Investigating the prevalence of malnutrition, frailty and physical disability and the association between them amongst older care home residents

Evate Fashho; Tanweer Ahmed; Gill Garden; Donna Readman; Lesley Storey; Lindsey Wilkinson; Graham Wilson; Adrian Slee

doi:10.1016/j.clnesp.2020.09.014

Investigating the prevalence of malnutrition, frailty and physical disability and the association between them amongst older care home residents

Clin Nutr ESPEN. 2020 Dec:40:231-236. doi: 10.1016/j.clnesp.2020.09.014. Epub 2020 Sep 22.

Authors

Evate Fashho¹, Tanweer Ahmed², Gill Garden³, Donna Readman⁴, Lesley Storey⁴, Lindsey Wilkinson⁵, Graham Wilson⁶, Adrian Slee⁷

Affiliations

¹ Division of Medicine, University College London, London, UK.
² Research and Development Department, Lincoln County Hospital, Lincoln, UK.
³ Lincoln Medical School, University of Lincoln, Lincoln, UK.
⁴ Beaumond House Community Hospice, Newark, UK.
⁵ St Barnabas Hospice, Lincoln, UK.
⁶ Lincolnshire Community Health Services Trust, UK.
⁷ Division of Medicine, University College London, London, UK. Electronic address: a.slee@ucl.ac.uk.

PMID: 33183542
DOI: 10.1016/j.clnesp.2020.09.014

Abstract

Background: Malnutrition, frailty and physical disability are inter-related, more prevalent in the older population and increase the risk of adverse health outcomes. Thus, screening is essential, especially in the understudied care home setting where the population is vulnerable and at higher risk of malnutrition. Furthermore, prevalence may vary depending upon screening tools used. The aims of this study were to: 1) investigate the prevalence of 1) malnutrition risk using Mini Nutritional Assessment - Short Form (MNA-SF) and Malnutrition Universal Screening Tool (MUST), 2) frailty using the Edmonton Frailty Scale (EFS), 3) physical disability using the Barthel Index (BI) and (4) examine the association between variables and coexistence of states.

Methods: Screening for malnutrition (MNA-SF and MUST) and frailty (EFS) was performed as part of a comprehensive geriatric assessment (CGA) in 527 residents from 17 care homes in Lincoln, UK. Mean age of the group was 85.6 ± 7.6 years and body mass index, BMI 23.0 ± 5.1 kg/m².

Results: A high prevalence of malnutrition risk was detected: 41.4% by MNA-SF and 25.5% by MUST (high risk/malnourished). Furthermore, there was a clear discordance between MNA-SF and MUST scoring of malnutrition; for example, the percentage of those identified as being at low risk was 18.8% using the MNA-SF and 57.0% using the MUST. In addition, there was a high prevalence of severe frailty by EFS (69.6%) and functional impairment by BI (62.0%). There was good association between some variables (P < 0.001) and 33.4% of residents had coexistence of all three states of malnutrition, frailty and physical disability.

Conclusions: Malnutrition risk, frailty and physical disability are highly prevalent in care home residents and interrelated. However, prevalence varies depending on the screening tool used. More research should be conducted in the care home setting to improve daily clinical practice as screening may impact upon subsequent treatment and care modalities and clinical outcomes.

Keywords: Cachexia; Frailty; Malnutrition; Physical function; Sarcopenia.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Child
Frailty* / diagnosis
Frailty* / epidemiology
Geriatric Assessment
Humans
Malnutrition* / diagnosis
Malnutrition* / epidemiology
Nutrition Assessment
Prevalence