A Two Year Follow up of Nutrition Status Among Veterans in a Nursing Home Setting: The Impact on Mortality

Introduction/Objective: In 2008, 55 veterans living in a nursing home were examined using the Mini Nutritional Assessment (MNA). (Bostrom AM, et al. Nutrition Status Among Residents Living in a Veterans' Long-Term Care Facility in Western Canada: A Pilot Study. J Am Med Dir Assoc 2011; 12:217-225) The sample was 90% male and the mean age was 87 years. Based on MDS 2.0 data, most (80%) had moderate/severe dementia (≥3 on the Cognitive Performance Scale (CPS), nearly half (47%) scored ≥6 on the Depression Rating Scale (DRS) and a quarter (25%) had unstable health (scored ≥3 on the Changes in Health, End-stage disease and Symptoms and Signs (CHESS)). The assessment with the MNA tool found the majority were at risk for malnutrition (58%) or malnourished (31%). Three predictors were identified that were statistically significant: 1) depression (DRS scores), 2) severity of dementia (CPS scores), and 3) health instability (CHESS scores). The three factors explained 42.6% of the variance of the total MNA score. Care changes were instituted after the first data collection. Food and fluid intake was more frequently monitored and weight more regularly monitored. Results of the dietitian's quarterly review of nutrition status were shared at team meetings. A nutritional supplement program was introduced for the veterans whose nutritional status was identified to be ‘high-risk’, i.e., a dose of the supplement was given 4 times daily when medications were administrated. The objectives of this follow-up study were to determine the impact of nutritional care changes, in particular in regards to introducing the nutritional supplement program for high-risk residents, and to examine whether nutritional status was a determining factor for residents who survived two years following the 2008 pilot study.