Nutritional risk in an urban homebound older population. The nutrition and healthy aging project.
OBJECTIVE
To establish the prevalence of nutritional problems and their related socio-demographic and health-related risk factors in the homebound elderly population.


METHODS
Subjects included 239 men and women, ages 65 to 105 years. Trained, two-person field teams conducted comprehensive in-home assessments. Medical record reviews assessed co-morbidity and medication use.


RESULTS
The majority of these urban study subjects are of very advanced age (mean age 81 years), female (72%), non-white (73%), living alone (51%), of low income (76%), and somewhat socially isolated (26% had no weekly social contact). More older women than men were widowed (60 vs. 33%, respectively) and poor (80 vs. 67%). The disease burden and functional dependency were both high in men and women; 77% had three or more chronic medical conditions; 76% were functionally dependent in one or more ADL's and 95% in one or more IADL's. Poor dietary quality was universal in these older men and women; half or more consumed diets that deviated from recommended standards for at least 13 of the 24 nutritional guidelines studied. Five percent of subjects were underweight (Body Mass Index (BMI) <18.5); 22% were overweight (BMI 25.0-29.9); and 33% were obese (BMI >30.0). Fasting albumin, hemoglobin, and absolute lymphocyte concentrations were borderline to very low in 18-32%. Dyslipidemia was more common in women; however, men and women had similar Total:HDL cholesterol ratios.


CONCLUSIONS
Nutritional status is poor in homebound persons of very advanced age with substantial co-morbidity and functional dependency. The complexities of nutritional risk necessitate multi-disciplinary and individualized nutritional intervention strategies.
Millen
B E
BE
Boston University Medical Center School of Public Health, 715 Albany Street, Talbot 259W, Boston, Massachusetts 02118, USA. bmillen@bu.edu
Silliman
R A
RA
Cantey-Kiser
J
J
Copenhafer
D L
DL
Ewart
C V
CV
Ritchie
C S
CS
Quatromoni
P A
PA
Kirkland
J L
JL
Chipkin
S R
SR
Fearon
N A
NA
Lund
M E
ME
Garcia
P I
PI
Barry
P P
PP
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology*; D004032:Diet; D005260:Female; D016330:Frail Elderly; D018577:Homebound Persons / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D009748:Nutrition Disorders / Q000453:epidemiology*; D009752:Nutritional Status; D009765:Obesity / Q000453:epidemiology; D015995:Prevalence; D012944:Social Support; D012959:Socioeconomic Factors; D014504:Urban Health; D014505:Urban Population / Q000706:statistics & numerical data*