Abstract
Background: New Zealand’s population is ageing rapidly, adding considerable demands for health care resources and aged care services. Good nutrition is associated with better physical and mental health, both of which are essential for maintaining quality of life in old age. Malnutrition is common in older adults residing in aged care facilities, with research conducted overseas reporting varying rates of 37% to 85%. However, there is very little information on the nutritional status and intakes of older adults residing in rest homes in New Zealand.
Objective: To describe malnutrition risk and examine the nutrient intakes of elderly residents from residential care homes in Dunedin.
Design: A cross-sectional study was conducted, involving 40 residents from 2 rest homes in Dunedin. The information collected included demographic characteristics, medical status and history, medication and supplement use, anthropometric measurements, physical and cognitive function, mental and oral health status. Malnutrition risk was evaluated using 2 screening tools: the Mini Nutritional Assessment-Short Form (MNA-SF) and Malnutrition Universal Screening Tool (MUST). Dietary intakes were assessed using 3-day weighed food records. Nutrient intake data were obtained by comparing the dietary intake data to nutrient lines using Kai-culator, and were then compared to the Australian New Zealand Nutrient Reference Values for older people to assess the adequacy of nutrient intakes. A fasting venous blood sample was collected and anaemia was estimated using two criteria: haemoglobin (Hb) <120 mg/L for women and <130 mg/L for men; and Hb <115 mg/L for both sexes.
Results: 82.5% of participants were women and the average duration of stay was 31 months. 24% of women were underweight (BMI <20kg/m2) while 43% of men and 48% of women were overweight (BMI>30kg/m2). When using the MNA-SF, 55% of the participants were classified as at risk of malnutrition and 10% were classified as malnourished. Similar proportions of participants were classified as at risk of malnutrition when using the MUST (55%) with 30% in the ‘high risk’ category. It is estimated that over 14% of participants were not likely to meet their Estimated Energy Requirements despite sufficient intakes of carbohydrate. Inadequate intakes of protein were present in 25% of participants while over 87% of participants did not achieve the Adequate Intake for fibre. In contrast, sugar intake was up to three times higher than recommended. All participants were at risk of suboptimal dietary intakes of vitamin D; however, 85% were taking vitamin D supplements. Furthermore, over 76% of the participants were not consuming sufficient calcium, selenium, and magnesium. Micronutrient intakes were also low for zinc, thiamin, vitamin B6, vitamin E and vitamin B12, which affected more than one-third of the participants. Additionally, anaemia was present in 37% of the participants according to the World Health Organisation’s criteria (Hb<13g/dL for men and<12g/dL for women).
Conclusion: Our results show that a large proportion of rest home residents in Dunedin are at risk of malnutrition and suboptimal intakes of nutrients. There is a need to develop an organised nutritional policy for better identification of malnutrition, and feasible interventions to improve nutritional status in New Zealand’s elderly aged-care residents.