title: Malnutrition in older adults on financial assistance in an urban Asian country: a mixed methods study.
abstract: OBJECTIVE
  The objectives of the present study were to assess the nutritional status, identify factors for malnutrition risk and evaluate barriers to adequate nutrition among recipients of the Public Assistance (PA) scheme for socio-economically disadvantaged Singaporeans.
  
  
  METHODS
  Using a cross-sectional study design, we assessed PA recipients' malnutrition risk using the DETERMINE Nutritional Health checklist and the full Mini-Nutritional Assessment (MNA), as well as their nutritional knowledge, co-morbidity burden, depression risk, instrumental and basic activities of daily living (IADL and BADL), and awareness and utilization of available food services. In-depth interviews were also conducted on malnourished individuals (MNA score < 17) to understand barriers to adequate nutrition.
  
  
  METHODS
  Homes of community-living older adults and nursing homes of institutionalized older adults.
  
  
  METHODS
  All PA recipients aged ≥55 years in Central Singapore District.
  
  
  RESULTS
  Four hundred and sixty-five of 511 (91·0 %) eligible PA recipients participated in the study. The prevalence of malnutrition in the study population was 2·8 %. However, 50·3 % were at risk of malnutrition. Among community-dwelling respondents, the risk of malnutrition was independently associated with age >75 years, currently unmarried, BADL impairment, depression risk and BMI < 19·0 kg/m2. Qualitative analysis revealed that financial, social and physical barriers and lack of knowledge were the main contributors to poor nutritional status. Only half were aware of subsidized food services and education increased interest in utilizing food services. Among nursing home respondents, those who were BADL impaired were more likely to be at risk of malnutrition.
  
  
  CONCLUSIONS
  Among PA recipients, the prevalence of malnutrition is low but the risk of malnutrition is high. Education on adequate nutrition and food services are recommended.
authors.affiliation: 1Yong Loo Lin School of Medicine,National University of Singapore,National University Health System,Singapore.
authors.forename: Yu Xuan
authors.initials: YX
authors.lastname: Koo
authors.affiliation: 1Yong Loo Lin School of Medicine,National University of Singapore,National University Health System,Singapore.
authors.forename: Min Li
authors.initials: ML
authors.lastname: Kang
authors.affiliation: 1Yong Loo Lin School of Medicine,National University of Singapore,National University Health System,Singapore.
authors.forename: Angie
authors.initials: A
authors.lastname: Auyong
authors.affiliation: 1Yong Loo Lin School of Medicine,National University of Singapore,National University Health System,Singapore.
authors.forename: Glen Zq
authors.initials: GZ
authors.lastname: Liau
authors.affiliation: 1Yong Loo Lin School of Medicine,National University of Singapore,National University Health System,Singapore.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Hoe
authors.affiliation: 1Yong Loo Lin School of Medicine,National University of Singapore,National University Health System,Singapore.
authors.forename: Melody
authors.initials: M
authors.lastname: Long
authors.affiliation: 1Yong Loo Lin School of Medicine,National University of Singapore,National University Health System,Singapore.
authors.forename: Aaron
authors.initials: A
authors.lastname: Koh
authors.affiliation: 1Yong Loo Lin School of Medicine,National University of Singapore,National University Health System,Singapore.
authors.forename: Frederick
authors.initials: F
authors.lastname: Koh
authors.affiliation: 2Institute of Technical Education,Singapore.
authors.forename: Rain
authors.initials: R
authors.lastname: Liu
authors.affiliation: 3Saw Swee Hock School of Public Health,National University of Singapore,National University Health System,Block MD3,#03-20,16 Medical Drive, 117597Singapore.
authors.forename: Gerald
authors.initials: G
authors.lastname: Koh
mesh_terms: D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D003863:Depression / Q000150:complications; D004032:Diet; D005260:Female; D063105:Food Assistance; D005522:Food Services / Q000706:statistics & numerical data; D005523:Food Supply; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000191:economics / Q000453:epidemiology / Q000209:etiology; D017533:Marital Status; D008875:Middle Aged; D009735:Nursing Homes; D009752:Nutritional Status; D011203:Poverty; D011632:Public Assistance; D012846:Singapore / Q000453:epidemiology; D014505:Urban Population