Abstract
This study describes the independent association between nutritional risk and death in older adults diagnosed with cognitive impairment. Canadian Study of Health and Aging participants who completed a clinical exam and were diagnosed with cognitive impairment and had complete data for regression analyses were included (n=735). Nutritional risk was defined as the presence of at least one abnormal nutrition indicator identified during the clinical exam (history of weight loss, abnormal serum albumin, poor appetite, body mass index < 20). Other covariates believed to influence mortality were modelled with nutritional risk using logistic regression. There were 373 deaths during the five-year follow-up period in this sample. Nutritional risk was found to independently increase the likelihood of death (OR=1.6, 95% CI 1.1, 2.2) in these older adults suffering from cognitive impairment. Further work is required to determine if interventions can improve nutritional status and quality of life of these older adults.
Résumé
Cette étude décrit l’association indépendante entre le risque nutritionnel et la mort chez des personnes âgées souffrant de déficience intellectuelle. On a inclus les participants (n = 735) à l’Étude sur la santé et la vieillissement au Canada qui avaient passé un examen physique, à qui on avait donné un diagnostique de déficience intellectuelle et pour lesquels on disposait de données complètes pour les analyses de régression. Le risque nutritionnel a été défini comme l’identification de la présence d’au moins un indicateur de nutrition anormale (antécédents de perte de poids, sérum-albumine anormale, manque d’appétit, indice de masse corporelle < 20) au cours de l’examen médical. À l’aide d’une analyse de régression logistique, on a modélisé les autres co-variables dont on pense qu’elles influencent la mortalité avec le risque nutritionnel. Dans cet échantillon, il y a eu 373 décès au cours des cinq ans de la période de suivi. On a constaté que le risque nutritionnel augmentait la probabilité de décès de façon indépendante (RR = 1,6, 95 % IC 1,1, 2,2) chez ces personnes âgées souffrant de déficience intellectuelle. D’autres études sont nécessaires pour déterminer si des interventions permettraient d’améliorer l’état nutritif et la qualité de vie de ces personnes.
Footnotes
(at the time of study was with the University of Western Ontario)
References
- 1.Canadian Study of HealthAging Working Group. The Canadian Study of Health and Aging: Methods and prevalence of dementia. Can Med Assoc J. 1994;150:819–914. [Google Scholar]
- 2.Brookmeyer R, Gray S, Kawas C. Projections of Alzheimer’s disease in the United States and the public health impact of delaying disease onset. Am J Public Health. 1998;88(9):1337–42. doi: 10.2105/AJPH.88.9.1337. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Besdine RW, Jarvik LF, Tangalos EG. Managing advanced Alzheimer’s disease. Patient Care. 1991;v:75–84. [Google Scholar]
- 4.Gray GE. Nutrition and dementia. J Am Diet Assoc. 1989;89:1795–802. [PubMed] [Google Scholar]
- 5.Keller HH, Østbye T, Bright-See E. Predictors of dietary intake in Ontario seniors. Can J Public Health. 1997;88(5):305–9. doi: 10.1007/BF03403895. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Fiatrone MA, Evans WJ. The etiology and reversibility of muscle dysfunction in the aged. J Gerontology. 1993;48(Specialissue):77–83. doi: 10.1093/geronj/48.Special_Issue.77. [DOI] [PubMed] [Google Scholar]
- 7.Keller HH. Weight gain impacts morbidity and mortality in institutionalized older persons. J Am Geriatrics Soc. 1995;43:165–69. doi: 10.1111/j.1532-5415.1995.tb06383.x. [DOI] [PubMed] [Google Scholar]
- 8.Vellas B, Conceica OJ, Lafont CH, et al. Malnutrition and falls. Lancet. 1990;336:1447. doi: 10.1016/0140-6736(90)93150-N. [DOI] [PubMed] [Google Scholar]
- 9.Sullivan DH, Walls RC. The risk of life-threatening complications in a select population of geriatric patients: The impact of nutritional status. J Am Coll Nutr. 1995;14(1):29–36. doi: 10.1080/07315724.1995.10718470. [DOI] [PubMed] [Google Scholar]
- 10.Tucker HN, Miguel SG. Cost containment through nutrition intervention. Nutr Rev. 1996;54(4):111–21. doi: 10.1111/j.1753-4887.1996.tb03885.x. [DOI] [PubMed] [Google Scholar]
- 11.Du W, DiLuca CH, Growdon JH. Weight loss in Alzheimer’s disease. J Geriatr Psychiatry Neurol. 1993;1:34–38. doi: 10.1177/002383099300600106. [DOI] [PubMed] [Google Scholar]
- 12.Finely B. Nutritional needs of the person with Alzheimer’s disease: Practical approaches to quality care. J Am Diet Assoc. 1997;97(10Suppl2):S177–S180. doi: 10.1016/S0002-8223(97)00758-X. [DOI] [PubMed] [Google Scholar]
- 13.Murphy C. Nutrition and chemosensory perception in the elderly. Crit Rev Food Sci Nutr. 1993;33(1):3–15. doi: 10.1080/10408399309527607. [DOI] [PubMed] [Google Scholar]
- 14.Chouinard J, Lavigne E, Villeneuve C. Weight loss, dysphagia, and outcome in advanced dementia. Dysphagia. 1998;13(3):151–55. doi: 10.1007/PL00009565. [DOI] [PubMed] [Google Scholar]
- 15.Cronin-Stubbs D, Beckett LA, Scherr PA, et al. Weight loss in people with Alzheimer’s disease: A prospective population based analysis. BMJ. 1997;314(7075)::178–79. doi: 10.1136/bmj.314.7075.178. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16.White H, Pieper C, Schmadeer K, Fillenbaum G. Weight change in Alzheimer’s disease. J Amer Geriatrics Soc. 1996;44:265–72. doi: 10.1111/j.1532-5415.1996.tb00912.x. [DOI] [PubMed] [Google Scholar]
- 17.White H, Pieper C, Schmader K. The association of weight change in Alzheimer’s disease with severity of disease and mortality: A longitudinal analysis. J Am Geriatr Soc. 1998;46(10):1223–27. doi: 10.1111/j.1532-5415.1998.tb04537.x. [DOI] [PubMed] [Google Scholar]
- 18.Gauthier S. Update on diagnostic methods, natural history and outcome variables in Alzheimer’s disease. Dement Geriatr Cogn Disord. 1998;9(Suppl3):2–7. doi: 10.1159/000051197. [DOI] [PubMed] [Google Scholar]
- 19.Volicer L, Hurley AC. Physical status and complications in patients with Alzheimer disease: Implications for outcome studies. Alzheimer Dis Assoc Disord. 1997;11(Suppl6):60–65. [PubMed] [Google Scholar]
- 20.Teng EL, Chui HC. The modified Mini-Mental State (3MS) Examination. J Clin Psychiatry. 1987;48:314–18. [PubMed] [Google Scholar]
- 21.Canadian Study of HealthAging. Risk factors for Alzheimer’s disease in Canada. Neurology. 1994;44:2073–80. doi: 10.1212/WNL.44.11.2073. [DOI] [PubMed] [Google Scholar]
- 22.Aylesworth R. Canadian Study of Health and Aging-2. Overview and Linking File Manual. 1998. [Google Scholar]
- 23.Graham JE, Rockwood K, Beattie BL, et al. Standardization of the diagnosis of dementia in the Canadian Study of Health and Aging. Neuroepidemiology. 1996;15(5):246–56. doi: 10.1159/000109914. [DOI] [PubMed] [Google Scholar]
- 24.Fillenbaum GG. Multidimensional Functional Assessment of Older Adults: The Duke Older Americans Resources and Services Program. Hillsdale, NJ: Lawrence Erlbaum Associates; 1988. [Google Scholar]
- 25.Roth M, Huppert FA, Tym E, Mountjuz CQ. CAMDEX: The Cambridge Mental Status Examination of the Elderly. Cambridge, UK: Cambridge University Press; 1985. [Google Scholar]
- 26.American Psychiatric Association Diagnostic and Statistical Manual, 3rd Ed., Rev. Washington, DC: American Psychiatric Association, 1987.
- 27.Kleinbaum DG. Logistic Regression: A Self-Learning Text. New-York: Springer-Verlag; 1994. [Google Scholar]
- 28.Hux MJ, O’Brien BJ, Iskedjian M, et al. Relation between severity of Alzheimer’s disease and costs of caring. CMAJ. 1998;159(5):457–65. [PMC free article] [PubMed] [Google Scholar]
- 29.Reuben DB, Greendale GA, Harrison GG. Nutrition screening in older persons. J Am Geriatrics Soc. 1995;43:415–25. doi: 10.1111/j.1532-5415.1995.tb05818.x. [DOI] [PubMed] [Google Scholar]
- 30.Forbes WF, Barham JF. Concerning the prevalence of dementia. Can J Public Health. 1991;82:185–88. [PubMed] [Google Scholar]