The journal of nutrition, health & aging

, Volume 17, Issue 1, pp 9–15 | Cite as

Malnutrition in elderly: Social and economic determinants

  • Lorenzo M. Donini
  • P. Scardella
  • L. Piombo
  • B. Neri
  • R. Asprino
  • A. R. Proietti
  • S. Carcaterra
  • E. Cava
  • S. Cataldi
  • D. Cucinotta
  • G. Di Bella
  • M. Barbagallo
  • A. Morrone


Malnutrition occurs frequently in the frailest groups of the population, especially in people who are on a low income and elderly subjects, overall if they are institutionalized. The aim of this study was to assess the prevalence of malnutrition in a sample of elderly people living in different settings and to identify the determinants of malnutrition.


A total of 718 subjects, 472 females (F) and 246 males (M), were recruited from nursing homes or were free living in three different regions in Italy. Nutritional status, depression, social, functional and cognitive status, were evaluated.


According to the Mini Nutritional Assessment (MNA), a high prevalence of malnutrition was found out in both genders: 26% of F and 16.3% of M were classified as being malnourished (MNA<17); 40.9% of F and 35% of M were at risk of malnutrition (MNA 17–23,5). The prevalence of malnutrition was significantly higher in NH subjects in both sexes. Moreover, a relationship was shown between malnutrition and inability to shop, prepare and cook meals because of a low income, distance from markets or supermarkets as well as impossibility to drive the car or to use public transportation. This study confirms the necessity to routinely perform nutritional status evaluation in elderly subjects, to carry out training courses for health workers (doctors, nurses, psychologists, dietitians), to implement nutritional education of the geriatric population, to develop tools and guidelines for health workers and caregivers, to identify and reduce clinical, functional, social or economic risk factors for malnutrition.

Key words

Malnutrition elderly poverty 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Stratton RJ, Green CJ, Elia M. Related Malnutrition: an Evidence Based Approach to Treatment Oxford: CABI; 2003.)Google Scholar
  2. 2.
    Lattanzio F, Laino I, Pedone C, Corica F, Maltese G, Salerno G, Garasto S. Corsonello A, Incalzi RA; on behalf of the PharmacosurVeillance in the elderly Care (PVC) Study Group.: Geriatric Conditions and Adverse Drug Reactions in Elderly Hospitalized Patients. Am Med Dir Assoc. 2011 May 27)Google Scholar
  3. 3.
    Joseph ML, Carriquiry A.: A measurement error approach to assess the association between dietary diversity, nutrient intake, and mean probability of adequacy. J Nutr. 2010 Nov;140(ll):2094S–2101S;.PubMedGoogle Scholar
  4. 4.
    Torheim LE, Ferguson EL, Penrose K, Arimond M: Women in resource-poor settings are at risk of inadequate intakes of multiple micronutrients. J Nutr. 2010 Nov;140(ll):2051S–2058S; Lee MR, Berthelot ER. Community covariates of malnutrition based mortality among older adults. Ann Epidemiol. 2010 May;20(5):371–9)PubMedGoogle Scholar
  5. 5.
    Office of National Statistics. Population trends. FT 118, table 1,4.(population age and sex) London: ONS;2004.)Google Scholar
  6. 6.
    Office of National Statistics. Living in Britain: results from the 2002 General Household Survey. London: ONS; 2004).Google Scholar
  7. 7.
    Paraielee PA, Thuras PD, Katz IR, Lawton MP: Validation of the Cumulative Illness Rating Scale in a geriatric residential population. J Am Geriatr Soc 1995, 43(2): 130–137).Google Scholar
  8. 8.
    Guigoz Y, Vellas B, Garry PJ. Facts, research and intervention in gerontology. In: The Mini Nutritional Assessment: a practical assessment tool for grading the nutritional state of elderly persons. 3rd ed. Paris: Serdi Publishing Company, 1997: 15–60.Google Scholar
  9. 9.
    Pfeiffer E: A short portable mental status questionnaire for the assessment of organic brain deficit in elderly subjects. J Am Geriatr Soc 1975, 23(10):433–441)PubMedGoogle Scholar
  10. 10.
    Yesavage JA, Brink TL, Rose TL. Development and validation of a geriatric depression screening scale. A preliminary report. J Psych Res 1983; 17: 37–49CrossRefGoogle Scholar
  11. 11.
    Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 1969; 9(3): 179–186PubMedCrossRefGoogle Scholar
  12. 12.
    Katz S. Assessing self-maintenance: activities of daily living, mobility, and instrumental activities of daily living. J Am Geriatr Soc 1983; 31:721–727.).PubMedGoogle Scholar
  13. 13.
    Rosen SL, Reuben DB: Geriatric assessment tools. Mt Sinai J Med. 2011 Jul;78(4):489–497PubMedCrossRefGoogle Scholar
  14. 14.
    Cereda E, Pedrolli C, Zagami A, Vanotti A, Piffer S, Opizzi A, Rondanelli M, Caccialanza R: Nutritional screening and mortality in newly institutionalised elderly: A comparison between the Geriatric Nutritional Risk Index and the Mini Nutritional Assessment. Clin Nutr. 2011 Jun 30)Google Scholar
  15. 15.
    Volkert D, Pauly L, Stehle P, Sieber CC: Prevalence of malnutrition in orally and tube-fed elderly nursing home residents in Germany and its relation to health complaints and dietary intake. Gastroenterol Res Pract. 2011;2011:247315.PubMedGoogle Scholar
  16. 16.
    Donini LM, Savina C, Piredda M, Cucinotta D, Fiorito A, Inelmen EM, Sergi G, Domiguez LJ, Barbagallo M, Cannella C. Senile anorexia in acute-ward and rehabilitations settings. J Nutr Health Aging. 2008 Oct;12(8):511–517PubMedCrossRefGoogle Scholar
  17. 17.
    De Lorenzo A, Deurenberg P, Pietrantuono M, Di Daniele N, Cervelli V, Andreoli A: How fat is obese? Acta Diabetol 2003, 40Suppl 1:S254–S257PubMedCrossRefGoogle Scholar
  18. 18.
    Kagansky N, Beraer Y, Koren-Morag N, Perelman L, Knobler H, Levy S: Poor nutritional habits are predictors of poor outcome in very old hospitalized subjects. Am J Clin Nutr 2005, 82(4):784–791; quiz 913–784)PubMedGoogle Scholar
  19. 19.
    Webber CB, Splett PL. Nutrition risk factors in a home health population. Home Health Care Serv Q 1995; 15: 97–110PubMedCrossRefGoogle Scholar
  20. 20.
    Wellman NS, Weddle DO, Kranz S, Brain CT. Elder insecurities: poverty, hunger, and malnutrition. J Am Diet Assoc 1997; 97(10 Suppl 2): S120–S122PubMedCrossRefGoogle Scholar
  21. 21.
    Macintosh C, Morley JE, Chapman IM. The anorexia of aging. Nutrition 2000; 16: 983–995PubMedCrossRefGoogle Scholar
  22. 22.
    Marcus EL, Berry EM. Refusal to eat in the elderly. Nutr Rev 1998; 56: 163–171PubMedCrossRefGoogle Scholar
  23. 23.
    Donini LM, Savina C, Piredda M, et al. Senile anorexia in acute-ward and rehabilitation settings. J Nutr Health Aging 2008; 12: 511–517PubMedCrossRefGoogle Scholar
  24. 24.
    Morley JE. Decreased food intake with aging. J Gerontol A Biol Sci Med Sci 2001; 56Spec No 2: 81–88PubMedCrossRefGoogle Scholar
  25. 25.
    Ramie E, Pranjic N, Batic-Mujanovic O, Karic E, Alibasic E, Alic A.: The effect of loneliness on malnutrition in elderly population. Med Arh. 2011;65(2):92–95Google Scholar
  26. 26.
    German L, Kahana C, Rosenfeld V, Zabrowsky I, Wiezer Z, Fraser D, Shahar DR.: Depressive symptoms are associated with food insufficiency and nutritional deficiencies in poor community-dwelling elderly people. J Nutr Health Aging. 2011;15(l):3–8).PubMedCrossRefGoogle Scholar
  27. 27.
    Morley JE. Anorexia of aging: physiological and pathological. Am J Clin Nutr. 1997;66:760–773PubMedGoogle Scholar
  28. 28.
    Donini LM, Savina C, Cannella C. Appetite and ageing. In: Raats M, van Staveren W, de Groot L, eds. Food for the ageing population. Cambridge (England): Woodhead Publishing Limited, 2009: 43–72CrossRefGoogle Scholar
  29. 29.
    Morley JE. Anorexia, sarcopenia, and aging. Nutrition 2001; 17: 660–673PubMedCrossRefGoogle Scholar
  30. 30.
    Morley JE, Thomas DR. Anorexia and aging: pathophysiology. Nutrition 1999; 15: 499–503PubMedCrossRefGoogle Scholar
  31. 31.
    Savina C, Donini LM, Cannella C. Anorexia of Aging. In: Randal LO, ed. Aging and the Elderly. New York: Nova Science Publisher, 2007: 139–151Google Scholar
  32. 32.
    Rivière S, Gillette-Guyonnet S, Voisin T, et al. A nutritional education program could prevent weight loss and slow cognitive decline in Alzheimer’s disease. J Nutr Health Aging 2001; 5: 295–299PubMedGoogle Scholar
  33. 33.
    Webber CB, Splett PL. Nutrition risk factors in a home health population. Home Health Care Serv Q 1995; 15: 97–110PubMedCrossRefGoogle Scholar
  34. 34.
    Wellman NS, Weddle DO, Kranz S, Brain CT. Elder insecurities: poverty, hunger, and malnutrition. J Am Diet Assoc 1997; 97(10 Suppl 2): S120–S122PubMedCrossRefGoogle Scholar
  35. 35.
    UNDP. Human Development Report 2008. New York: UNDP, 2008Google Scholar
  36. 36.
    ISTAT. La povertà assoluta in Italia nel 2007. Roma: ISTAT, 2009 Google Scholar
  37. 37.
    ISTAT 2009. La situazione del Paese nel 2008. Rapporto Annuale. Roma: ISTAT, 2009 Google Scholar
  38. 38.
    Casper RC. Nutrition and its relationship to aging. Exp Gerontol 1995; 30(3–4):299–314PubMedCrossRefGoogle Scholar
  39. 39.
    Donini LM, Savina C, Cannella C. Eating habitus and appetite control in the elderly: the anorexia of aging. Intern Psychogeriatr 2003; 15: 73–87CrossRefGoogle Scholar
  40. 40.
    Sun LJ, Frongillo, EA. Nutritional and health consequences are associated with food insecurity among US elderly persons. J Nutr 2001; 131:1503–1509Google Scholar
  41. 41.
    Wolfe, WS, Frongillo, EA, Valois, P. Understanding the experience of food insecurity by elders suggests ways to improve its measurement. J Nutr 2003; 133: 2762–2769PubMedGoogle Scholar
  42. 42.
    Che J, Chen J. Food insecurity in Canadian households. Health Rep 2001; 12: 11–22PubMedGoogle Scholar
  43. 43.
    Bouis HE, Eozenou P, Rahman A.: Food prices, household income, and resource allocation: socioeconomic perspectives on their effects on dietary quality and nutritional status. Food Nutr Bull. 2011 Mar;32(l Suppl):S14–S23)PubMedGoogle Scholar
  44. 44.
    Ferdous T, Cederholm T, Kabir ZN, Hamadani ID, Wahlin A. Nutritional status and cognitive function in community-living rural Bangladeshi older adults: data from the poverty and health in ageing project. J Am Geriatr Soc. 2010 May;58(5):919–924PubMedCrossRefGoogle Scholar
  45. 45.
    L.M. Donini, MR De Felice, L. Tassi, L. De Beraardini, A Pinto, AM Giusti, C. Cannella: A proportional and objective score for the Mini Nutritional Assessment in long-term geriatric care. J Nutr Health & Aging 2002, 6, 2141–2146Google Scholar
  46. 46.
    Tsai AC, Chang TL, Wang YC, Liao CY.: Population-specific short-form mini nutritional assessment with body mass index or calf circumference can predict risk of malnutrition in community-living or institutionalized elderly people in taiwan. J Am Diet Assoc. 2010 Sep; 110(9): 1328–1334.PubMedCrossRefGoogle Scholar
  47. 47.
    Kaiser MJ, Bauer JM, Uter W, Donini LM, Stange I, Volkert D, Diekmann R, Drey M, Bollwein J, Tempera S, Guerra A, Ricciardi LM, Sieber CC. Prospective validation of the modified mini nutritional assessment short-forms in the community, nursing home, and rehabilitation setting. J Am Geriatr Soc. 2011 Nov;59(11):2124–2128.PubMedCrossRefGoogle Scholar
  48. 48.
    Cudennec T, Lagrandeur J, Moulias S, Moussous W, Colombier B, Teillet L.: Should caregivers be concerned with the nutritional state of elderly patients?. Soins Gerontol. 2011 May–Jun;(89):24–26.Google Scholar
  49. 49.
    Seligman HK, Laraia BA, Kushel MB.: Food insecurity is associated with chronic disease among low-income NHANES participants J Nutr. 2010 Feb;140(2):304–310PubMedCrossRefGoogle Scholar

Copyright information

© Serdi and Springer-Verlag France 2013

Authors and Affiliations

  • Lorenzo M. Donini
    • 1
  • P. Scardella
    • 2
  • L. Piombo
    • 2
  • B. Neri
    • 3
  • R. Asprino
    • 1
  • A. R. Proietti
    • 1
  • S. Carcaterra
    • 3
  • E. Cava
    • 3
  • S. Cataldi
    • 4
  • D. Cucinotta
    • 4
  • G. Di Bella
    • 5
  • M. Barbagallo
    • 5
  • A. Morrone
    • 2
  1. 1.Sapienza University of Rome (Italy — Experimental Medicine Department, Medical Physiopathology, Food Science and Endocrinology Section, Food Science and Human Nutrition Research UnitRomeItaly
  2. 2.Istituto Nazionale per la promozione della salute delle popolazioni Migranti e per il contrasto delle malattie della Povertà (INMP)RomeItaly
  3. 3.Rehabilitation Clinical Institute “Villa delle Querce” — NemiRomeItaly
  4. 4.“Villa Laura”BolognaItaly
  5. 5.Dipartimento di Medicina Interna e Patologie Emergenti, UO GeriatriaUniversità degli Studi di PalermoPalermoItaly

Personalised recommendations