Skip to main content
NCBI home page
Canadian Journal of Public Health = Revue Canadienne de Santé Publique logoLink to Canadian Journal of Public Health = Revue Canadienne de Santé Publique
. 2007 Jul 1;98(4):331–336. doi: 10.1007/BF03405413

Predictors of Nutritional Risk in Community-dwelling Seniors

Karen C Roberts 119,✉, Christina Wolfson 119,219, Hélène Payette 319
PMCID: PMC6977535  PMID: 17896747

Abstract

Objectives

At any age, good nutrition is important for maintaining good health. Seniors are at risk of declining nutritional status due to the physiological, psychological, economic and social changes that accompany aging. We investigated medical, psychological, social and environmental characteristics as both correlates and predictors of elevated nutritional risk in community-dwelling seniors.

Methods

Data came from a prospective study of 839 seniors aged 75 and over, in Montreal. Face-to-face interviews were conducted at baseline and at 12 months. The validated Elderly Nutrition Screening (ENS©) tool was administered and subjects were assigned a level of “nutritional risk” based on the risk for energy and nutritional intake deficiencies. Using risk factors identified in the literature, analyses were performed to characterize those factors associated with both the level of risk at baseline and a change in risk over 12 months.

Results

At baseline, more than half (60%) of the participants were at elevated nutritional risk. Cross-sectional analyses supported the findings of previous research examining correlates of elevated nutritional risk. Longitudinal results showed that among those at low nutritional risk, only poor self-rated health was found to be a statistically significant predictor of elevated risk at 12 months (OR=3.30, p<0.05).

Conclusion

Proper nutrition can promote healthy aging by preventing disease and disability, improving health outcomes and maintaining autonomy, resulting in decreased health care utilization and costs. The findings of this research highlight the need for longitudinal studies in order to better understand and target nutritional risk in community-dwelling seniors.

MeSH terms: Aging, elderly, nutrition, free-living, longitudinal

Footnotes

Acknowledgements: The Montreal Unmet Needs study (“Unmet needs for community-based services for the elderly aged 75 years and over”) was funded by the Canadian Health Services Research Foundation (CHSRF), the Fonds de la Recherche en Santé du Québec (FRSQ), the Ministère de la Santé et des Services Sociaux du Québec (MSSS) and the Canadian Institutes of Health Research (CIHR). Karen Roberts was supported by a McGill University Faculty of Medicine Scholarship.

References

  • 1.Blumberg J. Nutrient requirements of the healthy elderly—should there be specific RDAs? Nutr Rev. 1994;52(8Suppl):S15–S18. doi: 10.1111/j.1753-4887.1994.tb01440.x. [DOI] [PubMed] [Google Scholar]
  • 2.Dewolfe J, Millan K. Dietary intake of older adults in the Kingston area. Can J Diet Pract Res. 2003;64(1):16–24. doi: 10.3148/64.1.2003.16. [DOI] [PubMed] [Google Scholar]
  • 3.Payette H, Gray-Donald K, Cyr R, Boutier V. Predictors of dietary intake in a functionally dependent elderly population in the community. Am J Public Health. 1995;85(5):677–83. doi: 10.2105/AJPH.85.5.677. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 4.Barrocas A, Bistrian BR, Blackburn GL, Chernoff R, Lipschitz DA, Cohen D, et al. Appropriate and effective use of the NSI checklist and screens. An update on caring for the elderly by preventing malnutrition. J Am Diet Assoc. 1995;95(6):647–48. doi: 10.1016/S0002-8223(95)00177-8. [DOI] [PubMed] [Google Scholar]
  • 5.Keller HH. Nutrition and health-related quality of life in frail older adults. J Nutr Health Aging. 2004;8(4):245–52. [PubMed] [Google Scholar]
  • 6.Keller HH, Ostbye T, Goy R. Nutritional risk predicts quality of life in elderly community-living Canadians. J Gerontol A Biol Sci Med Sci. 2004;59A(1):68–74. doi: 10.1093/gerona/59.1.M68. [DOI] [PubMed] [Google Scholar]
  • 7.Vellas B, Lauque S, Andrieu S, Nourhashemi F, Rolland Y, Baumgartner R, et al. Nutrition assessment in the elderly. Curr Opin Clin Nutr Metab Care. 2001;4(1):5–8. doi: 10.1097/00075197-200101000-00002. [DOI] [PubMed] [Google Scholar]
  • 8.Keller HH, McKenzie JD, Goy RE. Construct validation and test-retest reliability of the seniors in the community: Risk evaluation for eating and nutrition questionnaire. J Gerontol A Biol Sci Med Sci. 2001;56(9):M552–M558. doi: 10.1093/gerona/56.9.M552. [DOI] [PubMed] [Google Scholar]
  • 9.Keller HH, Hedley MR. Nutritional risk needs assessment of community-living seniors: Prevalence of nutrition problems and priorities for action. J Community Health. 2002;27(2):121–32. doi: 10.1023/A:1014561217190. [DOI] [PubMed] [Google Scholar]
  • 10.Keller HH, McKenzie JD. Nutritional risk in vulnerable community-living seniors. Can J Diet Pract Res. 2003;64(4):195–201. doi: 10.3148/64.4.2003.195. [DOI] [PubMed] [Google Scholar]
  • 11.MacLellan DL, van Til LD. Screening for nutritional risk among community-dwelling elderly on Prince Edward Island. Can J Public Health. 1998;89(5):342–46. doi: 10.1007/BF03404488. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 12.Payette H, Gray-Donald K, Cyr R, Coulombe C, Boutier V. Efficacy of a nutritional screening tool in free-living frail elderly. Age and Nutrition. 1996;7(3):168–74. [Google Scholar]
  • 13.Payette H, Hébert R, Boutier V, Voyer L. Efficacy of a nutrition screening program among community-dwelling elderly people at risk of functional decline; 1997. [Google Scholar]
  • 14.Shatenstein B, Nadon S, Ferland G. Determinants of diet quality among Quebecers aged 55–74. J Nutr Health Aging. 2004;8(2):83–91. [PubMed] [Google Scholar]
  • 15.Chen CCH, Schilling LS, Lyder CH. A concept analysis of malnutrition in the elderly. J Adv Nurs. 2001;36(1):131–42. doi: 10.1046/j.1365-2648.2001.01950.x. [DOI] [PubMed] [Google Scholar]
  • 16.Drewnowski A, Shultz JM. Impact of aging on eating behaviors, food choices, nutrition, and health status. [Review] [19 refs] J Nutr Health Aging. 2001;5(2):75–79. [PubMed] [Google Scholar]
  • 17.Liu L, Bopp MM, Roberson PK, Sullivan DH. Undernutrition and risk of mortality in elderly patients within 1 year of hospital discharge. J Gerontol A Biol Sci Med Sci. 2002;57(11):M741–M746. doi: 10.1093/gerona/57.11.M741. [DOI] [PubMed] [Google Scholar]
  • 18.Mowe M, Bohmer T, Kindt E. Reduced nutritional status in an elderly population (<70 y) is probable before disease and possibly contributes to the development of disease. Am J Clin Nutr. 1994;59(2):317–24. doi: 10.1093/ajcn/59.2.317. [DOI] [PubMed] [Google Scholar]
  • 19.Mowe M, Bohmer T. Nutrition problems among home-living elderly people may lead to disease and hospitalization. Nutr Rev. 1996;54(1Pt2):S22–S24. doi: 10.1111/j.1753-4887.1996.tb03782.x. [DOI] [PubMed] [Google Scholar]
  • 20.Payette H. Nutrition as a determinant of functional autonomy and quality of life in aging: A research program. Can J Physiol Pharmacol. 2005;83(11):1061–70. doi: 10.1139/y05-086. [DOI] [PubMed] [Google Scholar]
  • 21.Rosenberg IH, Miller JW. Nutritional factors in physical and cognitive functions of elderly people. Am J Clin Nutr. 1992;55(6Suppl):1237S–1243S. doi: 10.1093/ajcn/55.6.1237S. [DOI] [PubMed] [Google Scholar]
  • 22.Sullivan DH, Bopp MM, Robertson PK. Protein-energy undernutrition and life-threatening complications among the hospitalized elderly. J Gen Intern Med. 2002;17(12):923–32. doi: 10.1046/j.1525-1497.2002.10930.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 23.Chima CS, Barco K, Dewitt MLA, Maeda M, Teran JC, Mullen KD. Relationship of nutritional status to length of stay, hospital costs, and discharge status of patients hospitalized in the medicine service. J Am Diet Assoc. 1997;97(9):975–78. doi: 10.1016/S0002-8223(97)00235-6. [DOI] [PubMed] [Google Scholar]
  • 24.Martyn CN, Winter PD, Coles SJ, Edington J. Effect of nutritional status on use of health care resources by patients with chronic disease living in the community. Clin Nutr. 1998;17(3):119–23. doi: 10.1016/S0261-5614(98)80005-8. [DOI] [PubMed] [Google Scholar]
  • 25.Payette H, Coulombe C, Boutier V, Gray-Donald K. Nutrition risk factors for institutional-ization in a free-living functionally dependent elderly population. J Clin Epidemiol. 2000;53(6):579–87. doi: 10.1016/S0895-4356(99)00186-9. [DOI] [PubMed] [Google Scholar]
  • 26.Kuczmarski MF, Weddle DO, American Dietetic Association Position paper of the American Dietetic Association: Nutrition across the spectrum of aging. J Am Diet Assoc. 2005;105(4):616–33. doi: 10.1016/j.jada.2005.02.026. [DOI] [PubMed] [Google Scholar]
  • 27.Omran ML, Morley JE. Assessment of protein energy malnutrition in older persons, part I: History, examination, body composition, and screening tools. Nutrition. 2000;16(1):50–63. doi: 10.1016/S0899-9007(99)00224-5. [DOI] [PubMed] [Google Scholar]
  • 28.Payette H, Shatenstein B. Determinants of healthy eating in community-dwelling elderly people. Can J Public Health. 2005;96(Suppl3):S27–S31. [PubMed] [Google Scholar]
  • 29.Salvà A, Pera G. Screening for malnutrition in dwelling elderly. Public Health Nutr. 2001;4(6A):1375–78. doi: 10.1079/PHN2001222. [DOI] [PubMed] [Google Scholar]
  • 30.White JV. Risk factors for poor nutritional status in older Americans. Am Fam Physician. 1991;44(6):2087–97. [PubMed] [Google Scholar]
  • 31.Visvanathan R, Newbury JW, Chapman I. Malnutrition in older people—screening and management strategies. Aust Fam Physician. 2004;33(10):799–805. [PubMed] [Google Scholar]
  • 32.de Castro JM. Age-related changes in the social, psychological, and temporal influences on food intake in free-living, healthy, adult humans. J Gerontol A Biol Sci Med Sci. 2002;57(6):M368–M377. doi: 10.1093/gerona/57.6.M368. [DOI] [PubMed] [Google Scholar]
  • 33.McCormack P. Undernutrition in the elderly population living at home in the community: A review of the literature. J Adv Nurs. 1997;26(5):856–63. doi: 10.1046/j.1365-2648.1997.00415.x. [DOI] [PubMed] [Google Scholar]
  • 34.MacIntosh C, Morley JE, Chapman IM. The anorexia of aging. Nutrition. 2000;16(10):983–95. doi: 10.1016/S0899-9007(00)00405-6. [DOI] [PubMed] [Google Scholar]
  • 35.de Groot CPGM, van Staveren WA, de Graaf C. Determinants of macronutrient intake in elderly people. Eur J Clin Nutr. 2000;54:S70–S76. doi: 10.1038/sj.ejcn.1601028. [DOI] [PubMed] [Google Scholar]
  • 36.Alibhai SM, Greenwood C, Payette H. An approach to the management of unintentional weight loss in elderly people. [Review] [98 refs] CMAJ. 2005;172(6):773–80. doi: 10.1503/cmaj.1031527. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 37.Toth MJ, Poehlman ET. Energetic adaptation to chronic disease in the elderly. Nutr Rev. 2000;58(3Pt1):61–66. doi: 10.1111/j.1753-4887.2000.tb01840.x. [DOI] [PubMed] [Google Scholar]
  • 38.Stechmiller JK. Early nutritional screening of older adults: Review of nutritional support. J Infus Nurs. 2003;26(3):170–77. doi: 10.1097/00129804-200305000-00009. [DOI] [PubMed] [Google Scholar]
  • 39.Reuben DB, Greendale GA, Harrison GG. Nutrition screening in older persons. J Am Geriatr Soc. 1995;43(4):415–25. doi: 10.1111/j.1532-5415.1995.tb05818.x. [DOI] [PubMed] [Google Scholar]
  • 40.Quail J, Addona V, Wolfson C, Podoba JE, Levesque LY, Dupuis J. Association of unmet need with self-rated health in a community-dwelling cohort of disabled seniors 75 years of age and over. Eur J Ageing. 2007;4:45–55. doi: 10.1007/s10433-007-0042-8. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 41.Moride Y, Du Fort GG, Monette J, Ducruet T, Boivin JF, Champoux N, et al. Suboptimal duration of antidepressant treatments in the older ambulatory population of Quebec: Association with selected physician characteristics. J Am Geriatr Soc. 2002;50(8):1365–71. doi: 10.1046/j.1532-5415.2002.50357.x. [DOI] [PubMed] [Google Scholar]
  • 42.Von Korff M, Wagner EH, Saunders K. A chronic disease score from automated pharmacy data. J Clin Epidemiol. 1992;45(2):197–203. doi: 10.1016/0895-4356(92)90016-G. [DOI] [PubMed] [Google Scholar]
  • 43.Allen SM, Mor V. The prevalence and consequences of unmet need. Contrasts between older and younger adults with disability. Med Care. 1997;35(11):1132–48. doi: 10.1097/00005650-199711000-00005. [DOI] [PubMed] [Google Scholar]
  • 44.Préville M, Boyer R, Potvin L, Perrault C. Légaré G. La détresse psychologique: détermination de la fiabilité et de la validité de la mesure utilisée dans l’enquête Santé Québec,*Enquête Santé Québec 1987+ 1992. [Google Scholar]
  • 45.Boyer R, Préville M, Légaré G, Valois P. [Psychological distress in a noninstitutionalized population of Quebec: Normative results of the Quebec health survey] Can J Psychiatry. 1993;38(5):339–43. doi: 10.1177/070674379303800510. [DOI] [PubMed] [Google Scholar]
  • 46.Hosmer DW, Lemeshow S M-B S f L Regression. Applied Logistic Regression. 2nd. New York, NY: John Wiley & Sons, Inc.; 2000. pp. 91–144. [Google Scholar]
  • 47.Jylha M, Guralnik JM, Ferrucci L, Jokela J, Heikkinen E. Is self-rated health comparable across cultures and genders? J Gerontol B Psychol Sci Soc Sci. 1998;53(3Suppl):S144–S152. doi: 10.1093/geronb/53B.3.S144. [DOI] [PubMed] [Google Scholar]
  • 48.Singh-Manoux A, Martikainen P, Ferrie J, Zins M, Marmot M, Goldberg M. What does self-rated health measure? Results from the British Whitehall II and French Gazel cohort studies. J Epidemiol Community Health. 2006;60(4):364–72. doi: 10.1136/jech.2005.039883. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 49.Idler EL, Benyamini Y. Self-rated health and mortality: A review of twenty-seven community studies. J Health Soc Behav. 1997;38(1):21–37. doi: 10.2307/2955359. [DOI] [PubMed] [Google Scholar]
  • 50.Payette H, Cyr R. Centre de recherche en gérontologie et gériatrie, Sherbrooke, Québec. 1996. Les ressources communautaires en alimentation pour les personnes âgées: étude des services offerts et des caractéristiques de la clientèle (rapport de recherche) [Google Scholar]

Articles from Canadian Journal of Public Health = Revue Canadienne de Santé Publique are provided here courtesy of Springer

RESOURCES