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Factors associated with (risk of) undernutrition in community-dwelling older adults receiving home care: a cross-sectional study in the Netherlands

  • Rachel van der Pols-Vijlbrief (a1), Hanneke AH Wijnhoven (a1), Hilde Molenaar (a1) and Marjolein Visser (a1) (a2)

Abstract

Objective

It is generally thought that causes of undernutrition are multifactorial, but there are limited quantitative studies performed. We therefore examined a wide range of potential factors associated with undernutrition in community-dwelling older adults.

Design

Cross-sectional study.

Setting

Community-dwelling older adults (≥65 years) receiving home care in the Netherlands.

Subjects

Data on potential factors associated with (risk of) undernutrition were collected among 300 older adults. Nutritional status was assessed by the SNAQ65+ instrument. Undernutrition was defined as mid-upper arm circumference <25 cm or unintentional weight loss of ≥4 kg in 6 months. Being at risk of undernutrition was defined as having poor appetite and inability to walk up and down stairs of fifteen steps, without resting.

Results

Of all participants, ninety-two (31·7 %) were undernourished and twenty-four (8·0 %) were at risk of undernutrition. Based on multivariate logistic regression analyses, the statistically significant factors associated with (risk of) undernutrition (P<0·05) were: unable to go outside (OR=5·39), intestinal problems (OR=2·88), smoking (OR=2·56), osteoporosis (OR=2·46), eating fewer than three snacks daily (OR=2·61), dependency in activities of daily living (OR=1·21), physical inactivity (OR=2·01), nausea (OR=2·50) and cancer (OR=2·84); a borderline significant factor was depression symptoms (OR=1·83, P=0·053).

Conclusions

The study suggests that (risk of) undernutrition is a multifactorial problem and that associated factors can be found in several domains. These findings may support the development of intervention trials for the prevention and treatment of undernutrition in community-dwelling older adults.

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Copyright

Corresponding author

*Corresponding author: Email rachel.vijlbrief@vu.nl

References

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1. Chen, CC, Schilling, LS & Lyder, CH (2001) A concept analysis of malnutrition in the elderly. J Adv Nurs 36, 131142.
2. Meijers, JM, van Bokhorst-de van der Schueren, MA, Schols, JM et al. (2010) Defining malnutrition: mission or mission impossible? Nutrition 26, 432440.
3. Phillips, MB, Foley, AL, Barnard, R et al. (2010) Nutritional screening in community-dwelling older adults: a systematic literature review. Asia Pac J Clin Nutr 19, 440449.
4. Wijnhoven, HA, Schilp, J, van Bokhorst-de van der Schueren, MA et al. (2012) Development and validation of criteria for determining undernutrition in community-dwelling older men and women: the Short Nutritional Assessment Questionnaire 65+. Clin Nutr 31, 351358.
5. Lee, JS, Kritchevsky, SB, Tylavsky, F et al. (2005) Weight change, weight change intention, and the incidence of mobility limitation in well-functioning community-dwelling older adults. J Gerontol A Biol Sci Med Sci 60, 10071012.
6. Strobl, R, Muller, M, Emeny, R et al. (2013) Distribution and determinants of functioning and disability in aged adults – results from the German KORA-Age study. BMC Public Health 13, 137.
7. Vetta, F, Ronzoni, S, Taglieri, G et al. (1999) The impact of malnutrition on the quality of life in the elderly. Clin Nutr 18, 259267.
8. Atlantis, E, Browning, C & Kendig, H (2010) Body mass index and unintentional weight change associated with all-cause mortality in older Australians: the Melbourne Longitudinal Studies on Healthy Ageing (MELSHA). Age Ageing 39, 643646.
9. Luppa, M, Luck, T, Weyerer, S et al. (2010) Prediction of institutionalization in the elderly. A systematic review. Age Ageing 39, 3138.
10. Gaugler, JE, Duval, S, Anderson, KA et al. (2007) Predicting nursing home admission in the US: a meta-analysis. BMC Geriatr 7, 13.
11. van der Pols-Vijlbrief, R, Wijnhoven, HA, Schaap, LA et al. (2014) Determinants of protein–energy malnutrition in community-dwelling older adults: a systematic review of observational studies. Ageing Res Rev 18, 112131.
12. Wijnhoven, HA, van Bokhorst-de van der Schueren, MA, Heymans, MW et al. (2010) Low mid-upper arm circumference, calf circumference, and body mass index and mortality in older persons. J Gerontol A Biol Sci Med Sci 65, 11071114.
13. Centraal Bureau voor de Statistiek (2006) Opleidingsniveaus van de SOI 2006. Den Haag: CBS.
14. Lubben, J, Blozik, E, Gillmann, G et al. (2006) Performance of an abbreviated version of the Lubben Social Network Scale among three European community-dwelling older adult populations. Gerontologist 46, 503513.
15. Vrije-Universiteit-Amsterdam (2015) Longitudinal Aging Study Amsterdam (LASA). http://www.lasa-vu.nl/themes/navigator.htm (accessed May 2015).
16. RIVM (2014) Uitkeringsbedragen per 1 juli 2014. http://www.rijksoverheid.nl//nieuws/2014/06/25/uitkeringsbedragen-per-1-juli-2014 (accessed April 2015).
17. Barrocas, A, Bistrian, BR, Blackburn, GL et al. (1995) Appropriate and effective use of the NSI checklist and screens. An update on caring for the elderly by preventing malnutrition. J Am Diet Assoc 95, 647648.
18. White, JV, Dwyer, JT, Posner, BM et al. (1992) Nutrition screening initiative: development and implementation of the public awareness checklist and screening tools. J Am Diet Assoc 92, 163167.
19. van Domburg, RT, Meeter, K, van Berkel, DF et al. (2000) Smoking cessation reduces mortality after coronary artery bypass surgery: a 20-year follow-up study. J Am Coll Cardiol 36, 878883.
20. Kawachi, I, Colditz, GA, Stampfer, MJ et al. (1993) Smoking cessation in relation to total mortality rates in women. A prospective cohort study. Ann Intern Med 119, 9921000.
21. Garretsen, HFL (1983) Probleemdrinken: Prevalentiebepaling, beinvloedende factoren en preventiemogelijkheden: Theoretische overwegingen en onderzoek in Rotterdam. Lisse: Swets & Zeitlinger.
22. Kemper, H, Ooijendijk, W & Stiggelbout, M (2000) Consensus over de Nederlandse norm voor gezond bewegen. TSG 78, 180183.
23. Hoeymans, N, Schellevis, F, Oostrom, SV et al. (2013) Wat is een chronische ziekte en wat is multimorbiditeit? Bilthoven: RIVM; available at http://www.nationaalkompas.nl/gezondheid-en-ziekte/ziekten-en-aandoeningen/chronische-ziekten-en-multimorbiditeit/beschrijving/
24. Fried, TR, O’Leary, J, Towle, V et al. (2014) Health outcomes associated with polypharmacy in community-dwelling older adults: a systematic review. J Am Geriatr Soc 62, 22612272.
25. Lemmens, LC & Weda, M (2013) Polyfarmacie bij kwetsbare ouderen: inventarisatie van risico’s en mogelijke interventiestrategieën. Bilthoven: Rijksinstituut voor Volksgezondheid en Milieu, Ministerie van Volksgezondheid, Welzijn en Sport.
26. Hunt, SM, McEwen, J & McKenna, SP (1985) Measuring health status: a new tool for clinicians and epidemiologists. J R Coll Gen Pract 35, 185188.
27. Heim, N, Snijder, MB, Deeg, DJ et al. (2008) Obesity in older adults is associated with an increased prevalence and incidence of pain. Obesity (Silver Spring) 16, 25102517.
28. Jorm, AF (1994) A short form of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE): development and cross-validation. Psychol Med 24, 145153.
29. Quinn, TJ, Fearon, P, Noel-Storr, AH et al. (2014) Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) for the diagnosis of dementia within community dwelling populations. Cochrane Database Syst Rev 4, CD010079.
30. Andresen, EM, Malmgren, JA, Carter, WB et al. (1994) Screening for depression in well older adults: evaluation of a short form of the CES-D (Center for Epidemiologic Studies Depression Scale). Am J Prev Med 10, 7784.
31. Mahoney, FI & Barthel, DW (1965) Functional evaluation: the Barthel index. Md State Med J 14, 6165.
32. Guigoz, Y, Lauque, S & Vellas, BJ (2002) Identifying the elderly at risk for malnutrition. The Mini Nutritional Assessment. Clin Geriatric Med 18, 737757.
33. McWhinnie, JR (1981) Disability assessment in population surveys: results of the OECD Common Development Effort. Rev Epidemiol Sante Publique 29, 413419.
34. Ormel, J, Kempen, GI, Penninx, BW et al. (1997) Chronic medical conditions and mental health in older people: disability and psychosocial resources mediate specific mental health effects. Psychol Med 27, 10651077.
35. Schilp, J, Wijnhoven, HA, Deeg, DJ et al. (2011) Early determinants for the development of undernutrition in an older general population: Longitudinal Aging Study Amsterdam. Br J Nutr 106, 708717.
36. Wilson, MM, Thomas, DR, Rubenstein, LZ et al. (2005) Appetite assessment: simple appetite questionnaire predicts weight loss in community-dwelling adults and nursing home residents. Am J Clin Nutr 82, 10741081.
37. Eekhout, I, de Vet, HC, Twisk, JW et al. (2014) Missing data in a multi-item instrument were best handled by multiple imputation at the item score level. J Clin Epidemiol 67, 335342.
38. Itoh, M, Tsuji, T, Nemoto, K et al. (2013) Undernutrition in patients with COPD and its treatment. Nutrients 5, 13161335.
39. Hebuterne, X, Lemarie, E, Michallet, M et al. (2014) Prevalence of malnutrition and current use of nutrition support in patients with cancer. JPEN J Parenter Enteral Nutr 38, 196204.
40. Ikizler, TA, Cano, NJ, Franch, H et al. (2013) Prevention and treatment of protein energy wasting in chronic kidney disease patients: a consensus statement by the International Society of Renal Nutrition and Metabolism. Kidney Int 84, 10961107.
41. Twisk, JW (2010) Inleiding in de toegepaste biostatistiek. Amsterdam: Reed Business Education.
42. Payette, H, Gray-Donald, K, Cyr, R et al. (1995) Predictors of dietary intake in a functionally dependent elderly population in the community. Am J Public Health 85, 677683.
43. Margetts, BM, Thompson, RL, Elia, M et al. (2003) Prevalence of risk of undernutrition is associated with poor health status in older people in the UK. Eur J Clin Nutr 57, 6974.
44. Cochrane, WJ & Afolabi, OA (2004) Investigation into the nutritional status, dietary intake and smoking habits of patients with chronic obstructive pulmonary disease. J Hum Nutr Diet 17, 311.
45. Vennemann, MM, Hummel, T & Berger, K (2008) The association between smoking and smell and taste impairment in the general population. J Neurol 255, 11211126.
46. Gregersen, NT, Moller, BK, Raben, A et al. (2011) Determinants of appetite ratings: the role of age, gender, BMI, physical activity, smoking habits, and diet/weight concern. Food Nutr Res 2011, 55.
47. Blauw, LL, Boon, MR, Rosendaal, FR et al. (2015) Smoking is associated with increased resting energy expenditure in the general population: the NEO study. Metabolism 64, 15481555.
48. Engel, JH, Siewerdt, F, Jackson, R et al. (2011) Hardiness, depression, and emotional well-being and their association with appetite in older adults. J Am Geriatr Soc 59, 482487.
49. Meijers, JM, Schols, JM, van Bokhorst-de van der Schueren, MA et al. (2009) Malnutrition prevalence in The Netherlands: results of the annual Dutch national prevalence measurement of care problems. Br J Nutr 101, 417423.
50. Sheard, JM, Ash, S, Mellick, GD et al. (2013) Malnutrition in a sample of community-dwelling people with Parkinson’s disease. PLoS One 8, e53290.
51. Soenen, S & Chapman, IM (2013) Body weight, anorexia, and undernutrition in older people. J Am Med Dir Assoc 14, 642648.
52. Caroli, A, Poli, A, Ricotta, D et al. (2011) Invited review: Dairy intake and bone health: a viewpoint from the state of the art. J Dairy Sci 94, 52495262.
53. Czerwinski, E, Badurski, JE, Marcinowska-Suchowierska, E et al. (2007) Current understanding of osteoporosis according to the position of the World Health Organization (WHO) and International Osteoporosis Foundation. Ortop Traumatol Rehabil 9, 337356.
54. Sanchez-Lara, K, Ugalde-Morales, E, Motola-Kuba, D et al. (2013) Gastrointestinal symptoms and weight loss in cancer patients receiving chemotherapy. Br J Nutr 109, 894897.
55. Barrera, R (2002) Nutritional support in cancer patients. JPEN J Parenter Enteral Nutr 26, 5 Suppl., S63S71.
56. Lee, JS & Frongillo, EA Jr (2001) Nutritional and health consequences are associated with food insecurity among US elderly persons. J Nutr 131, 15031509.
57. Anderson, S (1990) Core indicators of nutritional state for difficult-to-sample populations. J Nutr 120, Suppl. 11, 15591600.
58. Quine, S & Morrell, S (2006) Food insecurity in community-dwelling older Australians. Public Health Nutr 9, 219224.
59. Ritchie, CS, Locher, JL, Roth, DL et al. (2008) Unintentional weight loss predicts decline in activities of daily living function and life-space mobility over 4 years among community-dwelling older adults. J Gerontol A Biol Sci Med Sci 63, 6775.
60. Milaneschi, Y, Tanaka, T & Ferrucci, L (2010) Nutritional determinants of mobility. Curr Opin Clin Nutr Metab Care 13, 625629.
61. Feldblum, I, German, L, Castel, H et al. (2007) Characteristics of undernourished older medical patients and the identification of predictors for undernutrition status. Nutr J 6, 37.
62. Johansson, Y, Bachrach-Lindstrom, M, Carstensen, J et al. (2009) Malnutrition in a home-living older population: prevalence, incidence and risk factors. A prospective study. J Clin Nurs 18, 13541364.
63. Han, Y, Li, S & Zheng, Y (2009) Predictors of nutritional status among community-dwelling older adults in Wuhan, China. Public Health Nutr 12, 11891196.
64. Eekhout, I, de Boer, RM, Twisk, JW et al. (2012) Missing data: a systematic review of how they are reported and handled. Epidemiology 23, 729732.

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