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Comparative Study of Nutritional Status of Elderly Population Living in The Home For Aged Vs Those Living in The Community
Comparative Study of Nutritional Status of Elderly Population Living in The Home For Aged Vs Those Living in The Community
Abstract
The higher incidence of malnutrition in elderly is well documented. Elderly nursing home
residents seem to have a higher risk of malnutrition with respect to the community dwell-
ing elderly population. A comparative study was therefore performed to evaluate the nutri-
tional status of elderly living at old age homes and in community, in the city of Mangalore.
Subjects aged over 60 years were included in this study. Nutritional status was evaluated
by anthropometric measurements to calculate the Body Mass Index, W/H ratio, and Tri-
ceps skin fold thickness and by data collected through the Mini Nutritional Assessment. A
total of two hundred and ten subjects participated in this study. The study subjects were
constituted by 108 inmates of old age homes and 102 people who were residing at their
houses. The results showed that the elderly at home had higher BMI (p<0.001) and higher
MNA scores (p<0.001) compared to those living in old age homes. The MNA results re-
vealed that 19.4% of subjects were malnourished and 57.4% were at risk of malnutrition
among the old age home residents. The prevalence of malnutrition by MNA was 2%, those
at risk of malnutrition were 14.7% in free living elderly. The results of this study show a
high risk of malnutrition (p<0.05) in the old age home residents, and confirm the need for
increased surveillance of nutritional status among residents of old age homes.
Those receiving artificial enteral or parentral nutrition. The data were analysed using SPSS for windows version
15 (Bangalore). A p value of less than 0.05 was consid-
A detailed history was taken and clinical examination was ered to be statistically significant.
done for each subject.
Results
Persons with chronic illness (diabetes, hypertension,
COPD) were categorized into the co-morbidity group. Out of the total 210 elderly population studied, 108 sub-
Every subject under study was individually assessed for jects were inmates of old age home and 102 subjects were
nutritional status with anthropometry and Mini nutritional residing at their houses. Table 1 shows the distribution of
assessment. elderly subjects according to residence and gender. The
age and anthropometric measurements of the subjects
Anthropometry according to the residence are depicted in Table 2. The
Height, weight, mid upper arm circumference (MUAC), mean MNA scores of the subjects were higher in the sub-
calf circumference (CC) and triceps skin fold thickness jects at home compared to those in old age homes
(TSF) of all subjects were measured by standard tech- (p<0.001). The prevalence of malnutrition was 2.0% in
niques. Lange calipers were used to measure triceps skin the free living elderly and 19.4% in old age home resi-
fold thickness. Body mass index (BMI) of all subjects dents (by MNA) (Table 3).Age wise prevalence of mal-
were calculated. Waist and hip circumferences were also nutrition is shown in Table 4. Table 5 gives the distribu-
measured and W/H ratio calculated. tion of elderly subjects according to co morbid illness.
There was no significant difference between at risk, mal-
Waist-Hip ratio >1.0 in men and >0.85 in women have a nourished and well-nourished groups
greater risk of stroke, coronary artery disease and diabetes (p=0.397 at old age home, p=0.197 at home). Total MNA
mellitus [9].Accordingly the W/H ratio of the elderly sub- scores positively correlated with mid upper arm circum-
jects were divided into normal or at risk groups. ference both in old age home residents (r=0.472,p=0.001)
Mini nutritional assessment- and in residents at home. (r=0.32,p=0.001).There was
significant positive correlation between MNA scores and
The test involves (1) anthropometric assessment (weight, calf circumference in both the groups (r=0.521,p<0.001 in
height, mid arm and calf circumferences, weight loss) (2) old age home subjects, r=0.38,p<0.001 in subjects at
general assessment (six questions related to lifestyle, home).With BMI there was significant correlation only
medication and mobility) (3)dietary assessment (eight with elderly at old age home (r=0.299,p<0.002).There
questions related to number of meals, food and fluid in- was no correlation of MNA scores with age. (Table
take, and autonomy of feeding); and (4) subjective as- 6).The waist hip ratio was at risk in 47% of subjects in old
sessment (self perception of health and nutrition). The test
age home and 60% in elderly at home. The difference was statistically different (p<0.027) (Table 7).
MNA score points Elderly at home Elderly at old age home Total
n=102 n (%) n=108 n (%) n=210 n (%)
malnourished <17 2 (2) 21 (19.4) 23 (11)
At risk of under- 17-23.5 15 (14.7) 62 (57.4) 77 (36.6)
nutrition
wellnourished >23.5 85 (83.3) 25 (23.1) 11 (52.4)
Table 4. Age wise prevalence of nutritional status according to Mini Nutritional Assessment
1.Body mass index BMI (weight in Kg/Height 12.Selected consumption markers for protein intake
in m2) at least one serving of dairy products (milk, cheese or yo-
a. less than 19 = 0 points b.19 to less than 21 ghurt)per day?
=1 points c.21 to less than 23 = 2 points d.23 or yes no
greater = 3points two or more servings of legumes or eggs per week? Yes no
2.Mid – upper arm circumference (MUAC) in Meat, fish or poultry every day? Yes no
cm a.0 or 1 yes=0.0 points b.2 yes =0.5 points c.3 yes =1.0 points
a. less than 21 cm = 0 points b. 21 or 22
=0.5points 13. Consumes two or more servings of fruits or vegetables per
c.MAC 22 or greater =1points day?
0= No 1= Yes
3.Calf circumference (CC) in cm
a. less than 31 = 0points b. CC 31 or great- 14. Has food intake declined over the past three months due to
er=1point loss of appetite, digestive problems, chewing or swallowing
4. Weight loss during last 3 months? difficulties?
a. Weight loss greater than 3 kg=0 points a. Severe loss of appetite=0 points b .Moderate loss of appe-
b. Does not know= 1 point tite= 1 point
c. Weight loss between 1 and 3 kg= 2 points c. No loss of appetite= 2 points
d. Weight loss = 3 points
15. How much fluid (water, juice, coffee, tea, milk) is con-
General Assessment sumed per day?
5.Lives independently (not in nursing home or a. less than 3 cups =0 points
hospital) b. 3-5 cups =0.5 points
a =0 point b= 1 point c. more than 5 cups =1 point
16.Mode of feeding
6.Takes more than 3 prescriptions per day a. unable to eat without assistance =0 points
a =0 point b= 1 point b. self fed with some difficulty =1 points
7.Has suffered psychological stress or acute c. self fed without any problem =2 points
disease in past 3 months Self Assessment
a = 0 points b = 1 point 17.Self view of nutritional status
8.Mobility a. view self as being malnourished=0 points
a. Bed or chair bound=0 points b. Able to get b. is uncertain of nutrition states =1 point
out of bed or chair but does not go out=1 point c. view self as having no nutritional problem =2 points
c. Goes out=2 point
9.Neuropsychological problems 18.In comparison with other people of the same age, how do
a. Severe dementia or depression=0 points they consider their health status
b. Mild dementia=1 point a. not as good =0 points b .does not know =0.5point
c .No psychological problems=2 points c. good =1.0 points d. better =2.0 points
In the present study the prevalence of malnutrition was The MNA score showed significant correlation with mid
2.0% in the free living elderly and 19.4% in old age home upper arm circumference and calf circumference in both
residents (by MNA) (table 3).The prevalence of malnutri- the groups. With BMI, there was significant correlation
tion in free living elderly is similar to that found by Soini only in nursing home residents (table 6). Thomas et al
et al [10] but less than in Maliheh et al[11]. In old age had found high correlation of MNA score only with BMI
home residents, the number of people who were malnour- [18].However with age, there was no correlation with
ished is less than in Souminen et al [12] more than Lan- MNA score. Anja Saletti et al showed that age correlated
giano et al [13]. According to MNA, those at risk of mal with MNA score and BMI [19]. A study on 1564 elderly
volunteers in Turkey showed a decrease in MNA score
with increase in age [20].
4. Guigoz Y. The Mini Nutritional Assessment (MNA)
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Conclusion
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Correspondence to:
Kirtana M Pai
Department of Physiology
Kasturba Medical College
Manipal-576 104, India