Food perception, lifestyle, nutritional and health status in the older people: Typologies and factors associated with aging well

Abstract

The aging process is associated with physiological, sensory, psychological, and sociological changes likely to have an impact on food intake and the nutritional status. The present study aimed to explore the heterogeneity of the French older population (>65 years old) using a multidisciplinary approach. More specifically, the study aimed to highlight different typologies (i.e. clusters of individuals with similar characteristics) within the older population. We conducted face-to-face interviews and tests with 559 French older people, recruited from different categories of dependency (at home without help, at home with help, in nursing homes). Clustering analysis highlighted seven clusters. Clusters 1–3 contained ‘young’ older people (<80) with a good nutritional status; these clusters differed according to food preferences, the desire to have a healthy diet, or interest in food. Clusters 4–7 mainly contained ‘old’ older people (80+), with an increase in the nutritional risk from cluster 4 to cluster 7. Two of these clusters grouped healthy and active people with a good level of appetite, while the two other clusters were associated with a clear decline in nutritional status, with people suffering from eating difficulties or depression. The results raise the need to develop targeted interventions to tackle malnutrition and implement health promotion strategies among the seniors.

Introduction

The aging process is associated with many physiological, sensory, psychological, and sociological changes likely to have an impact on food intake, and consequently on the nutritional status of the older people (Ahmed & Haboubi, 2010; de Boer et al., 2013 Bauer et al., 2013; Elsner, 2002; Hays & Roberts, 2006; Morley, 2001; Sulmont-Rossé, 2020). The meta-analysis carried out by Leij-Halfwerk et al. (2019) on 196 studies showed that in the European older population, the prevalence of risk of malnutrition ranged from 28.0% to 8.5%, depending on the screening tool used to assess malnutrition. In the older population, malnutrition is the result of a deficiency in nutritional intake and leads to numerous negative consequences: it increases the incidence of falls, fractures, disease, and hospitalization; it causes or worsens a state of frailty and disability; and it affects the quality of life of older people (Agarwal et al., 2013; Margetts et al., 2003; Nicolas et al., 2001; Rasheed & Woods, 2013). Malnutrition is not an inevitable side effect of aging, but it can be promoted by many age-related changes associated with this process (e.g., metabolic and hormonal changes, decline in sensory perception, oral health impairment) as well as with its trajectory (e.g., onset of frailty, disease, dependency).

Although it is widely acknowledged that the causes of malnutrition are extremely varied (Hickson, 2006; Morley, 2001; van der Pols-Vijlbrief et al., 2014) and could interact (Engelheart & Brummer, 2018), most studies have explored the factors associated with malnutrition from a discipline-specific point of view, such as the identification of a link between malnutrition status and chemosensory loss in the field of sensory perception (Duffy et al., 1995; Grinberg et al., 2020; Smoliner et al., 2013), oral health in the field of dental medicine (Bakker et al., 2018; Cousson et al., 2012; Saarela et al., 2014), loneliness in the field of sociology (Eskelinen et al., 2016; Ramic et al., 2011; Vesnaver et al., 2016), or depression in the field of psychology (Cabrera et al., 2007; Elstgeest et al., 2019). A few studies have considered a larger range of factors related to several disciplines, such as disease, depression, physical capacities, and chewing difficulties (Donini et al., 2013; Landi et al., 2013; Locher et al., 2008; van Bokhorst-de van der Schueren et al., 2013; Vanderwee et al., 2010). In addition, studies have generally explored the factors associated with malnutrition by focusing on specific populations, such as older people in a retirement community (van der Pols-Vijlbrief et al., 2014), at home (Wong et al., 2019), in a hospital (Jacobsen et al., 2016) or in an institution (Landi et al., 2013; Ji et al., 2012).

Finally, it is striking that malnutrition risk in the older people has seldom been investigated with respect to variables related to food attitudes, preferences, and habits. In 2014, van der Pols-Vijlbrief et al. conducted a systematic literature review to provide an overview of potential determinants of protein-energy malnutrition in community-dwelling older adults. In total, 28 studies were included, from which 122 unique potential determinants were identified. Among these, only a few were related to food habits such as ‘number of meals a day’, ‘snacking’, and ‘eating alone’. In the recent systematic literature review of O'Keeffe et al. (2019), thirty potentially modifiable determinants were identified from the 23 studies included in the review. However, only eight studies examined five determinants related to eating behavior: appetite/leaves food on plate, complaints about food taste, nutrient intake, modified texture diet, hunger and thirst. None were related to food preferences or food attitudes.

To fill the gap, the present study was an explorative study relying on a multidisciplinary approach. It explored the heterogeneity of the older population in France (>65 years old) using a large range of descriptors from various fields (geriatrics, psychology, sociology, sensory perception, eating behavior, food attitudes, food preferences) in relation to the nutritional status. More specifically, the study aimed to highlight different typologies (i.e. clusters of individuals with similar characteristics) and to identify factors associated with the risk of undernutrition which may vary from one typology to another. In order to include older people with different levels of autonomy, the volunteers were recruited from the following four living situations: living independently at home, living at home with non-food activity related assistance, living at home with food activity related assistance for at least three meals a week, and living in a nursing home.