Background: In 1992, local municipalities in Sweden took over full responsibility for the long-term care of elderly. This has led to an increased care burden for the various assisted accommodation services run by the municipalities. Objective: Since ageing and chronic diseases are risk factors for protein-energy malnutrition, we evaluated the nutritional status of all individuals in assisted accommodation, i.e., service flats (SF), old people’s homes (OPH), group living for the demented (GLD), and nursing homes (NH), in three Swedish municipalities. Methods: Of 994 eligible subjects, 872 were examined; the average age was 84.5 ± 8 years, and 69% were female. The Mini Nutritional Assessment (MNA) scale (0–30 points) was used, consisting of 18 point-weighted questions in four categories, i.e., anthropometry, global and dietary issues, and self-assessment. Results: MNA <17, i.e., malnutrition, was noted in 36% of the study population. Divided according to accommodation type, the MNA scores were <17 in 21% of individuals in SF, 33% of those in OPH, 38% of those in GLD, and 71% of those in NH. The corresponding values for MNA scores 17–23.5 (risk for malnutrition) were 49, 51, 57, and 29%, respectively. Average body mass index (BMI) values were 24.2 ± 5 (SF), 23.6 ± 5 (OPH), 23.9 ± 4 (GLD), and 22.3 ± 4 (NH). BMI values ≤20 were found in 18% of those in SF, in 25% of those in OPH, in 19% of those in GLD, and in 33% of those in NH. Both MNA and BMI correlated with upper arm and calf circumference, with r values ranging from 0.4 to 0.7 (p < 0.001). MNA and BMI correlated significantly (r = 0.52, p < 0.001). Age correlated with MNA and BMI with r values of 0.1 (p < 0.01) and 0.14 (p < 0.001), respectively. Subjects with signficant help requirements during meals ate fewer whole meals per day than those who could feed themselves. Conclusions: Based on the MNA, one third of the study subjects living in assisted accommodation, and more than half of those living in NH, appeared to be malnourished. Further studies are necessary to assess to what extent these nutritional disturbances are reversible.

Background: Elderly receiving public services and care are often frail, suffer from chronic diseases, and sustain a high risk for malnutrition. Objective: To evaluate nutritional status and long-term outcome in elderly living at home. Methods: Of 507 eligible subjects receiving home care in five Swedish municipalities, we examined 353 (age 82 ± 7 years, 64% females). The subjects were interviewed, and the nutritional status was assessed by means of the Mini Nutritional Assessment (0–30 points; the lower the score, the greater the risk). The Mini Nutritional Assessment consists of 18 questions concerning, e.g., anthropometry (body mass index or BMI; kg/m²) and global and dietary issues. The mortality was evaluated in 224 study participants after a 3-year period. In one municipality, 31 of 64 elderly were reexamined after 3 years. Results: 8 and 41% of the elderly were assessed as malnourished or at risk of malnutrition, respectively. BMIs <20 and <23 were found in 12 and 31% of the subjects, respectively. Chewing and swallowing problems and reduced appetite were more often reported by those at risk of being malnourished compared with the well-nourished study participants (p < 0.001). Meals-on-wheels services were given to one third, of whom 66% used one portion for several meals. The 3-year mortality was 50% for those who were malnourished, 40% for those at risk of malnutrition, and 28% for the well-nourished group (p < 0.05). The corresponding mortality was 50% for subjects with a BMI <20, 35% for those with BMIs 20–28, and 27% for those with a BMI >28 (p = 0.05). After 3 years, a weight loss of 4.0 ± 5.8 kg was registered (p < 0.001). Conclusions: About half of the home-living elderly with public support were malnourished or were at risk of malnutrition. The malnourished subjects often had problems during mealtimes and seldom ate full meals. Elderly with a BMI >28 displayed the lowest risk of death within 3 years.

Nutritional status predicts preterm death in older people: a prospective cohort study.

This is an accepted version of a paper published in Clinical Nutrition. This paper has been peer-reviewed but does not include the final publisher proof-corrections or journal pagination.Citation for the published paper: Söderström, L., Thors-Adolfsson, E., Rosenblad, A., Frid, H., Saletti, A. et al. (2013) "Mealtime habits and meal provision are associated with malnutrition among elderly patients admitted to hospital" Clinical Nutrition, 32 (2) are important for identifying individuals at risk. The aims of the present study were to estimate the prevalence of malnutrition and to examine the association between mealtime habits, meal provision, and malnutrition among elderly patients admitted to hospital.Methods: This cross-sectional study included patients aged ≥ 65 years admitted to internal medicine, surgical or orthopaedic wards. The MNA was used for their nutritional assessment, and factors potentially associated with malnutrition were recorded.Results: Of 1771 patients (mean age 78 years), 35.5% were well-nourished, 55.1% were at risk of malnutrition and 9.4% were malnourished. Overnight fasts exceeding 11 hours, fewer than four eating episodes a day, and not cooking independently were associated with both malnutrition and risk of malnutrition. Conclusions:The risk of malnutrition was high among elderly patients admitted to hospital, whereas the proportion with fully developed malnutrition was lower than expected. A long overnight fast, few eating episodes, and not cooking independently were associated with an increased risk of malnutrition. Knowledge of these factors when providing care to the elderly may assist health-care professionals to prevent malnutrition.

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