Malnutrition has been reported to prevail in 30-85% of the nation's 1.5 million elderly currently residing in nursing homes. Nutritional deficiencies, frequently not recognized, may be common underlying causes of adverse clinical outcomes. In a prospective non-interventional pilot study, clinical outcomes and biochemical indices of immune, integumentary, functional, and psychobehavioral status are examined in light of nutritional status in nursing home patients. The first specific aim is to characterize malnutrition in the institutionalized elderly by ascertaining: 1) its prevalence and natural progression in newly admitted nursing home patients receiving standard care; 2) the relationship of identified malnutritive states to mortality and morbidity, selected population-relevant immunologic, integumentary, and cognitive function clinical indices; and 3) which commonly recognized indices of malnutrition serve as primary indicators of compromised clinical outcome. The second specific aim is to develop, from preliminary information obtained, an operational definition of """"""""malnutrition"""""""" to be used in a larger scale study to test selected nutritional interventions in the prevention and treatment of malnutrition and its clinical sequalae in nursing homes. More specifically, nutritional assessments consisting of consumption studies, anthropometric measurements, biochemistries, and body composition determination by bioelectrical impedance are performed. Simultaneously, selected clinical outcomes and biochemical indices of immune (infection, cell-mediated immunity), integumentary (pressure sores), functional (activities of daily living), and psychobehavioral (cognition, depression, quality of life) status are examined in light of nutritional status (adequately nourished vs. malnourished) at baseline, and 1, 6, and 12 months after admission.
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