Objectives: Malnutrition in older persons is associated with an increased risk of mortality. Useful strategies to counteract malnutrition are nutritional interventions, such as fortified diets, oral nutritional supplements (ONS), tube feeding, and parenteral nutrition. Presently, it is not known if these strategies can reduce mortality risk of nursing home (NH) residents who are malnourished or at risk of malnutrition. Thus, the aim of this study was to investigate if nutritional intake and interventions are associated with mortality in this specific population.
Design: One-day cross-sectional study with outcome evaluation after 6 months, repeated in yearly intervals since 2007.
Setting: A total of 507 NH units from 15 countries.
Participants: NH residents participating in the nutritionDay between 2007 and 2014, aged 65 years or older with a poor nutritional status (body mass index <20 kg/m2 or weight loss >5 kg in the last year or at risk of malnutrition or malnourished according to NH staff).
Measurements: Data on resident and unit level were collected on nutritionDay and mortality status was assessed 6 months later. Residents' nutrition (intake at lunch on nutritionDay) and nutritional interventions (diet, use of ONS, supplementary tube feeding, supplementary parenteral nutrition) were of interest as influencing factors of 6-month mortality, adjusted for 23 potential confounders (residents' nutritional status, general residents' characteristics, and unit characteristics). Univariate generalized estimating equations were performed for all variables and significant predictors (P < .01) included in a multivariate analysis.
Results: Six-month mortality rate of the included 4857 NH residents was 20.3%. Univariate analysis identified residents' diet, use of ONS, intake at lunch, and 14 confounders as predictors of mortality. Intake at lunch and 7 confounders remained in the multivariate model [area under the receiver operating curve = 0.687; 95% confidence interval (CI) 0.669-0.706; P < .001]. The less residents ate for lunch, the higher was the risk of mortality, with the highest odds ratio (OR) for residents who ate nothing (OR 3.38; 95% CI 2.58-4.42). Mortality risk was OR 2.36; 95% CI 1.91-2.92, and OR 1.64; 95% CI 1.29-2.07 times higher for immobile and partially mobile compared with mobile residents. Cancer, dysphagia, weight loss >5 kg in the last year, body mass index <20 kg/m2, residents' country region, and increasing age were also associated with a higher mortality risk.
Conclusions: Poor intake at lunch on nutritionDay was a strong predictor of mortality, whereas the use of nutritional interventions was not associated with 6-month mortality in NH residents who are malnourished or at risk of malnutrition. The reasons for these findings need to be clarified.
Keywords: Nursing home; malnutrition; mortality; nutrition; nutritional intake; nutritional interventions.
Copyright © 2016 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.