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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.
The original Danish rules on product liability constituted a rather simple system. The liability of producers and suppliers for physical damage caused by dangerous/defective products was based on fault/negligence (culpa) following the ordinary principles of Danish judge-made tort law. A special feature was a court-developed principle of professional suppliers’ vicarious liability for product liability incurred by a previous link in the chain of production or distribution. The main justification for this principle is generally sought in the fact that the supplier is usually in a better position than the injured party to influence and to seek recourse against the producer and other previous links in the chain of distribution.
The principles mentioned above are based on (non-statutory) tort law and have no counterpart in sales law. Personal injury and damage caused to property (other than the defective product itself) are outside the scope of the seller's liability for breach of contract. This is not stipulated explicitly in any of the provisions of the Sale of Goods Act (from 1906) but has been and still is the way the Act is interpreted based on the travaux préparatoires of the Act. An exception to this, concerning damage to the buyer's property, is found in international non-consumer sales, see CISG arts 5 ff.
IMPLEMENTATION OF THE PRODUCT LIABILITY DIRECTIVE
In order to maintain the pre-existing rules as far as possible and going no further than required by the Directive, the Danish rules implementing the Directive were added ‘on top’ of the existing non-statutory rules. Thus, the 1989 Danish Product Liability Act (PLA) introduced the Directive's strict (no-fault) defect liability for the ‘producer’ (with a development risk defence) and codified the pre-existing principle of professional suppliers’ vicarious liability for product liability incurred by a previous link in the chain of production and distribution.
As ageing is associated with changes in body composition, BMI may not be the appropriate obesity measure for older adults. To date, little is known about associations between obesity measures and health-related quality of life (HRQoL). Thus, we aimed to compare different obesity measures in their association with HRQoL and self-rated physical constitution (SRPC) in older adults.
Seven obesity measures (BMI, waist circumference (WC), waist-to-hip ratio, waist-to-height ratio, fat mass percentage based on bioelectrical impedance analysis, hypertriglyceridaemic waist (HTGW) and sarcopenic obesity) were assessed at baseline in 2009. HRQoL, using the EQ-5D questionnaire, and SRPC, using one single question, were collected at baseline and at the 3-year follow-up in 2012. Linear and logistic regression analyses were used to examine the associations between the obesity measures and both outcomes. Model comparisons were conducted by area under the receiver-operating characteristic curve, R2, Akaike and Schwarz Bayesian information criteria.
KORA-Age study in Southern Germany (2009–2012).
Older adults (n 883; aged ≥65 years).
Nearly all obesity measures were significantly inversely associated with both outcomes in cross-sectional analyses. Concerning HRQoL, the WC model explained most of the variance and had the best model adaption, followed by the BMI model. Regarding SRPC, the HTGW and BMI models were best as rated by model quality criteria, followed closely by the WC model. Longitudinal analyses showed no significant associations.
These results suggest that, with regard to HRQoL/SRPC, simple anthropometric measures are sufficient to determine obesity in older adults in medical practice.