MALNUTRITION ACCORDING TO THE MINI NUTRITIONAL ASSESSMENT IN OLDER ADULTS IN DIFFERENT SETTINGS

Abstract

To the Editor: Kaiser and colleagues presented interesting pooled data on the prevalence of malnutrition in older people in various settings evaluated using the Mini Nutritional Assessment (MNA).1 In their combined dataset (4,507 people, 24 data sets from 12 countries), the prevalence of malnutrition was 22.8%, with considerable differences between settings (rehabilitation, 50.5%; hospital, 38.7%; nursing home, 13.8%; community, 5.8%). The prevalence of the “at risk” group was 46.2%, and consequently two-thirds of the study participants were at risk or malnourished. We have investigated the nutritional status of older people residing in different settings and have comparable findings. We present the results from the combined Finnish data set with 4,949 participants in long-term care facilities (LTCFs) (N=1,087),2 nursing homes (NHs) (N=1,987),3 and service houses (SHs) (N=1,475)4 and in the community (N=400) (CD)5 in the Helsinki region. The data for LTCFs and NHs were collected in 2003, SHs in 2007, and CD in 2000. LTCFs in Finland provide 24-hour nursing supervision and medical care to people who do not require acute hospitalization but require a more-intensive level of care than is provided in nursing homes. Most of the residents in LTCFs are frail older people with multiple comorbidities and dementia. Twenty-four-hour nursing and medical services are provided in NHs. In SHs, the residents live in their own apartments or in group homes. Nursing care is provided round the clock. The CD sample was 400 home-dwelling individuals aged 75 to 90 who were recruited from a random sample into a cardiovascular prevention trial in 2000. All subjects had a history of vascular disease at baseline. The details of these studies have been provided in previous articles.2-5 Nurses who had received thorough prior training collected the data. All participants underwent a personal interview to collect demographic data and medical history. Diagnoses were retrieved from medical records. Nutritional status was assessed using the MNA.6 Comorbidity was assessed using the Charlson Comorbidity Index, a weighted index taking into account the number and severity of comorbid conditions.7 The mean age of the groups varied from 83.7 (NH) to 80.3 (CD) (Table 1). The disability level was lowest among the community-dwelling older people (2.3%) and highest in LTCFs (83.5%). The proportion of patients with dementia increased similarly from CD to LTCFs. The highest mean Charlson Comorbidity Index was found in SHs, whereas residents in NHs had the lowest index. Malnutrition showed similar differences between the settings. The malnourished group was largest (56.0%) in LTCFs and smallest in CD (7.8%). The group at risk of malnutrition was largest in CD (85.5%), whereas in SHs there was the largest proportion of well-nourished individuals (22.0%). In the combined data set, the prevalence of malnutrition was 28.3%; 59.4% of participants were at risk of malnutrition, and 12.3% were well nourished. Similar to Kaiser's study,1 nutritional status according to the MNA varied among participants in different settings. Nutritional status deteriorates as dependence, dementia, and care needs grow. Prevalence of malnutrition and risk of malnutrition was high in our dataset. The malnourished group and the at-risk group were even larger than in previous studies.1, 8 The fact that a large proportion of the data was collected in 2000 and 2003 may explain the higher prevalence in the current study. At that time in Finland, older people's nutritional care and professionals' education still followed the nutritional guidelines of the general population. Accordingly, a large Swedish study published in 2000 showed an even higher prevalence of malnutrition than in the current study.9 Older patients with cardiovascular disease strictly following the healthy diet guidelines for the middle-aged population may especially be at risk of becoming malnourished. This may be the case in the CD, sample which had a higher prevalence of being at risk for malnutrition than those residing in SHs. In Finland, large descriptive studies that implemented the MNA in large scale for the first time raised awareness of the significance of older people's nutrition.2, 3 This was a starting point for greater use of MNA in older people's care, which led to development of the Finnish national guidelines of older people's nutrition.10 Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this paper. Author Contributions: Helena Soini: study concept and design, data collection, preparation of the manuscript. Merja Suominen: study design and finalizing the manuscript. Seija Muurinen: study concept and design, data collection, finalizing the manuscript. Timo Strandberg: study design, data collection, finalizing the manuscript. Kaisu Pitkälä: study concept and design, data collection, data analysis, supervision and preparation of the manuscript. Sponsor's Role: No sponsors in the design, methods, subject recruitment, data collections, analysis, or preparation of paper.