Malnutrition Prevalence Rates among Dutch Nursing Home Residents: What Has Changed over One Decade? A Comparison of the Years 2009, 2013 and 2018

Abstract

Objectives To assess changes in prevalence of malnutrition and its associated factors among people living in Dutch nursing homes in 2009, 2013 and 2018. Design Secondary data analysis of the International Prevalence Measurement of Care Quality (LPZ) study. Setting Dutch nursing homes. Participants Residents living at a psychogeriatric or somatic ward in Dutch nursing homes in 2009, 2013 or 2018. Measurements weight and height, unintentional weight loss over the last month and last six months, age, sex, length of stay up to the measurement day, care dependency, and the presence of various diseases (dementia, diabetes mellitus, stroke, diseases of the respiratory system, respiratory diseases and pressure ulcers). Results In total, 14,317 residents were included in this study with a mean age of 82.2, 70.9 female and 66.8% was living on a psychogeriatric ward. Results of this study show relative stability in background characteristics of the nursing home population over the last decade. In the total sample, 16.7% was malnourished and these percentages were 16.6% in 2009, 17.5% in 2013 and 16.3% in 2018. Multiple binary logistic regression analyses revealed having a pressure ulcer, female sex and living on a psychogeriatric department to be positively associated and having diabetes mellitus to be negatively associated with malnutrition throughout the years. These associations were strong and similar across years. Conclusion Even though much attention has been paid to prevent malnutrition in Dutch nursing homes over the last decades, results show a relatively stable malnutrition prevalence rate of around 16%. This leads to the question if nursing staff is able to sufficiently recognize residents with (a risk of) malnutrition, and if they are aware of interventions they could perform to decrease this rate.

Malnutrition during the journey of ageing

“…Residents included in our study were comparable to residents included in the Dutch National Prevalence Measurements of Care Problems 2018 (LPZ), a representative cohort of Dutch nursing-home residents. The overall age of the residents in our study, 85.0 (SD:7.4) years, was slightly higher than in LPZ in which the residents were 83.2 (SD: 9.5) years old [271] and BMI (26.0 (SD:5.0) kg/m 2 ) was comparable with LPZ (25.1 (SD:6.3) kg/m 2 ). Prevalence of malnutrition risk (based on SNAQ RC ) was also comparable to LPZ (both 24% at high risk) [272].…”

“…This is in line with the large group of community-dwelling older adults that already displays early determinants of malnutrition (chapters 2-4). Another reason for a low age-specific BMI could be the high prevalence of cognitive problems in (newly admitted) residents of long-term care facilities [271]. Doing grocery shopping and preparing food are among the first skills that are lost in older adults suffering from cognitive decline [188], which could lead to an inadequate intake.…”

“…This can be related to the accumulation of problems in persons with behavioural-cognitive problems; decreased cognitive functioning is associated with increased numbers of comorbidities [304]. We thus expect that residents with cognitive problems, the majority of residents [271], have cognitive as well as somatic problems. This assumption is confirmed by the correlation between total number of behavioural-cognitive problems and number of health-related problems/diseases (r=0.447, p<0.001).…”

Diseases, Health-Related Problems, and the Incidence of Malnutrition in Long-Term Care Facilities

“…Residents in our sample were relatively younger (83.1 years) compared to the average Dutch resident in 2019 (85.0 years) [ 24 ]. Compared to another Dutch representative cohort [ 25 ], our residents had a comparable BMI (24.8 vs. 24.7 kg/m 2 ), but the number of diseases was higher in our population (4.5 vs 3.0), which is probably explained by the fact that we also included health-related problems. In general, our population seems to reflect the average population in Dutch LTCFs.…”

Perspective Chapter: Early Diagnosis of Malnutrition

“…Everink et al compared the prevalence of malnutrition among nursing home residents in the Netherlands in 2009, 2013, and 2018 [28]. They reported that the prevalence of malnutrition was relatively stable at approximately 16% and that it was unclear whether nursing staff were adequately aware of malnourished (at-risk) residents and the interventions that could be implemented to reduce this occurrence.…”