Getting older means you now have special nutritional needs. This can make it more difficult to eat the right balance of nutritious foods. For example, you may be less physically active or have less interest in food than you did before. These changes can occur so gradually that you may not notice them while they are happening. The changes can result from illnesses or accidents, genetic patterns, or social, psychological, and economic factors.
Because of these changes, it may be necessary to change how you eat. If you do not take your new needs into consideration when you eat, you may be at risk for malnutrition [nutrient imbalance].
Malnutrition is more common in adults over age 65. This is a serious problem, because malnutrition can be bad for your health. It is linked to higher death rates, longer stays in the hospital, and more disability and medical complications. Also, malnutrition raises the risk of infections, anemia, skin problems, weakness, fatigue, and electrolyte imbalances in your blood. Unfortunately, malnutrition is often not identified. Even healthcare professionals may not notice that their patients are malnourished.
The Most Common Types of Malnutrition in Older People
Malnutrition refers both to “under-nutrition” and “over-nutrition.”
- Under-nutrition occurs when you do not eat enough food. This may lead to unintended weight loss, and eventually many significant health problems. People who have severe illness may experience extreme weight loss—sometimes known as “wasting” or cachexia. This is most likely to occur in older patients with serious diseases such as HIV/AIDS, rheumatoid arthritis, heart failure, cancer, or organ failure [including end-stage liver, kidney, or lung disease].
- Over-nutrition can occur when you become less physically active with age but continue to eat as you did when you were younger. This can put you at risk for becoming overweight or obese. Carrying extra weight is a risk factor for many serious diseases, particularly cardiovascular disease, arthritis, and diabetes. However, even in the case of over-nutrition, you may be missing adequate levels of important nutrients.
How Common is Malnutrition in Older Adults?
Many people over the age of 65 are either under- or over-nourished. Among older people living in their own homes, about 1 in 10 live with under-nutrition. Many older adults report that they skip at least one meal a day. For people over age 65 who become hospitalized, their risk of becoming undernourished may rise to as much as 60%. Up to 85% of people who live in long-term care facilities experience malnutrition in some form.
On the other hand, as much as one-third of people over the age of 65 suffer from over-nutrition. That is, they eat too much. The result is high rates of being overweight and obese for people in this age group.
Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán [INCMNSZ], Mexico
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ORIGINAL RESEARCH article
Front. Nutr., 14 June 2021
Sec. Clinical Nutrition
//doi.org/10.3389/fnut.2021.684438
Malnutrition Is Associated With Impaired Functional Status in Older People Receiving Home Care Nursing Service
- 1Graduate Program of Health Sciences, State University of Montes Claros, Montes Claros, Brazil
- 2Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
- 3Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- 4Graduate Program of Medicine [Neurology/Neuroscience], Federal Fluminense University, Rio de Janeiro, Brazil
- 5Old Age Psychiatry Research Network, Telemark Hospital Trust and Vestfold Hospital Trust, Tønsberg, Norway
- 6Department of Nursing and Health Sciences, University of South-Eastern Norway, Drammen, Norway
Objective: This study aimed to explore the magnitude and significance of associations among nutritional status, functional status, comorbidities, age, and gender in older adults receiving assistance from the in-home nursing care service.
Method: In this cross-sectional study, 210 home-dwelling persons 65 years or older who received in-home nursing care service were evaluated. Demographic variables, nutritional status, comorbidities, and the dependency levels of activities of daily living were analyzed. To assess the correlation among the factors that influence nutritional status, a theoretical model was developed and adjusted using the path analysis model.
Results: The primary finding is that functional status is directly associated with nutritional status [β = 0.32; p < 0.001] and severity of comorbidities is indirectly associated with nutritional status [β = −0.07; p < 0.017].
Conclusion: The elicited outcomes in this study reinforce the concept that nutritional status is linked with functional status in older adults receiving in-home care nursing service.
Introduction
According to demographic data, the older adult population has been increasing dramatically in the last 50 years, and it will increase further in the year to come. In 2019, 703 million people were aged 65 years or above in the world. In 2,050, the number is expected to increase to 1.5 billion, meaning that one in every six people worldwide will be aged 65 years or over [].
Aging is defined as an individual, sequential and cumulative series of physiological changes that occur in an organism over time, resulting in progressive deterioration of functioning, increased vulnerability to disease, and reduced viability []. Aging is in most people accompanied by multimorbidity and physically debilitating conditions such as sarcopenia, frailty, dementia, and/or malnutrition [].
Older people may suffer from frailty and malnutrition at the same time. Previous studies have shown a strong association between physical frailty and risk of malnutrition and malnutrition in older adults [, ]. Thus, a critical agent for healthy aging is an ideal nutritional status. There are several causes for this: reduced appetite and energy expenditure, fluid and electrolyte imbalance, altered levels of cytokines and hormones, delayed gastric emptying, and an impaired sense of smell and taste. Moreover, pathologic changes of aging such as chronic disease, depression, cognitive impairment, multiple morbidities, and polypharmacy play an important role in the complex etiology of malnutrition in older adults [–]. Hence, studies worldwide have shown the importance of an adequate nutritional status in this critical period of life [, ].
Early identification of older adults who are at risk for insufficient caloric intake and nutrient adequacy, termed nutritional risk, or malnutrition, is paramount to maintaining health, independence, quality of life, and longevity []. The prevalence of malnutrition is reported to be 10–50% in different populations of older people in need of health care services [, ]. A previous study of older patients receiving domiciliary health care in Norway reported that 41% had dementia and 72% had neuropsychiatric symptoms such as depression, apathy, and anxiety []. These findings underline that this population is very vulnerable and may consist of older frail people at risk for malnutrition, or even present insufficient caloric intake. Therefore, this study aimed to explore the magnitude and significance of associations among nutritional status, functional status, comorbidities, age, and gender in older adults receiving assistance from the in-home nursing care service in Norway.
Methods
Study Design and Population
This study is part of the Capturing Acute and Social Care in Dependent Elders [CASCADE], a prospective cross-sectional study on home-dwelling persons 65 years and older who received in-home nursing care service at least once a week in 2016 in a small city [Sandefjord] in the southeast of Norway. Sample size calculation was carried out using information regarding the Norwegian older population receiving home care nursing services [N = 140,000 individuals] [], the confidence level [95%], confidence interval [5%], and the proportion of potential events [prevalence of malnutrition = average 19%] []. Data were inserted in the Sample Size Calculator, a tool designed by the Australian Bureau of Statistics []. The estimated sample was established [n = 237 participants]. To be included, the patients must have had in-home nursing care service for 4 weeks or more to ensure the service's knowledge about the patients' function in a stable situation. From the 588 persons aged >65 years receiving home care nursing in this community, the head nurses continuously selected patients by alphabetical order that fulfilled the inclusion criteria. Patients were not included if they suffered from a terminal illness [life expectancy 0.90 are reached. The root mean squared error of approximation [RMSEA] was also used, whose value below 0.10 was considered an indicator of reasonable adjustment. In addition, the absolute index χ2/df was adopted, since this indicates an acceptable adjustment for a value