Elsevier

Clinical Nutrition

Volume 34, Issue 6, December 2015, Pages 1184-1188
Clinical Nutrition

Original article
Assessing the nutritional status of older individuals in family practice: Evaluation and implications for management

https://doi.org/10.1016/j.clnu.2014.12.005Get rights and content

Summary

Background & aims

Malnutrition is emerging as a multidimensional concern of ageing with a high prevalence among nursing home residents. This study investigated the extent of malnutrition among old subjects in family practice and its relationship with major complications.

Methods

Over 75 years old subjects (n = 274) filled the Mini Nutritional Assessment questionnaire. Appearance of major events in the following 6 months were registered.

Results

MNA scored were 11.5 ± 3.1, with 175 (64%) subjects showing no malnutrition, 69 (25%) resulted at risk, and 30 (11%) malnourished. Within at risk group, 1.4% was resident, 7% bed rested, 8% had a history of major bone fracture, 33% was demented and 24.6% hospitalized at least once in the last year. Among malnourished patients, 10% was resident, ten bed rested with 70% showing multiple bedsores, 20% have had bone fractures, 60% were demented and 13% hospital admitted in the previous year. In over 90% of them, malnutrition had neither diagnosed nor considered before. During follow-up, a significantly higher number of major events including death occurred in the malnourished group. By multivariate logistic regression, n = 56 (20.4%) patients resulted at risk of major complications. The sensitivity of the questionnaire in identifying these patients was 84% with the cut-off value of 7 associated with the highest prediction (positive predictive value, 0.92; negative predictive value, 0.71) yielding a specificity of 92%.

Conclusions

The prevalence of malnutrition is high among older subjects in the setting of family practice. The Mini Nutritional Assessment allows to identify malnourished subjects better than BMI and effectively predicts the risk of major events.

Introduction

Although campaigns are continuously advertising genuine food, nutritional changes are dramatically affecting the health status of human beings worldwide (obesity in Western societies, malnourishment in very poor countries). In this scenario the nutritional state of aged people and its impact on concomitant chronic conditions remains poorly considered. Indeed, as the age increases, the energy need varies accordingly. Often, the equilibrium between caloric intake and body expenditure is imbalanced in aged people, and malnutrition is frequently becoming a threatening sign and a serious problem [1], [2], [3], [4].

Malnutrition is defined as a faulty or inadequate nutritional behavior with insufficient food intake, poor appetite, muscle wasting and weight loss [5]. It rapidly declines health status and quality of life. Dependency, loneliness and chronic illnesses are major contributing factors. The social burden of malnourished aged people is high and represents a multidimensional concept encompassing both physical and psychological elements.

The prevalence of malnutrition is relatively low (5–10%) in community living old subjects and considerably high (30–60%) in hospitalized or institutionalized subjects [6], [7]. It is estimated that, in US, 50% of hospitalized older persons and 40% of nursing home residents are malnourished [8]. In Europe and Asia [1], [9] malnutrition ranges 10%–85% according to the diagnostic criteria used [10] and also in dependence on the Country, rural or town population, residency or home patients, co-morbidities, socio-economic classes. Despite these impressive data, nutritional problems are not yet acknowledged as a priority in managing older persons. Nutritional assessment and intervention are particularly crucial in this population, where incidence of chronic illnesses is high (dentition, dementia, depression, functional limitations, income, polypharmacy) [3], [4]. Malnutrition is associated with negative sequelae: infections, request of home care, hospitalization, death [11], [12], [13]. As the life expectancy increases, malnutrition becomes an emerging problem for general practitioners (GPs), who are required to check the nutritional status of their patients, to make early diagnosis of malnourishment and provide measures.

Conventional techniques assessing the nutritional status include anthropometrics, dietary recall and laboratory investigation together with other expensive approaches difficult to apply in family practice. Another option is the utilization of multidimensional techniques as the Mini Nutritional Assessment (MNA) [14], [15], [16], [17], [18]. Its short form (MNA-SF) is easy to administer, patient-friendly, inexpensive, very sensitive, highly specific and reproducible [19]. MNA-SF is a questionnaire (six simple and quick questions, plus one in reserve) giving a final score. MNA demonstrated an excellent reproducibility in bed resting patients who are not able to stand and therefore the calculation of the body mass index (BMI) not possible. Most studies are coming from hospitalized patients and few reports exist on the application of this test in the primary care setting.

Therefore, this study aimed to evaluate the nutritional status of patients over 75 in the setting of family practice and to look at the occurrence of major events.

Section snippets

Patients and methods

This study was entirely conducted in family practice from January to April 2013. The database of four GPs, working in 4 different southern Italian towns, were used to extract the list of patients over 75 years old. Both sexes were included. Patients with terminal illnesses, carrying malignancies, or with terminal renal failure, ascites or recurrent electrolyte imbalance were excluded. Consecutive patients at their first office or home check were enrolled (Table 1).

Body weight and height were

Results

The number of over 75 years old patients extracted from the GPs database was 555 on a total population of 5504 subjects (10%). Of them, 133 males and 141 females for a total of 274 (49%) subjects were seen during the observation period and enrolled in the study. The mean age was 82 ± 5 years (m 81 ± 5; f 82 ± 5) and the mean BMI was 28 ± 5 kg/m2, including one patient having <18.5 kg/m2 and considering that BMI was not calculated in 15 patients because bed rested.

The MNA score had a mean value

Discussion

The global care of older persons is a specific competence of GPs and, because of the increased rate of aged people worldwide, it will require more and more working time and social efforts in the next future. As a consequence, GPs are asked to keep a perspective view on the fast demographic changes and to reserve special attention to fragile subjects who are recognized by the means of a multidimensional evaluation based on a pool of complex scores with numerous items, not easy applicable in the

Conflict of interest

The authors have no conflict of interest to declare.

Funding sources

The authors declare that this was an independent study without funding sources.

Acknowledgments

Statement of authorship: TM: conceived of the study, participated in its design and wrote the manuscript; CP: conceived of the study, participated in its design; PP: consultation and preparation of figures; NM: collection of data; IG: conceived of the study, participated in its design, performed statistical analysis, coordinated and wrote the manuscript. All authors read and approved the final manuscript”.

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