Nutrition Research and Practice

The Korean Nutrition Society (한국영양학회)
권호 표지
DOI QR코드

DOI QR Code

Evaluation of malnutrition status and related risk factors in geriatric outpatient clinic

  • Cin, Pelin (Department of Nutrition and Dietetics, Faculty of Health Sciences, Istanbul Kultur University) ;
  • Tanriover, Ozlem (Department of Family Medicine and Medical Education, Faculty of Medicine, Yeditepe University) ;
  • Yavuzer, Hakan (Division of Geriatrics, Department of Internal Medicine, Faculty of Cerrahpasa Medicine, Istanbul University-Cerrahpasa) ;
  • Erdincler, Deniz Suna (Division of Geriatrics, Department of Internal Medicine, Faculty of Cerrahpasa Medicine, Istanbul University-Cerrahpasa)
  • Received : 2019.10.29
  • Accepted : 2020.08.24
  • Published : 2021.08.01
Download PDF
⟨ Previous Next ⟩

Abstract

BACKGROUND/OBJECTIVES: Malnutrition risk and malnutrition among the elderly is a public health concern. In combating this health-related problem, it is critically important to evaluate the risk factors in a multidimensional way and to apply appropriate nutrition intervention based on the results. SUBJECTS/METHODS: A cross-sectional study was conducted on 215 elderly patients (32.6% male, 67.4% female) in a geriatric outpatient clinic of a hospital in Turkey. Nutritional questionnaires that incorporated the 24-h recall method were applied to determine general characteristics of patients, their health status, nutritional habits, and daily energy and nutrient intakes. Mini Nutritional Assessment was used to determine nutritional status. Relevant anthropometric measurements were obtained. RESULTS: The subjects' mean age was 76.1 ± 7.0 years, and the prevalence of malnutrition (n = 7) and risk of malnutrition (n = 53) among the 215 subjects was 3.2% and 24.7%, respectively. Patients with malnutrition or risk of malnutrition were found to be single, have a depression diagnosis, in an older age group, have less appetite, more tooth loss, have more frequent swallowing/chewing difficulty, and have more frequent meal skipping. In addition, mean daily energy, carbohydrate, fat, fiber, vitamin E, vitamin B1, vitamin B2, vitamin B6, vitamin C, folates, potassium, magnesium, phosphorus, iron intake, and water consumption were found to be statistically significantly low in subjects with malnutrition or risk of malnutrition. After performing regression analysis to determine confounding factors, malnutrition risk was significantly associated with marital status, loss of teeth, appetite status, and depression. CONCLUSIONS: Routine nutritional screening and assessment of the elderly should be performed. If nutritional deficiencies cannot be diagnosed early and treated, self-sufficiency in the elderly may deteriorate, resulting in increased institutionalization.

Keywords

References

  1. Turconi G. Healthy aging: nutritional intervention to improve and extend quality of life among older people. J Nutr Food Sci 2011;1:1-2.
  2. Turkish Statistical Institute (TurkStat). Population projections, 2018-2080. Cankaya/Ankara: Turkish Statistical Institute; [cited 2019 June 30]. Available from: https://data.tuik.gov.tr/tr/display-bulletin/?bulletin=nufus-projeksiyonlari-2018-2080-30567.
  3. Cederholm T, Barazzoni R, Austin P, Ballmer P, Biolo G, Bischoff SC, Compher C, Correia I, Higashiguchi T, Holst M, et al. ESPEN guidelines on definitions and terminology of clinical nutrition. Clin Nutr 2017;36:49-64. https://doi.org/10.1016/j.clnu.2016.09.004
  4. Hyland P, Barnett Y, Allen LH. Aging. In: Allen LH, Prentice A, Caballero B, editors. Encyclopedia of Human Nutrition. Oxford: Academic Press; 2013. p.33-9.
  5. van der Pols-Vijlbrief R, Wijnhoven HA, Schaap LA, Terwee CB, Visser M. Determinants of protein-energy malnutrition in community-dwelling older adults: a systematic review of observational studies. Ageing Res Rev 2014;18:112-31. https://doi.org/10.1016/j.arr.2014.09.001
  6. John BK, Bullock M, Brenner L, McGaw C, Scolapio JS. Nutrition in the elderly. Frequently asked questions. Am J Gastroenterol 2013;108:1252-66. https://doi.org/10.1038/ajg.2013.125
  7. Agarwal E, Miller M, Yaxley A, Isenring E. Malnutrition in the elderly: a narrative review. Maturitas 2013;76:296-302. https://doi.org/10.1016/j.maturitas.2013.07.013
  8. Saka B, Kaya O, Ozturk GB, Erten N, Karan MA. Malnutrition in the elderly and its relationship with other geriatric syndromes. Clin Nutr 2010;29:745-8. https://doi.org/10.1016/j.clnu.2010.04.006
  9. Feldblum I, German L, Castel H, Harman-Boehm I, Bilenko N, Eisinger M, Fraser D, Shahar DR. Characteristics of undernourished older medical patients and the identification of predictors for undernutrition status. Nutr J 2007;6:37. https://doi.org/10.1186/1475-2891-6-37
  10. European Food Safety Authority (EFSA) Panel on Dietetic Products, Nutrition, and Allergies (NDA). Scientific opinion on establishing food-based dietary guidelines. EFSA J 2010;8:1460.
  11. Sanchez-Garcia S, Garcia-Pena C, Duque-Lopez MX, Juarez-Cedillo T, Cortes-Nunez AR, Reyes-Beaman S. Anthropometric measures and nutritional status in a healthy elderly population. BMC Public Health 2007;7:2. https://doi.org/10.1186/1471-2458-7-2
  12. Acar Tek N, Ongan D, Turker PF, Balci C, Iplikci G, Dedebayraktar D, Gurarslan O, Kelat Z. Weight management individual standard nutrition counseling program for the elderly. In: Rakicioglu N, Samur G, Basoglu S, editors. Patient Monitoring Guideline/Weight Management Handbook for Dietitians. Ankara: T.C. Saglik Bakanligi Halk Sagligi Genel Mudurlugu; 2017. p.69-86.
  13. Kondrup J, Allison SP, Elia M, Vellas B, Plauth MEducational and Clinical Practice Committee, European Society of Parenteral and Enteral Nutrition (ESPEN). ESPEN guidelines for nutrition screening 2002. Clin Nutr 2003;22:415-21. https://doi.org/10.1016/S0261-5614(03)00098-0
  14. Sarikaya D, Halil M, Kuyumcu ME, Kilic MK, Yesil Y, Kara O, Ozturk S, Gungor E, Karabulut E, Balam Yavuz B, et al. Mini nutritional assessment test long and short form are valid screening tools in Turkish older adults. Arch Gerontol Geriatr 2015;61:56-60. https://doi.org/10.1016/j.archger.2015.04.006
  15. Kalan U, Arik F, Isik AT, Soysal P. Nutritional profiles of older adults according the Mini-Nutritional Assessment. Aging Clin Exp Res 2020;32:673-80. https://doi.org/10.1007/s40520-019-01235-1
  16. Bernstein M, Kreutzer C, Steffen LM. Nutritional assessment for the older adult. In: Bernstein M, Munoz N, editors. Nutrition for the Older Adults. Burlington: Jones & Bartlett Learning; 2016. p.73-110.
  17. Gunduz E, Eskin F, Gunduz M, Bentli R, Zengin Y, Dursun R, Icer M, Durgun HM, Gurbuz H, Ekinci M, et al. Malnutrition in community-dwelling elderly in Turkey: a multicenter, cross-sectional study. Med Sci Monit 2015;21:2750-6. https://doi.org/10.12659/MSM.893894
  18. Mitri R, Boulos C, Adib SM. Determinants of the nutritional status of older adults in urban Lebanon. Geriatr Gerontol Int 2017;17:424-32. https://doi.org/10.1111/ggi.12732
  19. Agarwalla R, Saikia AM, Baruah R. Assessment of the nutritional status of the elderly and its correlates. J Family Community Med 2015;22:39-43. https://doi.org/10.4103/2230-8229.149588
  20. Damayanthi HD, Moy FM, Abdullah KL, Dharmaratne SD. Prevalence of malnutrition and associated factors among community-dwelling older persons in Sri Lanka: a cross-sectional study. BMC Geriatr 2018;18:199. https://doi.org/10.1186/s12877-018-0892-2
  21. Spirgiene L, Damuleviciene G, Tomkeviciute J, Riklikiene O. Nutritional status of rural community-dwelling older people and changes after following nutritional recommendations. Int J Nurs Pract 2018;24:e12688. https://doi.org/10.1111/ijn.12688
  22. Heuberger R, Wong H. The association between depression and widowhood and nutritional status in older adults. Geriatr Nurs 2014;35:428-33. https://doi.org/10.1016/j.gerinurse.2014.06.011
  23. Boulos C, Salameh P, Barberger-Gateau P. Social isolation and risk for malnutrition among older people. Geriatr Gerontol Int 2017;17:286-94. https://doi.org/10.1111/ggi.12711
  24. Fernandez-Barres S, Martin N, Canela T, Garcia-Barco M, Basora J, Arija VProject ATDOM-NUT group. Dietary intake in the dependent elderly: evaluation of the risk of nutritional deficit. J Hum Nutr Diet 2016;29:174-84. https://doi.org/10.1111/jhn.12310
  25. Arikbuka MO, Yucecan S. Assessment of nutritional status and its association with anthropometric measurements, blood results and body composition in elderly cardiovascular patients. Prog Nutr 2016;18:344-51.
  26. Leandro-Merhi VA, De Aquino JL. Anthropometric parameters of nutritional assessment as predictive factors of the Mini Nutritional Assessment (MNA) of hospitalized elderly patients. J Nutr Health Aging 2011;15:181-6. https://doi.org/10.1007/s12603-010-0116-8
  27. van der Meij BS, Wijnhoven HA, Lee JS, Houston DK, Hue T, Harris TB, Kritchevsky SB, Newman AB, Visser M. Poor appetite and dietary intake in community-dwelling. J Am Geriatr Soc 2017;65:2190-7. https://doi.org/10.1111/jgs.15017
  28. Hagglund P, Falt A, Hagg M, Wester P, Levring Jaghagen E. Swallowing dysfunction as risk factor for undernutrition in older people admitted to Swedish short-term care: a cross-sectional study. Aging Clin Exp Res 2019;31:85-94. https://doi.org/10.1007/s40520-018-0944-7
  29. Jyvakorpi SK, Pitkala KH, Puranen TM, Bjorkman MP, Kautiainen H, Strandberg TE, Soini HH, Suominen MH. High proportions of older people with normal nutritional status have poor protein intake and low diet quality. Arch Gerontol Geriatr 2016;67:40-5. https://doi.org/10.1016/j.archger.2016.06.012
  30. Lahiri S, Biswas A, Santra S, Lahiri S. Assessment of nutritional status among elderly population in a rural area of West Bengal, India. Int J Med Sci Public Health 2015;4:569-72. https://doi.org/10.5455/ijmsph.2015.20122014117
  31. Hirose T, Hasegawa J, Izawa S, Enoki H, Suzuki Y, Kuzuya M. Accumulation of geriatric conditions is associated with poor nutritional status in dependent older people living in the community and in nursing homes. Geriatr Gerontol Int 2014;14:198-205. https://doi.org/10.1111/ggi.12079