We aimed to evaluate if malnutrition and rurality are associated with fall risk and future falls in community-dwelling older adults.
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.
Fall Risk Questionnaire, DETERMINE Nutrition Risk Questionnaire, and fall history.
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.
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, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
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.
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.
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.
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).
Lee R. The CDC's STEADI initiative: Promoting older adult health and independence through fall prevention. Am Fam Physician 2017;96(4):220–1.
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.
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.
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.
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.
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).
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.
RUCA. RUCA data. Rural Health Res. Cent. depts.washington.edu/uwruca/rucauses.php (accessed February 12, 2020).
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.
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.
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.
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.
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).
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.
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.
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.
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.
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).
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.
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.
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.
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.
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.
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.
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.
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.
About this article
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 (2021). https://doi.org/10.1007/s12603-021-1592-8
- Fall risk
- rural health
- older adult