Abstract
Background: The proportion of New Zealander’s aged 65 years and older is expected to reach 25% by 2030, placing considerable demand on health and disability services, including residential care services. Good nutrition is essential for maintaining health, independence and well being in old age, and for minimizing the burden of the aging population on health services. While international research shows malnutrition is prevalent in residential care units, there is limited information on the nutritional status of New Zealand rest home residents.
Objective: To describe the prevalence of inadequate nutrient intakes of rest home residents in Hamilton; and to determine the risk of malnutrition in these residents.
Design: A cross-sectional survey involving 40 rest home residents (14 men, 26 women) aged 68 to 101 years from two homes in Hamilton. Dietary intake data was collected using weighed food records conducted on three non-consecutive days. Nutrient intakes were calculated using the dietary assessment software programme Kaiculator, based on the New Zealand Food Composition Tables. Nutrient intakes were compared to the Estimated Average Requirement to determine the prevalence of inadequate intakes. Malnutrition risk was assessed using two malnutrition-screening tools: the Malnutrition Universal Screening Tool (MUST) and the Mini Nutritional Assessment Short Form (MNA-SF). Information on demographics, health status, current medications, supplement use and dental status were collected. Anthropometric measurements (height, weight, calf circumference, ulna length, waist circumference and demispan) were taken using standardized protocols. Body mass index (BMI) was calculated (kg/m2). Physical function was assessed with a 5-m timed walk test, handgrip strength, and an Activities of Daily Living (ADL) questionnaire. Cognitive function was examined using the Clock Drawing Test. A fasting blood sample was collected, and haemoglobin concentration determined by a local health clinic.
Results: A high percentage of participants (>60%) had cognitive and physical function impairments, although most were independent in ADL for feeding. Half the participants (53%) were classified as overweight or obese, whereas 18% were underweight. Low energy intakes were observed in 22% of participants, and inadequate intakes of protein were observed in 64% and 27% of men and women, respectively. Almost all participants had low fibre intake. Total sugar and saturated fat were consumed in amounts above recommended values for optimal health. Of the micronutrient intakes assessed, over 85% of participants were at risk of inadequate intakes of calcium, zinc (for men), selenium, magnesium, vitamin B6 and vitamin D. However, 85% were taking vitamin D supplements. The MNA-SF and MUST tools identified 12.5% and 17.5%, respectively, as being at high risk of malnutrition. Lastly, approximately half the participants were anaemic based on the World Health Organisation criteria.
Conclusion: Based on dietary intake data, the intakes of several important nutrients are suboptimal for many Hamilton rest home residents. Furthermore, the number of residents at risk of malnutrition was unacceptably high. Considering the importance of good nutritional status for health and well being, further research is required to devise strategies to improve the nutrient intakes of these residents and to determine optimal nutrient requirements for older, frail New Zealanders.