Date Published: April 30, 2018
Publisher: Springer International Publishing
Author(s): Maurits F. J. Vandewoude, Janneke P. van Wijngaarden, Lieven De Maesschalck, Yvette C. Luiking, André Van Gossum.
In 2008, the NutriAction study showed that (risk of) malnutrition was highly prevalent (57%) among Belgian older people living in the community or in a nursing home. In 2013, this study was repeated to re-evaluate the occurrence of malnutrition, as well as mobility problems and dependence in activities of daily living (ADL).
Health care professionals (HCPs) associated with homecare organizations and nursing homes across Belgium were invited to screen their patients and complete an online questionnaire. Nutritional status, presence of pre-specified comorbidities, mobility, and ADL dependency were assessed.
In total, 3299 older patients were analysed: 2480 (86.3 ± 6.3 years) nursing home (NH) residents and 819 (82.7 ± 6.1 years) community dwelling (CD). Overall, 12% was malnourished (MNA-SF score < 8) and 44% was at risk of malnutrition (MNA-SF 8–11). The highest prevalence of (risk of) malnutrition was observed in NHs (63%) and in patients with dementia (CD: 68%; NH: 82%) or depression (CD: 68%; NH: 79%). Of all malnourished individuals, 49% was recognized as malnourished by HCPs and 13% of the malnourished recognized themselves as such. Mobility (stair climbing and walking) and ADL dependency (Belgian KATZ score) were impaired in older people with (risk of) malnutrition in comparison with individuals with normal nutritional status (p < 0.001). Despite public awareness initiatives, the prevalence of malnutrition remained stable among Belgian older people seen by HCPs in the period 2008–2013. Moreover, malnutrition is not well recognized. Under-recognition of malnutrition is problematic, because associated loss of mobility and independence may accelerate the transformation of frailty into disability in older people. The online version of this article (10.1007/s40520-018-0957-2) contains supplementary material, which is available to authorized users.
Older people show benefit from an optimal nutritional status, which sustains lean body mass, especially muscle; this in turn supports mobility, resilience, and resistance to potential disease. However, the risk of malnutrition increases with aging due to the presence of (multiple) chronic diseases, dementia, depression, and age-related anorexia caused by loss of appetite, swallowing difficulties, and alterations in taste sensibility [1–4]. Malnutrition is a problem, because it renders older people more vulnerable to (long term) hospitalisation, medical complications, and because it has a negative impact on their quality of life [1, 5]. Moreover, malnourished older people are likely to die sooner than their well-nourished peers [6–8].
The overall prevalence of (risk of) malnutrition in older individuals with homecare or residing in nursing homes, determined with the MNA-SF (cut-off ≤ 11), was similar (56%) to the observed prevalence with the previous NutriAction screening in 2008 (57%) . The observed prevalence of malnutrition was within the range of observations by others [3, 13], although the prevalence of (risk of) malnutrition in our community dwelling population was slightly higher . This may be explained by the selection of community dwelling individuals that were already under the care of a HCP. The 2013 NutriAction study furthermore revealed that the prevalence of (risk of) malnutrition was almost twice as high in the nursing home population (63%), compared to the community dwelling population (36%).
The prevalence of malnutrition has remained stable among Belgian older people in the period 2008–2013. Malnutrition remains a major problem, despite all awareness initiatives by the government and nutrition-focussed organisations. Malnutrition is especially prevalent in nursing homes and in those with comorbidities such as depression and dementia. Health care professionals and patients themselves greatly underestimate malnutrition in older people, both in the community and in nursing homes. Malnutrition is associated with mobility problems and dependence in ADL, and therefore may accelerate the transformation of frailty into disability. In the future, nutritional screening could be complemented with screening for frailty and functional limitations.