Elsevier

Clinical Nutrition

Volume 29, Issue 4, August 2010, Pages 507-511
Clinical Nutrition

Original Article
Comprehensive assessment of malnutrition risk and related factors in a large group of community-dwelling older adults

https://doi.org/10.1016/j.clnu.2010.01.006Get rights and content

Summary

Background & aims

Older adults are poorly assessed for malnutrition risk although malnutrition is not an uncommon problem in this population. The aim of this study was to determine the malnutrition risk and its correlates in geriatric outpatients.

Method

The study was performed in 2327 patients ≥65 years old who were admitted to our Geriatric Medicine outpatient clinic. Together with comprehensive geriatric assessment, nutritional assessment with short version of mini nutritional assessment test (MNA-SF) was performed. MNA-SF score ≤11 was determined as malnutrition risk.

Results

Mean age of patients was 72.14 ± 6.11 and 1479 (63.6%) were female. Mean MNA-SF score was 12.31 ± 2.18. The number of patients with MNA-SF score ≤11 was 651 (28%). Depression, haematocrit, plasma fasting glucose, albumin, erythrocyte sedimentation rate, instrumental activities of daily living scores and bone mineral density measured from total femur were found to be significantly associated with malnutrition risk.

Conclusion

In this study malnutrition risk was detected in 651 (28%) patients. This ratio was similar to the literature. In older adults malnutrition risk is found to be increased due to majority of chronic illnesses and physical dependency. In conclusion, nutritional assessment should be a part of comprehensive geriatric assessment.

Introduction

Malnutrition is a serious and frequent condition in older adults. The prevalence of malnutrition which is 5–10% among independently living older individuals is considerably higher (30–60%) in hospitalized or institutionalized older adults.1 There are many psychological, social and organic conditions related with malnutrition in older adults.

Malnutrition can adversely affect the well-being of older persons mainly by causing a decline in functional status, worsening of existing medical problems and even increases in mortality. Therefore routine screening for malnutrition has to be considered as a diagnostic standard for all those involved in the care of elder persons. The predictive validity of Mini Nutritional Test (MNA) has been evaluated by demonstrating its association with adverse health outcome,2 social functioning,3 mortality4 and a higher rate of visits to the general practitioner.5 The MNA has gained world-wide acceptance and shows a high prevalence of malnutrition in different settings. Due to its specific geriatric focus, the MNA should be recommended as the basis for nutritional screening in older people, at times supplemented by laboratory values, antropoemetric parameters or determination of body composition. The Mini Nutritional Assessment (MNA) is a validated assessment instrument for nutritional problems, but its length limits its usefulness for screening. Therefore Mini Nutritional Test-short form (MNA-SF) has been developed.

Correlation between MNA-SF and full MNA version was high in previous study.6, 7 It was confirmed that the MNA-SF in its original form is reliable as a nutritional screening tool. The MNA-SF increases the applicability of the rapid screen in clinical practice (Bauer J. The MNA-New Insights from an Internationally Pooled Database. 31th ESPEN Congress, Vienna, 2009).

The aim of this study was to investigate the malnutrition risk and related factors among the older adults.

Section snippets

Population and setting

The study was carried out at outpatient clinics of Division of Geriatric Medicine, Department of Internal Medicine, at Hacettepe University Hospital in Turkey between February 2002 and December 2004. All patients 65 years-of-age or older who were admitted for a comprehensive geriatric assessment as a routine clinical follow-up were included in this cross-sectional study (n = 2327). The inclusion criteria was being 65 years and older.

Measurements

All patients underwent a complete and a standardized

Results

A total of 2327 patients were included in this study. Mean age of patients was 72.14 ± 6.11, 32.5% of the study population was ≥75 years and 4.1% was ≥85 years. Most of the subjects were female 1479 (63.6%). The most frequent co-morbid disorder was hypertension (71.1%). Overall, within the study group, 651 (28%) were found to have nutritional risk. The mean S-MNA score was 12.31 ± 2.18. Baseline characteristics of the study population are shown in Table 1.

Discussion

The results of this study suggest that approximately 28% of geriatric outpatients are at the risk of malnutrition using a valid instrument, the MNA-SF and that poor nutritional status has a significant association with seven factors: Depression, IADL, Hct, PFG, albumin, triglycerides, ESR, and f-total. This result revealed the importance of comprehensive geriatric assessment including mental health and life situation for prevention of malnutrition.

Malnutrition is a frequent condition, both

Conflict of interest statement

None of the authors of this manuscript have any financial and personal relationships with other people or organisations that could inappropriately influence (bias) their work. None of the coauthors has any direct or indirect conflicts of interest, financial or otherwise, relating to the subject of our report.

References (30)

  • M.F. Folstein et al.

    “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician

    J Psychiatr Res

    (1975)
  • K.S. Ulicny et al.

    Nutrition and the cardiac surgical patient

    Chest

    (1992)
  • B. Dawson-Hughes

    Calcium supplementation and bone loss: a review of controlled clinical trials

    Am J Clin Nutr

    (1991)
  • B. Vellas et al.

    Nutrition assessment in the older adults

    Curr Opin Clin Nutr Metab Care

    (2001)
  • A.M. Beck et al.

    The ‘Mini Nutritional Assessment’ (MNA) and the ‘Determine Your Nutritional Health’ Checklist (NSI Checklist) as predictors of morbidity and mortality in an elderly Danish population

    Br J Nutr

    (1999)
  • M.I. Griep et al.

    Risk of malnutrition in retirement homes elderly persons measured by the ‘mini-nutritional assessment’

    J Gerontol A Biol Sci Med Sci

    (2000)
  • B. Compan et al.

    Epidemiological study of malnutrition in older adults in acute, sub-acute and longterm care using the MNA

    J Nutr Health Aging

    (1999)
  • A.M. Beck et al.

    A six months' prospective followup of 65+-y-old patients from general practice classified according to nutritional risk by the Mini Nutritional Assessment

    Eur J Clin Nutr

    (2001)
  • L.Z. Rubenstein et al.

    Screening for undernutrition in geriatric practice: developing the short-form Mini-Nutritional Assessment (MNA-SF)

    J Gerontol A Biol Sci Med Sci

    (2001)
  • M. Cuervo et al.

    Nutritional assessment interpretation on 22,007 Spanish community-dwelling elders through the Mini Nutritional Assessment test

    Public Health Nutr

    (2009)
  • W.J. Burke et al.

    The short form of the Geriatric Depression Scale: a comparison with the 30-item form

    J Geriatr Psychiatry Neurol

    (1991)
  • C.S. Jacelon

    The Barthel Index and other indices of functional ability

    Rehabil Nurs

    (1986)
  • M.P. Lawton et al.

    Assessment of older people: self-maintaining and instrumental activities of daily living

    Gerontologist

    (1969)
  • S. Mathias et al.

    Balance in older adults: the “get-up and go” test

    Arch Phys Med Rehabil

    (1986)
  • R. Cohendy et al.

    The Mini Nutritional Assessment-Short Form for preoperative nutritional evaluation of elderly patients

    Aging (Milano)

    (2001)
  • Cited by (0)

    Conference presentation: 31st ESPEN Congress, Vienna, Austria, 2009. (Awarded an ESPEN 2009 Travel Fellowship).

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