Inflammation Markers and Malnutrition as Risk Factors for Infections and Impaired Health-Related Quality of Life Among Older Nursing Home Residents

Objectives

To explore malnutrition and inflammation markers as risk factors for poor outcome such as infections and impaired health-related quality-of-life (HRQoL) among nursing home residents.

Design

Prospective study lasting 8 months.

Setting

Three nursing homes in Helsinki, Finland, in 2003.

Participants

Sample 1 included 199 residents whose Mini Nutritional Assessment (MNA) scores and complete follow-up records concerning infections and mortality were available, and Sample 2 included 55 patients (subsample) whose data concerning laboratory values, HRQoL, and infections during the 8 months follow-up period were available.

Measurements

At baseline all residents were interviewed with a structured questionnaire consisting of demographic characteristics, activities of daily living (ADL), MNA, and 15D HRQoL instrument. Blood samples were drawn at baseline (hsCRP, IL-10, TNF-alfa,TGF-beta 1,WBC) and during follow-up if infections arose (CRP). Data concerning infections and mortality during the 8-month follow-up were collected.

Results

In the whole study group (N=199), malnutrition according to the MNA (<17, n=79) was associated with poor outcome (a serious infection and/or death) during 8 months follow-up compared with those not malnourished according to the MNA (>17, n=120) (30.4% versus 14.2%, P=.006). However, MNA score below 17 did not predict infections in the subsample (n=55). The mean age of residents in subsample was 83 years, 44 (80%) were women. Those with MNA below 17 (n=18) did not differ from others (MNA>17, n=37) with respect to age, gender, ADL-functioning, cognition, or inflammatory markers. The group with MNA below 17 had significantly lower HRQoL according to the 15D both at baseline and at 8 months.

During the 8-month follow-up, subsample residents in the highest quartile of hsCRP at baseline (>4.38mg/L, n=13) had more infections than residents in lower quartiles (<4.38mg/L, n=42). None of the other inflammation markers were associated with the number of infections or with HRQoL.

Conclusion

Malnutrition according to the MNA and hsCRP may be used as markers to flag nursing home residents at risk for poor outcome.

Keywords: Aged, nursing home, MNA, infections, HRQoL, cytokines, hsCRP