Dehydration and loss of appetite: Key nutrition features in older people receiving home health care.

OBJECTIVES: The aim was to describe a population of older people in home health care based on what is probably a novel theoretical model, previously published, and to analyze longitudinal changes in different dimensions of nutritional status. METHODS: This explorative and longitudinal study examines nutritional status based on four domains in the novel theoretical model: health and somatic disorders; cognitive, affective, and sensory function; physical function and capacity; and food and nutrition. Inclusion criteria were age ≥65 y and need of home health care for more than three months. A total of 69 men and women were enrolled in the study. Participants' nutritional status was studied at baseline and regularly during the following three years. RESULTS: At baseline, 44% (n = 27) reported one or more severe symptoms and 83% had polypharmacy (≥5 prescribed medications). The prevalence of malnutrition, sarcopenia, frailty, and dehydration at baseline were, respectively, 83% (n = 35), 44% (n = 24), 34% (n = 18), and 45% (n = 25). Participants that died during the 3-y follow-up (n = 14) differed from survivors in the following aspects: more reduced appetite, lower quality of life, worse cognitive function, lower physical activity, and less intake of dietary fiber and water. Dehydration at baseline was associated with lower function in several domains and with general decline over time. CONCLUSIONS: Most participants had poor nutritional status. Dehydration and reduced appetite were important indicators of worsening nutritional and overall status and mortality.

Nutritional status in older people - An explorative analysis.

BACKGROUND & AIMS: The nutritional status is seldom defined in general, but is considered to be important throughout life span, especially in times of diseases and disabilities. We previously proposed a theoretical model of the nutritional status from a functional perspective [1], however without proposing a definition of the nutritional status. The model comprises four domains that might affect the nutritional and functional status in a bidirectional way. These four domains are: Food and nutrition; Health and somatic disorders; Physical function and capacity; and Cognitive, affective, and sensory function. This study contributes to the existing literature and knowledge by empirically analysing patterns and relationships of possible nutritional status indicators within and between the four domains. METHODS: This study is based on a sample of 69 men and women; older than 65 years, receiving home health care. They were followed up for three years. A broad set of nutritional status indicators in the participants were assessed in their home yearly. Given the small sample size and large number of variables, we used both correlation and factor analysis to explore patterns of nutritional status indicators within the four domains and relationships between the four domains suggested by the theoretical model of nutritional status which we proposed earlier. RESULTS: At baseline, between 4 and 18 components were extracted from the four domains, separately, using factor analysis. The first three components of each domain (called main components) were correlated (p < 0.05) with at least one of the main components of each of the other three domains (r = -0.34-0.79 at baseline, 0.38-0.74 at year 1, 0.40-0.77 at year 2 and 0.47-0.71 at year 3). At baseline, these main components explained, respectively, 31%, 52%, 57% and 63% of the sample variation in the four domains. This remained stable throughout all three years of follow up. In all four domains, there were statistically significant differences in prevalence of malnutrition, frailty, sarcopenia, and dehydration (all different inadequate nutritional status) between individuals' individual component scores. CONCLUSIONS: This study provides empirical evidence for the relationship between nutritional status indicators within and between the four domains suggested by our theoretical model of nutritional status. Components in all four domains were associated with inadequate nutritional status, highlighting that a wide perspective of the nutritional status assessment is necessary to be applied in clinical practice.

Meal patterns in relation to energy and protein intake in older adults in home health care.

BACKGROUND & AIMS: Inadequate dietary intake is common in frail elderly people, however knowledge of meal patters and their relation to dietary intake is scarce, but is important for planning meals and nutritional prevention and interventions. The aim of this study was to describe meal patterns and the relation to energy and protein intake in elderly people in home health care. METHODS: In this cross-sectional study, 69 men and women ≥65 years old with a lasting need for home health care were included. A 24-hour recall was used to analyse meal patterns as well as intake of energy and protein. Meal patterns were analysed in terms of number of eating occasions, time of the first, and the last meal each day, length of the overnight fast, timing of the energy and protein intake, energy content and time for the largest meal of the day, and classification as an early or late eater. RESULTS: In this population, 77% had four or five eating occasions per day. The median length of the overnight fast was 13 h and 87% of participants had an overnight fast of >11 h. Regarding the timing of the energy and protein intake, there were three peaks: in the morning, mid-day and in the evening. The mid-day meal was the most important eating occasion regarding total energy intake; mid-day was also the time of the day when most participants had a protein intake >20 g. The majority (60%) of participants were categorized as early eaters. Neither the number of eating occasions nor the length of the overnight fast was correlated with energy or protein intake; however, a large energy intake from the largest meal of the day was significantly correlated with an increased total energy and protein intake, indicating that daily energy intake is stimulated by at least one large meal per day. CONCLUSIONS: This study showed that one large meal a day had more impact on daily energy and protein intake than did several eating occasions or a short overnight fast in elderly people in home health care. Further research is needed to elucidate how to stimulate large energy intake at main meals to stimulate daily energy and protein intake.

Assessment of nutritional status in the elderly: a proposed function-driven model.

BACKGROUND: There is no accepted or standardized definition of 'malnutrition'. Hence, there is also no definition of what constitutes an adequate nutritional status. In elderly people, assessment of nutritional status is complex and is complicated by multi-morbidity and disabilities combined with nutrition-related problems, such as dysphagia, decreased appetite, fatigue, and muscle weakness. OBJECTIVE: We propose a nutritional status model that presents nutritional status from a comprehensive functional perspective. This model visualizes the complexity of the nutritional status in elderly people. DESIGN AND RESULTS: The presented model could be interpreted as the nutritional status is conditional to a person's optimal function or situation. Another way of looking at it might be that a person's nutritional status affects his or her optimal situation. The proposed model includes four domains: (1) physical function and capacity; (2) health and somatic disorders; (3) food and nutrition; and (4) cognitive, affective, and sensory function. Each domain has a major impact on nutritional status, which in turn has a major impact on the outcome of each domain. CONCLUSIONS: Nutritional status is a multifaceted concept and there exist several knowledge gaps in the diagnosis, prevention, and optimization of treatment of inadequate nutritional status in elderly people. The nutritional status model may be useful in nutritional assessment research, as well as in the clinical setting.