title: Nutritional risk and body mass index predict hospitalization, nursing home admissions, and mortality in community-dwelling older adults: results from the UAB Study of Aging with 8.5 years of follow-up.
abstract: BACKGROUND
  Nutritional risk and low BMI are common among community-dwelling older adults, but it is unclear what associations these factors have with health services utilization and mortality over long-term follow-up. The aim of this study was to assess prospective associations of nutritional risk and BMI with all-cause, nonsurgical, and surgical hospitalization; nursing home admission; and mortality over 8.5 years.
  
  
  METHODS
  Data are from 1,000 participants in the University of Alabama at Birmingham Study of Aging, a longitudinal, observational study of older black and white residents of Alabama aged 65 and older. Nutritional risk was assessed using questions associated with the DETERMINE checklist. BMI was categorized as underweight (<18.5), normal weight (18.5-24.9), overweight (25.0-29.9), class I obese (30.0-34.9), and classes II and III obese (≥35.0). Cox proportional hazards models were fit to assess risk of all-cause, nonsurgical, and surgical hospitalization; nursing home admission; and mortality. Covariates included social support, social isolation, comorbidities, and demographic measures.
  
  
  RESULTS
  In adjusted models, persons with high nutritional risk had 51% greater risk of all-cause hospitalization (95% confidence interval: 1.14-2.00) and 50% greater risk of nonsurgical hospitalizations (95% confidence interval: 1.11-2.01; referent: low nutritional risk). Persons with moderate nutritional risk had 54% greater risk of death (95% confidence interval: 1.19-1.99). BMI was not associated with any outcomes in adjusted models.
  
  
  CONCLUSIONS
  Nutritional risk was associated with all-cause hospitalizations, nonsurgical hospitalizations, and mortality. Nutritional risk may affect the disablement process that leads to health services utilization and death. These findings point to the need for more attention on nutritional assessment, interventions, and services for community-dwelling older adults.
authors.affiliation: dbuys@uab.edu.
authors.forename: David R
authors.initials: DR
authors.lastname: Buys
authors.affiliation: Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland.
authors.forename: David L
authors.initials: DL
authors.lastname: Roth
authors.affiliation: Department of Medicine, University of California at San Francisco.
authors.forename: Christine S
authors.initials: CS
authors.lastname: Ritchie
authors.affiliation: Division of Gerontology, Geriatrics and Palliative Care, Comprehensive Center for Healthy Aging, and.
authors.forename: Patricia
authors.initials: P
authors.lastname: Sawyer
authors.affiliation: Division of Gerontology, Geriatrics and Palliative Care, Comprehensive Center for Healthy Aging, and Birmingham/Atlanta VA Geriatric Research, Education, and Clinical Center Alabama.
authors.forename: Richard M
authors.initials: RM
authors.lastname: Allman
authors.affiliation: Division of Preventive Medicine.
authors.forename: Ellen M
authors.initials: EM
authors.lastname: Funkhouser
authors.affiliation: Department of Biostatistics, and.
authors.forename: Martha
authors.initials: M
authors.lastname: Hovater
authors.affiliation: Department of Health Care Organizations and Policy, University of Alabama at Birmingham.
authors.forename: Julie L
authors.initials: JL
authors.lastname: Locher
mesh_terms: D000368:Aged; D000407:Alabama; D015992:Body Mass Index; D015897:Comorbidity; D005500:Follow-Up Studies; D006801:Humans; D057187:Independent Living; D008137:Longitudinal Studies; D009026:Mortality; D009735:Nursing Homes / Q000706:statistics & numerical data*; D009752:Nutritional Status; D010343:Patient Admission; D016016:Proportional Hazards Models; D012307:Risk Factors; D012934:Social Isolation; D012944:Social Support
keywords: BMI; Health services utilization; Mortality.; Nutritional risk