Skip to main content
SpringerLink
Log in

Malnutrition Risk, Rurality, and Falls among Community-Dwelling Older Adults

  • Published:
The journal of nutrition, health & aging

Abstract

Objectives

We aimed to evaluate if malnutrition and rurality are associated with fall risk and future falls in community-dwelling older adults.

Design

Prospective Cohort.

Setting

Community, Vermont.

Participants

Older adults receiving home support services who completed a health risk assessment (n=3,300; Mean age 79.6 years ±8.4, 75% female). Additional analysis was completed with a subset of 2,043 participants with two-years of consecutive health assessments.

Measurements

Fall Risk Questionnaire, DETERMINE Nutrition Risk Questionnaire, and fall history.

Results

Independently, high malnutrition risk and rurality were associated with fall risk (p<0.001) and high malnutrition risk was associated with rurality (p<0.001). After adjusting for age, sex, and physical function, individuals with high nutrition risk had a 66% increase in the odds of falling over the next year, but rurality was not significantly associated with a new fall.

Conclusion

These findings suggest that falls are associated with malnutrition risk, but the relationship between falls and rurality is less evident. Further research is needed to identify services that may best alleviate malnutrition risk in older adults and aspects of nutrition that are most protective against fall risk.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Figure 1

Similar content being viewed by others

References

  1. Bergen G, Stevens M, Burns E. Falls and fall injuries among adults aged >65 years — United States, 2014. MMWR Morb Mortal Wkly Rep 2016;65(37):993–998. https://doi.org/10.15585/mmwr.mm6537a2.

    Article  Google Scholar 

  2. Burns ER, Stevens JA, Lee R. The direct costs of fatal and non-fatal falls among older adults — United States. J Safety Res 2016;58(Supplement C):99–103. https://doi.org/10.1016/j.jsr.2016.05.001.

    Article  Google Scholar 

  3. Grossman DC, Curry SJ, Owens DK, Barry MJ, Caughey AB, Davidson KW, et al. Interventions to prevent falls in community-dwelling older adults: US Preventive Services Task Force recommendation statement. JAMA 2018;319(16):1696–1704.

    Article  Google Scholar 

  4. Gillespie LD, Robertson MC, Gillespie WJ, Sherrington C, Gates S, Clemson LM, et al. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev 2012;9(11).

  5. Lee R. The CDC's STEADI initiative: Promoting older adult health and independence through fall prevention. Am Fam Physician 2017;96(4):220–1.

    PubMed  PubMed Central  Google Scholar 

  6. Chien M-H, Guo H-R. Nutritional status and falls in community-dwelling older people: A longitudinal study of a population-based random sample. PLOS ONE 2014;9(3):e91044. https://doi.org/10.1371/journal.pone.0091044.

    Article  Google Scholar 

  7. Torres MJ, Féart C, Samieri C, Dorigny B, Luiking Y, Berr C, et al. Poor nutritional status is associated with a higher risk of falling and fracture in elderly people living at home in France: the Three-City cohort study. Osteoporos Int J Establ Result Coop Eur Found Osteoporos Natl Osteoporos Found USA 2015;26(8):2157–64. https://doi.org/10.1007/s00198-015-3121-2.

    Article  CAS  Google Scholar 

  8. Meijers JMM, Halfens RJG, Neyens JCL, Luiking YC, Verlaan G, Schols JMGA. Predicting falls in elderly receiving home care: The role of malnutrition and impaired mobility. J Nutr Health Aging 2012;16(7):654–8. https://doi.org/10.1007/s12603-012-0010-7.

    Article  CAS  Google Scholar 

  9. Coben JH, Tiesman HM, Bossarte RM, Furbee PM. Rural-Urban Differences in Injury Hospitalizations in the U.S., 2004. Am J Prev Med 2009;36(1):49–55. https://doi.org/10.1016/j.amepre.2008.10.001.

    Article  Google Scholar 

  10. ver Ploeg M, Breneman V, Farrigan T, Hamrick K, Hopkins D, Kaufman P, et al. Access to Affordable and Nutritious Food: Measuring and Understanding Food Deserts and Their Consequences: Report to Congress. AgEcon Search. 2009. https://ageconsearch.umn.edu/record/292130 (accessed September 6, 2020).

  11. Averill JB. Priorities for Action in a Rural Older Adults Study. Fam Community Health 2012;35(4):358–72. https://doi.org/10.1097/FCH.0b013e318266686e.

    Article  Google Scholar 

  12. RUCA. RUCA data. Rural Health Res. Cent. depts.washington.edu/uwruca/rucauses.php (accessed February 12, 2020).

  13. Sinnett S, Bengle R, Brown A, et al. The validity of nutrition screening initiative DETERMINE checklist responses in older Georgians. J Nutr Elder 2010;29(4):393–409. https://doi.org/10.1080/01639366.2010.521031.

    Article  Google Scholar 

  14. Viera LS, Formoso Assuncao MC, Schafer AA, et al. Validity assessment of the nutrition screening initiative checklist in older adults. Clin Nutr ESPEN 2016;15:16–20. https://doi.org/10.1016/j.clnesp.2016.05.002.

  15. Rubenstein LZ, Vivrette R, Harker JO, Stevens JA, Kramer BJ. Validating an evidence-based, self-rated fall risk questionnaire (FRQ) for older adults. J Safety Res 2011;42(6):493–9. https://doi.org/10.1016/j.jsr.2011.08.006.

    Article  Google Scholar 

  16. Lorenzo-López L, Maseda A, de Labra C, Regueiro-Folgueira L, Rodríguez-Villamil JL, Millán-Calenti JC. Nutritional determinants of frailty in older adults: A systematic review. BMC Geriatr 2017;17(1):108. https://doi.org/10.1186/s12877-017-0496-2.

    Article  Google Scholar 

  17. Robinson S, Cooper C, Aihie Sayer A. Nutrition and Sarcopenia: A Review of the Evidence and Implications for Preventive Strategies. J. Aging Res. 2012;2012:e510801. https://www.hindawi.com/journals/jar/2012/510801/ (accessed October 16, 2020).

    Article  Google Scholar 

  18. Sim M, Blekkenhorst LC, Lewis JR. Vegetable and fruit intake and injurious falls risk in older women: a prospective cohort study. Br J Nutr 2018;190:925–34. https://doi.org/10.1017/S0007114518002155.

    Article  Google Scholar 

  19. Mosen DM, Banegas MP, Friedman N, Shuster E, Brooks N. Food insecurity associated with self-reported falls among medicare advantage members. Popul Health Manag 2019;22(6):536–9. https://doi.org/10.1089/pop.2018.0205.

    Article  Google Scholar 

  20. Bolin JN, Bellamy GR, Ferdinand AO, Vuong AM, Kash BA, Schulze A, et al. Rural healthy people 2020: new decade, same challenges. J Rural Health 2015;31(3):326–33. https://doi.org/10.1111/jrh.12116.

    Article  Google Scholar 

  21. Arcury TA, Preisser JS, Gesler WM, Powers JM. Access to transportation and health care utilization in a rural region. J Rural Health 2005;21(1):31–8. https://doi.org/10.1111/j.1748-0361.2005.tb00059.x.

    Article  Google Scholar 

  22. CMS. Rural-urban disparities in health care in Medicare. 2018. https://www.cms.gov/files/document/rural-urban-disparities-health-care-medicare-national-report (accessed August 10, 2020).

  23. Zhang L, Ding Z, Qiu L, Li A. Falls and risk factors of falls for urban and rural community-dwelling older adults in China. BMC Geriatr 2019;19(1):379. https://doi.org/10.1186/s12877-019-1391-9.

    Article  Google Scholar 

  24. Burns E, Kakara R. Deaths from falls among persons aged ≥65 years — United States, 2007–2016. Morb Mortal Wkly Rep 2018;67(18):509–14. https://doi.org/10.15585/mmwr.mm6718a1.

    Article  Google Scholar 

  25. Onega T, Weiss JE, Alford-Teaster J, Goodrich M, Eliassen MS, Kim SJ. Concordance of rural-urban self-identity and zip code-derived rural-urban commuting area (ruca) designation. J Rural Health 2020;36(2):274–80. https://doi.org/10.1111/jrh.12364.

    Article  Google Scholar 

  26. Pereira GF, Bulik CM, Weaver MA, Holland WC, Platts-Mills TF. Malnutrition among cognitively intact, noncritically ill older adults in the emergency department. Ann Emerg Med 2015;65(1):85–91. https://doi.org/10.1016/j.annemergmed.2014.07.018.

    Article  Google Scholar 

  27. Win AZ, Ceresa C, Arnold K, Allison TA. High prevalence of malnutrition among elderly veterans in home based primary care. J Nutr Health Aging 2017;21(6):610–3. https://doi.org/10.1007/s12603-017-0918-z.

    Article  CAS  Google Scholar 

  28. Quickstats: Percentage of adults with activity limitations, by age group and type of limitation — National Health Interview Survey,† United States, 2014. MMWR Morb Mortal Wkly Rep 2016;65. https://doi.org/10.15585/mmwr.mm6501a6.

Download references

Funding

Funding: Research reported in this publication was supported by an Institutional Development Award (IDeA) from the National Institute of General Medical Sciences of the National Institutes of Health under grant number P20GM103449. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of NIGMS or NIH.

Author information

Authors and Affiliations

  1. Department of Rehabilitation and Movement Science, University of Vermont, 306B Rowell, 106 Carrigan Dr., Burlington, VT, 05405, USA

    C. Eckert, Nancy M. Gell & M. Wingood

  2. SASH: Support and Services at Home, South Burlington, VT, USA

    J. Schollmeyer

  3. Department of Environmental and Health Sciences, Northern Vermont University, Johnson, USA

    E. K. Tarleton

Authors
  1. C. Eckert
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nancy M. Gell
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Wingood
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. Schollmeyer
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. E. K. Tarleton
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nancy M. Gell.

Ethics declarations

Ethics Declarations: This study was considered “non-human subjects” research by the University of Vermont Internal Review Board. Informed consent was deemed as not applicable for secondary analysis of the de-identified dataset.

Conflicts of interest: The authors have no potential conflicts of interest to declare with respect to the research, authorship, or publication of this article. No copyrighted materials were used in the conduct of this study or the preparation of this article.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Eckert, C., Gell, N.M., Wingood, M. et al. Malnutrition Risk, Rurality, and Falls among Community-Dwelling Older Adults. J Nutr Health Aging 25, 624–627 (2021). https://doi.org/10.1007/s12603-021-1592-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12603-021-1592-8

Key words

Search

Navigation