Early determinants for the development of undernutrition in an older general population: Longitudinal Aging Study Amsterdam (original) (raw)
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Clinical Nutrition, 2012
Background & aims: There is no valid, fast and easy-to-apply set of criteria to determine (risk of) undernutrition in community-dwelling older persons. The aim of this study was to develop and validate such criteria. Methods: Selection of potential anthropometric and undernutrition-related items was based on consensus literature. The criteria were developed using 15-year mortality in community-dwelling older persons ! 65 years (Longitudinal Aging Study Amsterdam, n ¼ 1687) and validated in an independent sample (InCHIANTI, n ¼ 1142). Results: Groups distinguished were: (1) undernutrition (mid-upper arm circumference <25 cm or involuntary weight loss !4 kg/6 months); (2) risk of undernutrition (poor appetite and difficulties climbing staircase); and (3) no undernutrition (others). Respective hazard ratio's for 15-year mortality were: (1) 2.22 (95% CI 1.83e2.69); and (2) 1.57 (1.22e2.01) ((3) ¼ reference). The area under the curve (AUC) was 0.55. Comparable results were found stratified by sex, excluding cancer/obstructive lung disease/(past) smoking, using 6-year mortality, and applying results to the InCHIANTI study (hazard ratio's 2.12 and 2.46, AUC 0.59). Conclusions: The developed set of criteria (SNAQ 65þ ) for determining (risk of) undernutrition in community-dwelling older persons shows good face validity and moderate predictive validity based on the consistent association with mortality in a second independent study sample.
High prevalence of undernutrition in Dutch community-dwelling older individuals
Nutrition, 2012
Objective: To examine the prevalence of undernutrition in community-dwelling older individuals (65 y) using data from various settings. Methods: A cross-sectional observational study was performed to examine the prevalence of undernutrition in three samples (all 65 y): 1) 1267 community-dwelling individuals participating in a large prospective population-based study, the Longitudinal Aging Study Amsterdam (LASA) in 1998/99; 2) 814 patients receiving home care in 2009/10; and 3) 1878 patients from general practices during the annual influenza vaccination in 2009/10. Undernutrition was assessed by the Short Nutritional Assessment Questionnaire 65þ. Results: Mean age was 77.3 y (SD 6.7) in the LASA sample, 81.6 y (SD 7.4) in the home care sample, and 75.3 y (SD 6.5) in the general practice sample. The prevalence of undernutrition was highest in the home care sample (35%), followed by the general practice (12%) and LASA (11%) samples. The prevalence of undernutrition increased significantly with age in the general practice and LASA samples. Gender differences were observed in the general practice and home care samples; women were more likely to be undernourished in the general practice sample and men were more likely to be undernourished in the home care sample. Conclusion: The prevalence of undernutrition in Dutch community-dwelling older individuals was relatively high, especially in home care patients.
SUN-LB306: Potentially Modifiable Determinants of Malnutrition in Older Adults: A Systematic Review
Clinical Nutrition, 2017
consumption and physical activity levels, complaints about taste of food and specific nutrient intake are not determinants of malnutrition. There is low evidence that loss of interest in life, access to meals and wheels, and modified texture diets are determinants of malnutrition. Furthermore, there is low evidence that psychological distress, anxiety, loneliness, access to transport and wellbeing, hunger and thirst are not determinants of malnutrition. There appears to be conflicting evidence that dental status, swallowing, cognitive function, depression, residential status, medication intake and/or polypharmacy, constipation, periodontal disease are determinants of malnutrition. Conclusion: There are multiple potentially modifiable determinants of malnutrition however strong robust evidence is lacking for the majority of determinants. Better prospective cohort studies are required. With an increasingly aging population, targeting modifiable factors will be crucial to the effective treatment and prevention of malnutrition.
International Journal of Environmental Research and Public Health, 2019
To stimulate undernutrition screening among Dutch community-dwelling adults, a website was developed with general information on healthy eating for healthy aging and self-tests. Based on cross-sectional data obtained from the self-tests, we studied nutritional risk factors (early determinants) as well as risk of undernutrition (late symptoms). SCREEN II (n = 2470) was used to asses nutritional risk factors. This tool consists of 16 items regarding nutritional intake, perception of body weight, appetite, oral health and meal preparation. An adjusted SNAQ65+ (n = 687) was used to assess risk of undernutrition. This four-item tool contains questions on weight loss, appetite, walking stairs and body mass index. Differences between age-groups (65-74, 75-84, ≥85) were tested by logistic regression. Overall prevalence of nutritional risk factors was 84.1%, and increased risk of undernutrition was 56.8%. Participants aged ≥85 scored worst on almost all items of the SCREEN II and the SNAQ65+. In conclusion: A large proportion of older adults reported early determinants for increased nutrition risk, while a smaller, yet remarkable proportion scored positive on undernutrition risk. Internet screening may be a useful, contemporary, and easy, accessible way to reach older adults who are at nutritional risk and may thus contribute to early identification and prevention of undernutrition.
Clinical Nutrition
Background & Aims: Malnutrition is widespread among older people and related to poor outcome. Reported prevalences vary widely, also because of different diagnostic criteria used. This study aimed to describe prevalences in several populations of older persons in different settings using harmonized definitions. Methods: Available studies within the Joint Programming Initiative (JPI) Knowledge Hub 'Malnutrition in the Elderly' (MaNuEL) were used to calculate and compare prevalences of malnutrition indicators: low BMI (<20 kg/m 2 ; age-specific BMI <20 if age 65-<70 and <22 kg/m 2 if age ≥70 years), previous weight loss (WL), moderate and severe decrease in food intake, and of combined BMI <20 kg/m 2 and/or WL in participants aged ≥65 years. Results: Fifteen samples with in total 5,956 participants (59.3% women) were included: 7 consisting of community-dwelling persons, 2 studies in geriatric day hospitals, 3 studies in hospitalized patients and 3 in nursing homes. Mean age of participants ranged between 67 and 87 years. Up to 4.2% of community-dwelling persons had a BMI <20 kg/m 2 , 1.6 and 9% of geriatric day hospital patients, 4.5-9.4% of hospital patients and 3.8-18.2% of nursing home residents. Using age-specific cutoffs doubled these prevalences. WL was reported in 2.3-10.5% of community-dwelling persons, 6% and 12.6% of geriatric day hospital patients, 5-14% of hospitalized patients and 4.5-7.7% of nursing home residents. Severe decrease in food intake was recorded in up to 9.6% of community-dwelling persons, 1.5% and 12% of geriatric day hospital patients, 3.4-34.2% of hospitalized patients and 1.5-8.2% of nursing home residents. The criteria age-specific BMI and WL showed opposing prevalences across all settings. Compared to women, low BMI and moderate decrease in food intake showed low prevalences in men but similar prevalences were observed for weight loss and severe decrease in food intake. In half of the study samples, participants in a younger age group had a higher prevalence of WL compared to those of an older age group. Prevalence of BMI <20 kg/m 2 and WL at the same time did not exceed 2.6% in all samples. The highest prevalences were observed based on combined definitions when only one of the three criteria had to be present. Conclusions: Prevalences for different criteria vary between and within the settings which might be explained by varying functional status. The criteria used strongly affect prevalence and it may be preferable to look at each criterion separately as each may indicate a nutritional problem.
Risk factors for malnutrition in older adults
2021
Introduction: Population ageing is a worldwide phenomenon that puts the organism through several anatomical, functional, biochemical and psychological changes with repercussions on health conditions. Malnutrition is described by several authors as a common condition in older adults. In this sense, knowing the factors that contribute to malnutrition is an important information for health professionals who care for the older adults on their daily lives. Objective: To identify the risk factors that contribute to malnutrition in the elderly. Methods: A systematic review of the literature was developed according to the methodology of the Joanna Briggs Institute. Studies with focus on the risk factors were searched for, with people aged ≥ 60 years old living in any setting. The critical analysis, extraction and synthesis of the results were developed by two independent researchers. Results: A total of 13 articles were included, with a total of 21568 elderly people and a predominance of wo...
Malnutrition in elderly: Social and economic determinants
The journal of nutrition, health & aging, 2012
Malnutrition occurs frequently in the frailest groups of the population, especially in people who are on a low income and elderly subjects, overall if they are institutionalized. The aim of this study was to assess the prevalence of malnutrition in a sample of elderly people living in different settings and to identify the determinants of malnutrition. Methods: A total of 718 subjects, 472 females (F) and 246 males (M), were recruited from nursing homes or were free living in three different regions in Italy. Nutritional status, depression, social, functional and cognitive status, were evaluated. Results: According to the Mini Nutritional Assessment (MNA), a high prevalence of malnutrition was found out in both genders: 26% of F and 16.3% of M were classified as being malnourished (MNA<17); 40.9% of F and 35% of M were at risk of malnutrition (MNA 17-23,5). The prevalence of malnutrition was significantly higher in NH subjects in both sexes. Moreover, a relationship was shown between malnutrition and inability to shop, prepare and cook meals because of a low income, distance from markets or supermarkets as well as impossibility to drive the car or to use public transportation. This study confirms the necessity to routinely perform nutritional status evaluation in elderly subjects, to carry out training courses for health workers (doctors, nurses, psychologists, dietitians), to implement nutritional education of the geriatric population, to develop tools and guidelines for health workers and caregivers, to identify and reduce clinical, functional, social or economic risk factors for malnutrition.
Revisiting the concept of malnutrition in older people
Journal of Clinical Nursing, 2007
Aim. The aim of this study is to revisit the concept of malnutrition in older people, trace the new development and test the use of refined framework with empirical data.Background. Malnutrition in older people is a common and significant problem worldwide. Continuing Chen's earlier work in 2001, a refinement was conducted and a prospective study was designed to test the use of this refined framework.Design. A cohort study of 114 hospitalized older patients in Northern Taiwan.Methods. The sample consists of 114 older patients aged 65 years and older, who were admitted for the cardiac and orthopaedic services at a tertiary 2300-bed hospital. From March to August 2004, assessed by one trained nurse, participants completed a structured face-to-face interview evaluating their age, visual/hearing impairments, oral health, cognitive status, comorbidities, medication use, social economic status, functional status, social support, depressive symptoms and nutritional status within 48 hours of admission. Participants who stayed >5 days were reassessed before discharge (n = 70). The data from admission were the main focus of this report.Results. Regression analysis revealed that that more medication taken, female gender, lower functional status (beta = 0·34, P < 0·001) and higher depressive symptoms were independent predictors of poor nutritional status, with the full model accounting for 48·2% of the variance. The result is in-line with the original theoretical underpinnings and it suggests that this refined framework detailing sub-concepts and measurable indices appears to fit the empirical data and suitable for clinical use.Conclusion. The findings lend support to the use of this framework in managing malnutrition in older people.Relevance to clinical practice. Nurses have an essential role in providing care for older people a framework like this would provide a road map guiding the intervention efforts.