Nutritional status and mealtime experiences in elderly care recipients

Abstract

Elderly people receiving municipal services and care are at risk for malnutrition due to frailty and chronic diseases. In this work, the nutritional status of elderly patients (>65 y) was evaluated in three different populations. One population lived in various care settings, i.e. service flats (SF), old peoples home (OPH), group living for demented (GLD) and nursing homes (NH) (Study I). The other two populations were free-living elderly receiving home nursing care (HNC) (Study II) or home help services (HHS) (Study III). In the HHS population we evaluated nutritional status and its relation to long-term mortality and performed a reexamination in a sub-sample after three years. In study IV qualitative interviews were performed in elderly people in SF and NH/OPH about their experiences of food, mealtimes and appetite. Also a repeated 24-hoursdietaryrecall was assessed and biochemical nutrition markers analyzed. Altogether 1,305 elderly subjects (85 y, 73 % female) were examined (I,II,III). Nutritional status was assessed by the Mini Nutritional Assessment (MNA, 0-30 points), which consists of 18 point-weighted questions, including anthropometrics, e.g. body mass index (BMI, kg/m2). After three years it was possible to register mortality in 224 of 353 subjects by examining Swedish population records (III). Of 64 subjects, 31 were possible to re-examine using the initial protocol (III). In study IV 14 elderly were interviewed. It was possible to collect data on food intake and blood tests of 11 persons.

According to the MNA, between 3% (HHS) and 71% (NH), with a mean of 26% in the whole population were assessed as malnourished (MNA <17 points), whereas none (NH) up to 51% (HHS), with a mean of 27% in the whole population, were assessed as well nourished (MNA >24 points). The rest were considered as at risk for malnutrition (MNA 17-23.5 points). A BMI <23 kg/m2 was found in 51% of the subjects, 25% had a BMI 24-26 and 24% had a BMI >=27 (I, II, III). Chewing and swallowing problems, reduced appetite as well as illness and feelings of depression were more often reported in those at risk for malnutrition as compared to the well nourished (p=0.001) (III). Fifty-four percent (28/58) of those who were assessed as being malnourished or were suspected of being malnourished did not have meals-on-wheels or other meal support (II). One-third received meals-on-wheels service and two of three used one portion for several meals (III). The three year mortality rate was 50% for the malnourished, 40% for those at risk for malnutrition and 28% for the well nourished (p<0.05). Corresponding mortality figures were 45% for those with a BMI of <23, 36% with a BMI of 23-28 and 22% with a BMI of >28, respectively (p<0.05) (III). In study IV the six SF respondents expressed that they were still able to have influence of their food intake and mealtimes. They used various strategies to maintain independency and experienced some degree of appetite. In contrast, the eight respondents living in NH/OPH experienced lack of influence over their food and mealtimes and lack of appetite. The dietary recalls indicated low intakes of energy and nutrients which was not confirmed by biochemical analyses.

In conclusion, one-fourth of the subjects were assessed to be malnourished, and almost half were at risk for malnutrition. The subjects with MNA <23.5 points, i.e. malnourished and at risk of malnutrition combined, reported a higher prevalence of eating problems during mealtime than the well nourished. Malnutrition as assessed by the MNA and underweight, i.e. a BMI <23 were associated with increased mortality. Elderly people s opportunity to influence food and mealtimes needs to be considered. Nutritional routines in the services and care for the elderly still need more attention.