title: Assessing the nutritional status of older individuals in family practice: Evaluation and implications for management.
abstract: OBJECTIVE
  Malnutrition is emerging as a multidimensional concern of ageing with a high prevalence among nursing home residents. This study investigated the extent of malnutrition among old subjects in family practice and its relationship with major complications.
  
  
  METHODS
  Over 75 years old subjects (n = 274) filled the Mini Nutritional Assessment questionnaire. Appearance of major events in the following 6 months were registered.
  
  
  RESULTS
  MNA scored were 11.5 ± 3.1, with 175 (64%) subjects showing no malnutrition, 69 (25%) resulted at risk, and 30 (11%) malnourished. Within at risk group, 1.4% was resident, 7% bed rested, 8% had a history of major bone fracture, 33% was demented and 24.6% hospitalized at least once in the last year. Among malnourished patients, 10% was resident, ten bed rested with 70% showing multiple bedsores, 20% have had bone fractures, 60% were demented and 13% hospital admitted in the previous year. In over 90% of them, malnutrition had neither diagnosed nor considered before. During follow-up, a significantly higher number of major events including death occurred in the malnourished group. By multivariate logistic regression, n = 56 (20.4%) patients resulted at risk of major complications. The sensitivity of the questionnaire in identifying these patients was 84% with the cut-off value of 7 associated with the highest prediction (positive predictive value, 0.92; negative predictive value, 0.71) yielding a specificity of 92%.
  
  
  CONCLUSIONS
  The prevalence of malnutrition is high among older subjects in the setting of family practice. The Mini Nutritional Assessment allows to identify malnourished subjects better than BMI and effectively predicts the risk of major events.
authors.affiliation: Italian College of General Practitioners, Bari, Italy.
authors.forename: Tecla
authors.initials: T
authors.lastname: Mastronuzzi
authors.affiliation: Italian College of General Practitioners, Bari, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Paci
authors.affiliation: Department of Biosciences and Human Oncology (DIMO), Clinica Medica 'A. Murri', University of Bari Medical School, Policlinico Hospital, Bari, Italy.
authors.forename: Piero
authors.initials: P
authors.lastname: Portincasa
authors.affiliation: Italian College of General Practitioners, Bari, Italy.
authors.forename: Nicoletta
authors.initials: N
authors.lastname: Montanaro
authors.affiliation: Italian College of General Practitioners, Bari, Italy. Electronic address: igratta@tin.it.
authors.forename: Ignazio
authors.initials: I
authors.lastname: Grattagliano
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D019468:Disease Management; D005194:Family Practice; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D016015:Logistic Models; D008297:Male; D044342:Malnutrition / Q000175:diagnosis* / Q000453:epidemiology*; D015999:Multivariate Analysis; D015596:Nutrition Assessment; D009752:Nutritional Status; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires
keywords: Ageing; Elderly; Malnutrition; Mini nutritional assessment