ArticlePDF Available


Content may be subject to copyright.
Kucuk EO et al.
Konuralp Tıp Dergisi 2017;9(3):46-51
Emine Ozer Kucuk1
Sevgisun Kapucu2
1 Ankara Numune Hospital,
Health Technology Assessment
Unit, Ankara, Turkey
2 Hacettepe University Faculty
of Nursing, Department Of
Medical Nursing, Ankara,
Corresponding Address:
Sevgisun Kapucu,
Hacettepe University Faculty of
Nursing, Sıhhiye, 06100, Ankara
Tel: +90 312 3051880/124
Geliş Tarihi: 02.06.2017
Kabul Tarihi: 22.08.2016
DOI: 10.18521/ktd.318404
Konuralp Tıp Dergisi
Malnutrition in Elderly Staying in Nursing Homes
Aim: The aim of this study was to assess the prevalence of malnutrition of
elderly people in living either public or private nursing home.
Methods: The sample of this descriptive study was 308 elderly, who were living
in public and private homes for the elderly in Ankara. Data were collected by
using an interview form, the Mini-Nutritional Assessment (MNA), the
Standardized Mini-Mental Test (SMMT), and the Barthel index.
Result: 28.6% of the elderly staying in the nursing home suffered from
malnutrition and 44.5% of them were at risk for malnutrition. Furthermore,
27.3% of participants were found to have sensory losses, 53.6% had
gastrointestinal problems, and 40% had deficiencies in their oral and dental
health. Those suffering from gastrointestinal problems have a lower mean
nutritional score (MNA) (p<0.05).
Conclusion: Results of this study demonstrated a higher incidence of
malnutrition among the elderly people receiving care in public or private nursing
Keywords: Elderly, Malnutrition, Nursing Home, Nutrition.
Huzurevinde Kalan Yaşlılarda Malnutrisyon
Amaç: Bu çalışmanın amacı, kamu ya da özel huzurevinde yaşayan yaşlıların
malnutrisyon prevalansını değerlendirmektir.
Yöntem: Tanımlayıcı olarak yapılan çalışmada örneklemi Ankara ilinde bulunan
özel ve devlet huzurevlerinde kalan 308 yaşlı birey oluşturmaktadır. Veriler anket
formu, Mini Nutrisyonel Değerlendirme (MND), Standardize Mini Mental Test
(SMMT) ve Bartel İndeksi (Bİ) kullanılarak toplanmıştır.
Bulgular: Çalışma sonucunda, huzurevlerinde kalan yaşlılarda malnutrisyon
oranı %28.6, malnutrisyon riski oranı ise %44.5 bulundu. Ayrıca yaşlıların
%27.3’ünde duyu kayıpları, %53.6’sında gastrointestinal sorunlar ve %40’ında
ağız ve diş sağlığı sorunları saptanmıştır. Gastrointestinal sorunu olana yaşlıların
beslenme skorları (MNA) düşük çıkmıştır (p<0.05).
Sonuç: Bu çalışmanın sonucunda özel ve devlet huzurevinde kalan yaşlılarda
malnutrisyon oranının oldukça yüksek olduğu saptanmıştır.
Anahtar Kelimeler: Beslenme, Huzur Evi, Malnutrisyon, Yaşlı.
Kucuk EO et al.
Konuralp Tıp Dergisi 2017;9(3):46-51
Malnutrition is more commonly seen among
the elderly (1,2). The prevalence of malnutrition is
considerably higher (25-49%) of elderly people in
the world (1-5). The prevalence of malnutrition risk
was 28-53.6% and malnutrition frequency was 8-
15.9% among elderly people in Turkey (6-11). It is
a problem experienced by all elderly living in their
own house or staying in a care-giving institution
such as a nursing home or hospital that is
significant, common, and often late diagnosed.
Elderly face a higher risk of malnutrition because of
physical and physiological changes associated with
aging (12,13). The most fundamental cause of
malnutrition is insufficient nutrient consumption.
The second is the increase in the need for nutrients
due to fever, infection, or catabolic disorders.
Common physiological problems that affect the
nutritional status of elderly are sensory loss, poor
mouth and dental health, decreased appetite,
chewing problems and dependency on help for
eating. Among the psychological factors leading to
malnutrition are depression, dementia, alcoholism,
and loss of beloved individuals. Theliterature
showed that the social factors are poverty, living
alone, social isolation, lack of social support, lack
of ethnic food supply for those who live in care-
giving institutions, inability to buy or prepare
foods, and inability to feed oneself (14-16).
Malnutrition has negative effects on many
functions of the body. These include
cardiovascular, renal, respiratory, gastrointestinal,
immunity-related, and mental effects. Because of
all these effects, untreated malnutrition leads to a
higher rate of morbidity and mortality among the
elderly (17,18). Determining malnutrition and
malnutrition risk at early stages enables taking
precautions and initiating appropriate nutritional
support on time. By this way the rate of
complications of malnutrition can be reduced. And
nurses play the role of health care professional in
evaluating the nutritional status of elderly staying in
a nursing home. In this study, we evaluated
nutritional status for malnutrition of elderly staying
in either public or private nursing home.
Setting and sample: This is a descriptive
study that aims to examine the risk factors
associated with nutrition and malnutrition among
the elderly individuals staying in nursing homes.
The population of this research was 1554 elderly
individuals and above staying in a public elderly
care institution or a private nursing home, and the
sample consisted of 308 individuals who are living
seven nursing home (accepting research) from the
population. Using stratified random sampling, 56%
of the sample (173 individuals) was selected from
public care-giving institutions, while 44% (135
individuals) were selected from private nursing
The exclusion criteria were: 1- staying
temporarily or living in the institution for <3
months, 2- receiving supplements or tube feeding 3-
being in a terminal condition of health, 4- not
accepting to take part in this survey.
Instruments: The nutritional status of
participants was assessed using the Mini
Nutritional Assessment” test (MNA), their cognitive
status was assessed using the Standardized Mini-
Mental State Test (SMMT), and Mini-Mental
State Test for the Uneducated” (SMMT-E), and
their functional health status was assessed using the
Modified Barthel Index”.
The MNA full form test consists of 18 items
structured in 4 parts: anthropometric assessment
(weight loss, body mass index, mid-arm
circumference and calf circumference), global
assessment (mobility, prescription drugs,
independent life, psychological stress or acute
disease, pressure sores or skin ulcers and
neuropsychological problems), dietary assessment
(full meals eaten daily, food intake decline, fluid
consumption, protein intake, fruit and vegetable
intake and mode of feeding) and self-assessment
(self-view of nutritional status and self-view of
health status) (19).
SMMT, Molloy and Standish (1997) created
a standardized version of the Mini-Mental State
Examination (MMSE) developed by Folstein et al.
(1975) (20,21). The test is commonly used
especially to assess the cognitive status of elderly
individuals. The reliability and validity test of the
Turkish version of the scale was conducted by
Gungen et al. (2002) (22).
The Modified Barthel Index developed by
Mahoney and Barthel (1965) helps evaluate the
dependency status of individuals on help for taking
care of themselves (23). The validity and reliability
test of the Turkish version of the scale was
performed by Yavuzer at al. (2000) (24). This
instrument aims to evaluate the capacity of
individuals to perform the activities of daily living
(such as eating, going to the restroom, taking a
bath, dressing up, getting around indoors, and
getting around outdoors) without any help from
Data collection procedure: The “Interview
Form” which consisted of questions addressing
descriptive characteristics and medical,
socioeconomic, and psychological status of
participants were filled in by examining the patient
files in these institutions as well as through face-to-
face interviews conducted with the participants.
Under nutrition was defined as a body mass index
<18.5. Anthropometric parameters (arm
circumference, waist circumference and triceps
Kucuk EO et al.
Konuralp Tıp Dergisi 2017;9(3):46-51
skinfold thickness) were measured, and information
was gathered on nutritional habits.
Anthropometric measurements: The
researcher performed all anthropometric
measurements and interviews necessary for the
assessment of nutritional status after take course
related to anthropometric measurements. Weight
was recorded to the nearest kilograms (kg). Height
in meters (m) was estimated from the demi-span
(distance from the tip of middle finger to midline of
the sternum) of all residents 20.
Ethical consideration: Official permission
was obtained from care-giving institutions prior to
the study. The researchers also obtained the
approval of the Hacettepe University Ethics
Committee (Issue: 886 Decree No: LUT 09/1-30).
An oral consent was obtained from participants
after informing them about the research.
Statistical analysis: The data collected from
participants were statistically analyzed using SPSS
15 software package (Statistical Package for Social
Sciences). Descriptive analyses were presented
using means and standart deviations. The
relationship between the nutritional status of elderly
individuals and independent variables were
analyzed using the t-test, chi-square, regression
analysis, and correlation test. P values <0,05 value
were accepted statistically significant in tests used.
According to result, malnutrition risk was
determined in 44.5% and malnutrition was
determined in 28.57% of the participants according
to MNA assessment (Figure 1). It was found that
58% were female; the mean±SD age of the
participants was 78.70±7.87 years (Table 1).
Female participants were found to have a lower
mean MNA score than males. A negative
relationship with a strength of 24.2% was found
between MNA scores and age, that is, MNA scores
went down as age increased.
It was found that 53% of participants had a
GIS-related problem (n=165.The most commonly
seen problems were loss of appetite (51.5%),
constipation (43.4%), dyspepsia (31.5%), and
difficulty chewing (28.4%). Those who were
suffering from loss of appetite, dysphagia,
vomiting, and difficulty chewing had a lower mean
nutritional score than those who did not suffer from
these gastrointestinal problems (p<0.05) (Table 2).
It was found that 40% of elderly individuals
staying in nursing homes had a mouth health-
related problem. Those who had a mouth health-
related problem had a lower mean nutritional score
than those who did not (p<0.05) (Table 2). Those
who lacked teeth (70,8%), had dentures or denture-
related problems(31,4%) and those who suffered
from dry mouth (34,9%) had a lower mean
nutritional score than those who did not have these
problems (p<0.05) (Table 2).
Figure 1. The nutritional status of the participants.
According to Barthel index, 25.3% of
participants were fully independent, while 22,7%
were moderately dependent, 21,7% were severe
dependent and 19.4% were completely dependent
(Table 2). Those who were independent in their
activities of daily living had a higher mean MNA
score than those who were dependent. The scores
received from the MNA test and the Barthel Index
was found to be positively correlated with strength
of 53.3%. It was also found that the nutritional
scores increased as the level of independence in
daily activities increased. 53.5% of participants did
not have a cognitive impairment, while 17,2% had
mild cognitive impairment, and 13.3% had a severe
cognitive impairment. The difference between the
mean MNA scores according to the cognitive health
status of participants were found to be statistically
significant (p<0.05) (table 2). Those whose
cognitive status was normal according to their
Standardized Mini-Mental Test score had a higher
mean MNA score than those who had cognitive
inefficiency. A positive correlation with a strength
of 51.7% was identified between cognitive health
status and MNA score. One's MNA score increased
as their cognitive health status got better (Table 2).
Variables affecting nutritional status (socio-
demographic characteristics, and variables
concerning medical, socio-economic, and
psychological status) were added to a multiple
regression model (Table 3). The total effect of
these independent variables on nutritional status as
the dependent variable (MNA score) was
investigated. Using the Stepwise Regression
Technique, the variables that were not significant
were gradually eliminated in order to find the ones
that were statistically significant. According to the
results of this regression analysis, the following
independent variables were found to have an effect
on MNA scores: use of medication, the presence of
GIS-related problems, dysphagia, reluctance about
joining in social activities, cognitive inefficiency,
dependency in the activities of daily living, and
lack of interest in food.
Kucuk EO et al.
Konuralp Tıp Dergisi 2017;9(3):46-51
Table 1. Socio-demographic characteristics of individuals according to groups (n=308).
Future of Personal
Risk of Malnutrition
Age (n=308)
80.7 + 8,2
78.8 + 7,3
Female (n=179, 58%)
59 (33,0%)
86 (48,0%)
Male (n=129, 42%)
29 (22,5 %)
51 (39,5%)
Illiterate (n=86, 28%)
22 (25,6%)
38 (44,2%)
Literate (n= 38, 12%)
9 (23,7%)
15 (39,5%)
Elementary school (n=90, 29%)
30 (33,3%)
36 (40,0%)
Junior high school (n=23, 8%)
5 (21,7%)
13 (56,5%)
High school (n=40, 13%)
13 (32,5%)
21 (52,5%)
University (n=31, 10%)
9 (29,0%)
14 (45,2%)
Civil status
Single (n=72, 23%)
19 (26,4%)
34 (47,2%
Married (n=45, 15%)
9 (20,0%)
19 (42,2%)
Widow (n=191, 62%)
60 (31,4%)
84 (44,0%)
frequency of
contact with
Frequent (n=136, 44%)
36 (26,5%)
59 (43,4%)
Rare (n=73, 24%)
17 (23,3%)
35 (47,9%)
Never (n=53, 17%)
19 (35,8%)
25 (47,2%)
No relatives (n=46, 15%)
16 (34,8%)
18 (39,1%)
Table 2. Medical conditions of individuals according to groups (n=308).
(mean + SD)
Risk of
(mean + SD)
(mean + SD)
MMSE scores (0-30) (cognitive impairment)
0-9 (Severe) [(n:41/13,3%), (14,7±4,6) ]
10-19 (Moderate) [(n:49/15,9%), (17,3±4,2)]
20-23 (Mild) [(n:53/17,2%), (19,7±4,6)]
24-30 (No) [(n:165/53,5%), (22,0±4,4) ]
15,8+ 9,1
22,1+ 7,3
26,5+ 4,1
Barthel index scores
0-20 (Complete dependent) [(n:60/19,4%), (15,3±5,7) ]
21-61 (Severe dependent ) [(n:67/21,7%), (18,4±4,2) ]
62-90 (Moderate dependent) (n:71/22,7%), (21,5±3,59 ]
91-99 (Mild dependent) [(n:32/10,3%), (22,0±3,9) ]
100 (Normal) [(n:78/25,3%), (22,3±4,6) ]
37,8+ 37,2
69,5+ 30,4
85,5+ 25,1
Regular taking drugs (n= 269)
4,1+ 2,3
4,0+ 2,6
3.1 + 2,8
Present (n=35, 11%)
16 (45,7%)
11 (31,4%)
8 (22,9%)
Absent (n=273, 89%)
72 (26,4%)
126 (46,2%)
75 (27,5%)
Present (n=272, 88%)
81 (29,8%)
122 (44,9%)
69 (25,4%)
Absent (n=36, 12%)
7 (19,4%)
15 (41,7%)
14 (38,9%)
Present (n=84, 27%)
31 (36,9%)
27 (32,1%)
26 (31,0%)
Appetite (51,5%)
Constipation (43,4%)
Dyspepsia (31,5%)
Difficulty chewing
(n=165, 53%)
58 (35,2%)
68 (41,2%)
39 (23,6%)
(n=143, 46%)
30 (21,0%)
69 (48,3%)
44 (30,8%)
health of
Lacked teeth (70,8%)
Dentures problem
Dry mouth (34,9%)
Mucositis (13,1%)
(n=124, 40%)
66 (32,0%)
90 (43,7%)
50 (24,3%)
(n=84, 60%)
22 (21,6%)
47 (46,1%)
33 (32,4%)
Kucuk EO et al.
Konuralp Tıp Dergisi 2017;9(3):46-51
Table 3. The results of multiple regression analysis of the MNA score of risk factors on the effect nutritional
The risk factors
Std. Error
%95 CI
Status of Drug Use
0,73 - 3,16
Problems of digestive
0,54 - 2,24
Difficulty in Swallowing
1,21 - 4,16
Participation in Social Activities
-1,08 - -0,03
Reduction of the interest to food
2,77 - 5,04
The score of MNA
0,12 - 0,24
The score of Barthel Index
0,02 - 0,05
R²=0.545; F=51.250
In Turkey, some studies have been
performed in these settings: It was found the
malnutrition risk and malnutrition incidence to be
31-71% and 8-15.9% respectively (6-11). In our
study, according to the MNA scores received on the
Mini Nutritional Assessment test, participants had a
malnutrition risk of 44,48% and a malnutrition
incidence of 28.6. We think that early diagnosis of
elderly individuals with malnutrition risk is very
important as it increases the likelihood of a timely
intervention and helps prevent possible future
Various studies on elderly individuals living
in nursing homes or in the society identify gender
as a dependent risk factor for malnutrition (7,26). In
harmony with these previous studies, our study
identified being female as a risk factor for
Gastrointestinal problems can be seen
among elderly just like any other age group, and
they bear special importance because of their
relationship with nutrition. Our study found that
participants who had a gastrointestinal problem had
a lower mean MNA score than those who did not
have one. Participants who suffered from a
gastrointestinal problem such as loss of appetite,
dysphagia, vomiting, and difficulty chewing had a
lower mean nutritional score than those who did
not. Many studies indicate a strong relationship
between mouth health and malnutrition (27,28).
Participants who had a mouth health problem
associated with lack of teeth, dry mouth, or
dentures had a lower mean nutrition score than
those who did not.
Other Factors Affecting Nutritional
Status; Dependency in ADLs and Cognitive
Health Status: Many studies indicate a strong
relationship between dependency in the activities of
daily life and mean MNA scores (10,12,26-29). Our
study suggested that participants who were
dependent in the activities of daily living according
to their Barthel Index score had a lower mean MNA
score than those who were independent. Nutrition
score also goes down as a dependency in the
activities of daily living goes up. Our study
suggested that participants who had a normal
cognitive status according to the Standardized
Mini-Mental Test had a higher mean MNA score
than those who had a cognitive problem. MNA
score goes up as cognitive health status increases.
Studies focusing on the relationship between
cognitive status and nutritional status show that the
individuals suffering from cognitive problems bear
a greater malnutrition risk than individuals who do
not have any cognitive problems (16,29).
In conclusion, according to our study,
among elderly individuals, those who were female,
those who had an acute and chronic illness, those
who were on medication, those who were suffering
from sensory loss, those who had gastrointestinal
problems, and those who had a mouth health issue
had a higher incidence of malnutrition. Being
dependent in the activities of daily living and
having a cognitive problem were found to be a risk
factor for malnutrition. It is necessary that the
elderly individuals be scanned for their nutritional
status and associated risk factors when they are first
admitted to care-giving institutions. Individuals
suffering from a nutritional problem should be
given proper dietary support.
Acknowledgements: This study was
conducted as a Thesis funded by Hacettepe
University of Scientific Research Projects
Coordination Unit (Project no: 2009-4892).
Declaration of interest: The authors declare
that there is no conflict of interest.
1. Bolmsjo BB, Jakobsson U, Mo lstad S, Ostgren CJ, Midlöv P. The nutritional situation in Swedish nursing
homes A longitudinal study. Arch Gerontol Geriat. 2015; 60(1):12833. doi:
10.1016/j.archger.2014.10.021. Epub 2014 Nov 6.
2. De Rouvray CL, Jésus P, Guerchet M, et al. The nutritional status of older people with and without dementia
living in an urban setting in Central Africa: the EDAC study. J Nutr Health Aging. 2014;18(10):868-75, doi:
3. Isaia G, Mondino S, Germinara C, et al. Malnutrition in an elderly demented population living at home.
Arch Gerontol Geriat. 2011;53(3):249-51. doi: 10.1016/j.archger.2010.12.015. Epub 2011 Jan 13.
Kucuk EO et al.
Konuralp Tıp Dergisi 2017;9(3):46-51
4. Lelovics Z, Bozo RK, Lampek K, Figler M. Results of nutritional screening in institutionalized elderly in
Hungary. Arch Gerontol Geriat. 2009;49(1):190-6. doi: 10.1016/j.archger.2008.07.009. Epub 2008 Sep 10.
5. Serrano-Urrea R, Garcia-Meseguer MJ. Malnutrition in an Elderly Population without Cognitive
Impairment Living in Nursing Homes in Spain: Study of Prevalence Using the Mini Nutritional Assessment
Test. Gerontology. 2013;59(6):490-8. doi: 10.1159/000351763. Epub 2013 Aug 14.
6. Ulger Z, Halil M, Kalan I, et al. Comprehensive assessment of malnutrition risk and related factors in a large
group of community-dwelling older adults. Clin Nutr. 2010;29(4):507-11. doi: 10.1016/j.clnu.2010.01.006.
Epub 2010 Feb 1.
7. Ulger Z, Halil M, Cankurtaran M, et al. Malnutrition in Turkish Nursing Homes: A Correlate of Short Term
Mortality, J Nutr Health Aging. 2013;17(4):305-9. doi: 10.1007/s12603-013-0016-9.
8. Kucukerdonmez O, Koksal E, Rakicioglu N, Pekcan G. Assessment and evaluation of the nutritional status
of the elderly using 2 different instruments. Saudi Med J. 2005; 26(10):1611-6.
9. Saka B, Kaya O, Ozturk GB, et al. Malnutrition in the elderly and its relationship with other geriatric
syndromes. Clin Nutr. 2010; 29(6):745-8. doi: 10.1016/j.clnu.2010.04.006. Epub 2010 Jun 2.
10. Sanlier N, Yabanci N. Mini nutritional assessment in elderly: living alone, with their family and nursing
home in Turkey. J Nutr Food Sci. 2006; 36(1): 50-8.
11. Cankurtaran M, Saka B, Sahin S, et al. Turkish nursing homes and care homes nutritional status assessment
project (THN-malnutrition). Eur Geriatric Med. 2013;4(5):329334. DOI: 10.1016/j.eurger.2013.02.003.
12. Stanga Z. Basics in clinical nutrition: Nutrition in the elderly. E-SPEN, the European e-Journal of Clinical
Nutrition and Metabolism. 2009; 4(6). DOI: 10.1016/j.eclnm.2009.06.019.
13. Ferry M, Gilbert T, Guerin O, et al. Frailty and nutrition: Searching for evidence. J Nutr Health Aging.
14. Holmes S. The effects of undernutrition in hospitalized patients. Nurs Stand. 2007; 22(12):35-8.
15. Lee LC, Tsai AC, Wang JY. Need-based nutritional intervention is effective in improving handgrip strength
and Barthel Index scores of older people living in a nursing home: A randomized controlled trial. Intl J Nurs
Stud. 2015;52:90412.
16. Muurinen S, Soini H, Suominen M, Pitkala K. Nutritional status and psychological well-being. e-SPEN, the
European e-Journal of Clinical Nutrition and Metabolism. 20010; 5(1):269.
17. Lilamand M, Kelaiditi E, Demougeot L, et al. The Mini Nutritional Assessment-Short Form and mortality in
nursing home residents-Results from the INCUR study. J Nutr Health Aging. 2015; 19(4): 383-8.
18. Peng LN, M.-H. Lin MH, Liu LK, et al. Nutritional status plays the mediating role of the functional status
and comorbidity among older patients admitted to the Geriatric Evaluation and Management Unit: A Tobit
model application. Eur Geriatric Med. 2014;5: 8791.
19. Sarikaya D, Halil M, Kuyumcu ME, et al. Mini nutritional assessment test long and short form are valid
screening tools in Turkish older adults, Arch Gerontol Geriat. 2015; 61(1):56-60. doi:
10.1016/j.archger.2015.04.006. Epub 2015 Apr 22.
20. Folstein MF, Folstein SE, McHugh PR. Mini mental state” a practical method for grading the cognitive state
of patients for the clinician. Journal Psychiatric Research. 1975;12:189-98.
21. Molloy DW, Standish TIM. A guide to the standardized mini mental state examination. International
Psychogeriatry. 1997;9 (suppl 1):87-94.
22. Güngen C, Ertan T, Eker E, Yasar R, Engin F. Standardize mini mental testin Türk toplumunda hafif
demans tanısında geçerlik ve güvenilirligi. Türk Psikiyatri Dergisi. 2002;13(4):273-281.
23. Mahoney FI, Barthel W. Functional evaluation: the Barthel index. Maryland State Medical Journal.
24. Yavuzer G, Süldür N, Küçükdeveci A, Elhan A. Türkiye’de nörorehabilitasyon hastalarının
değerlendirilmesinde Fonksiyonel Bağımsızlık Ölçeği ve Modifiye Barthel indeksi’nin yeri. Romatoloji ve
Tıbbi Rehabilitasyon Dergisi. 2000;11(1):26-31.
25. Bassey EJ. Demi-span as a measure of skeletal size. Ann Hum Biol. 1986; 13(5):499-502.
26. Nazemi L, Skoog I, Karlsson I, et al. Malnutrition, Prevalence and Relation to Some Risk Factors among
Elderly Residents of Nursing Homes in Tehran, Iran. Iran J Public Health. 2015; 44(2): 218-27.
27. Van Lancker A, Verhaeghe S, Hecke AV, et al. The association between malnutrition and oral health status
in elderly in long-term care facilities: A systematic review. Intl J Nurs Stud. 2012; 49(12):1568-81. doi:
10.1016/j.ijnurstu.2012.04.001. Epub 2012 Apr 27.
28. Marchi RJ, Hugo F, Hilgert J, Padilha D. Association between oral health status and nutritional status in
South Brazilian independent-living older people. Nutrition. 2008; 2(4):54653.
29. Stange I, Poeschl K, Stehle P, et al. Screening for malnutrition in nursing home residents: comparison of
different risk markers and their association to functional impairment. J Nutr Health Aging. 2013;17(4):357-
... A total of 33 studies were included in this systematic review [3,8,[18][19][20][21][22]. Twenty eight studies were cross-sectional studies [3,8,[18][19][20][21][22]26,[29][30][31][32][33][34][35][36][37][38][40][41][42][43][44][46][47][48][49]51], and five studies were of cohort design [27-28, 39, 45, 50] (Table 1). ...
Full-text available
Purpose: To evaluate whether poor oral health is associated with a higher risk of malnutrition based on the Mini Nutritional Assessment (MNA) or MNA-SF (short form) in older adults. Study Selection: For this meta-analysis, cohort and cross-sectional studies with adults 65 years and older, reporting oral health outcomes (i.e. edentulism, number of teeth) and either the MNA or MNA-SF were selected. Four electronic databases were searched (Medline via PubMed, Web of Science, Cochrane Library and EMBASE) through June 2020. Risk of bias was assessed with the checklist by the Agency for Healthcare Research and Quality scale. Results: A total of 928 abstracts were reviewed with 33 studies, comprising 27,559 participants, aged ≥65 being ultimately included. Meta-analyses showed that the lack of daily oral hygiene (teeth or denture cleaning), chewing problems and being partially/fully edentulous, put older adults at higher risk of malnutrition (p < 0.05). After adjustment for socio-demographic variables, the included studies reported lack of autonomy for oral care, poor/moderate oral health, no access to the dentist and being edentulous with either no dentures or only one denture were risk factors significantly associated with a higher risk of malnutrition (p < 0.05). Conclusions: These findings may imply that once elders become dependent on others for assistance with oral care, have decreased access to oral healthcare, and lack efficient chewing capacity, there is increased risk of malnourishment. Limitations of the study include heterogeneity of oral health variables and the observational nature of the studies. Further studies are needed to validate our findings.
Background: Malnutrition may decrease physical function and exacerbate health conditions and thus have a negative effect on health-related quality of life of older people. Aim: The study was aimed at evaluating the extent of malnutrition, physical function and other associated risk factors for the older persons (>65 years) living in the residential aged care facilities in Bangladesh. Methods: A cross-sectional study was performed with a sample of 200 older people in various residential aged care facilities in Dhaka, Bangladesh. Nutritional status was evaluated using the Mini Nutritional Assessment. A structured questionnaire was used to assess the socioeconomic condition, dietary diversity, functional ability and other related risk factors for malnutrition. Results: According to the Mini Nutritional Assessment, 33.5% of participants living in residential aged care facilities were malnourished and 52.5% were at risk of malnutrition. Dietary diversity score differs significantly (p<0.001) among malnourished (3.78 ± 0.45), at risk of malnutrition (4.46 ± 0.98) and well-nourished (4.75 ± 1.11) groups. Twenty-five percent of the study participants reported limitations in mobility and 26.5% reported limitations in activities of daily living. Females were more vulnerable in terms of malnutrition and physical function than males. Mini Nutritional Assessment score is significantly correlated (p<0.05) with several risk factors for malnutrition such as body mass index, education level, meal, protein consumption, dietary diversity score, weight loss, reduced food intake, mobility and activities of daily living of the older people. Conclusions: The study reaffirms that a high rate of malnutrition and risk of malnutrition is prevalent among aged care residents, who need special attention and may benefit from individualized nutrition interventions.
Full-text available
Malnutrition and dehydration are two most common types of ailments residents of nursing homes (NH) prone to. It is very important to assess these problems because they can predispose the residents to severe illnesses. The aim of this study was to gather information on nutritional status and its associated risk factors in elderly residents of NHs in Tehran, Iran. From 16 NHs in Tehran, 263 residents were randomly selected. Data were collected via questionnaires, including demographic characteristics, past medical history, present health problems and daily routines. The MNA questionnaire was used to gather information regarding their nutritional status. The present study showed that 10.3% of the elderly residents in nursing homes were malnourished. 66.4% of males and 70.8% of females were at risk of malnutrition. Multivariate analysis showed that after adjusting for confounders the following elderly-related factors were the independent risk factors of malnutrition: consuming half or less than of the food (OR=8.0, 95%CI=3.7-17.7), having no teeth or good prosthesis (OR=1.7, 95%CI=1.1-2.7), diabetes (OR=1.6, 95%CI=1.1-2.4), smoking (OR=0.6, 95%CI=0.3-1.2), studying (OR=0.4 95%CI=0.2-0.9) and praying in their free time (OR=1.8 95%CI=1.2-2.6). The subjects' health-related factors and their free-time activities and nutritional behavior are the most important factors associated with poor nutrition among elderly residents of NHs; however, further investigation is needed to clarify the role of other factors in maintaining a suitable nutritional plan for them.
Full-text available
Frailty is a geriatric syndrome that predicts disability, morbidity and mortality in the elderly. Poor nutritional status is one of the main risk factors for frailty. Macronutrients and micronutrients deficiencies are associated with frailty. Recent studies suggest that improving nutritional status for macronutrients and micronutrients may reduce the risk of frailty. Specific diets such as the Mediterranean diet rich in anti-oxidants, is currently investigated in the prevention of frailty. The aim of this paper is to summarize the current body of knowledge on the relations between nutrition and frailty, and provide recommendations for future nutritional research on the field of frailty.
To examine whether the Mini Nutritional Assessment-Short Form (MNA-SF) score and its individual items are predictors of mortality in a nursing home population. Prospective, secondary analysis from the Incidence of pNeumonia and related ConseqUences in nursing home Residents (INCUR) study with 1-year follow-up. A total of 773 older persons (women 74.4%) living in 13 French nursing homes. At baseline, nutritional status was assessed with the MNA-SF. Overall mortality rate was measured over a 12-month follow-up period after the baseline assessment visit. Cox proportional hazard models were performed to test the predictive capacity of the MNA-SF score and its single components for mortality. Mean age of participants was 86.2 (standard deviation, SD 7.5) years. Mean MNA-SF score was 9.8 (SD 2.4). Among participants, 198 (25.6%) presented a normal nutritional status (12-14 points), 454 (58.7%) were at risk of malnutrition (8-11 points), and 121 (15.7%) were malnourished. After one year of follow-up, 135 (17.5%) participants had died. Age, female gender, baseline weight, BMI and MNA-SF were significant predictors of mortality whereas no specific chronic disease was. The total MNA-SF score was a significant predictor of mortality (Hazard Ratio=0.83; 95% CI 0.75-0.91; p<0.001), even after adjustment for potential confounders. Four individual items: weight loss, decrease in food intake, recent stress and BMI were independent predictors of mortality. The MNA-SF appears to be an accurate predictor of one-year mortality in nursing home residents. Thus, this tool may be regarded not only as a nutritional screening tool, but also as an instrument for identifying the most-at-risk individuals in this population.
Nutritional status is associated with physical functioning in older people. Protein-energy malnutrition can limit functional performance. This study examined the effectiveness of a "need-based intervention" on improving the physical functioning of older adults living in nursing homes. A 24-week randomized, double-blind, controlled trial. A privately managed geriatric nursing home in Taiwan. Ninety-two persons who were ≥65 years old, ≤25kg/m(2), >1 month residence, non-bed-ridden, without acute infection, and able to self-feed or receive oral feeding. Qualified participants were stratified by gender and then randomly assigned to either the control group (n=45) or the intervention group (n=47). Each participant in the intervention group would receive a 50g/day soy-protein-based nutritional supplement when he/she was rated as undernourished, defined as Mini Nutritional Assessment score ≤24 and body mass index ≤24kg/m(2). The supplement contained 9.5g protein, 250kcal energy, and all essential micronutrients. The supplementation would be suspended if either one of the two "at risk" conditions was not met at the next measurement (every 4 weeks). Handgrip strength and Barthel Index were measured at baseline, mid-point (week 12), and end-point (week 24) of the trial. Results were analyzed with Student's t-test and by the Generalized Estimating Equations controlled for nutritional status. The intervention significantly improved (a) handgrip strength of the older adults at weeks 12 and 24, and (b) the overall Barthel Index at week 24 (all p<0.05) according to the Generalized Estimating Equations. "Need-based intervention" can be an effective and useful strategy for improving the physical functioning of older adults living in nursing homes, without adverse effects. The results probably are the indirect results of the improved nutritional status. The study highlights the importance of routine screening and timely intervention in geriatric care. The applicability of this need-based strategy to community-living older adults is an important issue and should be evaluated. We can probably reap a greater benefit by eliminating the risk of malnutrition at the emerging stage. Copyright © 2015 Elsevier Ltd. All rights reserved.
To determine the nutritional status of elderly African people and to investigate the association between undernutrition and dementia. Door-to-door cross-sectional surveys in the general population. Representative districts of Bangui (Central African Republic) and Brazzaville (Republic of Congo). Population aged over 65 years. Undernutrition was defined as a body mass index <18.5. Anthropometric parameters (arm circumference, waist circumference and triceps skinfold thickness) were measured, and information was gathered on nutritional habits. PARTICIPANTS underwent cognitive screening using the Community Screening Interview for Dementia (CSI-D) and the Five-Word Test. After further neuropsychological testing and neurological examination, the diagnosis of dementia was confirmed according to DSM-IV criteria. Multivariate logistic regression models were applied in order to identify factors associated with undernutrition in populations with or without dementia. 1016 people were included. In the general population, the prevalence of undernutrition was 19.2%. Dementia was found in 7.4% of elderly people. Compared with healthy people, patients with dementia had an increased prevalence of undernutrition (32.0% vs. 17.7%; p=0.002), lower weight (49.3±10.5 kg vs. 58.4±13.5 kg ; p<0.001), and lower BMI (20.8±4.1 vs. 22.9±4.8 ; p<0.001); they were less likely to eat their fill (38.9% vs. 45.9% ; p=0.001), had more dietary restrictions (36.1% vs. 24.3% ; p=0.03) and ate less often with their family (66.7% vs. 90.6% ; p<0.0001). Eating only one meal per day was the sole factor associated with undernutrition in dementia (OR: 7.23 [CI: 1.65-31.7]; p=0.03). The prevalence of undernutrition is high in the older population. The nutritional status of patients with dementia is more impaired than that of healthy patients. However, they are less often malnourished than in French home care settings. This study is the first to look at the nutritional status of at-home patients with dementia in Africa. These comparative data will eventually be used in the development of new nutritional intervention strategies.
Health care for older people is featured by simultaneous management of the multiple comorbid complex conditions, including acute illnesses, underlying comorbid conditions, nutritional status, functional status and many others. The purpose of this study was to investigate nutritional status and its effect on the relationship between co-existing diseases and functional status among older patients admitted to the geriatric ward in Taiwan. A descriptive correlational design was used and data of 401 patients were retrospectively collected for analysis. Comprehensive geriatric assessment was performed for all patients, which included the Mini-Nutritional Assessment, the Barthel Index, and the Charlson Comorbidity Index. The Tobit model was used to manage censoring data, and hierarchical logistic regressions were conducted to determine the relationships among nutrition status, functional status and comorbid conditions. A significant mediating effect of nutritional status on the relationship between multimorbidity and functional status was found. Although multimorbidity, nutritional status, and functional status are usually interlinked in geriatric care, results of this study showed that nutritional intervention may play a stronger role in improving functional status of older patients admitted for acute geriatric services. Further intervention study is needed to confirm the mediating role of nutritional status between comorbidity and functional status for older patients.
Background and aim Malnutrition is related with serious morbidity and mortality in institutionalized older adults. The aim of this study is to determine the frequency of malnutrition in nursing homes and care homes and to identify the factors associated with malnutrition in these settings. Methods This multicenter study was conducted in 14 centers of nursing homes/care homes in three different cities. Total number of 1797 residents aged ≥ 65 years was enrolled. Malnutrition screening was made by Mini Nutritional Assessment Short Form (MNA-SF) and full MNA. Statistical analyses were conducted by SPSS 15.0. Results The median age (min–max) of the study population was 78.0 (65.0–108.0) and 917 (51%) were female. MNA-SF score of the residents was 11 (0-14). According to the MNA-SF 850 (49.3%) residents had normal nutritional status, 654 (38.3%) residents were at malnutrition risk, and 204 (11.9%) had malnutrition. Number of medications, gender, duration of stay in the institution, frequency of family visits, social security status, type of nursing home (government or not), daily life activities (ADL), Geriatric Depression Scale (GDS) and MMSE scores, get up & go test, hypertension, dementia, depression, and Parkinson disease were associated with malnutrition. Regression analyses revealed that get up&go test, GDS, hypertension, and ADL were independently related to malnutrition diagnosed by MNA-SF. Conclusion This study provides important information on the prevalence and associated factors of malnutrition in a large multicentered setting of nursing homes and care homes. It will direct the screening plans and interventions taken in order to detect, prevent, and manage malnutrition in these settings.