High risk of malnutrition in older people
Almost 75 per cent of older adults involved in a recent Massey University study were at risk of malnourishment, or were
malnourished, when they were admitted to hospital.
The study, led by Associate Professor Carol Wham from the College of Health, aimed to investigate malnutrition risk in
older adults at the point of hospital admission. It follows an earlier pilot study which showed 23 per cent of
respondents were malnourished and 35 per cent were at high risk of malnourishment at hospital admission. The average age
of the 234 participants involved in the latest study was 84. The research was undertaken in Auckland within the
Waitemata District Health Board region, between July 2014 and September 2015.
“Malnutrition is preceded by a state of malnutrition risk and is associated with poor health outcomes. In many cases it
can be prevented or the trajectory slowed by identifying and addressing risk factors,” Dr Wham says.
The study used a validated screening tool, the Mini Nutritional Assessment Short Form (MNA®-SF), which provides a simple
and rapid method to identify those at high risk, by assessing appetite, weight loss, mobility, psychological stress or
acute disease, depression and body mass index
“Nearly half [46.6 per cent] were identified at malnutrition risk and just over a quarter [26.9 per cent] malnourished.
This means, almost three-quarters were malnourished or at malnutrition risk,” Dr Wham says.
Significant predictors of malnutrition risk at hospital admission were dysphagia risk (problems with swallowing), low
body mass index (BMI), low muscle strength and poor cognition. Some level of cognitive impairment was indicated in 62
per cent of the participants
Dr Wham says two-thirds of the participants required daily help with various tasks such as cooking, cleaning, showering
and dressing. “This may suggest loss of physical function among the participants and may relate to the low muscle
strength observed. Eighty-eight per cent of participants were admitted from the community, so their own homes rather
than rest homes or care facilities. This suggests the high prevalence of hospital malnutrition may be a result of
unrecognised community malnutrition.”
If we are to address malnourishment that is occurring in the community before an older adult reaches crisis point and
hospitalisation, screening in GP medical centres is needed, Dr Wham says.
“Malnutrition in community-living older adults is often attributed to long-standing inadequate intake.
Making screening of the most vulnerable part of the routine in primary care is important to identify those at risk.
Screening needs to be followed by referral to a dietitian, who are the experts in nutrition assessment and treatment, to
ensure the right people are receiving the right care at the right time.”
Dysphagia risk, low muscle strength and poor cognition predict malnutrition risk in older adults at hospital admission was recently published in BMC Geriatrics. The paper was co-authored by Idah Chatindiara (PhD student, Massey University), Dr Jacqueline Allen (University of
Auckland), Amy Popman (Master of Science [nutrition and dietetics] student, Massey University), Darshan Patel (Master of
Science [nutrition and dietetics] student, Massey University), Dr Marilize Richter (Massey University), Professor
Marlena Kruger (Massey University) and Dr Carol Wham (Massey University).