Malnutrition Risk, Physical Function Decline and Disability in Middle-Aged and Older Adults Followed Up in the Singapore Longitudinal Ageing Study

Abstract

Purpose

Malnutrition and population ageing are doubly global healthcare challenges. It is widely recognized that disability is a major contributor to malnutrition among older people, but the importance of reducing malnutrition risk (MR) for disability prevention is given little attention. We investigated the association between MR and risk of incident disability and functional decline among community-dwelling older persons.

Materials and Methods

Prospective cohort study of community-dwelling older adults aged 55 and above (Singapore Longitudinal Ageing Study) with 3–5 years follow-up. MR was measured at baseline using an appropriate and validated index (ENIGMA); physical and functional measures at baseline and follow-up included instrumental and basic activity of daily living (ADL), knee extension (KES), gait velocity (GV), timed up-and-go (TUG).

Results

Compared to low MR, mild-moderate MR (OR = 1.43, 95% CI = 1.02–2.01) and severe MR (OR=1.74, 95% CI=1.10–2.74) were associated with higher risks of incident disability. Severe MR was associated with functional decline (OR = 1.69, 95% CI = 1.11–2.57). Estimates were adjusted for demographic, social, lifestyle behaviour and health variables. In particular, eating difficulty was associated with incident disability and functional decline, and low lymphocyte with functional decline. Severe MR and low albumin were associated with 37% worse GV and 126% worse TUG declines; consuming few vegetables or fruits with 34% worse KES decline; polypharmacy with 56% worse TUG decline.

Conclusion

Malnutrition risk increased the risk of incident disability and functional decline in non-disabled persons, it worsened physical performance declines. Further studies should investigate the effectiveness of nutritional interventions in reducing the risk of disability among older people.

Keywords:

• malnutrition
• functionality
• ageing
• prospective cohort study

Acknowledgments

We thank the following voluntary welfare organizations for their support: Geylang East Home for the Aged, Presbyterian Community Services, Thye Hua Kwan Moral Society (Moral Neighbourhood Links), Yuhua Neighbourhood Link, Henderson Senior Citizen’s Home, National Trade Union Congress Eldercare Co-op Ltd, Thong Kheng Senior Activity Centre (Queenstown) and Redhill Moral Seniors Activity Centre.

Disclosure

Professor Tze Pin Ng report grants from Agency for Science, Technology and Research (A*STAR), grants from Ministry of Health (MOH) National Medical Research Council, during the conduct of the study. The authors report no other conflicts of interest in this work.