The Challenge of Managing Undernutrition in Older People with Frailty

Roberts, Helen; Lim, Stephen; Cox, Natalie; Ibrahim, Kinda

doi:10.3390/nu11040808

Cited by 59 publications

(53 citation statements)

References 144 publications

(176 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Due to a decline in many functions, including poor oral status, dietary intake is often compromised in older people and the risk of malnutrition is increased. Particularly, acute and chronic illnesses and medications as well as poor dentition can exacerbate anorexia [5,70,73]. Oral problems in older individuals are associated with modifications in food selection and, therefore, in nutrient intake [25].…”

Section: Impact Of Oral Health On Nutritional Statusmentioning

confidence: 99%

“…Reduction in smell and taste senses, poor appetite (the so-called "anorexia of aging"), and decreased energy expenditure may all contribute to poor nutrition. Moreover, illnesses, medications, as well as poor oral health (for example, due to teeth loss and poorly fitting dentures) can exacerbate anorexia [4][5][6]. Nutritional status among older people may be also influenced by living or eating alone, poor financial status, dismobility, and decreased ability to shop or prepare meals [7,8].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Poor Oral Health as a Determinant of Malnutrition and Sarcopenia

et al. 2019

View full text Add to dashboard Cite

Aging is accompanied by profound changes in many physiological functions, leading to a decreased ability to cope with stressors. Many changes are subtle, but can negatively affect nutrient intake, leading to overt malnutrition. Poor oral health may affect food selection and nutrient intake, leading to malnutrition and, consequently, to frailty and sarcopenia. On the other hand, it has been highlighted that sarcopenia is a whole-body process also affecting muscles dedicated to chewing and swallowing. Hence, muscle decline of these muscle groups may also have a negative impact on nutrient intake, increasing the risk for malnutrition. The interplay between oral diseases and malnutrition with frailty and sarcopenia may be explained through biological and environmental factors that are linked to the common burden of inflammation and oxidative stress. The presence of oral problems, alone or in combination with sarcopenia, may thus represent the biological substratum of the disabling cascade experienced by many frail individuals. A multimodal and multidisciplinary approach, including personalized dietary counselling and oral health care, may thus be helpful to better manage the complexity of older people. Furthermore, preventive strategies applied throughout the lifetime could help to preserve both oral and muscle function later in life. Here, we provide an overview on the relevance of poor oral health as a determinant of malnutrition and sarcopenia.

show abstract

Section: Impact Of Oral Health On Nutritional Statusmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Poor Oral Health as a Determinant of Malnutrition and Sarcopenia

et al. 2019

View full text Add to dashboard Cite

show abstract

“…Malnutrition is increasingly recognized as an important and independent marker of adverse outcomes in older adults, including higher chronic disease burden, frailty and mortality [1][2][3]. The process of malnutrition and involuntary weight loss can be driven by anorexia, inadequate dietary intake, sarcopenia, cachexia, or a combination of these factors [4].…”

Section: Introductionmentioning

confidence: 99%

The Simplified Nutritional Appetite Questionnaire (SNAQ) as a Screening Tool for Risk of Malnutrition: Optimal Cutoff, Factor Structure, and Validation in Healthy Community-Dwelling Older Adults

et al. 2020

View full text Add to dashboard Cite

Malnutrition is an independent marker of adverse outcomes in older adults. While the Simplified Nutritional Appetite Questionnaire (SNAQ) for anorexia has been validated as a nutritional screening tool, its optimal cutoff and validity in healthy older adults is unclear. This study aims to determine the optimal cutoff for SNAQ in healthy community-dwelling older adults, and to examine its factor structure and validity. We studied 230 community-dwelling older adults (mean age 67.2 years) who were nonfrail (defined by Fatigue, Resistance, Ambulation, Illnesses & Loss (FRAIL) criteria). When compared against the risk of malnutrition using the Mini Nutritional Assessment (MNA), the optimal cutoff for SNAQ was ≤15 (area under receiver operating characteristic (ROC) curve: 0.706, sensitivity: 69.2%, specificity: 61.3%). Using exploratory factor analysis, we found a two-factor structure (Factor 1: Appetite Perception; Factor 2: Satiety and Intake) which accounted for 61.5% variance. SNAQ showed good convergent, discriminant and concurrent validity. In logistic regression adjusted for age, gender, education and MNA, SNAQ ≤15 was significantly associated with social frailty, unlike SNAQ ≤4 (odds ratio (OR) 1.99, p = 0.025 vs. OR 1.05, p = 0.890). Our study validates a higher cutoff of ≤15 to increase sensitivity of SNAQ for anorexia detection as a marker of malnutrition risk in healthy community-dwelling older adults, and explicates a novel two-factor structure which warrants further research.

show abstract

“…In term of the associations between physical frailty and style of the institution, the present study was the rst, to our knowledge, that had observed such an association. The possible explanation could be that older people who had been living in a private institution (more expensive in the metropolitan areas than public institution) usually have higher social economic status; they were more likely to feel lonely [30] and loss of appetite [31] when staying away from family and changing their ways of previous life, resulting in higher likelihood of being frailer. Compared with people living with their partners in the same nursing home, those who live with alone or share the room with unknown person may become more frail because of poorer social ties [32] and mental disorders [33].…”

Section: Discussionmentioning

confidence: 99%

Physical Frailty and Its Associated Factors Among Elderly Nursing Home Residents in China

Liu

Puts

Fen

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Evidence is scarce on the trend in prevalence of physical frailty in China; the primary purpose of this study was to identify the prevalence and correlates of physical frailty among older nursing home residents in China.Methods: Cross-sectional study in 20 nursing homes in Changsha, China. Physical frailty was defined based on the frailty phenotype including weight loss, low grip strength, exhaustion, slow gait speed, and low physical activity. Participants with at least three affected criteria were defined as being frail. Participants with one or two affected criteria were considered as pre-frail, and those with no affected criteria were considered as robust. A total of 1004 nursing home residents aged 60 and over were included in this study. A multinomial logistic regression model was used to analyze the associations of physical frailty with its potential risk factors, including age, sex, education levels, marital status, type of institution, living status, current drinking, current smoking, regular exercise, and self-reported health.Results: The overall prevalence of physical frailty and prefrailty was 55.6%, and 38.5%, respectively. The rate of physical frailty substantially increased with age, and was higher in women than in men (69.5% vs. 30.5%). The multinomial logistic regression analysis showed that older age, being women, living in a private institution, living alone or with unknown person, having no regular exercise (≤ 2 times/week), and poor self-reported health were significantly associated with increased odds of being physically frail. Conclusion: We demonstrated physical frailty is highly prevalent among older residents in nursing homes in China, especially in women. The potential role of those associated factors of physical frailty warrant further investigations to explore their clinical application among elderly nursing home residents.

show abstract

The Challenge of Managing Undernutrition in Older People with Frailty

Cited by 59 publications

References 144 publications

Poor Oral Health as a Determinant of Malnutrition and Sarcopenia

Poor Oral Health as a Determinant of Malnutrition and Sarcopenia

The Simplified Nutritional Appetite Questionnaire (SNAQ) as a Screening Tool for Risk of Malnutrition: Optimal Cutoff, Factor Structure, and Validation in Healthy Community-Dwelling Older Adults

Physical Frailty and Its Associated Factors Among Elderly Nursing Home Residents in China

Contact Info

Product

Resources

About