriatric syndromes in older people can help to prevent, delay, and reduce PIM use and related adverse health outcomes.
... Denture wearing was requested also on a three-point scale-"no", "partial dentures" or "full denture"-again scored 1-3, respectively, where higher scores reflect greater disadvantage. Denture wearing is directly related to eating abilities and has been associated with greater risk of frailty and malnutrition [58,59]. All participants were also asked about the frequency with which they ate out or away from home and had food delivered, but these questions were thought to be too ambiguous for use as measures of physical disadvantage. ...
Many factors impact on eating behaviour and nutritional status in older adults. Strategies can be suggested to combat the impact of these factors, including the development of novel food products, but food neophobia (“the reluctance to eat and/or avoidance of novel foods”) may be a barrier to the acceptance of these foods/products. This work aimed to investigate associations between food neophobia, physical disadvantage, and demographic characteristics in adults over 55 years old. Cross-sectional data from 377 older adults was analysed for relationships between food neophobia scores and physical disadvantage (denture wearing, help with food shopping and/or preparing, and risk of sarcopenia), controlling for age group, gender, living status, education, and employment level. Initial analyses demonstrated higher food neophobia scores in association with denture wearing (Beta = 0.186, p = 0.001). However, when demographic characteristics were also considered, food neophobia scores were no longer related to denture wearing (Beta = 0.069, p = 0.226) but instead were related to a higher age, living alone, and a shorter education (smallest Beta = −0.104, p = 0.048). Food neophobia may thus act as a barrier to the consumption of novel foods/products in those who are of higher age, are living alone, and have a shorter education.
... L'existence d'une déficience masticatoire entraîne une restriction du régime alimentaire avec une sélection d'aliments plus faciles à mastiquer qui, à son tour, sera responsable d'un déséquilibre nutritionnel [128,129]. ...
La nutrition, marqueur du pronostic de morbidité et de mortalité s'impose comme l'un des déterminants majeur d'une vieillesse réussie.La cavité buccale, première étape de la digestion, joue un rôle déterminant dans lemaintien d'une bonne alimentation. La santé bucco-dentaire, outre son rôle joué dans l'alimentation, permet de faciliter les relations sociales, la communication, l'esthétique,l'estime et l'image de soi.Notre travail, réalisé auprès de sujets âgés indépendants résidant en foyer logements, a eu pour but de montrer l'existence d'une corrélation entre le mauvais état bucco-dentaire et les habitudes alimentaires nuisibles à une bonne nutrition.Cette étude montre qu'il est important d'essayer de conserver le plus longtempspossible les dents naturelles de la personne âgée, sinon de réaliser un remplacement prothétique adéquat pour maintenir des comportements alimentaires conformes au maintien d'un bon statut nutritionnel.Ainsi, il est nécessaire de mettre en place une information, une prévention et desactions sur l'hygiène et les soins bucco-dento-prothétiques des personnes âgées àdomicile comme en institution afin de conserver un bon statut nutritionnel et une bonne santé générale.
... A pesar de no haberse incluido un índice de pobreza en el estudio, para conocer los ingresos de los adultos mayores, sí pudimos corroborar que la percepción de no tener suficiente dinero para vivir se correlacionó con riesgo nutricional, factor ya descrito por otros autores (13). La presencia de comorbilidades predispone a riesgo nutricional (10,12,(14)(15)(16), sin embargo, en este estudio no se pudo establecer dicha asociación, como tampoco lo fue la presencia de polifarmacia en nuestros adultos mayores. No hubo diferencias en el sexo que predispusieran a riesgo, a diferencia de lo encontrado por otros autores (17)(18)(19). ...
Nutritional risk is the potential of developing malnutrition by the lack of food, due to various factors. The prevalence of nutritional risk in older adults using the minimum nutritional assessment (MNA®) in Europe and the United States is 15 % and 20 %. The SABE study in Mexico, determined a 31,8 % Objective: to know the prevalence of nutritional risk and its main factors in older adults who attend a first level of care in Costa Rica. Methodology: Study design is transverse, descriptive, prevalence type. 100 patients obtained by random sampling. An interview was conducted; complete geriatric history, anthropometric measurements, and the minimum nutritional assessment (MNA). Statistical package (SPSS v. 17). T Student to compare the differences in the variables. Logistic regression with all the variables. Results: Total of 100 patients, 39 % were men, and the remaining 61% women. The average age was 76,4 years, with a high of 97 years. The prevalence of nutritional risk was 34 % (95 % C.I.: 24,2 - 43,8). The results of logistic regression showed that loss of appetite, the risk of depression and a BMI equal to or less than 23, showed strong association with nutritional risk. Conclusions: The prevalence of nutritional risk was lower than reported in European studies, but similar as documented in the Latin American studies. The related factors obtain in this study could served as usable variables in nutritional risk detection instruments to be applicable at the national level.
... In short, our results provide additional support for the idea that smell is critical for pleasurable social activity and happiness in life (Griep et al. 2000;Miwa et al. 2001;Temmel et al. 2002;Hummel and Nordin 2005). ...
Olfactory dysfunction is a common complaint among physician visits. Olfactory loss affects quality of life and impairs function
and activities of daily living. The purpose of our study was to assess the degree of odor identification associated with mental
health. Olfactory function was measured using the brief smell identification test. Depressive symptoms were measured by the
Center for Epidemiologic Studies Depression scale. Loneliness was assessed by the de Jong-Gierveld Loneliness Scale. Cognition
was measured by a battery of 19 cognitive tests. The frequency of olfactory dysfunction in our study was ~40%. Older subjects
had worse olfactory performance, as previously found. More loneliness was associated with worse odor identification. Similarly,
symptoms of depression were associated with worse olfaction (among men). Although better global cognitive function was strongly
associated with better odor identification, after controlling for multiple factors, the associations with depression and loneliness
were unchanged. Clinicians should assess these mental health conditions when treating older patients who present with olfactory
deficits.
... Selon une étude américaine (188), 12 % des personnes âgées prennent au moins 10 médicaments et plus par jour, et environ 50 % en prennent 5 ou plus. Or, l'un des facteurs de risque de la dénutrition le plus fréquemment retrouvé dans la littérature est l'utilisation de plusieurs médicaments (104,107,117,121,131,134,158,189,190). L'excès de médicaments est associé à une perte de poids (191) De par leurs nombreux effets secondaires, les médicaments peuvent affecter le statut nutritionnel (193). ...
Peu de données ont été publiées sur le statut nutritionnel des personnes âgées vivant àdomicile. Le premier objectif de cette thèse était d’évaluer le statut nutritionnel de personnesâgées de 65 ans et plus vivant à domicile et les facteurs associés à cet état. Le second objectifde la thèse était d’étudier la survenue de plusieurs événements de santé en fonction du statutnutritionnel. Les données de deux cohortes prospectives incluant des personnes âgées de 65ans et plus (AMI, n=1002 et E3C, n=9294) ont été exploitées. Les résultats de cette thèsemontrent qu’une proportion non négligeable de personnes âgées vivant à domicile présente unstatut nutritionnel altéré. Les individus les plus concernés étaient les plus âgés, de genreféminin, veufs, de niveaux de revenus et scolaire faibles, déments, présentant unesymptomatologie dépressive et des incapacités aux activités de la vie quotidienne. Cesindividus avaient de moins bonnes habitudes alimentaires caractérisées par desconsommations faibles de poisson, légumes, fruits, et élevées de biscuits et viennoiseries. Unstatut nutritionnel altéré à l’inclusion était significativement associé à la survenue de diversévénements au cours des 12 ans de suivi: démence, chute, fracture, incapacités, incontinence,institutionnalisation et décès. L’ensemble de ces travaux montre qu’un état nutritionnel altéré,avant que la dénutrition ne soit installée, n’est pas rare chez les sujets âgés vivant à domicileet que cet état est associé à la survenue plus fréquente d’événements de santé graves. Cesrésultats plaident pour une détection plus active qu’actuellement de ces sujets à risque et pourune prise en charge adaptée.
... Drug treatment and polypharmacy may worsen nutritional status, most commonly as a manifestation of adverse drug effects [12][13][14]. Several studies have shown an inverse association between the number of drugs and nutritional status [15][16][17]. In particular, a recent crosssectional study performed among community-dwelling elderly aged 65 or older found a significant reduction in the intake of fiber, several fat -soluble vitamins (A,D, E) and water-soluble vitamins (B1, B3 and B7) and an increased intake of glucose, sodium, and dietary cholesterol with increasing number of drugs used. ...
The aging process is characterized by a high level of complexity with a progressive decline in several physiological systems coexisting with multiple chronic diseases (comorbidity), presence of cognitive and functional impairment and geriatric syndromes. Use of multiple drugs and problems in nutritional status are relevant components of this complex spectrum. Nutritional status may influence the pharmacokinetic and pharmacodynamic of many drugs, conversely drugs can impair nutrition by causing adverse drug reactions such as nausea and loss of appetite. The present article describes potential interactions between nutritional status and drug use in the elderly. The role of nutritional status in the pharmacokinetic of drugs (including absorption, distribution, metabolism and elimination) is reviewed and most relevant food drugs interactions are assessed. Malnutrition and nutritional problems are common conditions in older adults. Multiple chronic disease, inflammation, cognitive and functional impairment, geriatric syndromes (including delirium, falls or chronic pain) and drug use (i.e. polypharmacy, adverse drug reactions) may play a role in the onset of malnutrition and nutritional problems. In particular, drugs and nutrition are closely connected. Nutritional status may influence the pharmacokinetic and pharmacodynamic of many drugs, conversely, drugs can impair nutrition by causing adverse drug reactions such as nausea and loss of appetite. The present article will assess potential interactions between nutritional status and drug use in the elderly.
A healthy diet is essential to maintaining dental health.
Improving the patients' nutritional health requires both
dietary advice and replacement of lost teeth. Dietary
advice cannot be provided due to time constraints or
dentists' lack of nutritional counseling skills. Since
primary care physicians see most older patients, it is
wise for them to acknowledge the importance of oral
health in the elderly and recommend that patients with
dental issues see a dentist. Undergraduate clinical
training should require nutritional assessments, dietary
counseling, and follow-up, along with the creation of a
uniform methodology for the same. To guarantee
complete healthcare, dietetics, dentistry, medicine, and
allied health professions must work together on research,
teaching, and defining practice responsibilities for the
benefit of geriatric denture wearers
Objectives
To investigate the relationship between malnutrition and potential contributing factors such as poor oral health, dysphagia and mortality among older people in short‐term care.
Methods
This cross‐sectional study is a part of the multidisciplinary multicentre project SOFIA (Swallowing function, Oral health and Food Intake in old Age), which includes older people (≥65 years) in 36 short‐term care units in five regions of Sweden. Nutritional status was measured with version II of the Minimal Eating Observation and Nutrition Form (MEONF‐II), oral health with the Revised Oral Assessment Guide (ROAG), dysphagia with a water swallow test, and the mortality rate was followed for 1 year. Data were analysed using descriptive analysis and logistic regression models to calculate odds ratios for the association between malnutrition and these factors.
Results
Among the 391 participants, the median age was 84 years and 53.3% were women. Mortality rate was 25.1% within 1 year in the total group, and was higher among malnourished participants than among their well‐nourished counterparts. Severe dysphagia (OR: 6.51, 95% CI: 2.40–17.68), poor oral health (OR: 5.73, 95% CI: 2.33–14.09) and female gender (OR: 2.2, 95% CI: 1.24–3.93) were independently associated with malnutrition.
Conclusion
Mortality rate was higher among malnourished people than those who were well nourished. Severe dysphagia, poor oral health and female gender was predictors of malnutrition among older people in short‐term care. These health risks should be given more attention in short‐term care with early identification.
Older patients are prone to multimorbidity or related polypharmacy, which may cause various adverse drug reactions (ADRs) and a high incidence of drug-related health problems. Although not often noted, ADRs include nutrition-related adverse reactions. Aging, multiple illnesses, mental and psychological problems, declining physical function, and environmental factors can lead to decreased food intake and increased metabolic stress in older people, resulting in energy imbalances that cause malnutrition. ADRs can lead to appetite loss, followed by decreased food intake, which in turn causes malnutrition and deficiencies of various nutrients. However, these nutrition-related ADRs have received less attention. This review article describes drug-nutrition interactions, with a particular focus on older patients. Geriatr Gerontol Int 2023; ••: ••-••.
The goal of this paper was to explore the feeding practices and food types of the elderly in Edo Central Nigeria in Edo Central Nigeria. It focused on the main meals; revealed the provision/payment and cooking/preparation of food/meals for the elderly; and the food types and number of intakes. among others. Five hundred and forty elderly persons were selected by systematic random sampling and a total of 514 subjects aged 65 years and above completed the face to face interview administered with a questionnaire. A low consumption of fresh fruits and vegetables (the main source of vitamin C) that put the majority of the elderly at risk of poor nutritional habit was observed; the poor nutritional habit of consuming less than three main meals a day was more among elderly males than females; elderly males than elderly females were identified with one of the factors associated with poor nutritional status namely. the inability to provide and cook own food; and as people grow older they become more at risk of poor nutritional habit. It is recommended that caregivers and relatives of old people should improve on the feeding of the elderly through nutritional education.
Objectives
Using both clinical parameters and subjective measures of oral health, this study aimed to identify useful oral health indicators for the risk of malnutrition in elders. DesignCross-sectional study. SettingFive community centers run by non-government organizations (NGOs). Participants195 community dwelling elders (65 or above). MeasurementsAn interviewer-administered questionnaire was completed to collect information on elders’ socio-demographic background and oral health perception and practice. Their number of teeth, number of occluding tooth pairs, dental caries, and periodontal condition were examined. General Oral Health Assessment Index (GOHAI), an instrument for assessing oral health related quality of life (OHQoL), was used as a subjective measure of oral health. The elders’ nutritional status was evaluated by using the Mini-Nutritional Assessment (MNA). ResultsThe mean (SD) DFT was 3.3 (3.1). Over 60% of elders had periodontal pockets; 33% had fewer than 20 teeth and 6% were edentulous. The mean (SD) of occluding tooth pairs was 7.1 (4.8). The mean (SD) total GOHAI score was 56.4 (8.0); 60% reported negative impact of oral health on their quality of life. The mean (SD) MNA score was 25.0 (2.9); 30% had malnutrition or were at risk. After controlling for socio-demographic factors, none of the clinical indicators (dental caries, periodontal status, number of teeth, and number of occluding tooth pairs) were associated with risk of malnutrition (all p>0.05). Poorer OHQoL indicated a higher chance for malnutrition in both adjusted models (OR of 0.914; 95% CI of 0.850-0.982; p=0.014 and OR of 0.915; 95% CI of 0.852-0.984; p=0.017). Tooth loss and untreated decayed teeth (DT) were significant/marginally significant determinants of poor OHQoL. Conclusion
Elders’ tooth loss and unmet treatment need for dental caries were associated with compromised quality of life, which indicated increased likelihood for malnutrition..
The aim of dietary guidance specifically targeted for older adults is to maintain optimal health and forestall the onset of chronic disease. The actual dietary recommendations, for the most part, are consistent throughout the adult lifecycle. Diet quality can have an important effect on the ability to perform activities of daily life and survival rates. Due to lower levels of physical activity, decreased metabolic rates secondary to increased proportions of fat to lean muscle mass, energy requirements decline with advancing years yet nutrient requirements remain unchanged, or in some cases increase. This situation requires a greater emphasis on choosing nutrient-dense foods within each food category. With advancing years, special attention needs to be given to adapting living environments to retain the ability to acquire and prepare food. Changes in social situations that could impact on food intake should be monitored on a regular basis. Evidence suggests that diet and lifestyle interventions can forestall the onset of cardiovascular disease, osteoporosis, diabetes, hypertension, decline in immune function, and possibly some cancers. There are no data to suggest a person is too old to benefit from improvements in diet quality. The definitions of “old age” are changing, and expectations for the period of time individuals can remain active, productive, and live independently are expanding. Efforts towards improving diet quality and levels of physical activity as individuals get older should keep up with this trend.
The frailty syndrome is an ever-growing area of study among older adults because of its association with an increased risk of falls, hospitalization, institutionalization, dependency and mortality. Frailty is neither a disease nor a disability but is better understood as a medical syndrome of multisystem dysregulation that results in a diminished ability to overcome everyday stressors. The prevalence of frailty in any given population can vary widely, in part because of the way in which it is defined and measured, but in general it is higher among women and in those with advanced age and declining health. Whilst it is largely understood that older adults will differ biologically, psychologically and socially, and that each of these domains can impact oral health, we are only beginning to investigate how the mouth is affected in frailty. Given that both hard and soft structures contribute to oral health and disease status among older adults with varying degrees of impairment and disability, frailty adds yet another dimension to be considered. This paper will discuss how frailty can influence and be influenced by oral disorders, as well as the potential relationship to oral neglect and the resultant consequences among this vulnerable population.
Benzodiazepines are used for a variety of indications. Age-related changes in the pharmacokinetics and pharmacodynamics of benzodiazepines place older people at increased risk for side effects. Decreased hepatic blood flow, albumin level, lean body mass, and an increased elimination half-life of active metabolites all play a role. These drugs can result in excessive sedation, cognitive impairment, delirium, agitation, and balance problems leading to falls and fractures. Consistent adverse effects related to benzodiazepine use have been reported in the community, in nursing homes, and in hospitals. Guidelines for rational use of benzodiazepines in older individuals should be followed. If needed, short-term treatment (i.e. less than 4 weeks for insomnia) might be considered using an intermediate-acting benzodiazepine. Patients should be clearly informed of the risk of falls when using these drugs. Long-term prescribing should be avoided. Benzodiazepine withdrawal strategies should be proposed to chronic users with proper psychological support and a drug tapering schedule adjusted to the patient’s individual needs.
Polypharmacy is common among older adults, largely due to the need to treat the increasing number of diseases that present as a person ages. However, multiple medication use can lead to serious consequences such as adverse drug events and also contribute to geriatric syndromes. A number of strategies have been evaluated in an effort to improve polypharmacy. While such strategies consistently demonstrate significant reductions in inappropriate medication prescribing, their impact on clinical outcomes is equivocal. More research is needed to identify the most effective interventions to optimize medication use in the older population.
The present systematic review critically examines the available scientific literature on risk factors for malnutrition in the older population (aged ≥65 y). A systematic search was conducted in MEDLINE, reviewing reference lists from 2000 until March 2015. The 2499 papers identified were subjected to inclusion criteria that evaluated the study quality according to items from validated guidelines. Only papers that provided information on a variable's effect on the development of malnutrition, which requires longitudinal data, were included. A total of 6 longitudinal studies met the inclusion criteria and were included in the systematic review. These studies reported the following significant risk factors for malnutrition: age (OR: 1.038; P = 0.045), frailty in institutionalized persons (β: 0.22; P = 0.036), excessive polypharmacy (β:20.62; P = 0.001), general health decline including physical function (OR: 1.793; P = 0.008), Parkinson disease (OR: 2.450; P = 0.047), constipation (OR: 2.490; P = 0.015), poor (OR: 3.30; P value not given) or moderate (β: 20.27; P = 0.016) self-reported health status, cognitive decline (OR: 1.844; P = 0.001), dementia (OR: 2.139; P = 0.001), eating dependencies (OR: 2.257; P = 0.001), loss of interest in life (β: 20.58; P = 0.017), poor appetite (β: 21.52; P = 0.000), basal oral dysphagia (OR: 2.72; P = 0.010), signs of impaired efficacy of swallowing (OR: 2.73; P = 0.015), and institutionalization (β: 21.89; P < 0.001). These risk factors for malnutrition in older adults may be considered by health care professionals when developing new integrated assessment instruments to identify older adults' risk of malnutrition and to support the development of preventive and treatment strategies.
Evidence suggests that there is a direct relationship between the nutrient quality of the diet and survival rates. Due to decreased levels of physical activity, decreased metabolic rates, and increased proportions of fat to lean muscle mass, energy requirements decline with advancing years yet nutrient requirements remain either unchanged or increased. Hence, a greater emphasis should be placed on choosing nutrient dense foods. Attention also needs to be placed on monitoring nutrient supplement use in older adults to avoid overconsumption. Current data suggest those who are more likely to report using nutrient supplements have dietary and lifestyle characteristics that are more closely associated with lower rather than higher risk for nutrient insufficiency. Special attention needs to be given to adapting living environments for older adults to enable them to retain the ability to acquire and prepare familiar foods that are appealing. Changes in social situations that could impact on food intake should be monitored on a regular basis. The definitions for old age and expectations for the period of time individuals can remain active, productive, and independent are expanding. There is no data to suggest a person is too old to benefit from improvements in diet quality and physical activity.
The World Health Organization (WHO) European Region includes 52 member states with 879 million people.1 It covers a wide spectrum of cultures and societies with different ethnic and religious backgrounds, different economic and health situations. During the last decades, in many of these countries changes in health status and disease patterns occurred with increasing economic wealth, followed by demographic changes. Life expectancy, for example, increased in the 25 countries of today’s European Union (EU-25) by nearly 3 years during the last 10 decades. In 2002, it amounted to 75 years for men and 81 years for women, and thus was higher than that in the U.S. but lower than that in Japan or Canada.2 The proportion of people age 65 years or older also increased and is expected to double between 1995 and 2050. It presently ranges from 11% in Ireland and Slowakia to 19% in Italy and Greece and is anticipated to be more than 20% in 2015 in Italy, Greece, Germany, Finland, and Sweden. In the EU-25 more than 86 million people and in the WHO European Region more than 135 million people will then be older than 65 years.
The nurse has a key role in the field of nutrition, especially in monitoring the composition of the diets. The objectives of this study were to describe the type of patient who carries a pulverized diet and analyze the influence of diet on nutritional status crushed. This is a cross-sectional study with people 65 years or older and who attended medical centres in the city of Lleida. The descriptive study was conducted through the test X 2. The comparison between the dependent variable and the average of the total value of the test Mini Nutritional Assessment (MNA) and other nutritional data was analyzed by Student's t-test. We concluded that people who needed diet were crushed worse than those fed a normal diet required.
Objective. To assess oral and nutritional condition in nursing home residents and their relationships looking for the potential role of a dental hygienist in the nursing home at least as consultant. Methods. Seventy residents (50 F, 20 M) of a nursing home in Nomi (Prov. Trento) were randomly selected and assessed for malnutrition with Mini Nutritional Assessment; they were divided into three groups as far as their oral conditions were concerned: residents with own teeth (Group A), resident edentules without dentures (Group B), edentules with dentures (Group C). Results. 27.1% were malnourished, 55.7% at nutritional risk and 17.1% well nourished. Group A (natural teeth) consisted of 25 people, Group B (edentules without dentures) of 14, Group C (edentules with dentures) of 21. In group A teeth were 6.04 ± 6.17, of whom just 0.7 ± 3.4 normal with a % of plaque and tartar respectively 72.7 ± 16.7 and 74.3 ± 15.7%. In group B DFMT was obvioulsy 28 ± 0. In group C there was no partial denture, but in 12% there was a superior denture, in 80% there was a complete denture, just in 6% an inferior denture. In 70% of residents denture was not fit and often used just at meals. People wearing dentures showed % of plaque and tartar respectively 71.6 ± 17.4 and 63.3 ± 17.2%. Conclusions. Oral and nutritional conditions in nursing homes residents are not reassuring; even though it is out of doubt that teeth not proper make feeding much difficult, it was not possibile to show a relationship between bad dentition and malnutrition. The importance of a registred dental hygienist is stressed within a nursing home together with its unvaluable role in monitoring oral condition starting from admission in the setting with at least an annual planned revaluation.
Abnormal nutritional status (malnutrition) is a major clinical problem in the general population, and even more important in specific populations (children and elderly people). Unfortunately, prevalence of malnutrition is usually underestimated, its importance is often minimized, and the assessment overlooked in the routine examination of patients. The recommendations regarding the evaluation of nutritional status of hospitalized patients were introduced in Poland recently. Elderly population is one of the specific population at the highest risk of malnutrition. Among seniors the phenomenon of protein and energy deficiency (called protein-energy malnutrition, PEM) is observed. High incidence of malnutrition among seniors is a consequence of many factors. Some of them are general in nature, the other are typical of their age (including both biological and psychosocial factors). A long list of factors includes: processes of aging, loss of appetite, decreased sense of taste and/or odour, malabsorption, dental prosthetic, gastrointestinal diseases, systemic illness, medications, sensory deficits, altered level of activity and social changes for food preferences, physical condition and mental state. Malnutrition is frequent in demented patients and is associated with increased severity of neuropsychiatric symptoms (hallucinations, apathy, behaviour disorders, sleep disorders), worse prognosis, increased risk of nursing home placement and, consequently, an increase in mortality. In this context, it is essential to detect the improperly nourished cases. There is a wide array of diagnostic methods, ranging from simple screening instruments through very extensive questionnaires, to methods using specialized and expensive equipment (bioelectrical impedance analysis, dual X-ray absorptiometry).
Background
Disease-associated malnutrition (DAM) is a health problem involving all sanitary levels, especially hospitalised elderly patients. Different MNA (Mini Nutritional Assessment)-based forms have been validated in different settings, but it remains unclear if they are appropriate to evaluate the nutritional status of geriatric hospitalised patients with diabetes.
Objective
The aim of this work was to analyse the accuracy of several MNA reduced forms to detect malnutrition in hospitalised elderly diabetic patients. Methods: A multicentre observational study was carried out in diabetic patients, who were over the age of 65, from 35 Spanish hospitals. Principal component analysis (PCA) selected the minimal components to elaborate the newly-proposed reduced new version of the MNA (r-MNA). Cohen’s Kappa index (KI), with its 95% confidence interval (CI), was used to measure the agreement between the different reduced forms (r-MNA, MNA-SF-BMI, MNA-SF-CC, m-MNA) with the original MNA.
Results
Five hundred and ninety-one elderly diabetic patients were included in the study. ROC analysis determined the following cut-off points for the newly proposed r MNA: 0-< 10 “malnourished”, 10-12 “at risk” and > 12-15 “well-nourished”. The upper cut-off point demonstrated a sensitivity of 87.7%, a specificity of 78.3% and an area under the curve of 0.93. The lower cut-off point showed a sensitivity of 95.9%, a specificity of 78.3% and an area under the curve of 0.95. The best agreement with the original MNA was observed for the MNA-SF-BMI (K index 80.7; 95% CI: 77.4-84) and the worst for the r-MNA (K index 72; 95% CI: 68.2-75.4).
Conclusions
This study found that MNA-SF-BMI is the most accurate screening tool for determining the nutritional status of hospitalised diabetic elderly patients. This is an easy-to-use, fast screening tool with a low risk of misclassification.
Malnutrition screening should be performed among all nursing home (NH) residents. Malnutrition is frequent in NH and strongly associated with various adverse outcomes that can be prevented by early and personalized clinical intervention. Few tools have been designed specifically for the NH setting but a large number have been developed to screen malnutrition in the older people and can be used in NH. Follow-up of nutritional intake is an important task of the NH team and the first step of malnutrition screening. Residents should be weighed at least monthly and weekly in case of malnutrition. Based on the French national guidelines, diagnostic of malnutrition relies on one or several of the following criteria: weight loss (≥5% in the past month or ≥10% in the past 6 months), body mass index (BMI) below 21 kg/m2, albumin level below 35 g/l, Mini-Nutritional Assessment (MNA) score below 17/30. Normality of one item does not exclude the diagnosis of malnutrition especially among obese resident (BMI>30). Various other tools have been developed to screen malnutrition but none have demonstrated its superiority. The Simplify Nutritional Assessment Questionnaire (SNAQ) can predict residents at risk of clinically significant weight loss before malnutrition. Physicians and all the NH staff need to pay careful attention to weight loss and malnutrition in NH, look for its multiple causes and organize its personalized treatment.
Ce travail étudie le lien entre état nutritionnel et état bucco-dentaire (en particulier capacité fonctionnelle masticatoire). L�échantillon était constitué de 251 personnes (pour l�âge et le sexe selon la méthode des quotas de manière à être représentatif de la population française). Les antécédents médicaux, étaient relevées ainsi que de l�état bucco-dentaire.En regroupant les types d�édentements et de prothèses, on a pu définir les indicateurs suivants: capacité fonctionnelle masticatoire, gradient fonctionnel. L�état nutritionnel était apprécié grâce au BMI et au MNA. Les résultats essentiels sont: 1) la capacité fonctionnelle masticatoire protège de la dénutrition ou malnutrition (OR: 0.581; IC 95%: 0.941 � 0.359) 2) le gradient fonctionnel appréciant différemment cette capacité masticatoire est aussi protecteur.
La prise d�hypnotiques ou de tranquillisants constitue un facteur de risque. Dans ce travail est mis en évidence le lien entre capacité fonctionnelle masticatoire, réhabilitation prothétique.
Abstract:
Title: Functional assessment and quality of life in relation to health: implications for different social groups, age and morbidity.
Objective: The aim of this paper is to study the different forms of assessment of disease from the biological, physical, mental, functional, social and community as a comprehensive and positive assessment of health.
Material and Methods: We used four works with different approach: The first is a descriptive observational visits in a 1.496 primary care from 1996 to 1999 with a record of activity by the WONCA code. The second case, analysis of a series of cases (204 queries elderly), where variables are analyzed using the Mini Nutritional Assessment (MNA), analytical parameters (albumin, transferrin, lymphocytes and cholesterol) and functional status (Barthel and Lawton Index). The third work is descriptive and analytical in a population survey (7.341 people over 15 years) of the City of Madrid, using the questionnaire COOP / WONCA to assess the quality of life in relation to health, through a multivariate analysis model which considers the value of the Snedecor´s F as a measure. The fourth work is about case-control in a health survey population (1.074 people), the Health Survey of the City of Madrid, analyzing the self-perceived health status, level of health, mental health questionnaire with the GHQ -12 (more than 2 points, case) and quality of life with charts COOP / WONCA.
Results: The profile consultation of paperless immigrants, corresponds to a young South American woman (mean age 34.9 years) with common health problems: respiratory, depression and lower back, and also some important of infectious problems in the 7% (hepatitis and onychomycosis), with high absence of consultations (14% of citations).
The high prevalence of nutritional problems in older people attending the consultation of a geriatric center (44%) and significantly associated with loss of physical function (p <0.001).
The high prevalence of chronic disease in cities like Madrid (53% of those over 15 years), being the most common problems: hypertension, hypercholesterolemia, depression or anxiety, osteoporosis or varices. In terms of quality of life and taking into account the sociodemographic variables of age, sex, social class and presence of comorbidity, the most relevant problems are depression (F = 461.63),Arthrosis/ arthritis / rheumatism (F = 175.41) and Alzheimer´s disease (F = 65 , 70) for the total score, depression impacting each of the areas that make up the quality of life.
Significant difference in the worst perceived health of diabetics in the GHQ-12 score above 2 and poorer quality of life in diabetics, both in overall score and in most areas. The relationship with lack of exercise (p <0.001), obesity (p = 0.010) and depression (p = 0.010), are all factors that explain the worst quality of life in relation to health in most diabetics.
Conclusions: The knowledge of each situation and each community with its special features is key to understanding and assessing the health of individuals.
The clear association between functional loss and malnutrition in the elderly, nutritional assessment justifies the central axis of the quadruple Geriatric assessment.
Depression and rheumatic problems are two chronic conditions have greater impact on quality of life, so that strategies aimed at prevention, promotion and health education and allow for the reduction of morbidity from these disorders.
The worst perceived quality of life, self-perception of health status and mental health in diabetics, are explained in relevant by the absence of exercise, obesity and the presence of depression.
Considering the possible role of age-related phenomena such as general health, dental health and nutrition in odour perception, their joint effect on variability in odour perception was evaluated in the present study. A total of 171 apparently healthy adults with a mean age of 66.0 years (S.D. 7.3), ranging between 53 and 86 years, living in the community took part in this study. The SENIEUR protocol was used to assess the general health status and anthropometric measures were obtained to assess the nutritional status of the persons. The sensory detection threshold for isoamyl acetate was determined to measure odour perception. Oral examinations were used to assess dental status. Those in poor general health had lower mean values for odour perception than those in good or reasonably general health. Complete denture wearers and those with partial dentures had significantly lower values for odour perception than those with only natural teeth. Odour perception correlated significantly with measures of body fat and muscle mass, indicating that a poor sense of smell is associated with low body fat and muscle area. Our results indicate that general health and dental state are important age-associated factors in odour perception. Since odour perception is an important determinant of food consumption, early detection of diminished odour perception might be an indication of physical deterioration.
An experiment explored how well young, middle-aged, and elderly subjects could discriminate the presence or absence of the spice marjoram in a soup prepared according to a published recipe. Whereas most young made the discrimination at a level above chance, most middle-aged and elderly failed to. A clinical test that entails odor threshold and identification revealed that olfactory ability also diminished with age among these subjects. Furthermore, the odor thresholds measured in the test correlated significantly with the subjects' ability to discriminate flavor. Subsequent testing wherein subjects sought to discriminate flavor with their noses blocked confirmed that olfactory ability largely underlay the discrimination. The results emphasize that losses in olfaction measured most commonly with environmental odors are serious enough to have an impact on discrimination of flavors in everyday foods, even among persons of middle age. Loss of such discriminative capacity may entail risks of avoiding dangerous and overlooking beneficial ingredients in foods.
Revue generale du probleme de la consommation alimentaire et de la nutrition chez les personnes âgees. L'auteur fait le point sur la quantite des divers nutriments dans l'alimentation et critique certaines idees recues, met en evidence des domaines non explores et relie la nutrition des personnes âgees a divers facteurs. Enfin les supplementations en nutriments ont ete evaluees en vue de determiner leur impact sur la nutrition des personnes âgees
Odor perception plays an important role in nutrition. In the present study, the effect of aging and health status on detection
of food odors is shown and interrelations with nutritional status are explored. We have tested 26 healthy young (20–25 yrs)
and 23 elderly (61–74 yrs) subjects who were screened according to the SENIEUR protocol. Anthropometric measures and blood
samples provided 20 parameters of nutritional status. A validated measurement procedure under forced choice conditions was
used to quantify the detection thresholds of two food odors of which one had a trigeminal effect and the other mainly had
an olfactory effect. There is a significant declining sensitivity for both odors. Our observations indicate that a relation
between nutrition and odor perception in the elderly population exists. Whether olfactory deficits cause or are caused by
increased nutritional risk deserves further study.
Comprehensive oral health care is an essential feature of quality of life. In the near future, a greater number of elderly people will retain more natural teeth, whether or not supplemented by prosthetic provisions, and/or may be provided with implants. As a consequence, oral self-care will be much more demanding. Prevention must reduce the greater risk of oral disease for elderly people. Effective early intervention strategies are: promotion of over-all general health, obviation of stereotypes, education by dental hygienists, instruction and demonstration combined with systematic evaluation, use of a fluoride containing dentifrice, and regular professional support and use of chlorhexidine rinses for less well and confused elderly.
Oral malodor has many etiologies. The use of accurate descriptor terms to describe this condition facilitates its clinical diagnosis and treatment by health care professionals. Oral malodor, a generic descriptor term for foul smells emanating from the mouth, encompasses ozostomia, stromatodysodia, halitosis (both pathological halitosis and physiological halitosis) and fetor oris or fetor ex ore. These latter terms, in turn, denote different sources of oral malodor. The terms ozaena, fetor narium, dysosmia, hyperosmia, cacogeusia, and dysgeusia are also related to oral malodor, and assist in accurately describing a clinical presentation. Systemic pathological states, such as diabetes mellitus, uremia and hepatic diseases, induce metabolic products that are detectable as oral smells. Local oral conditions produce volatile sulphur compounds and other breakdown products that intensify oral malodors. The clinical labelling and interpretation of different oral malodors both contribute to the diagnosis and treatment of underlying disease. This article stresses the relationship between smell and taste, emphasizes specific meanings for related oral malodor terms, reviews smell comprehension and indicates some of those commonly-encountered associated clinical conditions.