Nutritional assessment of older New Zealand adults in Auckland residential care homes
Background: New Zealand is currently experiencing an exponential growth in the older adult population, leading to an increasing demand for residential care. To ensure healthy aging in this population occurs, adequate dietary intakes are essential. However, overseas studies show high prevalence of inadequate nutrient intake in older adults. The research in New Zealand on dietary adequacy and nutritional intakes of older adults, especially in rest home level care, is limited. Objective: To describe the dietary adequacy and nutritional status of long-term Auckland rest-home residents and to describe malnutrition risk in this population. Design: A cross-sectional study. Setting: Two low-level care Auckland rest homes. Participants: A convenience sample of 40 older adults aged ≥70 years, having resided in the rest home for ≥12 weeks. Measurements: Nutritional intakes, including all food, beverages and supplements, were assessed by 3-day non-consecutive weighed food records for all food consumed between breakfast and dinner at the rest home. In addition, 12-hour food recalls were performed for food and beverage consumption overnight. Information on demographics, medical history, medications, supplement use, and activity levels were collected from medical records. Anthropometric measures (ulna length, weight, waist circumference), malnutrition screening using the Mini Nutritional Assessment-Short Form (MNA-SF) and the Malnutrition Universal Screening Tool (MUST), self-reported dental health, and biochemical samples (blood and urine) were also collected. Cognitive function was assessed with the Clock-Drawing Test. Physical function was measured by a handgrip test, a timed walk test, and the Activities of Daily Living Scale. Mood was measured with the Geriatric Depression Scale. All information was collected by a trained student dietitian. Results: Forty participants with a mean age of 87 years participated. Participants had multiple medical conditions. Cognitive defects were observed in 60% of participants. Furthermore, 48% of residents were depressed. High frailty rates were shown, with weak handgrip present in 75% of participants. Women were more likely to have slower gait speed than men, however rates of slow gait were high in both genders (men = 50%, women 88%; P = 0.034). Energy intakes were low, with 47% of participants having usual intakes below the EER. Compared with the EAR, >55% of participants had suboptimal protein intakes. The mean daily intake of fibre was low (~19g). More than two-thirds of participants had inadequate intakes of calcium, zinc, magnesium, selenium, vitamin B6 and vitamin D. Men were more likely to be anaemic than women using the WHO cut-offs for haemoglobin (71% vs. 27%; P = 0.025). As calculated by BMI, 38% of participants were classed as normal weight and 43% were classed as overweight or obese. A fifth (20%) of participants were underweight. Malnutrition rates, calculated by the MNA-SF and the MUST screening tools, identified high rates (~50%) of participants at risk of malnutrition. Conclusion: The findings from this study show that residents in Auckland low-level of care rest homes have suboptimal energy and protein intakes along with high rates of micronutrient inadequacies. This is of concern as adequate intakes are essential for maintaining health and well being in old age. Further research is needed to investigate the possible causes of low nutrient intakes, and how this can be improved.
Advisor: Houghton, Lisa; Miller, Jody; MacDonell, Sue
Degree Name: Master of Dietetics
Degree Discipline: Human Nutrition
Publisher: University of Otago
Keywords: older adults; New Zealand; Nutrition; Assessment; Malnutrition; residential care; diet
Research Type: Thesis