Nutritional risk and low weight in community-living older adults: a review of the literature (1995-2005)

Social factors associated with changes in nutrition risk scores measured using SCREEN-8: data from the Canadian Longitudinal Study on Aging

Purpose: To examine the social network factors associated with changes in nutrition risk scores, measured by SCREEN-8, over three years, in community-dwelling Canadians aged 45 years and older, using data from the Canadian Longitudinal Study on Aging (CLSA).Methods: Change in SCREEN-8 scores between the baseline and first follow-up waves of the CLSA was calculated by subtracting SCREEN-8 scores at follow-up from baseline scores. Multivariable linear regression was used to examine the factors associated with change in SCREEN-8 score.Results: The mean SCREEN-8 score at baseline was 38.7 (SD = 6.4), and the mean SCREEN-8 score at follow-up was 37.9 (SD = 6.6). The mean change in SCREEN-8 score was -0.90 (SD = 5.99). Higher levels of social participation (participation in community activities) were associated with increases in SCREEN-8 scores between baseline and follow-up, three years later.Conclusions: Dietitians should be aware that individuals with low levels of social participation may be at risk for having their nutritional status decrease over time and consideration should be given to screening them proactively for nutrition risk. Dietitians can develop and support programs aimed at combining food with social participation.

Nutrition knowledge assessment tools for older adults and their carers: a scoping review

Poor nutritional intake is common among older adults. Given that nutrition knowledge is an important determinant of eating behaviour and nutritional status, understanding areas of inadequate knowledge can guide educational interventions to reduce risk of nutritional deficiencies and promote healthy ageing. This review investigated tools assessing general nutritional knowledge of older adults and their carers. Following the Joanna Briggs for Scoping Reviews guidelines, 4 databases (MEDLINE, CINAHL, Global Health and Embase) and grey literature were searched. Studies of any type containing general nutrition knowledge assessment tools for older adults or their carers were included. In total, 6934 articles were identified, of which 24 met the eligibility criteria, and 23 unique nutrition knowledge assessment tools were included. Of these tools, 14 were original, 6 were modified from other tools and 3 used dietary-related responses from national dietary survey questions. 6 tools were developed for carers (mostly nurses) and 17 tools for older adults. Tools had between 4 and 110 items. The most common topics for general nutrition knowledge questions were related to nutrients and roles, food sources of nutrients, and diet-disease relationships. 8 tools were developed prior to 2000. Most studies did not specify or assess psychometric properties of the tool, with only 9 (38 %) and 6 (26 %) studies testing for reliability and validity, respectively, and only 1 tool was considered reliable. Additional research for the development of reliable and validated tools or the validation of existing tools to assess nutrition knowledge of older adults and their carers is needed across different healthcare settings.

Determinants of a decline in a nutrition risk measure differ by baseline high nutrition risk status: targeting nutrition risk screening for frailty prevention in the Canadian Longitudinal Study on Aging (CLSA)

OBJECTIVES

Nutrition risk is a key component of frailty and screening, and treatment of nutrition risk is part of frailty management. This study identified the determinants of a 3-year decline in nutrition risk (measured by SCREEN-8) for older adults stratified by risk status at baseline.

METHODS

Secondary data analysis of the comprehensive cohort sample of the Canadian Longitudinal Study on Aging (CLSA) (n = 5031) with complete data for covariates at baseline and 3-year follow-up. Using a conceptual model to define covariates, determinants of a change in nutrition risk score as measured by SCREEN-8 (lower score indicates greater risk) were identified for those not at risk at baseline and those at high risk at baseline using multivariable regression.

RESULTS

Models stratified by baseline nutrition risk were significant. Notable factors associated with a decrease in SCREEN-8 for those not at risk at baseline were mental health diagnoses (- 0.83; CI [- 1.44,  -0.22]), living alone at follow-up (- 1.98; CI [- 3.40,  -0.56]), and lack of dental care at both timepoints (- 0.91; CI [- 1.62,  -0.20]) and at follow-up only (- 1.32; CI [- 2.45,  -0.19]). For those at high nutrition risk at baseline, decline in activities of daily living (- 2.56; CI [- 4.36,  -0.77]) and low chair-rise scores (- 1.98; CI [- 3.33, - 0.63]) were associated with lower SCREEN-8 scores at follow-up.

CONCLUSION

Determinants of change in SCREEN-8 scores are different for those with no risk and those who are already at high risk, suggesting targeted approaches are needed for screening and treatment of nutrition risk in primary care.

Social Network Factors Affect Nutrition Risk in Middle-Aged and Older Adults: Results from the Canadian Longitudinal Study on Aging

OBJECTIVES

To determine which social network, demographic, and health-indicator variables are associated with SCREEN-8 (nutrition risk) scores at two time points, three years apart, using data from the Canadian Longitudinal Study on Aging.

DESIGN

A retrospective cross-sectional study.

SETTING AND PARTICIPANTS

17051 Canadians aged 45 years and older with data from baseline and first follow-up of the Canadian Longitudinal Study on Aging.

MEASUREMENTS

Nutrition risk was measured using SCREEN-8. Social network factors included social network size, frequency of contact with social network members, social participation, social support, self-rated social standing, and household income. Demographic variables included age, sex assigned at birth, marital status, educational attainment, and living situation (alone or with others). Health-indicator variables included depression, disability, and self-rated general health, mental health, healthy aging, and oral health. Multivariable linear regression was used to analyze the relationship between the social network, demographic, and health-indicator variables and SCREEN-8 scores at two time points, three years apart.

RESULTS

Among the social network variables, individuals with higher social participation, self-rated social standing, and social support had higher SCREEN-8 scores at baseline and follow-up. Among the demographic variables, individuals who were single or widowed, compared to married or partnered, had lower SCREEN-8 scores at both time points. For the health-indicator variables, individuals who screened negative for depression, and those with higher self-rated general health, healthy aging, and oral health had higher SCREEN-8 scores at both time points. At baseline, as age increased, SCREEN-8 scores also increased.

CONCLUSION

Individuals with low social participation, low social standing, and low social support may be at increased nutrition risk and should be proactively screened by healthcare professionals. Interventions and community programs designed to increase levels of social participation and foster social support may help to reduce the prevalence of nutrition risk.

Age is the most important factor for change in body mass index and waist circumference in older people in southern Brazil

OBJECTIVES

The aim of this study is to assess the changes in body mass index and waist circumference (WC) and their associations with sociodemographic, behavioral, and health characteristics in non-institutionalized older people in southern Brazil over a period of ≤6 y.

METHODS

This is a prospective study, with interviews conducted in 2014 and in 2019 to 2020. Of the 1451 individuals from Pelotas, Brazil, aged >60 y and interviewed in 2014, 537 were reevaluated in 2019 to 2020. An increase or decrease was defined as a variation of ≥5% in body mass index and WC in the second visit compared with the first. The association with changes in outcomes was assessed according to sociodemographic, behavioral, and health characteristics using multinomial logistic regression.

RESULTS

Approximately 29% of the older participants lost body mass. Regarding WC, there was an increase in 25.6% in the older participants. The older participants ages ≥80 y had greater odds of losing body mass (odds ratio [OR] = 4.73; 95% confidence interval [CI], 2.29-9.76) and of reducing WC (OR = 2.84; 95% CI, 1.59-6.94). Former smokers had, on average, 41% and 64% lower odds of losing and gaining body mass (95% CI, 0.37-0.95 and 95% CI, 0.19-0.68, respectively), and those who were on ≥5 medications had greater odds of gaining body mass (OR = 1.92; 95% CI, 1.12-3.28) and WC (OR = 1.79; 95% CI, 1.18-2.74).

CONCLUSIONS

Despite the high proportion of older people who kept their body mass index and WC stable during this period, many of them lost body mass and gained WC. The findings also highlighted the importance of age in the nutritional changes observed in the population.

Dietary supplement use by older adults with chronic venous leg ulcers: A retrospective, descriptive study

Nearly 70% of older adults in the U.S. report using ≥1 dietary supplements (DSs) daily. While DSs may have health benefits, there is risk for toxicity or harmful drug-supplement interactions if not taken correctly. Older adults with chronic wounds who use DSs are at increased risk of adverse drug-supplement interactions because they usually have comorbidities requiring polypharmacy management. However, no studies have evaluated DS use in this population. The aim of this retrospective pilot study was to describe DS use by a sample of older adults (n = 40) with chronic venous leg ulcers (CVLUs) who participated in a clinical trial testing the effects of fish oil supplementation on wound healing. At baseline, study personnel assisted all participants in completing an electronic questionnaire about DS use. Descriptive statistics were used to characterize the data. Twenty-five of the 40 participants (62.5%) reported taking ≥1 DS daily. On average, DS users were 65.16 years (SD = 8.51) and the majority were men (64.0%), white (68.0%), and had at least some college education (72.0%). Fifteen (60.0%) reported taking 1-2 DSs/day, and 10 (40.0%) reported taking ≥3/day. The most frequently reported DSs used were multivitamin/mineral complex (60.0%), vitamin D (36.0%), vitamin B complex (28.0%) and calcium (28.0%). Reasons for using DSs were to maintain or improve health (44.0%), improve bone density (12%), and boost the immune system (12%). Supplement users reported consuming an average of 9.12 (SD = 6.46) prescription drugs daily and 21 (84.0%) reported ≥3 chronic health conditions. In summary, DS use in this sample of chronic wound patients was high. Moreover, DS users reported using multiple prescription drugs (2-23/day) concomitantly with DSs. While older adults with CVLUs may benefit from targeted DS therapy, monitoring their DS use to reduce risk for adverse drug-supplement interactions is best practice.

Older consumers' attitudes towards food carriers for protein-enrichment

Understanding the demands of older consumers is of importance for successful development of functional foods targeted at this segment of the population. This study aimed to examine older adults' attitudes towards food carriers for protein enrichment. In total 182 consumers (mean age: 66.6 ± 6.9) participated in a survey designed to evaluate their willingness to try and purchase 16 target food carriers for protein enrichment. Food carriers were chosen to vary systematically on three fundamental dimensions: healthiness (healthy vs. unhealthy), novelty (traditional vs. novel), and types of meal (meal-component vs. snack). Results showed that among the carrier formats, older consumers were most willing to purchase and try healthy, traditional meal component foods enriched with protein. By segmenting older consumers using a latent class approach, an increase in purchase willingness of protein-enriched foods was found when protein-enriched foods were tailored to particular segments, suggesting that a segmentation-based approach to product development would be beneficial. Future studies may need to explore older consumers' actual purchase intention through the tasting of appealing protein-enriched foods in real life, which might help reduce older consumers' skepticism towards protein-enriched foods.

Psychosocial correlates of unintentional weight loss in the second half of life in the German general population

Background

Unintentional weight loss (UWL) is common in older age and associated with adverse outcomes including mortality. The aim of the present study was to determine psychosocial correlates of UWL.

Methods

Data were derived from a large, nationally representative study of community-dwelling individuals in the second half of life (40 years and over) in Germany in 2014 (n = 7,933). Data on UWL were assessed in face-to-face interviews as unintentional loss of more than 5kg (11 pounds) in weight in the past 12 months, and data on psychosocial factors were recorded in self-administered questionnaires.

Results

Multiple logistic regressions revealed that UWL was positively associated with depressive symptoms and positive affect, whereas it was negatively associated with self-esteem. Individuals with UWL were more likely to feel lonely and perceive themselves as socially excluded.

Conclusion

The findings of important psychosocial correlates of UWL may help to identify individuals at risk for UWL in older age. This is in particular important since interventions to treat this phenomenon in older age are available that reduce adverse consequences resulting from UWL.

Dietary Supplement Use Was Very High among Older Adults in the United States in 2011-2014

Background: Dietary supplements (DSs) have the potential to be both beneficial and harmful to health, especially in adults aged ≥60 y, and therefore it is important to monitor the patterns of their use.Objective: This study evaluated DS use by adults aged ≥60 y to characterize the use of DSs, determine the motivations for use, and examine the associations between the use of DSs and selected demographic, lifestyle, and health characteristics.Methods: Data from 3469 older adults aged ≥60 y from the 2011-2014 NHANES were analyzed. DSs used in the past 30 d were ascertained via an interviewer-administered questionnaire in participants' homes. The prevalence of overall DS use and specific types of DSs were estimated. The number of DSs reported and the frequency, duration, and motivation(s) for use were assessed. Logistic regression models were constructed to examine the association between DS use and selected characteristics.Results: Seventy percent of older adults in the United States reported using ≥1 DS in the past 30 d; 54% of users took 1 or 2 products, and 29% reported taking ≥4 products. The most frequently reported products were multivitamin or mineral (MVM) (39%), vitamin D only (26%), and omega-3 fatty acids (22%). Women used DSs almost twice as often as men [adjusted OR (aOR), 1.8; 95% CI: 1.5, 2.3). Those not reporting prescription medications were less likely to take a DS than those reporting ≥3 prescription medications (aOR, 0.4; 95% CI: 0.3, 0.6). The most frequently reported motivation for DS use was to improve overall health (41%).Conclusions: Use of DSs among older adults continues to be high in the United States, with 29% of users regularly taking ≥4 DSs, and there is a high concurrent usage of them with prescription medications.

Fruit and vegetable intake among older adults: a scoping review

Older adults are the fastest growing segment of the world population. Older adults are also at heightened risk of chronic conditions (such as diabetes, heart disease, and cancer) and specific geriatric conditions (such as cognitive impairment, frailty, and falls). Research studies have examined the relationship between fruit and vegetable intake and subsequent health outcomes and the correlates of fruit and vegetable intake in the U.S. population. However, relatively few studies have specifically examined health impacts and correlates of fruit and vegetable intake among older adults, who have unique biophysical and socioeconomic circumstances. Evidence is reviewed to (1) describe findings related to consumption and chronic, geriatric, and other health outcomes among older adults and (2) describe patterns in fruit and vegetable consumption among older adults and how these patterns vary within and among populations. This review addresses specific barriers faced by older adults in obtaining and consuming fruits and vegetables in community settings. Recommendations for practice and policy are discussed.

Depression trajectories and obesity among the elderly in Taiwan

BACKGROUND

The present study aimed to (a) characterize 10-year trajectory patterns of depressive symptoms and (b) investigate the association between depressive trajectory and subsequent obesity, metabolic function and cortisol level.

METHOD

In a prospective study of Taiwanese adults aged ≥60 years (n=3922) between 1989 and 1999, depression was assessed using a 10-item short-form of the Center for Epidemiologic Studies Depression Scale and information on body mass index (BMI) was collected by self-report. A subsample (n=445) of the original cohort in 1989 was drawn to assess metabolic variables and cortisol levels in a 2000 follow-up. After trajectory analyses were performed, multinomial logistic regression analyses were used to estimate the association estimates.

RESULTS

We identified four distinctive trajectories of depressive symptoms: class 1 (persistent low, 41.8%); class 2 (persistent mild, 46.8%); class 3 (late peak, 4.2%); and class 4 (high-chronic, 7.2%). The results from both complete cases and multiple imputation analyses indicated that the odds of obesity were lower in the class 2, 3 or 4 elderly, as compared with those in class 1, while the odds of underweight were higher. The classes of older adults with more and persistent depressive symptoms showed a trend toward having both a lower BMI (p=0.01) and a higher cortisol level (p=0.04) compared with those with low depressive symptoms.

CONCLUSIONS

Incremental increases in depressive symptoms over time were associated with reduced risk of obesity and higher cortisol levels.

How is the risk of undernutrition associated with cardiovascular disease among individuals of advanced age?

BACKGROUND

The oldest old (85+) are the fastest growing population segment in New Zealand. Cardiovascular disease (CVD) is the main cause of death and is associated with various risk factors including risk of undernutrition.

OBJECTIVES

To determine if there is an association between CVD and nutrition risk in advanced age.

SETTING

Three North Island locations (rural and urban areas) in New Zealand.

PARTICIPANTS

108 participants aged 85 years (75-79 for Maori).

MEASUREMENTS

Comprehensive health assessments were undertaken. Clinically manifest CVD was pre-defined and ascertained from interviews and hospitalisation records. Nutrition risk was assessed using a validated questionnaire-Seniors in the Community: Risk evaluation for eating and nutrition, Version II (SCREEN II).

RESULTS

72 participants (67%) had CVD (49% men); 52% of participants had a SCREEN II score < 50. Those with CVD had lower HDL level [median(IQR)] [1.4(0.7) vs. 1.6(0.6)] (p=0.041), and higher waist circumference [97.5(19.1) vs. 89.3(20.6)] (p=0.043) compared to those without CVD. Those with CVD were at no greater nutrition risk than those without CVD (SCREEN II score: [49(7) vs. 51(10)] (p=0.365). Using logistic regression controlling for confounders, SCREEN II scores trended towards an inverse association with CVD (p=0.10).

CONCLUSION

Two thirds of the study participants had CVD and half were at risk of undernutrition. Nutrition risk was mildly associated with CVD. This study provides further evidence that those in advanced age are at risk of undernutrition. Further research is needed to establish how the causes and consequences of CVD are related to nutrition risk.

Factors associated with recovery of prehospital function among older persons admitted to a nursing home with disability after an acute hospitalization

BACKGROUND

The objective of this study was to identify the factors associated with recovery of prehospital function among older persons admitted to a nursing home with disability after an acute hospitalization.

METHODS

The analytic sample included 292 participants of an ongoing cohort study who had one or more admissions to a nursing home with disability after an acute hospitalization during nearly 10 years of follow-up, yielding a total of 364 "index" nursing home admissions. Information on nursing home admissions, hospitalizations, and disability in essential activities of daily living was ascertained during monthly telephone interviews. Data on potential predictors of functional recovery were collected during comprehensive assessments, which were completed every 18 months for 90 months. Participants were considered to have recovered if they were discharged home within 6 months of their nursing home admission at (or above) their prehospital level of function.

RESULTS

Recovery of prehospital function was observed for 115 (31.6%) of the 364 index nursing home admissions. In the multivariate analysis, the strongest associations were observed for the best category of performance, relative to the poorest category, for gross motor coordination (hazard ratio [HR] 13.5, 95% confidence interval [CI] 4.02-45.0) and manual dexterity (HR 10.0, 95% CI 2.94-34.3). Only two other factors were independently associated with recovery of prehospital function: not cognitively impaired (HR 3.0, 95% CI 1.46-6.14) and no significant weight loss (HR 1.96, 95% CI 1.06-3.63).

CONCLUSIONS

In the setting of an acute hospitalization leading to a nursing home admission with disability, the likelihood of recovering prehospital function is low. The factors associated with recovery include faster performance on tests of gross motor coordination and manual dexterity and the absence of cognitive impairment and significant weight loss.

Socioeconomic characteristics, dietary and lifestyle patterns, and health and weight status of older adults in NHANES, 1999-2002: a comparison of Caucasians and African Americans

There are disparities among older Caucasian and African American adults in many areas. The study used data from the National Health and Nutrition Examination Survey conducted from 1999 to 2002 and compared the self-reported dietary intakes, physical activity, and economic and health status of Caucasian (N = 1,398) and African American (N = 354) adults aged 65 years and older. Regression models and t-tests (alpha = 0.05) were used for comparisons. More African Americans than Caucasians lived in low-income households (40.4% vs. 21.3%), lived in households that were not fully food-secure (15.6% vs. 4.9%), watched five or more hours of television (34% vs. 20%), and were told that they had diabetes (10% vs. 4%) or high blood pressure (67 % vs. 52 %). They consumed 253 fewer calories than Caucasians. About 75 % of African American women were overweight. Our findings indicate that for those greater than 65 years of age, low-income African Americans are at a greater risk for poor nutrition and chronic health conditions than Caucasians.

Promoting food intake in older adults living in the community: a review

Older adults (>65 y) living in the community have the potential to have significant nutrition concerns and deficits owing to the physiological, social, and psychological changes that occur with ageing. However, poor nutrition should not be considered an inevitable consequence of ageing. Older adults are quite heterogenous, including those ageing "successfully", "usually", and at "accelerated" rates. By improving the nutritional status of older adults, significant health and quality of life gains can be realized. These three subgroups of older adults have different concerns and risk factors and thus need different interventions. A substantial amount of research on older adult nutrition needs, determinants of food intake, risk of poor nutrition, and interventions has occurred in the past decade in Canada. The purpose of this review is to summarize this research and identify how nutrition promotion for older adults can be improved. Research to date indicates that the need for nutrition promotion is substantial. A variety of interventions have improved food intake and health of participants, although most programs are provided at a tertiary prevention level. Nutrition screening can help to identify in a timely manner those older adults who may benefit from limited services and which secondary prevention activities need to be increased. Nutrition promotion policy is currently lacking for older adults in Canada and is an important barrier to improving food intake in this growing segment of the population.

Community-living elder's views on normal and low weight

OBJECTIVES

To investigate community-living older adult's understanding of normal and low weight.

DESIGN

Cross-sectional exploratory.

SETTING

Three counties in the Western United States.

PARTICIPANTS

Community-living older adults (n=130), aged 65 and older, with a body mass index (BMI) < 24 kg/m2.

MEASUREMENT

Interviews, using semi-structured questions, were analyzed using content analysis.

RESULTS

Only 22% (n=28) of the participants reported knowing the normal weight range for their age, and even fewer (2%, n=3) knew what a low weight was for their age. Most (n=125) reported receiving no information from their health care provider (HCP) on normal and low weight for their age.

CONCLUSION

The majority of the participants were unaware that they were at-risk for poor nutritional status and low weight; they reported receiving little information from their HCP on preventing weight loss. Since most community-living older adults do not know what normal or low weight is for their age, they would benefit from receiving this information from their HCP.

RATIONALE

Knowledge of older adults' views on normal and low weight may lead to early identification of weight problems and improve an older adult's nutritional status.

Chocolate, well-being and health among elderly men

OBJECTIVE

We hypothesized that chocolate preference would be related to health and psychological well-being in old men.

DESIGN, SETTING AND PARTICIPANTS

We have followed up a socio-economically homogenous group of men, born in 1919-1934, since the 1960s. In 2002-2003, a mailed questionnaire was used to assess the health and well-being (including questions related to positive life orientation, visual analogue scales and the Zung depression score) of survivors. In addition, candy preference was inquired. Those men who reported no candy consumption (n=108) were excluded from the analyses.

OUTCOME MEASURES

Psychological well-being in old age.

RESULTS

The response rate was 69% (1367 of 1991). Of the respondents, 860 and 399 preferred chocolate and other type of candy, respectively. The average age in both candy groups was 76 years. Of the respondents, 99% were home-dwelling, 96% were retired and 87% were presently married, without differences between the candy groups. Men preferring chocolate had lower body mass index and waist circumference, and they also reported more exercise and better subjective health (P=0.008) than other candy consumers. Variables related to psychological well-being were consistently better in those preferring chocolate. The differences were statistically significant in feeling of loneliness (P=0.01), feeling of happiness (P=0.01), having plans for the future (P=0.0002) and the Zung depression score (P=0.02).

CONCLUSIONS

In this socioeconomically homogenous male cohort, chocolate preference in old age was associated with better health, optimism and better psychological well-being.

SPONSORSHIP

The Academy of Finland, the Päivikki and Sakari Sohlberg Foundation, the Helsinki University Central Hospital and the Finnish Foundation for Cardiovascular Research.