Screening for nutrition risk and dysphagia among older adults newly admitted to age related residential care facilities in the Waitemata DHB region : a thesis presented in partial fulfillment of the requirements for the degree of Master of Science in Nutrition and Dietetics at Massey University, Auckland, New Zealand
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Date
2014
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Massey University
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Abstract
Background: New Zealand has an ageing population, reflected by an older average
population age and reduced mortality. Good nutrition is essential for successful ageing.
Many factors are known to influence nutrition risk, and a high prevalence has been observed
overseas in people living in age related residential care (ARRC) facilities. In New Zealand,
there is limited data on both the prevalence of nutrition risk in ARRC facilities and the health
factors that contribute to risk. The changing demographics of the population means that a
greater understanding in this area will be important to develop strategies which support the
maintenance of good nutrition status for longer, thus potentially reducing health burden. This
study aims to determine nutrition risk and the risk of dysphagia (swallowing difficulties) in
older adults recently admitted to an ARRC facility in the Waitemata District Health Board
(DHB) region.
Methods: Fifty-six individuals aged ≥65 years (or ≥55 years for Māori and Pacific) who were
admitted for the first time to an ARRC facility within the Waitemata DHB region were invited
to participate in the study. Potential contributors to nutrition risk were explored using a
questionnaire that asked about nutritional and non-nutritional risk factors. The Mini
Nutritional Assessment®-SF (MNA®-SF) was used to determine level of nutrition risk. Risk
of dysphagia was identified using the Eating Assessment Tool (EAT-10). The Montreal
Cognitive Assessment (MoCA) was carried out at the end of the interview and was used as
a measure of cognitive function.
Results: A total of 53 participants with a mean age of 88 years were included. Overall, 91%
of the participants were either malnourished (47%) or at risk of malnutrition (43%). Normal
nutritional status was only prevalent in 9% of participants. Fifty-seven percent of participants
were widowed, of which, 52% were malnourished. When malnourished participants were
compared to those with normal nutritional status, malnourished participants were more likely
to be underweight, in hospital level care, have a recent severe decrease in food intake,
recent weight loss of greater than 3kg, have poorer mobility, experienced psychological
stress or acute disease and have severe dementia or depression. Malnourished participants
were more likely to report weight loss of greater than 3 kg than those at risk of malnutrition
(56% vs. 13% respectively, p = 0.03; Fisher’s exact test). Those who were malnourished had
poorer mobility (χ2 = 8.592 p = 0.003) and were more likely to be at risk of dysphagia (χ2 =
6.273 p = 0.01) compared to those at risk of malnutrition. Participants in hospital level of
care were also more likely to be at risk of dysphagia compared to those in rest home level of
care (χ2 = 4.627 p = 0.03).
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Conclusions: These findings suggest there may be a high prevalence of nutrition risk
among older adults newly admitted to ARRC facilities within New Zealand and that existing
poor nutrition may have contributed to the need to move into ARRC. The predisposing
factors that affect nutrition status warrant further investigation so initiatives can be
undertaken to avoid a change in living situation. The results highlight the need for nutrition
screening and early intervention by a dietitian.
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Keywords
Older people, Older adults, Elderly, Nutrition, Malnutrition, Dysphagia, Residential care, Screening, Evaluation, Waitemata, New Zealand