Nutritional assessment of older New Zealand adults living in rest homes in the lower South Island

Abstract

Background: The increasing numbers of New Zealanders aged over 65 years will place a large burden on healthcare resources and rest home facilities around the country. Malnutrition is a major contributor to adverse health outcomes in the elderly, leading to higher mortality, morbidity and lower quality of life. There is very little information on the prevalence of malnutrition among New Zealand rest home residents, and there is not any information on the adequacy of nutrient intakes in this population. However, international data show very high rates of malnutrition and poor nutrient intakes amongst elderly residents in long-term low-level care.

Objective: The specific aims of the study are in residents of two rest homes in the Lower South Island: i) To describe the prevalence of inadequate nutrient intakes; ii) To describe the prevalence of malnutrition risk; and, iii) To describe the prevalence of anaemia. Design: This cross-sectional study included 35 participants (14 men and 21 women), aged 69-102 years who lived in 2 rest homes in the lower South Island. Information on demographics, medical history, medications and supplement use were collected from medical notes. Malnutrition screening was done using two different screening tools- Mini Nutritional Assessment-Short Form and Malnutrition Universal Screening Tool. Cognitive function and mood were examined using the Clock Drawing Test and the Geriatric Depression Scale. Anthropometry measurements collected were; height, ulna length, weight, using standard protocols and body mass index (kg/m2) was calculated using average ulna length measurements. Dietary intake data were collected with 3-day food records, over 2 non-consecutive week days and one weekend day. Food intakes were matched to nutrient lines in the New Zealand Food Composition Tables to determine nutrient intakes. Nutrient intakes were then compared with current recommendations to estimate the prevalence of inadequate intakes. Blood and urine samples were taken for later analysis of biochemical nutritional status. Ethical approval was granted by the University of Otago Human Ethics Committee (Health) (H13/118). Results: The duration of stay in the rest homes ranged from 4 to 161 months (mean = 47months. Fifty percent of participants had a BMI over 25kg/m2, and 11% were underweight (BMI <20 kg/m2). Overall energy intakes were low, with 43% of men and 76% of women having suboptimal energy intakes (P=0.046 for differences between men and women). Sixty-three percent had inadequate protein intakes. Mean saturated fat intake was high, (16% of total energy intake), and average fibre intakes were low (19 g/day). All participants had suboptimal selenium and vitamin D intakes, although 83% of participants were on a monthly vitamin D supplement. Over 90% had inadequate intakes of calcium, magnesium, vitamin B6 and vitamin E, and over 20% had inadequate intakes of thiamin and vitamin B12. When assessed with the MNA-SF tool, 53% were classified as being at risk of malnutrition. When using the MUST screening tool, 39%, were classified as being at risk of malnutrition. Anaemia rates were high in both men and women (57%). Conclusion: We have shown that malnutrition and inadequate micronutrient intakes are prevalent in rest home residents in the lower South Island. More research and strategies are needed to ensure that rest home residents are gaining the appropriate level of nutrition required to stay healthy and functional for as long as possible.