Health and Social Factors Associated with Nutrition Risk: Results from Life and Living in Advanced Age: A Cohort Study in New Zealand (LiLACS NZ).

OBJECTIVES: To establish the prevalence of high nutrition risk and associated health and social risk factors for New Zealand Maori and non-Maori in advanced age. DESIGN: A cross sectional analysis of inception cohorts to LiLACS NZ. SETTING: Bay of Plenty and Lakes region of the North Island, New Zealand. PARTICIPANTS: 255 Maori and 400 non- Maori octogenarians. MEASUREMENTS: Nutrition risk was assessed using a validated questionnaire Seniors in the Community: Risk Evaluation for Eating and Nutrition (SCREEN II). Demographic, social, physical and health characteristics were established using an interviewer administered questionnaire. Health related quality of life (HRQOL) was assessed with the SF-12, depressive symptoms using the GDS-15. RESULTS: Half (49%) of Maori and 38% of non-Maori participants were at high nutrition risk (SCREEN II score <49). Independent risk factors were for Maori younger age (p=0.04), lower education (p=0.03), living alone (p<0.001), depressive symptoms (p=0.01). For non- Maori high nutrition risk was associated with female gender (p=0.005), living alone (p=0.002), a lower physical health related quality of life (p=0.02) and depressive symptoms (p=0.002). CONCLUSION: Traditional risk factors apply to both Maori and non-Maori whilst education as indicative of low socioeconomic status is an additional risk factor for Maori. High nutrition risk impacts health related quality of life for non-Maori. Interventions which socially facilitate eating are especially important for women and for Maori to maintain cultural practices and could be initiated by routine screening.

The BRIGHT Trial: what are the factors associated with nutrition risk?

OBJECTIVES: To determine the nutrition risk status and factors associated with nutrition risk among older adults enrolled in the Brief Risk Identification Geriatric Health Tool (BRIGHT Trial). DESIGN: A cluster randomised controlled trial. SETTING: Three main centres in New Zealand. PARTICIPANTS: A total of 3,893 older adults were recruited from 60 general practices in three of the District Health Board (DHB) regions aged 75 years and older (or 65 years and older if Maori). MEASUREMENTS: Nutrition risk was assessed using the Australian Nutrition Screening Initiative (ANSI). Validated questionnaires were used to establish quality of life (WHOQOL-BREF), physical function (the Nottingham Extended Activities of Daily Living) and depressive symptoms (15 item Geriatric Depression Scale). Demographic, standard of living and health data were established. RESULTS: Sixty two percent of participants were identified to be at moderate or high nutrition risk. The mean ANSI score was 4.9 (range 0-21, maximum 29). Factors which independently predicted moderate or high nutrition risk were female gender, being Maori and other ethnicities versus European, not being married, taking multiple medications, having more depressive symptoms, cardiovascular disease and diabetes. Protective factors independently related to low nutrition risk were living with others, higher physical and social health related QOL and higher functional status. WHOQOL environmental and psychological factors were not associated with nutrition risk when other predictive factors were taken into account. CONCLUSION: Nearly two thirds of participants were identified to be at higher nutrition risk. Women, living alone, taking multiple medications, with depressive symptoms, cardiovascular disease and ndiabetes were factors associated with higher nutrition risk. Those at low nutrition risk had a better functional status and physical and social health related QOL.

Validation of the nutrition screening tool 'Seniors in the Community: Risk Evaluation for Eating and Nutrition, version II' among octogenarians.

OBJECTIVE: To determine the validity of the nutrition screening tool 'Seniors in the Community: Risk Evaluation for Eating and Nutrition, version II' (SCREEN II) among a purposive sample of octogenarians. DESIGN: Cross-sectional validation study. SETTING: Bay of Plenty, New Zealand. PARTICIPANTS: Forty-five community-living residents aged 85-86 years. Equal proportions of participants were recruited at low, medium and high nutrition risk based on their SCREEN II score 12 months prior. MEASUREMENTS: Nutrition risk was assessed using SCREEN II. Demographic and health data were established. Using established criterion a dietitian's nutrition risk rating assessment ranked participants from low risk (score of 1) to high risk (score of 10). The assessment included a medical history, anthropometric measures and dietary intake. Dietary intake was established from three 24 hour multiple pass recalls (MPR). A Spearman's correlation determined the association between the SCREEN II score and the dietitian's risk score. Receiver operating characteristic (ROC) curves were completed to determine the sensitivity and specificity of the cut-off point for high nutrition risk. RESULTS: The SCREEN II score was significantly correlated with the dietitian's risk rating (rs = -0.76 (p<0.01). A newly defined cut-off point <49 was established for high nutrition risk derived from ROC curves and AUC (0.87, p < 0.01); sensitivity 90% and specificity 86%. CONCLUSION: SCREEN II is a simple, easy to use, 14 item questionnaire and appears to be a valid tool for detection of nutrition risk people aged 85-86 years.

What is associated with nutrition risk in very old age?

OBJECTIVES: To identify factors associated with nutrition risk among a purposive sample of those in advanced aged. DESIGN: A cross sectional feasibility study. SETTING: Three North Island locations in New Zealand. PARTICIPANTS: One hundred and eight community-living residents aged 75- 85 years. MEASUREMENTS: Nutrition risk was assessed using a validated questionnaire, Seniors in the Community: Risk Evaluation for Eating and Nutrition, Version II (SCREEN II). A Physical Activity Scale for the Elderly (PASE) was used to determine level of physical activity. Markers of body composition, grip strength and fasting blood samples were collected. RESULTS: Fifty-two percent of participants were at high nutrition risk (SCREEN II score < 50; range 29-58; out of maximum score 64). The mean score for SCREEN II was higher for older people who lived with others (50.3 ± 5.1) compared to those who lived alone (46.4 ± 5.8) p=0.001. The SCREEN II score was positively correlated with the total PASE score r= 0.20 (p=0.042), grip strength r=0.20 (p=0.041), and muscle mass percentage r=0.31 (p=0.004). Lower levels of haemoglobin, serum zinc and physical activity were associated with higher nutrition risk. CONCLUSION: Half the participants were at high nutrition risk. They tended to be widowed or live alone and had lower levels of haemoglobin and serum zinc. Those at lower nutrition risk had greater muscle mass and strength, lower body fat, consumed alcohol more frequently and engaged in more physical activity. Strategies which encourage older people to eat meals and be physically active with others may assist to improve their health.