The aims of this work were (a) to provide a detailed description of the association between nutritional (Mini Nutritional Assessment; MNA®) and functional status in a sample of older adults receiving home care, using both questionnaire- and performance-based functional methods, and (b) to investigate the impact of different MNA subscales on this association.
296 persons ≥65 years in need of care (80.7±7.7 y).
Nutritional status was determined by the MNA and functional status by two questionnaires (Instrumental and Basic Activities of Daily Living; IADL, ADL) and three performance tests (handgrip strength, HGS; Short Physical Performance Battery, SPPB; Timed ‘Up and Go’ Test, TUG). A categorical and a covariance analytical approach were used to test for differences in functional status between MNA groups (well nourished, risk of malnutrition, malnourished). In addition, functional parameters were correlated with total MNA, a modified MNA version (modMNA), where functional items were excluded, and MNA subscales (‘functionality’, ‘general assessment’, ‘anthropometry’, ‘dietary assessment’, and ‘subjective assessment’).
57% of the participants were at risk of malnutrition and 12% malnourished. 35% reported severe limitations in IADL, 18% in ADL. 40%, 39% and 35% had severe limitations in HGS, SPPB and TUG; 9%, 28% and 34% were not able to perform the tests. Functional status deteriorated significantly from the well nourished to the malnourished group in all functional measures. The modMNA was weak but still significantly related to all functional parameters except TUG. The subscale ‘functionality’ revealed strongest correlations with functional measures. All other MNA subscales showed only weak or no associations.
More than one half of the seniors receiving home care were at nutritional risk and poor functional level, respectively. Malnutrition according to MNA was significantly associated to both questionnaire- and performance-based functional measures even after exclusion of functional MNA items.
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Kaiser MJ, Bauer JM, Ramsch C, Uter W, Guigoz Y, Cederholm T, Thomas DR, Anthony PS, Charlton KE, Maggio M et al. Frequency of malnutrition in older adults: a multinational perspective using the mini nutritional assessment. J Am Geriatr Soc 2010; 58:1734–1738
Cereda E. Mini nutritional assessment. Curr Opin Clin Nutr Metab Care 2012; 15:29–41
Muscaritoli M, Anker SD, Argiles J, Aversa Z, Bauer JM, Biolo G, Boirie Y, Bosaeus I, Cederholm T, Costelli P et al. Consensus definition of sarcopenia, cachexia and pre-cachexia: joint document elaborated by Special Interest Groups (SIG) “cachexia-anorexia in chronic wasting diseases’ and “nutrition in geriatrics’. Clin Nutr 2010;29:154–159
Volkert D. The role of nutrition in the prevention of sarcopenia. Wien Med Wochenschr 2011;161:409–415
Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, Seeman T, Tracy R, Kop WJ, Burke G et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 2001;56:M146–156
Guigoz Y, Vellas B, Garry PJ. Mini Nutritional Assessment: A practical assessment tool for grading nutritional state of elderly patients, facts and research in gerontology 1994; 15–59
Ferdous T, Cederholm T, Razzaque A, Wahlin A, Nahar Kabir Z. Nutritional status and self-reported and performance-based evaluation of physical function of elderly persons in rural Bangladesh. Scand J Public Health 2009;37:518–524
Norman K, Smoliner C, Valentini L, Lochs H, Pirlich M. Is bioelectrical impedance vector analysis of value in the elderly with malnutrition and impaired functionality? Nutrition 2007;23:564–569
Kaburagi T, Hirasawa R, Yoshino H, Odaka Y, Satomi M, Nakano M, Fujimoto E, Kabasawa K, Sato K. Nutritional status is strongly correlated with grip strength and depression in community-living elderly Japanese. Public Health Nutr 2011;14:1893–1899
Statistisches Bundesamt (2011) Pflegestatistik 2009 [Care within the nursing insurance -results for Germany]. Statistisches Bundesamt, Wiesbaden,pp 1–30.
Sorbye LW, Schroll M, Finne Soveri H, Jonsson PV, Topinkova E, Ljunggren G, Bernabei R. Unintended weight loss in the elderly living at home: the aged in Home Care Project (AdHOC). J Nutr Health Aging 2008; 12:10–16
Saletti A, Johansson L, Yifter-Lindgren E, Wissing U, Osterberg K, Cederholm T. Nutritional status and a 3-year follow-up in elderly receiving support at home. Gerontology 2005;51:192–198
Sharkey JR, Giuliani C, Haines PS, Branch LG, Busby-Whitehead J, Zohoori N Summary measure of dietary musculoskeletal nutrient (calcium, vitamin D, magnesium, and phosphorus) intakes is associated with lower-extremity physical performance in homebound elderly men and women. Am J Clin Nutr 2003;77:847–856
Folstein MF, Folstein SE, McHugh PR. “Mini-mental state’. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12:189–198
German Federal Ministery of Justice (1994) [Social Security Code (SGB) book XI, § 15 Level of care dependency], http://www.gesetze-im-intemet.de/sgb_11/15.html. Accessed 18 June 2012
Yesavage JA, Brink TL, Rose TL, Lum O, Huang V, Adey M, Leiter VO. Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res 1982; 17:37–49
Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 1969;9:179–186
Mahoney FI, Barthel DW. Functional Evaluation: The Barthel Index. Md State Med J 1965;14:61–65
Kaiser R, Winning K, Uter W, Volkert D, Lesser S, Stehle P, Kaiser MJ, Sieber CC, Bauer JM. Functionality and mortality in obese nursing home residents: an example of ‘risk factor paradoxl? J Am Med Dir Assoc 2010;11:428–435
Volkert D, Saeglitz C, Gueldenzoph H, Sieber CC, Stehle P. Undiagnosed malnutrition and nutrition-related problems in geriatric patients. J Nutr Health Aging 2010; 14:387–392
Bassey EJ, Harries UJ. Normal values for handgrip strength in 920 men and women aged over 65 years, and longitudinal changes over 4 years in 620 survivors, Clin Sci (Lond) 1993;84:331–337
Guralnik JM, Simonsick EM, Ferrucci L, Glynn RJ, Berkman LF, Blazer DG, Scherr PA, Wallace RB. A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol 1994;49:M85–94
Guralnik JM, Ferrucci L, Simonsick EM, Salive ME, Wallace RB. Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability. N Engl J Med 1995;332:556–561
Podsiadlo D, Richardson S. The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 1991;39:142–148
Beauchet O, Dubost V, Allali G, Gonthier R, Hermann FR, Kressig RW. Faster counting while walking as a predictor of falls in older adults. Age Ageing 2007;36:418–423
Soini H, Routasalo P, Lagstrom H. Characteristics of the Mini-Nutritional Assessment in elderly home-care patients. Eur J Clin Nutr 2004;58:64–70
Yang Y, Brown CJ, Burgio KL, Kilgore ML, Ritchie CS, Roth DL, West DS, Locher JL. Undernutrition at baseline and health services utilization and mortality over a 1-year period in older adults receiving Medicare home health services. J Am Med Dir Assoc 2011;12:287–294
Kaiser R, Winning K, Uter W, Lesser S, Stehle P, Sieber CC, Bauer JM. Comparison of two different approaches for the application of the mini nutritional assessment in nursing homes: resident interviews versus assessment by nursing staff. J Nutr Health Aging 2009;13:863–869
Volkert D, Pauly L, Stehle P, Sieber CC. Prevalence of malnutrition in orally and tube-fed elderly nursing home residents in Germany and its relation to health complaints and dietary intake. Gastroenterol Res Pract 2011:247315
Sharkey JR, Branch LG, Giuliani C, Zohoori M, Haines PS. Nutrient intake and BMI as predictors of severity of ADL disability over 1 year in homebound elders. J Nutr Health Aging 2004;8:131–139
Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW. Studies of illness in the aged. the index of ADL: a standardized measure of biological and psychological function. JAMA 1963;185:914–919
Millan-Calenti JC, Tubio J, Pita-Fernandez S, Rochette S, Lorenzo T, Maseda A. Cognitive impairment as predictor of functional dependence in an elderly sample. Arch Gerontol Geriatr 2012;54:197–201
Norman K, Stobäus N, Gonzalez MC, Schulzke JD, Pirlich M. Hand grip strength: outcome predictor and marker of nutritional status. Clin Nutr 2011;30:135–142
Matthews MM, Hsu FC, Walkup MP, Barry LC, Patel KV, Blair SN. Depressive symptoms and physical performance in the lifestyle interventions and independence for elders pilot study. J Am Geriatr Soc 2011;59:495–500
Avila-Funes JA, Gray-Donald K, Payette H. Association of nutritional risk and depressive symptoms with physical performance in the elderly: the Quebec longitudinal study of nutrition as a determinant of successful aging (NuAge). J Am Coll Nutr 2008;27:492–498
Cereda E, Valzolgher L, Pedrolli C. Mini nutritional assessment is a good predictor of functional status in institutionalised elderly at risk of malnutrition. Clin Nutr 2008;27:700–705
Millan-Calenti JC, Maseda A, Rochette S, Vazquez GA, Sanchez A, Lorenzo T. Mental and psychological conditions, medical comorbidity and functional limitation: differential associations in older adults with cognitive impairment, depressive symptoms and co-existence of both. Int J Geriatr Psychiatry 2011;26:1071–1079
Sharkey JR, Branch LG, Zohoori N, Giuliani C, Busby-Whitehead J, Haines PS. Inadequate nutrient intakes among homebound elderly and their correlation with individual characteristics and health-related factors. Am J Clin Nutr 2002;76:1435–1445
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Kiesswetter, E., Pohlhausen, S., Uhlig, K. et al. Malnutrition is related to functional impairment in older adults receiving home care. J Nutr Health Aging 17, 345–350 (2013). https://doi.org/10.1007/s12603-012-0409-1
- Mini Nutritional Assessment
- functional status
- Activities of Daily Living
- performance tests
- home care