Depressive symptoms and risk for malnutrition among hospitalized elderly people

  • L. German
  • I. Feldblum
  • N. Bilenko
  • H. Castel
  • I. Harman-Boehm
  • D. R. Shahar
Clinical Neurosciences


Objectives: To explore the association between depressive symptoms and risk for malnutrition in hospitalized elderly people.Methods: 195 hospitalized medical patients older than 65 years of age were studied in a cross-sectional design. Depression was assessed by 30-item Geriatric Depression Scale (GDS), nutritional status was evaluated by the Mini-Nutritional Assessment (MNA). Eating and digestive problems were assessed using selected items of Nutrition Risk Index (NRI), cognitive and functional status by Folstein and Barthel indices respectively; demographic data, diagnoses and medications were obtained from medical records.Results: The prevalence of depression in the studied population was 28%. MNA scores were significantly lower among depressed patients as compared with non-depressed (22.86 vs. 24.96, p < 0.001), indicating a higher risk for undernutrition among depressed persons. After controlling for age, cognitive status, functional ability, and number of illnesses, undernutrition was significantly associated with depression (OR = 2.23; 95% CI: 1.04–4.8).Conclusions: Nutritional risk is associated with depression in aged inpatients. Close case management of the elderly hospitalized patients that include assessment and treatment for both disorders may be beneficial.

Key words

Depressive symptoms elderly risk for malnutrition 



calf circumference


Geriatric Depression Scale


mid-arm circumference


Modified Barthel Index


Mini-Mental State Examination


Mini-Nutritional Assessment


Nutritional Risk Index


  1. 1.
    Beekman AT, Copeland JR, Prince MJ: Review of community prevalence of depression in later life. Br J Psychiatry 174: 307–311, 1999.PubMedCrossRefGoogle Scholar
  2. 2.
    Meldon SW, Emerman CL, Schubert DS, Moffa DA, Etheart RG: Depression in geriatric ED patients: prevalence and recognition. Ann Emerg Med 30: 141–145, 1997.PubMedCrossRefGoogle Scholar
  3. 3.
    Raccio-Robak N, McErlean MA, Fabacher DA, Milano PM, Verdile VP: Socioeconomic and health status differences between depressed and nondepressed ED elders. Am J Emerg Med 20: 71–73, 2002.PubMedCrossRefGoogle Scholar
  4. 4.
    Krishnan KR, Delong M, Kraemer H, Carney R, Spiegel D, Gordon C, Mcdonald W, Dew M, Alexopoulos G, Buckwalter K, Cohen PD, Evans D, Kaufmann PG, Olin J, Otey E, Wainscott C: Comorbidity of depression with other medical diseases in the elderly. Biol Psychiatry 52: 559–588, 2002.PubMedCrossRefGoogle Scholar
  5. 5.
    Luber MP, Meyers BS, Williams-Russo P, Hollenberg JP, DiDomenico TN, Charlson ME, Alexopoulos GS: Depression and service utilization in elderly primary care patients. Am J Geriatr Psychiatry 9: 169–176, 2001.PubMedCrossRefGoogle Scholar
  6. 6.
    de Jonge P, Ormel J, Slaets JP, Kempen GI, Ranchor AV, van Jaarsveld CH, Scaf-Klomp W, Sanderman R: Depressive symptoms in elderly patients predict poor adjustment after somatic events. Am J Geriatr Psychiatry 12: 57–64, 2004.PubMedCrossRefGoogle Scholar
  7. 7.
    Black SA, Markides KS, Ray LA: Depression predicts increased incidence of adverse health outcomes in older Mexican Americans with type 2 diabetes. Diab Care 26: 2822–2828, 2003.CrossRefGoogle Scholar
  8. 8.
    Bula CJ, Wietlisbach V, Burnand B, Yersin B: Depressive symptoms as a predictor of 6-month outcomes and services utilization in elderly medical inpatients. Arch Intern Med 161: 2609–2615, 2001.PubMedCrossRefGoogle Scholar
  9. 9.
    Tierney AJ: Undernutrition and elderly hospital patients: a review. J of Adv Nurs 23: 228–246, 1996.CrossRefGoogle Scholar
  10. 10.
    Omran ML, Morley JE: Assessment of protein energy malnutrition in older persons, part I: history, examination, body composition, and screening tools. Nutrition 16;50–63, 2000.PubMedCrossRefGoogle Scholar
  11. 11.
    Sullivan DH, Sun S, Walls RC: Protein-energy undernutrition among elderly hospitalized patients. JAMA 281: 2013–2019, 1999.PubMedCrossRefGoogle Scholar
  12. 12.
    Donini LM, De Bernardini L, De Felice MR, Savina C, Coletti C, Cannella C: Effect of nutritional status on clinical outcome in a population of geriatric rehabilitation patients. Aging Clin Exp Res 16: 132–138, 2004.PubMedGoogle Scholar
  13. 13.
    Neumann SA, Miller MD, Daniels L, Crotty M: Nutritional status and clinical outcomes of older patients in rehabilitation. J Hum Nutr Diet 18: 129–36, 2005.PubMedCrossRefGoogle Scholar
  14. 14.
    Schneider SM, Veyres P, Pivot X, Soummer AM, Jambou P, Filippi J, van Obberghen E, Hebuterne X: Malnutrition is an independent factor associated with nosocomial infections. Br J Nutr 92: 105–111, 2004.PubMedCrossRefGoogle Scholar
  15. 15.
    Correia MI, Waitzberg DL: The impact of malnutrition on morbidity, mortality, length of hospital stay and costs evaluated through a multivariate model analysis. Clin Nutr 22: 235–239, 2003.PubMedCrossRefGoogle Scholar
  16. 16.
    Horrobin DF: Food, micronutrients, and psychiatry. Int Psychogeriatr 14: 331–334, 2002.PubMedCrossRefGoogle Scholar
  17. 17.
    Morley JE, Silver AJ: Anorexia in the elderly. Neurobiol Aging 9: 9–16, 1988.PubMedCrossRefGoogle Scholar
  18. 18.
    D’Anci KE, Rosenberg IH: Folate and brain function in the elderly. Curr Opin Clin Nutr Metab Care 7: 659–664, 2004.PubMedCrossRefGoogle Scholar
  19. 19.
    Ramos MI, Allen LH, Haan MN, Green R, Miller JW: Plasma folate concentrations are associated with depressive symptoms in elderly Latina women despite folic acid fortification. Am J Clin Nutr 80: 1024–1028, 2004.PubMedGoogle Scholar
  20. 20.
    Wolters M, Strohle A, Hahn A: Cobalamin: a critical vitamin in the elderly. Prev Med 39: 1256–1266, 2004.PubMedCrossRefGoogle Scholar
  21. 21.
    Morley JE, Kraenzle D: Causes of weight loss in a community nursing home. J Am Geriatr Soc 42: 583–585, 1994.PubMedGoogle Scholar
  22. 22.
    Guigoz Y., Vellas BJ, Garry PJ: Mini Nutritional Assessment: A practical assessment tool for grading the nutritional state of elderly patients. Facts Res Gerontol 4(Suppl 2): 15–59, 1994.Google Scholar
  23. 23.
    Christakis G: Nutritional assessment in health programs, Washington DC, 1973, American Public Health Association and Dietary Interview Questionnaire. In: Schlenker ED: “Nutrition in Aging.” St. Louis, MO: Mosby. pp 363–366, 1993.Google Scholar
  24. 24.
    Wolinsky ED, Coe RM, McIntosh WA, Kubena KS, Prendergast JM, Chavez MN, Miller DK, Romeis JC, Landmann WA. Progress in the development of a nutritional risk index. J Nutr 120(Suppl 11): 1549–1553, 1990.PubMedGoogle Scholar
  25. 25.
    Yesavage JA, Brink TL, Rose TL, Lum O, Huang V, Adey M. Leirer, VO: Development and validation of a geriatric depression screening scale: a preliminary report J Psychiatr Res 17: 37–49, 1982-83.PubMedCrossRefGoogle Scholar
  26. 26.
    Lyness JM, Noel TK, Cox C, King DA, Conwell Y, Caine ED: Screening for depression in elderly primary care patients. A comparison of the Center for Epidemiologic Studies-Depression Scale and the Geriatric Depression Scale. Arch Intern Med 157: 449–454, 1997.PubMedCrossRefGoogle Scholar
  27. 27.
    Folstein MF, Folstein SE, McHugh PR: Mini-Mental State: A practical method for grading the state of patients for the clinician. J Psychiatr Res 12: 189–198, 1975.PubMedCrossRefGoogle Scholar
  28. 28.
    Shah S, Vanclay F, Cooper B: Improving the sensitivity of the Barthel Index for stroke rehabilitation. J Clin Epidemiol 42: 703–709, 1989.PubMedCrossRefGoogle Scholar
  29. 29.
    Gama EV, Damian JE, Perez de Molino J, Lopez MR, Lopez Perez M, Gavira Iglesias FJ: Association of individual activities of daily living with self-rated health in older people. Age Ageing 29: 267–270, 2000.PubMedCrossRefGoogle Scholar
  30. 30.
    Dawson B, Trapp RG: “Basic & Clinical Biostatistics, forth edition”. USA: The McGraw-Hill companies, Inc, 2004.Google Scholar
  31. 31.
    SPSS for Windows (version 13.0 for Windows). Chicago, IL: SPSS. Inc., 2005.Google Scholar
  32. 32.
    Kockler M, Heun R: Gender differences of depressive symptoms in depressed and nondepressed elderly persons. Int J Geriatr Psychiatry 17: 65–72, 2002.PubMedCrossRefGoogle Scholar
  33. 33.
    Blazer DG: “Depression in Late Life.” New York: Springer Vetlag, 2002.Google Scholar
  34. 34.
    Lebowitz BD, Person JL, Schneider LS: Diagnosing and treatment of depression in late life. Consensus statement update. JAMA 278: 1186–1190, 1997.PubMedCrossRefGoogle Scholar
  35. 35.
    NIH Consensus Conference: NIH Consensus Development Panel on Depression in Late Life. JAMA 268: 1018–1024, 1992.CrossRefGoogle Scholar
  36. 36.
    Bruce ML, Seeman TE, Merrill SS, Blazer DG: The impact of depressive symptomatology on physical disability: MacArthur studies of successful aging. Am J Public Health 84: 1796–1799, 1994.PubMedCrossRefGoogle Scholar
  37. 37.
    Baldwin RC, Chiu E, Katona C, Graham N: “Guidelines on Depression in Older People.” London: Martin Dunitz, Ltd., 2002.Google Scholar
  38. 38.
    Miller DK, Carter ME, Sigmund RH, Smith JQ, Miller JP, Bentley JA, McDonald K, Coe RM, Morley JE: Nutritional risk in inner-city-dwelling older black Americans. J Am Geriatr Soc 44: 959–962, 1996.PubMedGoogle Scholar
  39. 39.
    Bodnar LM, Wisner KL: Nutrition and depression: implications for improving mental health among childbearing-aged women. Biol Psychiatry 58: 679–685, 2005.PubMedCrossRefGoogle Scholar
  40. 40.
    Fava M, Boras JS, Alpert JE, Nirenberg AA, Rosenbaum JF, Bottiglieri T: Folate, vitamin B12, and homocysteine in major depressive disorder. Am J Psychiatry 154: 426–428, 1997.PubMedGoogle Scholar
  41. 41.
    Reynolds EH: Folic acid, ageing, depression, and dementia. BMJ 324: 1512–1515, 2002.PubMedCrossRefGoogle Scholar
  42. 42.
    Penninx BW, Deeg DJ, van Eijk JT, Beekman AT, Guralnik JM: Changes in depression and physical decline in older adults: a longitudinal perspective. J Affect Disord 61: l-12, 2000.CrossRefGoogle Scholar
  43. 43.
    Rosenbloom CA, Whittington FJ: The effects of bereavement on eating behaviors and nutrient intakes in elderly widowed persons. J Gerontol 48: S223–229, 1993.PubMedGoogle Scholar
  44. 44.
    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 85: 677–683, 1995.PubMedCrossRefGoogle Scholar
  45. 45.
    Shahar DR, Shai I, Vardi H, Fraser D: Factors associated with low reported energy intake in the elderly. J Nutr Health Aging 9: 300–304, 2005.PubMedGoogle Scholar
  46. 46.
    Kivela SL, Nissinen A, Tuomilehto J, Pekkanen J, Punsar S, Lammi UK, Puska P: Prevalence of depressive and other symptoms in elderly Finnish men. Acta Psychiatr Scand 73: 93–100, 1986.PubMedCrossRefGoogle Scholar
  47. 47.
    Bleda MJ, Bolibar I, Pares R, Salva A: Reliability of the mini nutritional assessment (MNA) in institutionalized elderly people. J Nutr Health Aging 6: 134–7, 2002.PubMedGoogle Scholar
  48. 48.
    Salminen H, Saaf M, Johansson SE, Ringertz H, Strender LE: Nutritional status, as determined by the Mini-Nutritional Assessment, and osteoporosis: a cross-sectional study of an elderly female population. Eur J Clin Nutr 60: 486–93, 2006.PubMedCrossRefGoogle Scholar
  49. 49.
    Guigoz Y, Lauque S, Vellas BJ: Identifying the elderly at risk for malnutrition. The Mini Nutritional Assessment Clin Geriatr Med 18: 737–757, 2002.Google Scholar
  50. 50.
    Shahar DR, Shahar A. CEBQ: Composite Eating Behavior Questionnaire development and performance. J Nutr Health Aging 3: 11–18, 1999.PubMedGoogle Scholar

Copyright information

© Springer-Verlag France and Serdi Éditions 2008

Authors and Affiliations

  • L. German
    • 1
    • 2
    • 3
  • I. Feldblum
    • 1
  • N. Bilenko
    • 1
    • 2
    • 4
  • H. Castel
    • 3
    • 5
  • I. Harman-Boehm
    • 5
  • D. R. Shahar
    • 1
    • 3
  1. 1.The S. Daniel Abraham International Center for Health and NutritionBen-Gurion University of the NegevBeer-ShevaIsrael
  2. 2.Department of Epidemiology and Health Services Evaluation, Faculty of Health SciencesBen-Gurion University of the NegevBeer-ShevaIsrael
  3. 3.The Center for Multidisciplinary Research in AgingBen-Gurion University of the NegevBeer-ShevaIsrael
  4. 4.Ministry of Health, Southern DistrictBeer-ShevaIsrael
  5. 5.Department of Internal Medicine C, Soroka University Medical CenterBen-Gurion University of the NegevBeer-ShevaIsrael

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