Nutritional and Fall Risk Among Older Women Living in Long-Term Care Facilities of India

Abstract

The objectives of the study were to assess the nature of nutritional and fall risk in older adults living in LTC facilities in New Delhi, evaluate the inter-relationship of nutritional and fall risk, and assess whether depression, fear of falling, and physical function predict fall risk, and to test the reliability of nutrition and fall risk measures. Eighty five women aged 60 years and over living in six LTC facilities in New Delhi were recruited. Measures included the Mini Nutritional Assessment (MNA), Falls Efficacy Scale International (FES-I), Downton Index, SF-36 Health Survey, Geriatric Depression Scale (GDS), Mini Mental State Exam (MMSE), and a background profile and physical activity questionnaire. Mobility was assessed using Timed up and go test (TUG), and handgrip strength was assessed using Jamar hydraulic hand dynamometer. Using SPSS software (version 22.0), descriptive statistics, correlation between different variables, predictors of fall risk, and reliability measures were analysed. The mean age of participants was 74.21(5.52) years. A majority were widowed with poor educational and income level. Findings revealed that 54% of the older women were at a high level of nutritional risk. The factors that accounted for a large proportion of variance in the nutritional risk level were mobility status, intake of psychotropic medications, low dietary intake, and poor self-perception of health status. MNA scores had significant negative correlation with Downton Index scores (R= -.419, p<.001) which implies that higher MNA scores (lower nutritional risk) were associated with lower scores on Downton Index (lower fall risk). Multiple regression analysis revealed that fear of falling, fall history, body pain, functional mobility, gait condition, and depression were predictors of fall risk. Analysis of the psychometric properties of the main constructs showed that the reliability of MNA was low (Cronbach’s alpha= 0.3) while the reliability of Downton Index was fair but acceptable (Cronbach’s alpha=0.7). The study highlights the burden of nutritional and fall risk among older adults living in LTC in India, the need to establish the psychometric properties of tools for various cultural contexts, and plan intervention studies to address this significant co-existing health issue.