Malnutrition

Estimates of nutrition risk in older persons vary by setting. For example, while it has been reported that some 15 percent of community-dwelling elders are undernourished, the prevalence of protein-energy malnutrition (PEM) among those living in nursing homes or institutions may range from 30 to 60 percent (Omran and Morely), depending on the component measured.

Risk of PEM increases with loss of appetite, decrease in usual weight, increased percentage of weight change in the previous year, and low body mass index (BMI) (White et al.). It has been suggested that loss of more than 4 percent of body weight in a one-year period predicts an increased risk of mortality. Indeed, weight loss alone usually heralds increased morbidity and mortality in elderly people (Losonczy et al.). Furthermore, unintentional weight loss is generally associated with advanced age, lower educational level, and poor health status. In the long-term care setting, malnourished residents are older and more dependent on others, and require more eating assistance than those with adequate nutrition status. Among participants in the Canadian Study of Health and Aging, low BMI, poor appetite, weight loss, and low levels of albumin (a protein that reflects nutrition status in older people) were highly intercorrelated and characterized nutritional risk, which was a significant independent predictor of mortality (Keller and Ostbye).