Abstract
The origin of malnutrition in older age is multifactorial and risk factors may vary according to health and living situation. The present study aimed to identify setting-specific risk profiles of malnutrition in older adults and to investigate the association of the number of individual risk factors with malnutrition. Data of four cross-sectional studies were harmonized and uniformly analysed. Malnutrition was defined as BMI < 20 kg/m2 and/or weight loss of >3 kg in the previous 3-6 months. Associations between factors of six domains (demographics, health, mental function, physical function, dietary intake-related problems, dietary behaviour), the number of individual risk factors and malnutrition were analysed using logistic regression. Community (CD), geriatric day hospital (GDH), home care (HC), nursing home (NH). CD older adults (n 1073), GDH patients (n 180), HC receivers (n 335) and NH residents (n 197), all ≥65 years. Malnutrition prevalence was lower in CD (11 %) than in the other settings (16-19 %). In the CD sample, poor appetite, difficulties with eating, respiratory and gastrointestinal diseases were associated with malnutrition; in GDH patients, poor appetite and respiratory diseases; in HC receivers, younger age, poor appetite and nausea; and in NH residents, older age and mobility limitations. In all settings the likelihood of malnutrition increased with the number of potential individual risk factors. The study indicates a varying relevance of certain risk factors of malnutrition in different settings. However, the relationship of the number of individual risk factors with malnutrition in all settings implies comprehensive approaches to identify persons at risk of malnutrition early.
Highlights
MethodsPhysical function was defined by having mobility limitations and eating difficulties using the respective items of the Barthel Index for activities of daily living[29] in the geriatric day hospital (GDH), home care (HC) and nursing home (NH) studies and the German version of the Health Assessment Questionnaire (HAQ)(30) in the CD study
In the CD sample, poor appetite, difficulties with eating, respiratory and gastrointestinal diseases were associated with malnutrition; in geriatric day hospital (GDH) patients, poor appetite and respiratory diseases; in home care (HC) receivers, younger age, poor appetite and nausea; and in nursing home (NH) residents, older age and mobility limitations
As both HC receivers and NH residents belong to the population dependent on care, especially physical and mental functional status were impaired compared with the other samples
Summary
Physical function was defined by having mobility limitations and eating difficulties using the respective items of the Barthel Index for activities of daily living[29] in the GDH, HC and NH studies and the German version of the Health Assessment Questionnaire (HAQ)(30) in the CD study. Items of both instruments were dichotomized (see Supplemental Table S1). Demographics were not considered as living alone was not assessed in all four studies and age and gender were used as adjustment variables in the regression models. Statistical analysis was performed with the statistical software package IBM SPSS Statistics version 24
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