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Journal of Primary Health Care Journal of Primary Health Care Society
Journal of The Royal New Zealand College of General Practitioners
RESEARCH ARTICLE (Open Access)

High prevalence of malnutrition and frailty among older adults at admission to residential aged care

Idah Chatindiara 1 3 , Jacqueline Allen 2 , Dushanka Hettige 1 , Stacey Senior 1 , Marilize Richter 1 , Marlena Kruger 1 , Carol Wham 1
+ Author Affiliations
- Author Affiliations

1 College of Health, Massey University, Turitea Placem Albany, Auckland, New Zealand

2 Department of Surgery, University of Auckland, Auckland, New Zealand

3 Corresponding author. Email: ichatindi@gmail.com

Journal of Primary Health Care 12(4) 305-317 https://doi.org/10.1071/HC20042
Published: 22 December 2020

Journal Compilation © Royal New Zealand College of General Practitioners 2020 This is an open access article licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License

Abstract

INTRODUCTION: Malnutrition is an under-recognised and under-treated problem often affecting older adults.

AIM: The aim of this study was to evaluate the prevalence of and factors associated with malnutrition and frailty among older adults at early admission to residential aged care.

METHODS: A cross-sectional study was undertaken among eligible older adults within the first week of admission to residential aged care. Participants were assessed for malnutrition risk using the Mini Nutritional Assessment Short Form, frailty using the Fried phenotype criterion, muscle strength using a grip strength dynamometer and gait speed using a 2.4-m walk test. A Cox regression analysis was conducted to identify factors associated with malnutrition risk and frailty status.

RESULTS: Of 174 participants (mean age 85.5 years, 61% women), two-thirds (66%) were admitted to residential aged care from the community. Most (93%) were either malnourished (48%) or at risk of malnutrition (45%). A total of 76% of participants were frail and 24% were pre-frail. Forty-three percent were both malnourished and frail. Low risk of malnutrition was associated with increases in muscle strength [0.96 (0.93–0.99)], gait speed [0.27 (0.10–0.73)] and pre-frailty status [0.32 (0.12–0.83)].

DISCUSSION: This study provides preliminary evidence for high prevalence of malnutrition and frailty at admission to residential aged care. Almost all participants were malnourished or at nutrition risk. Findings highlight the need for strategies to prevent, detect and treat malnutrition in community health care and support nutrition screening at admission to residential aged care.

Keywords: Malnutrition; frailty; residential aged care


References

[1]  Verlaan S, Ligthart-Melis GC, Wijers SL, et al. High prevalence of physical frailty among community-dwelling malnourished older adults–A systematic review and meta-analysis. J Am Med Dir Assoc. 2017; 18 374–82.
High prevalence of physical frailty among community-dwelling malnourished older adults–A systematic review and meta-analysis.Crossref | GoogleScholarGoogle Scholar | 28238676PubMed |

[2]  Laur CV, McNicholl T, Valaitis R, Keller HH. Malnutrition or frailty? Overlap and evidence gaps in the diagnosis and treatment of frailty and malnutrition. Appl Physiol Nutr Metab. 2017; 42 449–58.
Malnutrition or frailty? Overlap and evidence gaps in the diagnosis and treatment of frailty and malnutrition.Crossref | GoogleScholarGoogle Scholar | 28322060PubMed |

[3]  Hu X, Zhang L, Wang H, et al. Malnutrition-sarcopenia syndrome predicts mortality in hospitalized older patients. Sci Rep. 2017; 7 3171
Malnutrition-sarcopenia syndrome predicts mortality in hospitalized older patients.Crossref | GoogleScholarGoogle Scholar | 28600505PubMed |

[4]  Cruz-Jentoft AJ, Kiesswetter E, Drey M, Sieber CC. Nutrition, frailty, and sarcopenia. Aging Clin Exp Res. 2017; 29 43–8.
Nutrition, frailty, and sarcopenia.Crossref | GoogleScholarGoogle Scholar | 28155181PubMed |

[5]  Jeejeebhoy KN. Malnutrition, fatigue, frailty, vulnerability, sarcopenia and cachexia: overlap of clinical features. Curr Opin Clin Nutr Metab Care. 2012; 15 213–9.
Malnutrition, fatigue, frailty, vulnerability, sarcopenia and cachexia: overlap of clinical features.Crossref | GoogleScholarGoogle Scholar | 22450775PubMed |

[6]  Rasheed S, Woods RT. Malnutrition and quality of life in older people: a systematic review and meta-analysis. Ageing Res Rev. 2013; 12 561–6.
Malnutrition and quality of life in older people: a systematic review and meta-analysis.Crossref | GoogleScholarGoogle Scholar | 23228882PubMed |

[7]  Kojima G, Iliffe S, Jivraj S, Walters K. Association between frailty and quality of life among community-dwelling older people: a systematic review and meta-analysis. J Epidemiol Community Health. 2016; 70 716–21.
Association between frailty and quality of life among community-dwelling older people: a systematic review and meta-analysis.Crossref | GoogleScholarGoogle Scholar | 26783304PubMed |

[8]  Kamo T, Takayama K, Ishii H, et al. Coexisting severe frailty and malnutrition predict mortality among the oldest old in nursing homes: a 1-year prospective study. Arch Gerontol Geriatr. 2017; 70 99–104.
Coexisting severe frailty and malnutrition predict mortality among the oldest old in nursing homes: a 1-year prospective study.Crossref | GoogleScholarGoogle Scholar | 28126636PubMed |

[9]  Wiles JL, Leibing A, Guberman N, et al. The meaning of “ageing in place” to older people. Gerontologist. 2011; 52 gnr098
The meaning of “ageing in place” to older people.Crossref | GoogleScholarGoogle Scholar | 21983126PubMed |

[10]  Jorgensen D, Arksey H, Parsons M, et al. Why do older people in New Zealand enter residential care rather than choosing to remain at home, and who makes that decision? Ageing Int. 2009; 34 15–32.
Why do older people in New Zealand enter residential care rather than choosing to remain at home, and who makes that decision?Crossref | GoogleScholarGoogle Scholar |

[11]  Chatindiara I, Sheridan N, Kruger M, Wham C. Eating less the logical thing to do? Vulnerability to malnutrition with advancing age: a qualitative study. Appetite. 2019; 146 104502
Eating less the logical thing to do? Vulnerability to malnutrition with advancing age: a qualitative study.Crossref | GoogleScholarGoogle Scholar | 31678148PubMed |

[12]  Ministry of Health. DHB spending on services for older people. Wellington, New Zealand: Ministry of Health; 2016. [cited 2018 January 31]. Available from: http://www.health.govt.nz/nz-health-statistics/health-statistics-and-data-sets/older-peoples-health-data-and-stats/dhb-spending-services-older-people.

[13]  Broad JB, Ashton T, Gott M, et al. Likelihood of residential aged care use in later life: a simple approach to estimation with international comparison. Aust N Z J Public Health. 2015; 39 374–9.
Likelihood of residential aged care use in later life: a simple approach to estimation with international comparison.Crossref | GoogleScholarGoogle Scholar | 26095070PubMed |

[14]  Connolly MJ, Broad JB, Boyd M, et al. Residential aged care: the de facto hospice for New Zealand’s older people. Australas J Ageing. 2014; 33 114–20.
Residential aged care: the de facto hospice for New Zealand’s older people.Crossref | GoogleScholarGoogle Scholar | 24521449PubMed |

[15]  Australian and New Zealand Society for Geriatric Medicine Position Statement: undernutrition and the older person. Australas J Ageing. 2017; 36 75
Position Statement: undernutrition and the older person.Crossref | GoogleScholarGoogle Scholar | 27357752PubMed |

[16]  Thiyagarajan JA, Cesari M, Kumar S, et al. Diagnostic accuracy of screening tool for non-specialist health care settings: a summary of findings from ICOPE rapid reviews. Geneva, Switzerland: World Health Organization; 2017.

[17]  Kaiser MJ, Bauer JM, Rämsch C, et al. Frequency of malnutrition in older adults: a multinational perspective using the mini nutritional assessment. J Am Geriatr Soc. 2010; 58 1734–8.
Frequency of malnutrition in older adults: a multinational perspective using the mini nutritional assessment.Crossref | GoogleScholarGoogle Scholar | 20863332PubMed |

[18]  Kaiser MJ, Bauer J, Ramsch C, et al. Validation of the Mini Nutritional Assessment Short-Form (MNA®-SF): a practical tool for identification of nutritional status. J Nutr Health Aging. 2009; 13 782–8.
Validation of the Mini Nutritional Assessment Short-Form (MNA®-SF): a practical tool for identification of nutritional status.Crossref | GoogleScholarGoogle Scholar | 19812868PubMed |

[19]  Gaskill D, Black LJ, Isenring EA, et al. Malnutrition prevalence and nutrition issues in residential aged care facilities. Australas J Ageing. 2008; 27 189–94.
Malnutrition prevalence and nutrition issues in residential aged care facilities.Crossref | GoogleScholarGoogle Scholar | 19032620PubMed |

[20]  Keller H, Vucea V, Slaughter SE, et al. Prevalence of malnutrition or risk in residents in long term care: comparison of four tools. J Nutr Gerontol Geriatr. 2019; 38 329–44.
Prevalence of malnutrition or risk in residents in long term care: comparison of four tools.Crossref | GoogleScholarGoogle Scholar | 31335280PubMed |

[21]  Suominen M, Muurinen S, Routasalo P, et al. Malnutrition and associated factors among aged residents in all nursing homes in Helsinki. Eur J Clin Nutr. 2005; 59 578–83.
Malnutrition and associated factors among aged residents in all nursing homes in Helsinki.Crossref | GoogleScholarGoogle Scholar | 15744328PubMed |

[22]  Fávaro-Moreira NC, Krausch-Hofmann S, Matthys C, et al. Risk factors for malnutrition in older adults: a systematic review of the literature based on longitudinal data. Adv Nutr. 2016; 7 507–22.
Risk factors for malnutrition in older adults: a systematic review of the literature based on longitudinal data.Crossref | GoogleScholarGoogle Scholar | 27184278PubMed |

[23]  Morley JE, Vellas B, Van Kan GA, et al. Frailty consensus: a call to action. J Am Med Dir Assoc. 2013; 14 392–7.
Frailty consensus: a call to action.Crossref | GoogleScholarGoogle Scholar | 23764209PubMed |

[24]  Fried LP, Tangen CM, Walston J, et al. Frailty in older adults evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001; 56 M146–57.
Frailty in older adults evidence for a phenotype.Crossref | GoogleScholarGoogle Scholar | 11253156PubMed |

[25]  Buta BJ, Walston JD, Godino JG, et al. Frailty assessment instruments: systematic characterization of the uses and contexts of highly-cited instruments. Ageing Res Rev. 2016; 26 53–61.
Frailty assessment instruments: systematic characterization of the uses and contexts of highly-cited instruments.Crossref | GoogleScholarGoogle Scholar | 26674984PubMed |

[26]  Dent E, Kowal P, Hoogendijk EO. Frailty measurement in research and clinical presidential aged caretice: a review. Eur J Intern Med. 2016; 31 3–10.
| 27039014PubMed |

[27]  Kojima G. Prevalence of frailty in nursing homes: a systematic review and meta-analysis. J Am Med Dir Assoc. 2015; 16 940–5.
| 26255709PubMed |

[28]  Agarwal E, Miller M, Yaxley A, Isenring E. Malnutrition in the elderly: a narrative review. Maturitas. 2013; 76 296–302.
| 23958435PubMed |

[29]  Pegorari MS, Tavares DMdS. Factors associated with the frailty syndrome in elderly individuals living in the urban area. Rev Lat Am Enfermagem. 2014; 22 874–82.
Factors associated with the frailty syndrome in elderly individuals living in the urban area.Crossref | GoogleScholarGoogle Scholar | 25493685PubMed |

[30]  Statistics New Zealand. Population. Wellington, New Zealand: Stats NZ; 2018. [cited 2017 November 22]. Available from: https://www.stats.govt.nz/topics/population.

[31]  Ministry of Health. Long-term residential care for older people: what you need to know. Wellington: Ministry of Health; 2012.

[32]  Rubenstein LZ, Harker JO, Salvà A, et al. Screening for undernutrition in geriatric practice developing the short-form mini-nutritional assessment (MNA-SF). J Gerontol A Biol Sci Med Sci. 2001; 56 M366–72.
Screening for undernutrition in geriatric practice developing the short-form mini-nutritional assessment (MNA-SF).Crossref | GoogleScholarGoogle Scholar | 11382797PubMed |

[33]  Belafsky PC, Mouadeb DA, Rees CJ, et al. Validity and reliability of the Eating Assessment Tool (EAT-10). Ann Otol Rhinol Laryngol 2008; 117 919–24.
Validity and reliability of the Eating Assessment Tool (EAT-10).Crossref | GoogleScholarGoogle Scholar | 19140539PubMed |

[34]  Nasreddine ZS, Phillips NA, Bédirian V, et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc 2005; 53 695–9.
The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment.Crossref | GoogleScholarGoogle Scholar | 15817019PubMed |

[35]  Nasreddine Z. Montreal Cognitive Assessment (MoCA): administration and scoring instructions. Canada; 2004. Available from: http://www.mocatest.org/.

[36]  Cruz-Jentoft AJ, Baeyens JP, Bauer JM, et al. Sarcopenia: European consensus on definition and diagnosis Report of the European Working Group on Sarcopenia in Older People. Age Ageing. 2010; 39 412–23.
Sarcopenia: European consensus on definition and diagnosis Report of the European Working Group on Sarcopenia in Older People.Crossref | GoogleScholarGoogle Scholar | 20392703PubMed |

[37]  Roberts HC, Denison HJ, Martin HJ, et al. A review of the measurement of grip strength in clinical and epidemiological studies: towards a standardised approach. Age Ageing. 2011; 40 afr051
A review of the measurement of grip strength in clinical and epidemiological studies: towards a standardised approach.Crossref | GoogleScholarGoogle Scholar | 21624928PubMed |

[38]  Guralnik JM, Simonsick EM, Ferrucci L, et al. A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol. 1994; 49 M85–94.
A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission.Crossref | GoogleScholarGoogle Scholar | 8126356PubMed |

[39]  Guralnik JM, Ferrucci L, Pieper CF, et al. Lower extremity function and subsequent disability: consistency across studies, predictive models, and value of gait speed alone compared with the Short Physical Performance Battery. J Gerontol A Biol Sci Med Sci. 2000; 55 M221–31.
Lower extremity function and subsequent disability: consistency across studies, predictive models, and value of gait speed alone compared with the Short Physical Performance Battery.Crossref | GoogleScholarGoogle Scholar | 10811152PubMed |

[40]  Bieniek J, Wilczyński K, Szewieczek J. Fried frailty phenotype assessment components as applied to geriatric inpatients. Clin Interv Aging. 2016; 11 453
| 27217729PubMed |

[41]  Santos-Eggimann B, Cuénoud P, Spagnoli J, Junod J. Prevalence of frailty in middle-aged and older community-dwelling Europeans living in 10 countries. J Gerontol A Biol Sci Med Sci. 2009; 64A 675–81.
Prevalence of frailty in middle-aged and older community-dwelling Europeans living in 10 countries.Crossref | GoogleScholarGoogle Scholar |

[42]  Orme JG, Reis J, Herz EJ. Factorial and discriminant validity of the Center for Epidemiological Studies Depression (CES-D) scale. J Clin Psychol. 1986; 42 28–33.
Factorial and discriminant validity of the Center for Epidemiological Studies Depression (CES-D) scale.Crossref | GoogleScholarGoogle Scholar | 3950011PubMed |

[43]  Barros AJ, Hirakata VN. Alternatives for logistic regression in cross-sectional studies: an empirical comparison of models that directly estimate the prevalence ratio. BMC Med Res Methodol. 2003; 3 21
Alternatives for logistic regression in cross-sectional studies: an empirical comparison of models that directly estimate the prevalence ratio.Crossref | GoogleScholarGoogle Scholar | 14567763PubMed |

[44]  interRAI New Zealand. [cited 2019 September 18]. Available from: https://www.interrai.co.nz/about/

[45]  Radich MJ. Comparison of nutritional components of InterRAI-HC to validated nutrition screening tools (Thesis, Master of Dietetics). Dunedin: University of Otago; 2014.

[46]  Wei K, Nyunt MSZ, Gao Q, et al. Frailty and malnutrition: related and distinct syndrome prevalence and association among community-dwelling older adults: Singapore Longitudinal Ageing Studies. J Am Med Dir Assoc. 2017; 18 1019–28.
Frailty and malnutrition: related and distinct syndrome prevalence and association among community-dwelling older adults: Singapore Longitudinal Ageing Studies.Crossref | GoogleScholarGoogle Scholar | 28804010PubMed |

[47]  Boulos C, Salameh P, Barberger-Gateau P. Malnutrition and frailty in community dwelling older adults living in a rural setting. Clin Nutr. 2016; 35 138–43.
Malnutrition and frailty in community dwelling older adults living in a rural setting.Crossref | GoogleScholarGoogle Scholar | 25649256PubMed |

[48]  Syddall H, Cooper C, Martin F, et al. Is grip strength a useful single marker of frailty? Age Ageing. 2003; 32 650–6.
Is grip strength a useful single marker of frailty?Crossref | GoogleScholarGoogle Scholar | 14600007PubMed |

[49]  Clegg A, Rogers L, Young J. Diagnostic test accuracy of simple instruments for identifying frailty in community-dwelling older people: a systematic review. Age Ageing. 2014; 44 148–52.
Diagnostic test accuracy of simple instruments for identifying frailty in community-dwelling older people: a systematic review.Crossref | GoogleScholarGoogle Scholar | 25355618PubMed |

[50]  Kaiser M, Bandinelli S, Lunenfeld B. Frailty and the role of nutrition in older people. A review of the current literature. Acta Biomed. 2010; 81 37–45.
| 20518190PubMed |

[51]  Goisser S, Guyonnet S, Volkert D. The role of nutrition in frailty: an overview. J Frailty Aging. 2016; 5 74–7.
| 27224496PubMed |

[52]  Martone AM, Onder G, Vetrano D, et al. Anorexia of aging: a modifiable risk factor for frailty. Nutrients. 2013; 5 4126–33.
Anorexia of aging: a modifiable risk factor for frailty.Crossref | GoogleScholarGoogle Scholar | 24128975PubMed |

[53]  Payne M, Morley JE. Dysphagia, dementia and frailty. J Nutr Health Aging 2018; 22 562–565.
Dysphagia, dementia and frailty.Crossref | GoogleScholarGoogle Scholar | 29717753PubMed |

[54]  Wham CA, Teh R, Moyes S, et al. Health and social factors associated with nutrition risk: results from life and living in advanced age: a cohort study in New Zealand (LILACS NZ). J Nutr Health Aging. 2015; 19 637–45.
Health and social factors associated with nutrition risk: results from life and living in advanced age: a cohort study in New Zealand (LILACS NZ).Crossref | GoogleScholarGoogle Scholar | 26054500PubMed |

[55]  Chatindiara I, Allen J, Popman A, et al. Dysphagia risk, low muscle strength and poor cognition predict malnutrition risk in older adults at hospital admission. BMC Geriatr. 2018; 18 78
Dysphagia risk, low muscle strength and poor cognition predict malnutrition risk in older adults at hospital admission.Crossref | GoogleScholarGoogle Scholar | 29562879PubMed |

[56]  Chatindiara I, Williams V, Sycamore E, et al. Associations between nutrition risk status, body composition and physical performance among community-dwelling older adults. Aust N Z J Public Health. 2018; 43 56–62.
Associations between nutrition risk status, body composition and physical performance among community-dwelling older adults.Crossref | GoogleScholarGoogle Scholar | 30457191PubMed |

[57]  Bahat G, Yilmaz O, Kilic C, et al. Association between dysphagia and frailty. Clin Nutr. 2018; 37 S181