Background: Veterans account for approximately one-third of the elderly population in Taiwan. Most of these veterans came to Taiwan with the central government in late 1940s and have served in the armed forces since then. Their lives are different from most civilian citizens and they have special health
problems.
Objective: The study was to gain an understanding of the nutritional status of the veterans and to identify the factors important in determining their nutritional status.
Methods: Using purposive sampling, the study recruited 160 of the 350 male veterans in a nursing home managed by a VA hospital in central Taiwan as study subjects. Only those who were cognitively functional and without acute disease/infection were allowed to participate. Each subject was interviewed with a structured questionnaire for personal data, health status and answers to the MNA (Mini Nutritional Assessment), GDS (Geriatric depression scale), CNAQ (Council on Nutrition Appetite Questionnaire) and ADL (Activities of Daily Living), and was measured for anthropometric parameters. Subjects bio-barkers were obtained from their routine measurements carried out at the institution. Their nutritional statuses were graded with three versions of the MNA: the original, MNA-TI which adopted population-specific anthropometric cut-points, and MNA-TII which further had the BMI question in the scale removed and its scores reassigned. All subjects signed a written consent and the IRB of the Hospital approved the study protocol.
Results: The average age was 81 years. The original MNA graded 14.4% malnourished, 64.4% at risk and 21.3% normal; the MNA-TI graded 10.6, 63.8 and 25.6%; and the MNA-TII graded 19.4, 54.4 and 26.3%, respectively. Analysis of these results with Frieman test and Wilcoxon multiple-rank test showed
significantly differences among the results of all three versions. However, when malnourished and at risk proportions were combined, only the original MNA was different from the two revised versions. Results also showed that 71.3% of veterans had the tendency to have depression, over 80% had moderate to
dependency in ADL, and 54% had poor appetite. The MNA scores of all three versions were highly correlated with hemoglobin, serum albumin, ADL scores, CNAQ scores, MAC, CC, BMI, hospital length of stay, and number of emergency visits, but not with number of chronic diseases and number of prescribed drugs. With the exception of BMI, all parameters showed the strongest correlations with the scores of MNA- TII than of the original scale or MNA-TI. Regression analysis showed that only MAC, CC and albumin were parameters significantly associated with the MNA scores.
Conclusion: Results of this study suggest that a relatively high proportion of veteran residents are at risk of malnutrition and high proportions of these residents also have impaired ADL, psychological problems and poor appetite. The MNA, especially MNA-TII can grade the nutritional status of the veterans effectively. Calf circumference is the leading factors associated with the nutritional status. These results suggest that the MNA can be used for routine screening for individuals with emerging nutritional problems and routine exercise is important for maintaining good nutrition and health.
Keywords: Veterans, nutritional status, Nutritional assessment, calf circumference, elderly.
