Nutritional assessment of elderly people in nursing house and at home in Tallinn.

In Merivälja nursing house, the actual nutrition in 2000 (by menus in 10 days intervals in January and April) of 105 elderly was calculated (with the local ANKE-PC-program) and compared with the nutrition data of the same nursing house in 1978 and of the home-living retired elderly people in 1995. Nutritional status has been estimated by Mini Nutritional Assessment (MNA) and Body Mass Index (BMI) in 51 elderly (aged 51-97 years) at the nursing house and in 150 elderly (aged 58-86 years) living at home in Tallinn. Over 20 years interval there was only a modest improvement in nutrition (P/C ratio had achieved 0.5 and dietary cholesterol has decreased) and in choice of healthier foods at the nursing house. Calculated total food energy was high, depending on highly planned carbohydrates (from cereals and sugar) content (57-63% of total energy in 2000 vs. 46% in 1978); in 1978 predominated more animal foodstuffs as main protein (60%) and fat sources (87%) than in 2000 (41-46%) and 64-74%), minerals and vitamins met recommended level, expect of calcium (because of reduced consumption of milk and milk products). The risk of malnutrition by MNA (score <17 or 17-24) was found with the same frequency as in the elderly living at home (26%) as in the nursing house (27.5%). Comparison of MNA results with BMI values showed that 10-22% of the elderly with high BMI (>25) were at malnutrition risk estimated with MNA (by threshold value of risk <24). In conclusion, it is not enough to improve the diets composition in nursing homes for the optimal nutritional status of elderly people. MNA is a better tool for this purpose, because MNA detects more often the malnutrition risk than BMI. Malnutrition has to be considered much more in provision of food and nursing of elderly in nursing houses and at home as well.