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Abstract: Objectives: To explore the association between depressive symptoms and risk for malnutrition in hospitalized elderly people. Methods: 195 hospitalized medical patients older than 65 years of age were studied in a cross-sectional design. Depression was assessed by 30-item Geriatric Depression Scale (GDS), nutritional status was evaluated by the Mini-Nutritional Assessment (MNA). Eating and digestive problems were assessed using selected items of Nutrition Risk Index (NRI), cognitive and functional status by Folstein and Barthel indices respectively; demographic data, diagnoses and medications were obtained from medical records. Results: The prevalence of depression in the studied population was 28%. MNA scores were significantly lower among depressed patients as compared with non-depressed (22.86 vs. 24.96, p < 0.001), indicating a higher risk for undernutrition among depressed persons. After controlling for age, cognitive status, functional ability, and number of illnesses, undernutrition was significantly associated with depression (OR = 2.23; 95% CI: 1.04-4.8). Conclusions: Nutritional risk is associated with depression in aged inpatients. Close case management of the elderly hospitalized patients that include assessment and treatment for both disorders may be beneficial.
Key words: Depressive symptoms, elderly, risk for malnutrition.
Abbrevations: CC: calf circumference; GDS: Geriatric Depression Scale; MAC: mid-arm circumference; MBI: Modified Barthel Index; MMSE: Mini-Mental State Examination; MNA: Mini-Nutritional Assessment; NRI: Nutritional Risk Index.
Introduction
The prevalence of depressive symptoms in older outpatients ranges from 10% to 20% (1), in elderly patients hospitalized with somatic illness the prevalence of depressive symptoms is even higher: from 22% to 34% (2, 3). Depression in aged persons is associated with increased morbidity (4), prolonged hospital course (5), poor compliance with therapy, poor recovery from somatic illness (6, 7) and higher readmission rates (8).
Undernutrition is likewise prevalent among elderly people; it is estimated that in Europe and North America 20-62% of hospitalized patients are at risk for malnutrition (9-11). Poor nutritional status has been associated with higher rates of complications (12, 13), an increased incidence of nosocomial infections (14), higher hospital costs, and higher mortality rates (15). However, despite the adverse outcomes associated with both depression and undernutrition among hospitalized older adults (4, 5, 7, 12, 13, 15), detection and treatment of these conditions in this population is inadequate (9).
Recent studies suggest that depressive symptoms are more prevalent...