Skip to main content
SpringerLink
Log in

Predictors of Nutritional Risk in Community-dwelling Seniors

  • Published:
Canadian Journal of Public Health Aims and scope Submit manuscript

Abstract

Objectives

At any age, good nutrition is important for maintaining good health. Seniors are at risk of declining nutritional status due to the physiological, psychological, economic and social changes that accompany aging. We investigated medical, psychological, social and environmental characteristics as both correlates and predictors of elevated nutritional risk in community-dwelling seniors.

Methods

Data came from a prospective study of 839 seniors aged 75 and over, in Montreal. Face-to-face interviews were conducted at baseline and at 12 months. The validated Elderly Nutrition Screening (ENS©) tool was administered and subjects were assigned a level of “nutritional risk” based on the risk for energy and nutritional intake deficiencies. Using risk factors identified in the literature, analyses were performed to characterize those factors associated with both the level of risk at baseline and a change in risk over 12 months.

Results

At baseline, more than half (60%) of the participants were at elevated nutritional risk. Cross-sectional analyses supported the findings of previous research examining correlates of elevated nutritional risk. Longitudinal results showed that among those at low nutritional risk, only poor self-rated health was found to be a statistically significant predictor of elevated risk at 12 months (OR=3.30, p<0.05).

Conclusion

Proper nutrition can promote healthy aging by preventing disease and disability, improving health outcomes and maintaining autonomy, resulting in decreased health care utilization and costs. The findings of this research highlight the need for longitudinal studies in order to better understand and target nutritional risk in community-dwelling seniors.

Résumé

Objectifs

À tout âge, une bonne nutrition est essentielle pour maintenir la santé. Le risque de détérioration de l’état nutritionnel augmente considérablement avec l’avance en âge dû aux changements physiologiques, psychologiques, économiques et sociaux qui accompagnent le vieillissement. Nous avons examiné la relation entre le risque nutritionnel et les caractéristiques physiologiques, psychologiques, sociales et environnementales de personnes âgées vivant dans la communauté.

Méthodologie

Les données ont été recueillies dans le cadre d’une étude prospective de 839 Montréalais âgés de ≥75 ans par entrevues face-à-face, à l’entrée dans l’étude et 12 mois plus tard. Le DNA© (Dépistage Nutritionnel des Aînés) a été utilisé pour déterminer le niveau de risque nutritionnel selon le risque de carences d’apports alimentaires. Utilisant les facteurs de risque déjà reconnus, des analyses bi- et multivariées ont été utilisées pour identifier les facteurs associés au risque nutritionnel à l’entrée dans l’étude et à l’incidence de ce risque 12 mois plus tard.

Résultats

À l’entrée dans l’étude, plus de la moitié (60 %) des participants étaient à risque nutritionnel élevé. Les résultats de nos analyses transversales appuient ceux d’autres études. Ceux des analyses longitudinales montrent que, parmi les sujets à faible risque nutritionnel, une mauvaise santé perçue prédit une augmentation de ce risque après 12 mois (RC=3,30, p<0,05).

Conclusion

Une bonne nutrition peut aider à vieillir en santé en prévenant la maladie et l’incapacité. L’amélioration de la santé et le maintien de l’autonomie fonctionnelle résulteront en une réduction de l’utilisation et des coûts des soins de santé. Nos résultats soulignent l’importance des études longitudinales pour améliorer notre compréhension du risque nutritionnel chez les personnes âgées afin de mieux adapter nos interventions.

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

References

  1. Blumberg J. Nutrient requirements of the healthy elderly—should there be specific RDAs? Nutr Rev 1994;52(8 Suppl):S15–S18.

    CAS  PubMed  Google Scholar 

  2. Dewolfe J, Millan K. Dietary intake of older adults in the Kingston area. Can J Diet Pract Res 2003;64(1):16–24.

    Article  Google Scholar 

  3. Payette H, Gray-Donald K, Cyr R, Boutier V. Predictors of dietary intake in a functionally dependent elderly population in the community. Am J Public Health 1995;85(5):677–83.

    Article  CAS  Google Scholar 

  4. Barrocas A, Bistrian BR, Blackburn GL, Chernoff R, Lipschitz DA, Cohen D, et al. Appropriate and effective use of the NSI checklist and screens. An update on caring for the elderly by preventing malnutrition. J Am Diet Assoc 1995;95(6):647–48.

    Article  CAS  Google Scholar 

  5. Keller HH. Nutrition and health-related quality of life in frail older adults. J Nutr Health Aging 2004;8(4):245–52.

    CAS  PubMed  Google Scholar 

  6. Keller HH, Ostbye T, Goy R. Nutritional risk predicts quality of life in elderly community-living Canadians. J Gerontol A Biol Sci Med Sci 2004;59A(1):68–74.

    Article  Google Scholar 

  7. Vellas B, Lauque S, Andrieu S, Nourhashemi F, Rolland Y, Baumgartner R, et al. Nutrition assessment in the elderly. Curr Opin Clin Nutr Metab Care 2001;4(1):5–8.

    Article  CAS  Google Scholar 

  8. Keller HH, McKenzie JD, Goy RE. Construct validation and test-retest reliability of the seniors in the community: Risk evaluation for eating and nutrition questionnaire. J Gerontol A Biol Sci Med Sci 2001;56(9):M552–M558.

    Article  CAS  Google Scholar 

  9. Keller HH, Hedley MR. Nutritional risk needs assessment of community-living seniors: Prevalence of nutrition problems and priorities for action. J Community Health 2002;27(2):121–32.

    Article  Google Scholar 

  10. Keller HH, McKenzie JD. Nutritional risk in vulnerable community-living seniors. Can J Diet Pract Res 2003;64(4):195–201.

    Article  Google Scholar 

  11. MacLellan DL, van Til LD. Screening for nutritional risk among community-dwelling elderly on Prince Edward Island. Can J Public Health 1998;89(5):342–46.

    CAS  PubMed  Google Scholar 

  12. Payette H, Gray-Donald K, Cyr R, Coulombe C, Boutier V. Efficacy of a nutritional screening tool in free-living frail elderly. Age and Nutrition 1996;7(3):168–74.

    Google Scholar 

  13. Payette H, Hébert R, Boutier V, Voyer L. Efficacy of a nutrition screening program among community-dwelling elderly people at risk of functional decline. Proceedings of the 16th International Congress of Nutrition, Montreal, Quebec, 1997.

    Google Scholar 

  14. Shatenstein B, Nadon S, Ferland G. Determinants of diet quality among Quebecers aged 55–74. J Nutr Health Aging 2004;8(2):83–91.

    CAS  PubMed  Google Scholar 

  15. Chen CCH, Schilling LS, Lyder CH. A concept analysis of malnutrition in the elderly. J Adv Nurs 2001;36(1):131–42.

    Article  CAS  Google Scholar 

  16. Drewnowski A, Shultz JM. Impact of aging on eating behaviors, food choices, nutrition, and health status. [Review] [19 refs]. J Nutr Health Aging 2001;5(2):75–79.

    CAS  PubMed  Google Scholar 

  17. Liu L, Bopp MM, Roberson PK, Sullivan DH. Undernutrition and risk of mortality in elderly patients within 1 year of hospital discharge. J Gerontol A Biol Sci Med Sci 2002;57(11):M741–M746.

    Article  Google Scholar 

  18. Mowe M, Bohmer T, Kindt E. Reduced nutritional status in an elderly population (<70 y) is probable before disease and possibly contributes to the development of disease. Am J Clin Nutr 1994;59(2):317–24. [erratum appears in Am J Clin Nutr 1994;60(2):298].

    Article  CAS  Google Scholar 

  19. Mowe M, Bohmer T. Nutrition problems among home-living elderly people may lead to disease and hospitalization. Nutr Rev 1996;54(1 Pt 2):S22–S24.

    CAS  PubMed  Google Scholar 

  20. Payette H. Nutrition as a determinant of functional autonomy and quality of life in aging: A research program. Can J Physiol Pharmacol 2005;83(11):1061–70.

    Article  CAS  Google Scholar 

  21. Rosenberg IH, Miller JW. Nutritional factors in physical and cognitive functions of elderly people. Am J Clin Nutr 1992;55(6 Suppl):1237S–1243S.

    Article  CAS  Google Scholar 

  22. Sullivan DH, Bopp MM, Robertson PK. Protein-energy undernutrition and life-threatening complications among the hospitalized elderly. J Gen Intern Med 2002;17(12):923–32.

    Article  Google Scholar 

  23. Chima CS, Barco K, Dewitt MLA, Maeda M, Teran JC, Mullen KD. Relationship of nutritional status to length of stay, hospital costs, and discharge status of patients hospitalized in the medicine service. J Am Diet Assoc 1997;97(9):975–78.

    Article  CAS  Google Scholar 

  24. Martyn CN, Winter PD, Coles SJ, Edington J. Effect of nutritional status on use of health care resources by patients with chronic disease living in the community. Clin Nutr 1998;17(3):119–23.

    Article  CAS  Google Scholar 

  25. Payette H, Coulombe C, Boutier V, Gray-Donald K. Nutrition risk factors for institutional-ization in a free-living functionally dependent elderly population. J Clin Epidemiol 2000;53(6):579–87.

    Article  CAS  Google Scholar 

  26. Kuczmarski MF, Weddle DO, American Dietetic Association. Position paper of the American Dietetic Association: Nutrition across the spectrum of aging. J Am Diet Assoc 2005;105(4):616–33.

    Article  Google Scholar 

  27. Omran ML, Morley JE. Assessment of protein energy malnutrition in older persons, part I: History, examination, body composition, and screening tools. Nutrition 2000;16(1):50–63.

    Article  CAS  Google Scholar 

  28. Payette H, Shatenstein B. Determinants of healthy eating in community-dwelling elderly people. Can J Public Health 2005;96(Suppl 3):S27–S31.

    PubMed  Google Scholar 

  29. Salvà A, Pera G. Screening for malnutrition in dwelling elderly. Public Health Nutr 2001;4(6A):1375–78.

    Article  Google Scholar 

  30. White JV. Risk factors for poor nutritional status in older Americans. Am Fam Physician 1991;44(6):2087–97.

    CAS  PubMed  Google Scholar 

  31. Visvanathan R, Newbury JW, Chapman I. Malnutrition in older people—screening and management strategies. Aust Fam Physician 2004;33(10):799–805.

    PubMed  Google Scholar 

  32. de Castro JM. Age-related changes in the social, psychological, and temporal influences on food intake in free-living, healthy, adult humans. J Gerontol A Biol Sci Med Sci 2002;57(6):M368–M377.

    Article  Google Scholar 

  33. McCormack P. Undernutrition in the elderly population living at home in the community: A review of the literature. J Adv Nurs 1997;26(5):856–63.

    Article  CAS  Google Scholar 

  34. MacIntosh C, Morley JE, Chapman IM. The anorexia of aging. Nutrition 2000;16(10):983–95.

    Article  CAS  Google Scholar 

  35. de Groot CPGM, van Staveren WA, de Graaf C. Determinants of macronutrient intake in elderly people. Eur J Clin Nutr 2000;54:S70–S76.

    Article  Google Scholar 

  36. Alibhai SM, Greenwood C, Payette H. An approach to the management of unintentional weight loss in elderly people. [Review] [98 refs]. CMAJ 2005;172(6):773–80.

    Article  Google Scholar 

  37. Toth MJ, Poehlman ET. Energetic adaptation to chronic disease in the elderly. Nutr Rev 2000;58(3 Pt 1):61–66.

    CAS  PubMed  Google Scholar 

  38. Stechmiller JK. Early nutritional screening of older adults: Review of nutritional support. J Infus Nurs 2003;26(3):170–77.

    Article  Google Scholar 

  39. Reuben DB, Greendale GA, Harrison GG. Nutrition screening in older persons. J Am Geriatr Soc 1995;43(4):415–25.

    Article  CAS  Google Scholar 

  40. Quail J, Addona V, Wolfson C, Podoba JE, Levesque LY, Dupuis J. Association of unmet need with self-rated health in a community-dwelling cohort of disabled seniors 75 years of age and over. Eur J Ageing 2007;4:45–55.

    Article  Google Scholar 

  41. Moride Y, Du Fort GG, Monette J, Ducruet T, Boivin JF, Champoux N, et al. Suboptimal duration of antidepressant treatments in the older ambulatory population of Quebec: Association with selected physician characteristics. J Am Geriatr Soc 2002;50(8):1365–71.

    Article  Google Scholar 

  42. Von Korff M, Wagner EH, Saunders K. A chronic disease score from automated pharmacy data. J Clin Epidemiol 1992;45(2):197–203.

    Article  Google Scholar 

  43. Allen SM, Mor V. The prevalence and consequences of unmet need. Contrasts between older and younger adults with disability. Med Care 1997;35(11):1132–48.

    Article  CAS  Google Scholar 

  44. Préville M, Boyer R, Potvin L, Perrault C, Légaré G. La détresse psychologique: détermination de la fiabilité et de la validité de la mesure utilisée dans l’enquête Santé Québec,*Enquête Santé Québec 1987+. 1992. Cahier de Recherche No 7, ministère de la Santé et des Services sociaux, Gouvernement du Québec.

    Google Scholar 

  45. Boyer R, Préville M, Légaré G, Valois P. [Psychological distress in a noninstitutionalized population of Quebec: Normative results of the Quebec health survey]. Can J Psychiatry 1993;38(5):339–43.

    Article  CAS  Google Scholar 

  46. Hosmer DW, Lemeshow S. Model-Building Strategies and Methods for Logistic Regression. Applied Logistic Regression, 2nd ed. New York, NY: John Wiley & Sons, Inc., 2000;91–144.

    Book  Google Scholar 

  47. Jylha M, Guralnik JM, Ferrucci L, Jokela J, Heikkinen E. Is self-rated health comparable across cultures and genders? J Gerontol B Psychol Sci Soc Sci 1998;53(3 Suppl):S144–S152.

    Article  CAS  Google Scholar 

  48. Singh-Manoux A, Martikainen P, Ferrie J, Zins M, Marmot M, Goldberg M. What does self-rated health measure? Results from the British Whitehall II and French Gazel cohort studies. J Epidemiol Community Health 2006;60(4):364–72.

    Article  Google Scholar 

  49. Idler EL, Benyamini Y. Self-rated health and mortality: A review of twenty-seven community studies. J Health Soc Behav 1997;38(1):21–37.

    Article  CAS  Google Scholar 

  50. Payette H, Cyr R. Les ressources communautaires en alimentation pour les personnes âgées: étude des services offerts et des caractéristiques de la clientèle (rapport de recherche). Centre de recherche en gérontologie et gériatrie, Sherbrooke, Québec, 1996;63 p.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Epidemiology, Biostatistics and Occupational Health, Department of Medicine, McGill University, 1025 Pine Avenue West, Suite P2.028, Montreal, QC, H3A 1A1, Canada

    Karen C. Roberts MSc & Christina Wolfson PhD

  2. Division of Clinical Epidemiology (DICE), McGill University Health Centre (MUHC), Montreal, Canada

    Christina Wolfson PhD

  3. Faculty of Medicine and Health Sciences, University of Sherbrooke, Research Centre on Aging, Health and Social Services Centre-University Institute of Geriatrics of Sherbrooke, Sherbrooke, QC, Canada

    Hélène Payette PhD

Authors
  1. Karen C. Roberts MSc
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christina Wolfson PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hélène Payette PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Karen C. Roberts MSc.

Additional information

Acknowledgements: The Montreal Unmet Needs study (“Unmet needs for community-based services for the elderly aged 75 years and over”) was funded by the Canadian Health Services Research Foundation (CHSRF), the Fonds de la Recherche en Santé du Québec (FRSQ), the Ministère de la Santé et des Services Sociaux du Québec (MSSS) and the Canadian Institutes of Health Research (CIHR). Karen Roberts was supported by a McGill University Faculty of Medicine Scholarship.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Roberts, K.C., Wolfson, C. & Payette, H. Predictors of Nutritional Risk in Community-dwelling Seniors. Can J Public Health 98, 331–336 (2007). https://doi.org/10.1007/BF03405413

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF03405413

MeSH terms

Search

Navigation