Skip to main content
SpringerLink
Log in

Institutional factors associated with the nutritional status of residents from 10 german nursing homes (ernstes study)

  • Published:
The journal of nutrition, health & aging

Abstract

Objectives

In nursing homes malnutrition among residents is widespread. Because residents place part of their personal freedom of choice into institutional hands, institution-specific factors may influence nutritional status of residents.

Design

Multi-centre cross-sectional study.

Setting

10 nation-wide German nursing homes.

Participants

714 exclusively orally fed residents (aged 65 years and older, not in final weeks of life).

Measurements

Participants’ characteristics (e. g. gender, age, level of care, dementia diagnosis), body mass index (BMI), mini nutritional assessment (MNA), energy intake (3-day dietary record, BLS II.3), and selected institution-specific factors (size of institution, daily rate for food supply, number of residents per care staff member). Metric data are given as median (P25, P75).

Results

11 % of residents (81 % female, 85 (81, 91) years) had a BMI <20 kg/m2 (n=658). According to MNA, 10 % of the residents were malnourished (n=650). Capacity of institutions was 116 (56, 139) beds, care staff ratio was 4.1 (3.5, 4.2) residents per care person (mean over all care levels), and daily food budget was 4.45 (4.10, 4.71) Euro/d. Low daily food budget was associated with a higher risk for a BMI <20 kg/m2 (OR 3.30 [95 %CI 1.70–6.42]). Higher food budget also decreased malnutrition risk (OR 0.66 [0.46–0.95]) according to MNA. Residents’ mean energy intake was 6.1 (5.2, 7.1; n=565) MJ/day in women and 7.1 (6.2, 8.2; n=132) MJ/day in men. Intake was higher with small facility size, higher food budget, and lower care staff ratio (P <0.05).

Conclusion

The institutional environment affects the nutritional status of nursing home residents as an independent risk factor. The results suggest promotion of small facilities and the provision of more care staff and more financial resources for food in the structural design of residential homes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Abbreviations

B:

beta coefficient

BLE:

Bundesanstalt für Landwirtschaft und Ernährung

BLS:

Bundeslebensmittelschluessel

BMI:

body mass index

CC:

calf circumference

cv:

coefficient of variation

ErnSTES:

‘Ernährung in stationären Einrichtungen für Senioren und Seniorinnen’

m:

meter

MDK:

medical services of the German statutory health insurance

MNA:

mini nutritional assessment

NH:

nursing home

ns:

not significant

OR:

odds ratio

p.:

points

P:

level of significance

P25:

25th percentile

P75:

75th percentile

SE:

standard error

SPSS:

Statistical Package for the Social Sciences

UAC:

upper arm circumference

95%CI:

95 % confidence interval of the OR

Reference

  1. Statistisches Bundesamt (2011) Pflegestatistik 2009. https://www.destatis.de/DE/Publikationen/Thematisch/Soziales/Pflege/PflegeDeutschlandergebnisse5224001099004.pdf?__blob=publicationFile. Accessed 4 January 2012

  2. Statistisches Bundesamt (2007) Pflegestatistik 2005. https://www.destatis.de/DE/Publikationen/Thematisch/Soziales/Pflege/PflegeDeutschlandergebnisse5224001059004.pdf?__blob=publicationFile. Accessed 11 May 2012

  3. Pauly L, Stehle P, Volkert D (2007) Nutritional situation of elderly nursing home residents. Z Gerontol Geriatr 40:3–12

    Article  PubMed  CAS  Google Scholar 

  4. Morley JE, Silver AJ (1995) Nutritional issues in nursing home care. Ann Intern Med 123:850–859

    PubMed  CAS  Google Scholar 

  5. Potter J, Klipstein K, Reilly JJ, Roberts M (1995) The nutritional status and clinical course of acute admissions to a geriatric unit. Age Ageing 24:131–136

    Article  PubMed  CAS  Google Scholar 

  6. Rajala SA, Kanto AJ, Haavisto MV, Kaarela RH, Koivunen MJ, Heikinheimo RJ (1990) Body weight and the three-year prognosis in very old people. Int J Obes 14:997–1003

    PubMed  CAS  Google Scholar 

  7. Crogan NL, Pasvogel A (2003) The influence of protein-calorie malnutrition on quality of life in nursing homes. J Gerontol A Biol Sci Med Sci 58:159–164

    Article  PubMed  Google Scholar 

  8. Volkert D, Pauly L, Stehle P, Sieber CC (2011) Prevalence of Malnutrition in Orally and Tube-Fed Elderly Nursing Home Residents in Germany and Its Relation to Health Complaints and Dietary Intake. Gastroenterology Research and Practice. doi: 10.1155/2011/247315

  9. Kaiser R, Winning K, Uter W, Volkert D, Lesser S, Stehle P, Kaiser MJ, Sieber CC, Bauer JM (2010) Functionality and mortality in obese nursing home residents: an example of ‘risk factor paradox’? J Am Med Dir Assoc 11:428–435

    Article  PubMed  Google Scholar 

  10. Schmid A, Weiss M, Heseker H (2003) Recording the nutrient intake of nursing home residents by food weighing method and measuring the physical activity. J Nutr Health Aging 7:294–295

    PubMed  CAS  Google Scholar 

  11. Volkert D, Frauenrath C, Micol W, Kruse W, Oster P, Schlierf G (1992) Nutritional status of the very old: anthropometric and biochemical findings in apparently healthy women in old people’s homes. Aging (Milano) 4:21–28

    CAS  Google Scholar 

  12. Challa S, Sharkey JR, Chen M, Phillips CD (2007) Association of resident, facility, and geographic characteristics with chronic undernutrition in a nationally represented sample of older residents in U.S. nursing homes. J Nutr Health Aging 11:179–184

    CAS  Google Scholar 

  13. Bundesministerium der Justiz (1995) Sozialgesetzbuch (SGB) XI, §15, 1995. http://bundesrecht.juris.de/sgb_11/__15.html. Accessed 10 Januar 2012

  14. Guigoz Y, Lauque S, Vellas BJ (2002) Identifying the elderly at risk for malnutrition. The Mini Nutritional Assessment. Clin Geriatr Med 18:737–757

    Article  Google Scholar 

  15. Vellas B, Guigoz Y, Garry PJ, Nourhashémi F, Bennahum D, Lauque S, Albarede JL (1999) The Mini Nutritional Assessment (MNA) and its use in grading the nutritional state of elderly patients. Nutrition 15:116–122

    Article  PubMed  CAS  Google Scholar 

  16. Chumlea WC, Guo SS, Wholihan K, Cockram D, Kuczmarski RJ, Johnson CL (1998) Stature prediction equations for elderly non-Hispanic white, non-Hispanic black, and Mexican-American persons developed from NHANES III data. J Am Diet Assoc 98:137–142

    Article  PubMed  CAS  Google Scholar 

  17. Volkert D, Berner YN, Berry E, Cederholm T, Coti Bertrand P, Milne A, Palmblad J, Schneider S, Sobotka L, et al. (2006) ESPEN Guidelines on Enteral Nutrition: Geriatrics. Clin Nutr 25:330–360

    Article  PubMed  CAS  Google Scholar 

  18. Statistisches Bundesamt (2008) Pflegestatistik 2007. https://www.destatis.de/DE/Publikationen/Thematisch/Soziales/Pflege/PflegeDeutschlandergebnisse5224001079004.pdf?__blob=publicationFile. Accessed 10 January 2012

  19. Wan TT, Zhang NJ, Unruh L (2006) Predictors of resident outcome improvement in nursing homes. West J Nurs Res 28:974–993

    Article  PubMed  Google Scholar 

  20. O’Neill C, Harrington C, Kitchener M, Saliba D (2003) Quality of care in nursing homes: an analysis of relationships among profit, quality, and ownership. Med Care 41:1318–1330

    Article  PubMed  Google Scholar 

  21. Rantz MJ, Hicks L, Grando V, Petroski GF, Madsen RW, Mehr DR, Conn V, Zwygart-Staffacher M, Scott J, et al. (2004) Nursing home quality, cost, staffing, and staff mix. Gerontologist 44:24–38

    Article  PubMed  Google Scholar 

  22. Kane RA, Lum TY, Cutler LJ, Degenholtz HB, Yu TC (2007) Resident outcomes in small-house nursing homes: a longitudinal evaluation of the initial green house program. J Am Geriatr Soc 55:832–839

    Article  PubMed  Google Scholar 

  23. Kayser-Jones J (2002) Malnutrition, dehydration, and starvation in the midst of plenty: the political impact of qualitative inquiry. Qual Health Res 12:1391–1405

    Article  PubMed  Google Scholar 

  24. Hu TW, Huang LF, Cartwright WS (1986) Evaluation of the costs of caring for the senile demented elderly: a pilot study. Gerontologist 26:158–163

    Article  PubMed  CAS  Google Scholar 

  25. Berkhout AM, Cools HJ, van Houwelingen HC (1998) The relationship between difficulties in feeding oneself and loss of weight in nursing-home patients with dementia. Age Ageing 27:637–641

    Article  PubMed  CAS  Google Scholar 

  26. Simmons SF, Keeler E, Zhuo X, Hickey KA, Sato HW, Schnelle JF (2008) Prevention of unintentional weight loss in nursing home residents: a controlled trial of feeding assistance. J Am Geriatr Soc 56:1466–1473

    Article  PubMed  Google Scholar 

  27. Franzoni S, Frisoni GB, Boffelli S, Rozzini R, Trabucchi M (1996) Good nutritional oral intake is associated with equal survival in demented and nondemented very old patients. J Am Geriatr Soc 44:1366–1370

    PubMed  CAS  Google Scholar 

  28. Bourdel-Marchasson I, Rolland C, Jutand MA, Egea C, Baratchart B, Barberger-Gateau P (2009) Undernutrition in geriatric institutions in South-West France: policies and risk factors. Nutrition 25:155–164

    Article  PubMed  Google Scholar 

  29. Zekry D, Herrmann FR, Grandjean R, Meynet MP, Michel JP, Gold G, Krause KH (2008) Demented versus non-demented very old inpatients: the same comorbidities but poorer functional and nutritional status. Age Ageing 37:83–89

    Article  PubMed  Google Scholar 

  30. Wirth R, Sieber CC (2011) Dementia and Malnutrition — from an early symptom to a therapeutic challenge. Aktuel Ernaehrungsmed 36:90–93

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Institute of Nutrition, Consumption and Health, Paderborn University, Paderborn, Germany

    S. Strathmann, S. Overzier & H. Heseker

  2. IEL-Nutritional Physiology, Bonn University, Bonn, Germany

    Stephanie Lesser, J. Bai-Habelski, H. S. Paker-Eichelkraut & P. Stehle

  3. IEL-Nutritional Physiology, Bonn University, Endenicher Allee 11-13, D-53115, Bonn, Germany

    Stephanie Lesser

Authors
  1. S. Strathmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Stephanie Lesser
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. Bai-Habelski
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. S. Overzier
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. H. S. Paker-Eichelkraut
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. P. Stehle
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. H. Heseker
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Stephanie Lesser.

Additional information

Part of the data has been presented as: Strathmann S, Bai J, Lesser S, Overzier S, Paker-Eichelkraut HS, Stehle P, Heseker H (2009): Einfluss einrichtungsspezifischer Faktoren auf den Ernährungsstatus von Altenheimbewohnern in Deutschland. 46th Scientific Congress of the German Nutrition Society (DGE), 2009-03-12/13, Gießen. Proc Germ Nutr Soc 13: 40, PI-21.

The ErnSTES study was financially supported by the Federal Ministry of Food, Agriculture and Consumer Protection via Bundesanstalt für Landwirtschaft und Ernährung (BLE; 05HS017/1-2).

Rights and permissions

Reprints and permissions

About this article

Cite this article

Strathmann, S., Lesser, S., Bai-Habelski, J. et al. Institutional factors associated with the nutritional status of residents from 10 german nursing homes (ernstes study). J Nutr Health Aging 17, 271–276 (2013). https://doi.org/10.1007/s12603-012-0410-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12603-012-0410-8

Key words

Search

Navigation