The nutritional status of 250 older Australian recipients of domiciliary care services and its association with outcomes at 12 months

Abstract

OBJECTIVES:To identify predictors and consequences of nutritional risk, as determined by the Mini Nutritional Assessment (MNA), in older recipients of domiciliary care services living at home. DESIGN:Baseline analysis of subject characteristics with low MNA scores (<24) and follow-up of the consequences of these low scores. SETTING:South Australia. PARTICIPANTS:Two hundred fifty domiciliary care clients (aged 67-99, 173 women). MEASUREMENTS:Baseline history and nutritional status were determined. Information about hospitalization was obtained at follow-up 12 months later. INTERVENTION:Letters suggesting nutritional intervention were sent to general practitioners of subjects not well nourished. RESULTS:At baseline, 56.8% were well nourished, 38.4% were at risk of malnutrition, and 4.8% were malnourished (43.2% not well nourished). Independent predictors of low MNA scores (<24) were living alone, and the physical and mental component scales of the 36-item Short Form Health Survey. Follow-up information was obtained for 240 subjects (96%). In the ensuing year not well-nourished subjects were more likely than well-nourished subjects to have been admitted to the hospital (risk ratio (RR) = 1.51, 95% confidence interval (CI) = 1.07-2.14), have two or more emergency hospital admissions (RR = 2.96, 95% CI = 1.15-7.59), spend more than 4 weeks in the hospital (RR = 3.22, 95% CI = 1.29-8.07), fall (RR = 1.65, 95% CI = 1.13-2.41), and report weight loss (RR = 2.63, 95% CI = 1.67-4.15). CONCLUSION:The MNA identified a large number of subjects with impaired nutrition who did significantly worse than well-nourished subjects during the following year. Studies are needed to determine whether nutritional or other interventions in people with low MNA scores can improve clinical outcomes.