title: Malnutrition in institutionalized elderly: how and why?
abstract: OBJECTIVE
  To determine the prevalence of undernutrition and overnutrition in long-term care elderly patients and the functional, behavioral, environmental, nutritional, and medical variables associated with this prevalence.
  
  
  METHODS
  Cross-sectional, observational.
  
  
  METHODS
  Long-term care hospital in Canada.
  
  
  METHODS
  Two hundred elderly patients (n = 166 male), average age 78.5 years.
  
  
  METHODS
  Assessment of nutritional status and presence of specific behavioral, medical, environmental, and functional characteristics known to impact on nutritional status. Nutritional status was determined by weight, % weight loss, BMI, skinfolds, arm circumference, area measurements, and % body fat. Multiple regression analyses were performed to identify the factors associated specifically with undernutrition and overnutrition in this population.
  
  
  RESULTS
  Severe undernutrition was present in 18% (n = 36) and severe overnutrition in 10% (n = 20). Mild/moderate undernutrition was present in 27.5% (n = 55) and mild/moderate overnutrition in 18% (n = 36). Overnutrition was positively associated with primary diagnosis and number of medications and negatively associated with poor appetite, number of feeding impairments, protein intake, and mental state. Undernutrition was positively associated with dysphagia, slow eating, low protein intake, poor appetite, presence of a feeding tube, and age and negatively associated with primary diagnosis.
  
  
  CONCLUSIONS
  Undernutrition exists at a level that is high (45.5%) but not unusual for this type of institutional setting. Behavioral, environmental, and disease-related factors greatly influence nutritional status. Undernutrition appears to be affected by nutritional factors more than overnutrition. Efforts should be directed toward influencing some of these factors to decrease undernutrition in the institutionalized elderly.
authors.affiliation: Parkwood Hospital, London, Ont., Canada.
authors.forename: H H
authors.initials: HH
authors.lastname: Keller
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003677:Deficiency Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D004032:Diet; D005247:Feeding Behavior; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D007326:Institutionalization; D016014:Linear Models; D008297:Male; D015596:Nutrition Assessment; D009748:Nutrition Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D009749:Nutrition Surveys; D009752:Nutritional Status; D009765:Obesity / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D009864:Ontario; D015995:Prevalence; D012307:Risk Factors; D012720:Severity of Illness Index; D012866:Skilled Nursing Facilities / Q000706:statistics & numerical data*