Perspectives on the Causes of Undernutrition of Community-Dwelling Older Adults: A Qualitative Study.

OBJECTIVES: Undernutrition is a major health concern particularly in vulnerable older adults. The present study aimed to reveal the causes of undernutrition as reported by community-dwelling older adults. DESIGN: Twenty-five semi-structured interviews and two focus group discussions were performed and analyzed. SETTING: Community-dwelling. PARTICIPANTS: Older adults. MEASUREMENTS: A questionnaire on demographics, Short Nutritional Assessment Questionnaire 65+ and interviews on the potential causes of undernutrition. RESULTS: 33 older adults agreed to participate in the interviews and focus groups. Our findings indicate that a wide variety of causes of undernutrition, both modifiable and non-modifiable, were mentioned by the older adults. Many modifiable causes of undernutrition were reported in the mental, social or food and appetite theme, such as poor food quality provided by meal services, the inability to do groceries, loneliness and mourning. Non-modifiable causes included, forgetfulness, aging, surgery and hospitalization. CONCLUSIONS: This study provides guidance to better understand the underlying causes of undernutrition from an older adult's perspective. The modifiable causes provide specific direction towards practical implications that might decrease or prevent undernutrition. Non-modifiable causes should raise awareness of an increased risk of undernutrition by health professionals in primary and secondary care, caregivers and family members.

Symptom burden and its association with change in glucose metabolism status over a 7-year period: the Hoorn Study.

AIMS: To study symptom burden among older people and its associations with change in glucose metabolism status over a 7-year period. METHODS: We conducted a prospective population-based cohort study among 397 older people. We used the revised Diabetes Symptom Checklist to assess symptom burden. Glucose metabolism status was determined using an oral glucose tolerance test. Analyses were adjusted for multiple confounders, including cardiovascular risk and risk of depression (Center for Epidemiological Studies Depression Scale score ≥ 16). RESULTS: Revised Diabetes Symptom Checklist total scores (range 0-100) increased slightly over time among people with normal glucose metabolism (mean difference ß1.04; P = 0.04) and those with impaired glucose metabolism (ß1.96; P = 0.01), but not among people with Type 2 diabetes (ß0.46; P = 0.55). These associations between symptom burden and glucose status were attenuated after full adjustment for multiple confounders and remained statistically significant for those with impaired glucose status. Linear mixed models showed significant mean differences in revised Diabetes Symptom Checklist total scores over time when comparing people with Type 2 diabetes with those with normal or impaired glucose metabolism, but not when comparing subjects with impaired vs normal glucose metabolism; these results did not alter after full adjustment. CONCLUSIONS: Symptom burden increased gradually over time in the people with impaired glucose metabolism and those with normal glucose metabolism, but not in patients with Type 2 diabetes over a 7-year follow-up period.