Original articleFactors associated with poor nutritional status among the oldest-old☆
Introduction
Nutritional health is an essential component of quality of life among older adults. Malnutrition in the elderly has been described as a “silent crisis” because it often goes undetected.1 Clinical studies have linked poor nutrition with adverse health outcomes in a growing elderly population.2, 3, 4 Specifically, poor nutrition is one of the most important contributors to frailty, and early identification of individuals with poor nutritional status holds important implications for both prevention and treatment.5, 6 In addition, recent evidence from randomized controlled trial suggests that nutritional treatment of patients at risk of malnutrition is effective in preventing weight loss and improving ADL (Activity of Daily Living) functions in geriatric patients at risk of malnutrition.7 Therefore, given the importance of nutritional health and the potential for effective clinical intervention, early detection of nutritional risk and timely interventions are critical for the maintenance of health in the elderly.
Earlier studies have found that malnutrition is prevalent among Chinese older adults. For example, a recent study reported that the prevalence of malnutrition was 41.6% among a sample of surgical patients.8 Using Body Mass Index (BMI) less than 18.5 kg/m² as the cut-point, Lin and colleagues have shown that among individuals aged 60 and over, 7.1% of men and 7.5% of women in urban area, 17.7% of men and 20.0% of women in rural area were malnourished.9 This represents almost a doubling of the risk as compared to that among middle-aged (45–60) adults in China. Therefore, timely nutrition screening in the older population should help detecting early signs of malnutrition and enable timely treatment.
A number of factors have been found to be associated with poor nutritional health. These factors include age, living alone, eating and oral health issues, loss in sensory function, low functional capacity, diminished cognitive function, depression, poor vision, and changes in body composition.5, 10, 11 While age has been found to be a major risk factor for malnutrition,12 most studies of nutritional status focus on younger elderly population. As such, the current understanding of risk factors associated with poor nutritional health among the oldest-old is very limited.10 In addition, previous studies have shown that community-living older adults tend to have poor nutritional knowledge, attitude, and behavior.13 Because the majority of older Chinese live in the community, their access to nutrition screenings may be limited. Malnutrition identified by clinical examination after symptoms arises may miss the window of opportunity for correcting nutritional issues.5 The purpose of this study is to describe the nutritional status in a sample of community-dwelling oldest-old Chinese and to examine risk factors associated with poor nutritional status in this population.
Section snippets
Study population and settings
In July 2005, as part of the Project of Longevity and Aging in Dujiangyan (PLAD) study,14 a census of individuals aged 90 and above was conducted in 21 towns of Dujiangyan, Sichuan Province, China. Of the total population of 621,980, a total number of 1401 were identified as age-eligible. Of these, 870 (62%) individuals participated in the PLAD study. For the purpose of the present study, 632 respondents who have completed the Mini Nutritional Assessment Short-Form (MNA-SF) were included in the
Results
The mean MNA-SF score of the sample was 10.3 (SD = 1.8, range: 4–14). A total of 36 participants (5.7%) were classified as malnourished (MNA-SF < 8), 445 (70.4%) were classified as at risk for malnutrition (MNA-SF between 8 and 11), and the remaining 151 (23.9%) were classified as having normal nutritional status.
Table 1 shows the baseline characteristics of the study sample by gender. The mean age of the sample was 93.5 years (range 90–104). The sample was predominately female (67.1%), most
Discussion
This study examined the prevalence of malnutrition and the risk factors associated with poor nutritional status in a sample of community-living Chinese older adults aged 90 and above. We found high prevalence (76.9%) of low nutritional status (malnutrition or at risk for malnutrition) in the study sample. However, the great majority of respondents believed that they were in normal nutritional status, suggesting that nutritional risks were frequently underestimated by the study participants. The
Funding
Not applicable.
Author contributions
L. Ji: concept and design, analysis of data, preparation of manuscript.
H. Meng: concept and design, interpretation of data, critical revision of manuscript.
B. Dong: concept and design, acquisition of data, interpretation of data.
Conflict of interest
None of the authors have any financial or other kinds of conflict with this manuscript.
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Conference presentation: An earlier version of the paper has been presented at the 2010 American Public Health Association Annual Meeting.