Original articleQuality of life, functional impairment and social factors as determinants of nutritional status in older adults: The VERISAÚDE study
Introduction
Malnutrition is a significant and highly frequent public health problem in older people [1], associated with higher health care costs in institutionalized and community-dwelling elderly [2]. The prevalence of risk of malnutrition varies widely, from 0% to 83%, in these older adults due to the use of different nutritional screening tools and different subject's characteristics [3]. In Spain, a prevalence of poor nutritional status among community-dwelling elderly of 14.5% was reported [4]. However, there is a high amount of malnourished older people that are unrecognized [5].
Comprehensive gerontological assessments should incorporate nutritional status or nutritional risk screening to identify the main determinants of malnutrition in older adult communities. This identification would determinate the use of appropriate interventions and follow-up to improve their nutritional status [3]. Individuals with poor nutritional status are more likely to experience poor quality of life [6], together with physical, mental and social disability [7]. A current review suggests an increase in hospitalization, morbidity and mortality in malnourished patients [2].
Body mass index, depressive symptoms, polymedication, pre-frailty or frailty status, poor self-rated health [4], and cognitive impairment or chronic diseases [8] are health factors identified as determinants of nutritional status. Other authors found that social isolation and subjective loneliness [9], female sex, older age, unmarried status (as an indicator of social support) or low socioeconomic level [10], [11] are also risk factors for poor nutritional status in elderly. Poor functional status (dependence on activities of daily living, IADL) and mental health-related quality of life also contribute to malnutrition [12], [13].
Furthermore, a systematic review and meta-analysis identified different studies that found an association between nutritional status and quality of life (QOL) in older people [6]. World Health Organization (WHO) defines QOL as “an individual's perception of their position in life in the context of the culture and value systems in which they live, and in relation to their goals, expectations, standards and concerns” [14] and researchers must focus our studies to ensure a better quality of life in older adults, especially in those with a poor nutritional status. Intervention programs including appropriate designs to improve nutritional status significantly improve the quality of life in both physical and mental components [6].
To our knowledge, social support, functional status and quality of life have been identified, at individual level, as risk factors of poor nutritional status. Besides, no published studies associating social resources (assessed with a standardized full-scale and assessing two concepts: the satisfaction with the subject's social network, and the adequacy of social support in case of disability) and malnutrition were found. Moreover, research is not considering these multiple factors with a possible joint effect providing a joint likelihood for malnutrition or risk of malnutrition in a large elderly sample. Besides, most of the studies are involving frail or institutionalized older adults but not healthy elders, the priority for early identification of poor nutritional status.
Based on the above, the aim of this study is to examine the relationship between socio-demographic factors, social resources, functional status and quality of life and malnutrition or risk of malnutrition in a representative community-dwelling elderly population.
Section snippets
Selection and description of participants
Data were used from baseline assessments from the VERISAÚDE (Effectiveness of the Comprehensive Gerontological Assessment and longitudinal follow-up in the healthy ageing promotion) project, which is a large longitudinal study (in this study, we are using the cross-sectional data) covering a sample of 749 community-dwelling subjects representative of Galician population (NW of Spain), aged 65 years and older living at their home and attending senior centers. Older adults were recruited from 43
Results
For nutritional status, 642 participants (85.7%) were well-nourished, 101 participants (13.5%) were at risk of malnutrition and 6 (0.8%) were malnourished. The combined prevalence for the malnourished/at risk of malnutrition group was 14.3%. The mean score of MNA-SF was significantly (P < 0.0001) lower in the subjects at risk of malnutrition compared to the normal group (10.1 ± 1.2 versus 13.5 ± 0.8).
Various sociodemographic variables were associated with the presence of malnourishment/risk of
Discussion
Our results are consistent with those from other authors that found that female gender was associated with poor nutritional status [8], [21], [32], [33].
In our study and probably due to the characteristics of the sample with a high functional ability and low frailty status [4], age and educational level were not associated with malnutrition/risk of it neither bivariate nor regression analysis, as previously found [34]. However, other studies with a higher presence of functional disability,
Conclusions
The present study demonstrates how various factors are associated with the presence of malnutrition or risk of it. Only the gender and the unmarried status as socio-demographic factors were associated with the nutritional status of community-dwelling older people. Social factors that were linked to changes in nutritional status were measures of subjective loneliness and social resources rating. There is a tendency for lower scores in IADL scale, poor satisfaction with the general facet on
Funding source
This research was supported by the Xunta de Galicia project EM 2012/100: “VERISAÚDE project: Effectiveness of the Comprehensive Gerontological Assessment and longitudinal follow-up in the healthy ageing promotion”. The sponsor was not involved in the study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication.
Statement of authorship
AM, CDD and JCMC contributed with the conception and design of the study along with the critical revision of the manuscript before the final submission. CDD, LLL, RLL and LRF contributed with the acquisition of data. AM contributed with the analysis and interpretation of data along with the drafting of the manuscript. All the authors revised the final version of the manuscript and approved it to be submitted.
Conflict of interest
The authors have no potential conflicts of interest.
Acknowledgments
The authors sincerely thank the staff and elderly users of the 43 senior centers who contributed to this study. We would like to thank World Health Organization for granting permission to use and providing the Spanish version of the WHOQOL-BREF.
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