Assessment of nutritional status in the elderly: a proposed function-driven model
Background: There is no accepted or standardized definition of ‘malnutrition’. Hence, there is also no definition of what constitutes an adequate nutritional status. In elderly people, assessment of nutritional status is complex and is complicated by multi-morbidity and disabilities combined with nutrition-related problems, such as dysphagia, decreased appetite, fatigue, and muscle weakness.
Objective: We propose a nutritional status model that presents nutritional status from a comprehensive functional perspective. This model visualizes the complexity of the nutritional status in elderly people.
Design and results: The presented model could be interpreted as the nutritional status is conditional to a person’s optimal function or situation. Another way of looking at it might be that a person’s nutritional status affects his or her optimal situation. The proposed model includes four domains: (1) physical function and capacity; (2) health and somatic disorders; (3) food and nutrition; and (4) cognitive, affective, and sensory function. Each domain has a major impact on nutritional status, which in turn has a major impact on the outcome of each domain.
Conclusions: Nutritional status is a multifaceted concept and there exist several knowledge gaps in the diagnosis, prevention, and optimization of treatment of inadequate nutritional status in elderly people. The nutritional status model may be useful in nutritional assessment research, as well as in the clinical setting.
- Johansson Y, Bachrach-Lindstrom M, Carstensen J, Ek AC. Malnutrition in a home-living older population: prevalence, incidence and risk factors. A prospective study. J Clin Nurs 2009; 18(9): 1354–64.
- Odlund Olin A, Koochek A, Cederholm T, Ljungqvist O. Minimal effect on energy intake by additional evening meal for frail elderly service flat residents – a pilot study. J Nutr Health Aging 2008; 12(5): 295–301.
- Meijers JM, van Bokhorst-de van der Schueren MA, Schols JM, Soeters PB, Halfens RJ. Defining malnutrition: mission or mission impossible? Nutrition 2010; 26(4): 432–40.
- Torma J, Winblad U, Cederholm T, Saletti A. Does undernutrition still prevail among nursing home residents? Clin Nutr 2013; 32(4): 562–8.
- Serrano-Urrea R, Garcia-Meseguer MJ. Malnutrition in an elderly population without cognitive impairment living in nursing homes in SpaIn: study of prevalence using the Mini Nutritional Assessment test. Gerontology 2013; 59(6): 490–8.
- van Nie-Visser NC, Meijers J, Schols J, Lohrmann C, Bartholomeyczik S, Spreeuwenberg M, et al. Which characteristics of nursing home residents influence differences in malnutrition prevalence? An international comparison of The Netherlands, Germany and Austria. Br J Nutr 2014; 111(6): 1129–36.
- Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, et al. Sarcopenia: European consensus on definition and diagnosis: report of the European Working Group on Sarcopenia in Older People. Age Ageing 2010; 39(4): 412–23.
- Evans WJ, Morley JE, Argiles J, Bales C, Baracos V, Guttridge D, et al. Cachexia: a new definition. Clin Nutr 2008; 27(6): 793–9.
- White JV, Guenter P, Jensen G, Malone A, Schofield M, Academy of Nutrition and Dietetics Malnutrition Work Group, et al. Consensus statement of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition: characteristics recommended for the identification and documentation of adult malnutrition (undernutrition). J Acad Nutr Diet 2012; 112(5): 730–8.
- van Bokhorst-de van der Schueren MA, Guaitoli PR, Jansma EP, de Vet HC. A systematic review of malnutrition screening tools for the nursing home setting. J Am Med Dir Assoc 2014; 15(3): 171–84.
- Cederholm T, Jensen GL. To create a consensus on malnutrition diagnostic criteria: a report from the Global Leadership Initiative on Malnutrition (GLIM) meeting at the ESPEN Congress 2016. Clin Nutr 2017; 36(1): 7–10.
- Fischer M, JeVenn A, Hipskind P. Evaluation of muscle and fat loss as diagnostic criteria for malnutrition. Nutr Clin Pract 2015; 30(2): 239–48.
- Christensen K, Doblhammer G, Rau R, Vaupel JW. Ageing populations: the challenges ahead. Lancet 2009; 374(9696): 1196–208.
- European Commission. Eurostat. Your key to European statistics., 2014.
- Saragat B, Buffa R, Mereu E, Succa V, Cabras S, Mereu RM, et al. Nutritional and psycho-functional status in elderly patients with Alzheimer’s disease. J Nutr Health Aging 2012; 16(3): 231–6.
- Donini LM, Savina C, Rosano A, Cannella C. Systematic review of nutritional status evaluation and screening tools in the elderly. J Nutr Health Aging 2007; 11(5): 421–32.
- Marengoni A, Winblad B, Karp A, Fratiglioni L. Prevalence of chronic diseases and multimorbidity among the elderly population in Sweden. Am J Public Health 2008; 98(7): 1198–200.
- Engelheart S, Akner G. Dietary intake of energy, nutrients and water in elderly people living at home or in nursing home. J Nutr Health Aging 2015; 19(3): 265–72.
- Koopman R, van Loon LJC. Aging, exercise, and muscle protein metabolism. J Appl Physiol 2009; 106(6): 2040–8.
- Zuliani G, Romagnoni F, Volpato S, Soattin L, Leoci V, Bollini MC, et al. Nutritional parameters, body composition, and progression of disability in older disabled residents living in nursing homes. J Gerontol A Biol Sci Med Sci 2001; 56(4): M212–16.
- van Bokhorst-de van der Schueren MA, Lonterman-Monasch S, de Vries OJ, Danner SA, Kramer MH, Muller M. Prevalence and determinants for malnutrition in geriatric outpatients. Clin Nutr 2013; 32(6): 1007–11.
- Persson M, Hytter-Landahl A, Brismar K, Cederholm T. Nutritional supplementation and dietary advice in geriatric patients at risk of malnutrition. Clin Nutr 2007; 26(2): 216–24.
- French SA, Folsom AR, Jeffery RW, Williamson DF. Prospective study of intentionality of weight loss and mortality in older women: the Iowa Women’s Health Study. Am J Epidemiol 1999; 149(6): 504–14.
- Allison DB, Zannolli R, Faith MS, Heo M, Pietrobelli A, VanItallie TB, et al. Weight loss increases and fat loss decreases all-cause mortality rate: results from two independent cohort studies. Int J Obes Relat Metab Disorders 1999; 23(6): 603–11.
- Beaufrère B, Morio B. Fat and protein redistribution with aging: metabolic considerations. Eur J Clin Nutr 2000; 54(Suppl 3): S48–53.
- Vasto S, Candore G, Balistreri CR, Caruso M, Caruso C, Colonna-Romano G, et al. Inflammatory networks in ageing, age-related diseases and longevity. Mech Ageing Dev 2007; 128(1): 83–91.
- Franceschi C. Inflammaging as a major characteristic of old people: can it be prevented or cured? Nutr Rev 2007; 65(12 Pt 2): S173–6.
- Fernandez-Real JM, Ferri MJ, Vendrell J, Ricart W. Burden of infection and fat mass in healthy middle-aged men. Obesity 2007; 15(1): 245–52.
- Franceschi C, Bonafe M, Valensin S, Olivieri F, De Luca M, Ottaviani E, et al. Inflamm-aging. An evolutionary perspective on immunosenescence. Ann N Y Acad Sci 2000; 908: 244–54.
- de Araujo AL, Silva LC, Fernandes JR, Benard G. Preventing or reversing immunosenescence: can exercise be an immunotherapy? Immunotherapy 2013; 5(8): 879–93.
- Sullivan DH, Johnson LE, Dennis RA, Roberson PK, Heif M, Garner KK, et al. The Interrelationships among albumin, nutrient intake, and inflammation in elderly recuperative care patients. J Nutr Health Aging 2011; 15(4): 311–15.
- Lammes E, Akner G. Repeated assessment of energy and nutrient intake in 52 nursing home residents. J Nutr Health Aging 2006; 10(3): 222–30.
- Suominem M, Laine T, Routasalo P, Pitkala KH, Rasanen L. Nutrient content of served food, nutrient intake and nutritional status of residents with dementia in a Finnish nursing home. J Nutr Health Aging 2004; 8(4): 234–8.
- Akner G, Flöistrup H. Individual assessment of intake of energy, nutrients and water in 54 elderly multidiseased nursing-home residents. J Nutr Health Aging 2003; 7(1): 1–12.
- Nowson CA, Sherwin AJ, McPhee JG, Wark JD, Flicker L. Energy, protein, calcium, vitamin D and fibre intakes from meals in residential care establishments in Australia. Asia Pac J Clin Nutr 2003; 12(2): 172–7.
- Norden. Nordic nutrition recommendations 2012. Integrating nutrition and physical activity. Copenhagen: Nordic Council of Ministers; 2014.
- Andreucci VE, Russo D, Cianciaruso B, Andreucci M. Some sodium, potassium and water changes in the elderly and their treatment. Nephrol Dial Transplant 1996; 11(Suppl 9): 9–17.
- Buffa R, Mereu RM, Putzu PF, Floris G, Marini E. Bioelectrical impedance vector analysis detects low body cell mass and dehydration in patients with Alzheimer’s disease. J Nutr Health Aging 2010; 14(10): 823–7.
- Armstrong-Esther CA, Browne KD, Armstrong-Esther DC, Sander L. The institutionalized elderly: dry to the bone! Int J Nurs Stud 1996; 33(6): 619–28.
- Mentes JC. A typology of oral hydration problems exhibited by frail nursing home residents. J Gerontol Nurs 2006; 32(1): 13–19; quiz 20–1.
- Popkin BM, D’Anci KE, Rosenberg IH. Water, hydration, and health. Nutr Rev 2010; 68(8): 439–58.
- Benton D. Dehydration influences mood and cognition: a plausible hypothesis? Nutrients 2011; 3(5): 555–73.
- Secher M, Ritz P. Hydration and cognitive performance. J Nutr Health Aging 2012; 16(4): 325–9.
- Grandjean AC, Grandjean NR. Dehydration and cognitive performance. J Am Coll Nutr 2007; 26(5 Suppl): 549S–54S.
- Lieberman HR. Hydration and cognition: a critical review and recommendations for future research. J Am Coll Nutr 2007; 26(5 Suppl): 555–61.
- Chaudhury H, Hung L, Badger M. The role of physical environment in supporting person-centered dining in long-term care: a review of the literature. Am J Alzheimers Dis Other Demen 2013; 28(5): 491–500.
- Odlund Olin A, Koochek A, Ljungqvist O, Cederholm T. Nutritional status, well-being and functional ability in frail elderly service flat residents. Eur J Clin Nutr 2005; 59(2): 263–70.
- Keller HH, Edward HG, Cook C. Mealtime experiences of families with dementia. Am J Alzheimers Dis Other Demen 2007; 21(6): 431–8.
- Smoliner C, Norman K, Wagner K-H, Hartig W, Lochs H, Pirlich M. Malnutrition and depression in the institutionalised elderly. Br J Nutr 2009; 102(11): 1663–7.
- Toffanello ED, Inelmen EM, Imoscopi A, Perissinotto E, Coin A, Miotto F, et al. Taste loss in hospitalized multimorbid elderly subjects. Clin Interv Aging 2013; 8: 167–74.
- Smoliner C, Fischedick A, Sieber CC, Wirth R. Olfactory function and malnutrition in geriatric patients. J Gerontol A Biol Sci Med Sci 2013; 68(12): 1582–8.
Authors retain copyright of their work, with first publication rights granted to SNF Swedish Nutrition Foundation. Read the full Copyright- and Licensing Statement.