Malnutrition During the Journey of Ageing

• Main Author: Borkent, Jos W
• Format: Dissertation
• Language: English
• Published: ProQuest Dissertations & Theses 01.01.2022
• Subjects: Aging; Body mass index; Frailty; Gerontology; Health sciences; Meals; Mortality; Older people
• ISBN: 9798380566742

Over the last decades, life expectancy has increased rapidly. The process of ageing is often linked to an increase in co-morbidities, malnutrition being one of them. The first expressions of developing (risk of ) malnutrition (so-called ‘early determinants) may be having problems with grocery shopping or cooking, decreased appetite, swallowing or chewing problems, or an impaired food intake. Eventually, this can result in so-called ‘late-phase malnutrition’ when malnutrition manifests itself in weight loss, loss of muscle mass and strength and then reduced physical functioning. Thus, malnutrition covers a continuum over time, taking on more serious forms with increasing age.We studied the continuum of malnutrition during the journey of ageing; from older adults in the community to residents in long-term care facilities. In the community, we assessed prevalence rates and groups at increased risk of malnutrition and tested the effect of ready-made meals on protein intake. In long-term care facilities, we investigated how behavioral-cognitive problems and diseases and health-related problems were related to being malnourished at admission, or becoming malnourished during stay. In addition, we measured the food intake of Dutch residents of long-term care facilities.In chapter 2, we provided an overview of risk factors for early determinants of malnutrition in Dutch community-dwelling older adults. We used data from www.goedgevoedouderworden.nl, a website that aims to inform older adults about healthy nutrition and malnutrition during the process of ageing. On this website, malnutrition screening tools can be filled in to assess the presence of early determinants of malnutrition (SCREEN II) or symptoms of late-phase malnutrition (SNAQ65+). Based on this self-reported data, early determinants of malnutrition (84.1%) and late phase malnutrition (56.8%) were highly present and increased with age. These results underline the importance of such a website to create awareness of malnutrition at an early stage among citizens interested in the topic.In chapter 3, we compared the data of www.goedgevoedouderworden.nl with the data of www.nutritionscreen.ca. Both websites use SCREEN II as a self-screening tool to identify early determinants of malnutrition. Data from The Netherlands (n=2482), Canada (n=9538), and New Zealand (n=217) were compared. The prevalence of the presence of early determinants of malnutrition differed only slightly between the three countries and ranged from 61.5% (the Netherlands) to 70.1% (Canada). However, individual risk factors differed between countries. These data indicate that early determinants of malnutrition are a common problem in the western societies. As risk factors differed between countries, policy to address these problems should be tailored to national needs.In chapter 4, we compared two screening tools for malnutrition (SCREEN II and SNAQ65+) within 200 community-dwelling older adults. Prevalence rates of older adults at risk differed widely between both tools: 69.0% were at risk based on SCREEN II, compared to 13.5% based on SNAQ65+.The agreement between the two tools was low (kappa <0.20). Being at risk based on SCREEN II was associated with social factors such as living alone, income and activity level, but also with food intake.