Nutritional assessment in an Asian nursing home and its association with mortality

Abstract

Objective: To study the nutritional status of nursing home residents in a multi-racial Asian society and its role in predicting short-term mortality independent of functional status and comorbidities.

Design: Cross-sectional study with prospective collection of mortality data.

Setting: Nursing home facility in Singapore.

Subjects: A total of 154 patients (mean age 77 +/- 12 years, 53.2% women).

Methods: We evaluated the demographic details, Mini Nutritional Assessment (MNA) scores, body mass index (BMI) and anthropometric measurements of the participants. Functional status and comorbidities were characterized by the modified Barthel Index and Charlson's comorbidity index respectively.

Results: Prevalence of undernutrition were 52% (n= 80) and 39% (n=60) when determined by BMI < 18.5 kg/m2 and MNA <17 respectively. Mortality was 25.3% (n= 39) over 2 years. Baseline factors associated with mortality include increased age, low Barthel's score, BMI < 18.5 kg/m2 and MNA < 17 (OR= 1.05, 1.01, 3.08 and 3.03 respectively, all p < 0.05). The association between low BMI and mortality remained significant (p=0.027) after adjustment for patient's age, gender, Barthel's and Charlson's scores, and prior nutritional intervention, but the association between MNA and mortality was diminished (p=0.106).

Conclusion: There was a high prevalence of undernutrition in this nursing home population, and the diagnosis is an important predictor of mortality. Formal nutritional screening and targeted interventions may improve important clinical outcomes.