Malnutrition and Polypharmacy in Older Adult Patients Receiving Home Care Nursing Services: A Cross-sectional Study

Mari Fiske; Anne Moen; Ibrahimu Mdala; Jørund Straand

doi:10.1016/j.jamda.2023.11.016

Malnutrition and Polypharmacy in Older Adult Patients Receiving Home Care Nursing Services: A Cross-sectional Study

J Am Med Dir Assoc. 2024 Mar;25(3):526-531. doi: 10.1016/j.jamda.2023.11.016. Epub 2023 Dec 26.

Authors

Mari Fiske¹, Anne Moen², Ibrahimu Mdala³, Jørund Straand⁴

Affiliations

¹ Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway.
² Department of Public Health Science, Institute of Health and Society, University of Oslo, Oslo, Norway.
³ General Practice Research Unit, Department of General Practice, University of Oslo, Oslo, Norway.
⁴ Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway; General Practice Research Unit, Department of General Practice, University of Oslo, Oslo, Norway. Electronic address: jorund.straand@medisin.uio.no.

PMID: 38158191
DOI: 10.1016/j.jamda.2023.11.016

Abstract

Objective: We studied the nutritional status of older adult adults receiving home nursing care using demographic data, household category, polypharmacy, and potentially inappropriate medications (PIMs).

Design: Cross-sectional study.

Setting and participants: Two Norwegian municipalities during 2017-2019; home nursing service clients aged ≥70 years.

Methods: Inclusion of patients and data collection were done by nurses working in the home services. Recorded data were participants' age, sex, living alone or with others, nutritional status (Mini Nutritional Assessment-Short Form and body mass index), regular prescription drugs, and potentially inappropriate medications (PIMs) according to the Norwegian General Practice Nursing home (NORGEP-NH) criteria. Descriptive statistics and logistic regression were used.

Results: Of the 270 patients (mean age 84.2 years; 64.8% females; 188 living alone), 25 (9.3%) were malnourished and 154 (57%) at risk of malnutrition; in addition, 14.8% had a BMI <21 and 27.8% had lost weight in the previous 3 months. The odds for being at malnutrition risk was higher if living with others vs living alone: adjusted odds ratio (OR) 2.23 (1.20-4.13). Female sex, older age, and better mobility was associated with living alone. The mean number of regular drugs was 7.3. Overall, 43.3% of the participants used at least 1 PIM. Using 0 to 5 drugs vs ≥6 drugs (polypharmacy) was associated with higher odds for malnutrition risk: adjusted OR 1.97 (1.04-3.75). Compared with well-nourished patients, those at risk for or who were malnourished used fewer cardiovascular and musculoskeletal drugs. Exposure to PIMs was not associated with nutritional status.

Conclusions and implications: Two-thirds of home nurse clients were either malnourished or at risk for malnutrition. Living with others or using fewer daily drugs implied increased risk for malnourishment, probably reflecting differences in morbidity and possible inappropriateness of medication use. Future research on nutritional status and medication use should aim for including more clinical data than simple drug counts.

Keywords: Malnutrition; Mini Nutritional Assessment–Short Form (MNA-SF); family characteristics; health services for the aged; polypharmacy; potentially inappropriate medication list (NORGEP-NH).

MeSH terms

Aged
Aged, 80 and over
Cross-Sectional Studies
Female
Home Care Services*
Humans
Male
Malnutrition* / epidemiology
Nutritional Status
Polypharmacy