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

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.

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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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Authors

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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).

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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

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

Key words

  • Nursing home resident
  • elderly
  • energy intake
  • BMI
  • MNA