Energy and protein intake, anthropometrics, disease burden and 1-year mortality in elderly home-care receivers living in Germany

Abstract

The demographic structure in Germany has changed remarkably within the last decades. The number of old and very old people rises steadily and subsequently the number of elderly home-care receivers. Quality of life of this population group is decisively dependent upon their health status and, thus, also upon their nutritional status. Current data from studies with nursing home residents and geriatric patients revealed a high risk of underweight that correlates with a high risk of morbidity and mortality. However, to date corresponding data about the situation of elderly home-care receivers living in Germany is lacking.<br /> Therefore, the first aim of this thesis was to capture the nutritional and health status of elderly home-care receivers living in Germany and to identify negative associations between nutritional status and individual disease burden. The cross-sectional study (funded by the Federal Ministry of Food, Agriculture and Consumer Protection, BMELV) investigated the nutritional and health status of 353 elderly home-care receivers in the age of 65 years and above in three urban areas of Germany (Bonn, Nuremberg, Paderborn). Energy and protein intake were monitored by a three-day prospective nutrition diary, the nutritional status was assessed by BMI, mid upper arm and calf circumference measured by researchers. Medical conditions were assessed in personal interviews. <br /> Participants reported an average of 5 chronic diseases, while one third was suffering from dementia. Further, over one third complained about a moderate (30%) or a poor (7%) appetite. More than half (52%) suffered from chewing problems and almost one third (28%) from swallowing problems. Daily mean energy intake was 2017 kcal in men and 1731 kcal in women and mean protein intake amounted to 1.0 g/kg body weight for both male and female participants. Mean BMI was 28.2±6.2kg/m², 4% of seniors had a BMI of <20kg/m². Critical mid upper arm circumference (<22 cm) was indicated in 6% of subjects while 11% of the male and 21% of the female subjects showed a calf circumference of <31 cm. BMI, mid upper arm and calf circumference were significantly negatively associated with high care level (I: 29.1±6.4; II: 27.6±6.0; III: 25.1±4.5), prevalence of dementia, hospitalization in the previous year, nausea/vomiting, poor appetite, and eating difficulties like dependency, chewing and swallowing problems. Considering the BMI, home-cared elderly have a lower risk for underweight in comparison with nursing home residents. However, the negative association between disease burden and nutritional status underscores the necessity to implement timely nutrional intervention as part of home care. <br /> To date, the relation between BMI and all-cause mortality in older adults has been inconclusive and no study has investigated this interrelation for a German population of elderly home-care receivers. Second aim of the present thesis was to investigate the relationship between BMI and 1-year mortality in the aforementioned study population. Mean BMI of elderly people that deceased within one year was 25.4±4.4 kg/m² which was significantly lower than that of survivors (28.7±6.4 kg/m²). BMI values <20 kg/m² at study entry were associated with highest mortality risk (one year mortality rates for BMI <20, 20-30, >30 were 39%, 17% and 9%, respectively).