Nutritional status and independence in instrumental activities of daily life in the elderly living in nursing homes and community dwellings: A comparative study

Abstract

Background and objective: Dietary habits and patterns have been shown to have strong influence on the mental wellbeing of elderly. Aim of the study: to compare the current nutritional status and independence in instrumental activities of daily life (IADL) in the elderly living in nursing homes and community dwellings.

Methods: The study was carried out in nursing homes and elderly clubs in Cairo using descriptive comparative design. It involved a group of 125 institutionalized elderly from six nursing homes in Cairo and a second group (community dwellers) of 250 elderly from social clubs or elderly daycare centers in Cairo. The data collection tools were an interview questionnaire including the Mini Nutritional Assessment (MNA), the IADL, and the 24-hour recall for dietary intake in addition to an inventory checklist for the nursing homes. The data collection lasted from October 2016 to December 2017.

Results: The institutionalized elderly had significantly higher median age, more divorced /widows, from urban areas, with higher education, and more insufficient income; they were more obese (p = .02). In MNA 62.0% of those in community dwellings were normal compared to only 17.6% of institutionalized (p < .001), but significantly more institutionalized elders had deficient caloric intake (80.0%) compared to 69.6% of those in community dwellings (p = .03). The IADL were significantly better among those in community dwellings. In multivariate analysis, having recreations was a positive predictor of MNA score, while smoking and institutionalization were negative predictors. As for the IADL score, the level of education was its positive predictor, whereas age and institutionalization were negative predictors. Body mass index (BMI) was positively predicted by female gender, educational level, and having recreations, and negatively predicted by age. For institutionalized elderly, income was a positive predictor of the MNA score, whereas the length of institutionalization was a negative predictor.

Conclusion and recommendations: Malnutrition and dependency in IADL are more prevalent among elderly in nursing homes, and are related to the duration and characteristics of the institutionalization. The study recommends improving the dietary services in nursing homes, with training programs for their staff and regular monitoring of food services.