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



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.


Multi-centre cross-sectional study.


10 nation-wide German nursing homes.


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


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).


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).


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 



beta coefficient


Bundesanstalt für Landwirtschaft und Ernährung




body mass index


calf circumference


coefficient of variation


‘Ernährung in stationären Einrichtungen für Senioren und Seniorinnen’




medical services of the German statutory health insurance


mini nutritional assessment


nursing home


not significant


odds ratio




level of significance


25th percentile


75th percentile


standard error


Statistical Package for the Social Sciences


upper arm circumference


95 % confidence interval of the OR


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  1. 1.
  2. 2.
  3. 3.
    Pauly L, Stehle P, Volkert D (2007) Nutritional situation of elderly nursing home residents. Z Gerontol Geriatr 40:3–12PubMedCrossRefGoogle Scholar
  4. 4.
    Morley JE, Silver AJ (1995) Nutritional issues in nursing home care. Ann Intern Med 123:850–859PubMedGoogle Scholar
  5. 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 24:131–136PubMedCrossRefGoogle Scholar
  6. 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 14:997–1003PubMedGoogle Scholar
  7. 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 58:159–164PubMedCrossRefGoogle Scholar
  8. 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: 10.1155/2011/247315Google Scholar
  9. 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 11:428–435PubMedCrossRefGoogle Scholar
  10. 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 7:294–295PubMedGoogle Scholar
  11. 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) 4:21–28Google Scholar
  12. 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 11:179–184Google Scholar
  13. 13.
    Bundesministerium der Justiz (1995) Sozialgesetzbuch (SGB) XI, §15, 1995. Accessed 10 Januar 2012
  14. 14.
    Guigoz Y, Lauque S, Vellas BJ (2002) Identifying the elderly at risk for malnutrition. The Mini Nutritional Assessment. Clin Geriatr Med 18:737–757CrossRefGoogle Scholar
  15. 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 15:116–122PubMedCrossRefGoogle Scholar
  16. 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 98:137–142PubMedCrossRefGoogle Scholar
  17. 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 25:330–360PubMedCrossRefGoogle Scholar
  18. 18.
  19. 19.
    Wan TT, Zhang NJ, Unruh L (2006) Predictors of resident outcome improvement in nursing homes. West J Nurs Res 28:974–993PubMedCrossRefGoogle Scholar
  20. 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 41:1318–1330PubMedCrossRefGoogle Scholar
  21. 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 44:24–38PubMedCrossRefGoogle Scholar
  22. 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 55:832–839PubMedCrossRefGoogle Scholar
  23. 23.
    Kayser-Jones J (2002) Malnutrition, dehydration, and starvation in the midst of plenty: the political impact of qualitative inquiry. Qual Health Res 12:1391–1405PubMedCrossRefGoogle Scholar
  24. 24.
    Hu TW, Huang LF, Cartwright WS (1986) Evaluation of the costs of caring for the senile demented elderly: a pilot study. Gerontologist 26:158–163PubMedCrossRefGoogle Scholar
  25. 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 27:637–641PubMedCrossRefGoogle Scholar
  26. 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 56:1466–1473PubMedCrossRefGoogle Scholar
  27. 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 44:1366–1370PubMedGoogle Scholar
  28. 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 25:155–164PubMedCrossRefGoogle Scholar
  29. 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 37:83–89PubMedCrossRefGoogle Scholar
  30. 30.
    Wirth R, Sieber CC (2011) Dementia and Malnutrition — from an early symptom to a therapeutic challenge. Aktuel Ernaehrungsmed 36:90–93CrossRefGoogle Scholar

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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