Nutritional Status and a 3-Year Follow-Up in Elderly Receiving Support at Home

Abstract

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, as determined by the Mini-Nutritional Assessment, and osteoporosis: a cross-sectional study of an elderly female population

“…Older people living at home receiving regular home-care services are also more at risk than the free-living elderly of our study, as shown by Soini et al (2004), who found, also using the MNA instrument, that 3% of the subjects in their study were Nutritional status and osteoporosis H Salminen et al malnourished and 48% were at risk of malnutrition. Similar results were found in the study by Saletti et al (2005), who found that 8% of the elderly receiving public services and home care were malnourished and around 40% were at risk of malnutrition. The 3-year mortality was highly elevated for the malnourished and those at risk of malnutrition, 50 and 40%, respectively.…”

“…The Mini-Nutritional Assessment (MNA), a test developed to determine the risk of malnutrition in older people (Guigoz et al, 1996), has been employed to detect nutritional deficiencies in institutional settings (Saletti et al, 2000) as well as in healthy general populations (Scheirlinckx et al, 1999). Moreover, this test has been found to predict mortality in geriatric patients (Persson et al, 2002) and in both an elderly Danish population and among free-living elderly Swedish subjects receiving public services and care (Beck et al, 2001;Saletti et al, 2005). In a comparison of ultrasound measurements of the calcaneus with MNA test scores in a population of institutionalized elderly women, Gerber et al (2003) observed no correlation at all between the MNA score and the ultrasound parameter Speed of Sound (SOS) and only a weak trend towards a correlation with the Broadband Ultrasound Attenuation (BUA).…”

Mini nutritional assessment and 10-year mortality in free-living elderly women: a prospective cohort study with 10-year follow-up

“…6 A low MNA score, indicating malnutrition, has been associated with longer hospital stays, 7 lower quality of life 8 and an increased mortality rate. [9][10][11][12] The initial part of the MNA test constitute the MNA-short form (MNA-SF) and has been shown to have a good correlation with the full MNA test. 13 MNA's ability to predict mortality has nearly exclusively been studied in hospitals, nursing homes and patients with professional care at home.…”

“…13 MNA's ability to predict mortality has nearly exclusively been studied in hospitals, nursing homes and patients with professional care at home. [9][10][11][12][14][15][16][17][18] However, the great majority of the elderly are free-living. In fact, in 2009, 94% of Swedish persons aged X65 years were living at home, according to the Statistics Sweden.…”

“…Elderly hospital in-patients were examined with MNA in a study by Persson et al 11 Participants classified by MNA to be 'at risk of malnutrition' or 'malnourished' had a three-time higher risk to die during 3 years of follow-up than those classified to have a 'normal nutritional status'. Freeliving elderly, receiving help with activities of daily living (ADL), such as cooking, vacuum cleaning or shopping groceries, were examined with MNA in a study by Saletti et al 10 The 3-year mortality was 50% for the 'malnourished', 40% for those being 'at risk of malnutrition' and 28% for the participants with 'normal nutritional status'. In free-living elderly, to be in need of help with ADL is a known risk factor for malnutrition.…”