Weight loss in elderly women in low-level care and its association with transfer to high-level care and mortality

Abstract

Background: The purpose of this study was to determine whether unintentional weight loss in older women predicts an imminent transition out of low-level care (either to higher-level care or by mortality).

Methods: Fifty-three Australian women, ambulatory while living in low-level care and requiring minimal assistance, were studied. At baseline, when the women were aged (mean ± standard deviation) 86.2 ± 5.3 years, body composition was assessed by dual energy X-ray absorptiometry, dietary intake was determined by a three-day weighed food record, a venous blood sample was taken, and both muscle strength and physical functioning were measured. The women were then followed up for 143 weeks to record the composite outcome of transfer to high-level care or mortality.

Results: During follow-up, unintended loss of body weight occurred in 60% of the women, with a mean weight loss of -4.6 ± 3.6 kg. Seven women (13.2%) died, and seven needed transfer to high-level care. At baseline, those who subsequently lost weight had a higher body mass index (P < 0.01) because they were shorter (P < 0.05) but not heavier than the other women. Analysis of their dietary pattern revealed a lower dietary energy (P < 0.05) and protein intake (P < 0.01). The women who lost weight also had lower hip abductor strength (P < 0.01), took longer to stand and walk (P < 0.05), and showed a slower walking speed (P < 0.01). Their plasma C-reactive protein was higher (P < 0.05) and their serum albumin was lower (P < 0.01) than women who did not lose weight. Nonintentional weight loss was a significant predictor of death or transfer to high care (hazards ratio 0.095, P = 0.02).

Conclusion: Weight loss in older women predicts adverse outcomes, so should be closely monitored.

Keywords: aged care; high care; mortality; weight loss.

Figure 1

Kaplan-Meier plot comparing the incidence of death or transfer to high-level care in elderly women (n = 53) who experienced weight loss (hatched line) compared with those who experienced no weight loss (solid line) over a 143-week period. Note: Marked lines have been censored (P < 0.01, log rank, Mantel Cox).