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The journal of nutrition, health & aging

, Volume 17, Issue 3, pp 271–276 | Cite as

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

  • S. Strathmann
  • Stephanie Lesser
  • J. Bai-Habelski
  • S. Overzier
  • H. S. Paker-Eichelkraut
  • P. Stehle
  • H. Heseker
Article

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.

Key words

Nursing home resident elderly energy intake BMI MNA 

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

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Copyright information

© Serdi and Springer-Verlag France 2012

Authors and Affiliations

  • S. Strathmann
    • 1
  • Stephanie Lesser
    • 2
    • 3
  • J. Bai-Habelski
    • 2
  • S. Overzier
    • 1
  • H. S. Paker-Eichelkraut
    • 2
  • P. Stehle
    • 2
  • H. Heseker
    • 1
  1. 1.Institute of Nutrition, Consumption and HealthPaderborn UniversityPaderbornGermany
  2. 2.IEL-Nutritional PhysiologyBonn UniversityBonnGermany
  3. 3.IEL-Nutritional PhysiologyBonn UniversityBonnGermany

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