title: Nutritional risk in an urban homebound older population. The nutrition and healthy aging project.
abstract: 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.
authors.affiliation: Boston University Medical Center School of Public Health, 715 Albany Street, Talbot 259W, Boston, Massachusetts 02118, USA. bmillen@bu.edu
authors.forename: B E
authors.initials: BE
authors.lastname: Millen
authors.forename: R A
authors.initials: RA
authors.lastname: Silliman
authors.forename: J
authors.initials: J
authors.lastname: Cantey-Kiser
authors.forename: D L
authors.initials: DL
authors.lastname: Copenhafer
authors.forename: C V
authors.initials: CV
authors.lastname: Ewart
authors.forename: C S
authors.initials: CS
authors.lastname: Ritchie
authors.forename: P A
authors.initials: PA
authors.lastname: Quatromoni
authors.forename: J L
authors.initials: JL
authors.lastname: Kirkland
authors.forename: S R
authors.initials: SR
authors.lastname: Chipkin
authors.forename: N A
authors.initials: NA
authors.lastname: Fearon
authors.forename: M E
authors.initials: ME
authors.lastname: Lund
authors.forename: P I
authors.initials: PI
authors.lastname: Garcia
authors.forename: P P
authors.initials: PP
authors.lastname: Barry
mesh_terms: 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*