Nutrition Assessment of Older Adults in Residential Care in Wellington, New Zealand

Abstract

Background: Good nutrition is essential for optimal health in old age. Poor nutrition is associated with increased falls, disability, infection, poor wound healing, cognitive decline and substantially reduced quality of life. The New Zealand population is ageing and it is expected by 2031 the number of New Zealanders aged 65 years and older, will nearly double. A large number will require care in rest homes. Overseas data show that up to 54% of long term rest home residents are malnourished and that there is a high prevalence of multiple nutrient deficiencies; however, there is limited information about the nutritional status of New Zealand rest home residents. Objective: The aims of this study were to: 1) describe the prevalence of inadequate nutrient intakes of selected nutrients; and 2) determine the prevalence of malnutrition among residents receiving rest home level care. Design: A cross sectional study of older adults living in two rest homes in the Wellington region. Dietary data were collected using 3-day weighed food records and nutrient intakes calculated using dietary assessment software, Kai-culator. Information on general socio-demographic characteristics, medical history, medications, smoking status and alcohol intake, self perceived oral health, cognitive function and depression were collected. Anthropometric measurements were taken; weight, height, ulna length, demi span, waist and calf circumference. Physical function was measured using a 5 metre timed walk test and hand grip strength. Malnutrition was assessed using two screening tools: the Malnutrition Universal Screening Tool (MUST) and the Mini Nutrition Assessment – Short Form (MNA-SF). A fasting blood sample was collected, and a complete blood count conducted. Results: A total of 40 residents enrolled in the study; 22 men and 18 women. The average age of participants was 80.5 years, with length of stay in the home ranging from 4 to 156 months. The majority had a high falls risk, were cognitively impaired and had poor physical function. Most participants (79%) had a waist circumference above current recommendations and the prevalence of anaemia was 23%. Approximately half (45%) of the participants had energy and protein intakes below the estimated energy requirements (EER) and estimated average requirements (EAR) respectively, and greater than 80% of participants were at risk of inadequate intakes of fibre, calcium, selenium, magnesium, vitamin B6 and D. Risk of inadequate intake of zinc and vitamin E were also observed in over half of the participants. A low prevalence of inadequate intakes was noted for iron, vitamin A, niacin, and vitamin C. The overall malnutrition rate was low, with 3% being classified as malnourished using MNA-SF and 6% were at a high risk of malnutrition using MUST. Conclusion: Despite having a low rate of malnutrition, older adults living in residential care facilities in Wellington do not meet the recommendations for protein and are at risk of inadequacy of multiple micronutrients, potentially contributing to adverse health outcomes in this population. The information collected will provide baseline information for future interventions to improve the prevalence of inadequate intakes and health outcomes for this population.