Research is still limited on nutrition and quality of life among older adults

Abstract

IntroductionGlobally, the number of older adults is growing exponentially. Yet, while living longer, people are not necessarily healthier. Nutrition can positively impact healthy aging and quality of life (QoL). Two decades ago, nutrition and diet were rarely viewed as key QoL domains, were not part of QoL screening, and QoL studies frequently used unvalidated tools. It is unclear how the nutrition and QoL research area may have since evolved.MethodsA scoping review was conducted in Pubmed of research with community-living older adults (aged ≥65) from developed economies that included 1 of 29 common, valid QoL instruments, nutrition indices, and was published between 1/2000–12/2022. The review followed published methodology guidance and used the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) flow diagram to document identified studies and record number of included/excluded studies (based on scoping review’s pre-specified criteria).ResultsOf 258 studies identified initially, 37 fully met scoping review inclusion criteria; only 2 were QoL studies, 30 focused on nutrition, 3 on measurement tool validation/testing, and 2 were other study types. Most studies (n = 32) were among populations outside of North America; majority were conducted in Europe (n = 22) where the EuroQol 5 Dimension (Eq5D) was used in >1/2 the studies. Of 5 North American studies, the 36-Item Short Form Survey (SF-36) was most frequently used (n = 4). Myriad nutrition indices described various aspects of eating, dietary intake, and nutrition status, making comparability between studies difficult. Studies included several different nutrition questionnaires; Mini Nutritional Assessment (MNA) (n = 8) or Mini Nutritional Assessment Short Form (MNA-SF) (n = 5) were used most frequently. The most frequent anthropometric measure reported was Body Mass Index (BMI) (n = 28). Nutrition-related biochemical indices were reported infrequently (n = 8).DiscussionThe paucity of studies over the last two decades suggests research on nutrition and QoL among community-living older adults remains underdeveloped. Valid QoL instruments and nutrition indices are now available. To ensure greater comparability among studies it is important to develop consensus on core indices of QoL and particularly nutrition. Greater agreement on these indices will advance further research to support healthy aging and improve QoL for community-dwelling older adults.

How quality of life is measured in studies of nutritional intervention: a systematic review

“…Nutrition interventions assist older individuals in meeting nutritional requirements, maintaining physical and cognitive function, key components of QoL. However, we identified few studies focusing on this population, consistent with Arensberg et al findings [ 183 ]. The absence or exclusion of older adults from clinical trials restricts data availability, forcing clinicians to make treatment decisions for older adults without adequate guidance [ 184 ].…”

Quality-of-Life Instruments and Nutrition Screening Tools

“…Further, we identified that a wide variety of instruments measuring different attributes had been used to describe QoL. This disparity can make it difficult for professionals unfamiliar with QoL measurements to choose a tool best aligned with their research purposes 11 . Such findings reiterate the observations of Siette et al that disagreement on core QoL concepts and the inability of a single tool to meet every need have contributed to the lack of development of a standard QoL measure 8 …”

“…The first step in our research was selection of common, validated QoL instruments used in community-living older adult populations. Our previous scoping review of QoL and nutrition research in older adults 11 found that Siette et al had published a systematic review in 2021, describing 29 QoL instruments that were (1) designed for adults (>18 years of age), (2) available in English, (3) used in peer-reviewed research examining QoL outcomes in adults >65 years of age from various care settings (home care, support center, residential care, assisted living group facilities, training facilities, and primary care), and (4) previously assessed for validity and/or reliability 8 . From the 29 QoL instruments described by Siette et al, 8 we selected 20 QoL instruments that were (1) used in countries with developed economies based on the United Nations definition of a “developed economy” 14 and (2) used in community care, that is, home care (supported independent living at home), a support center (provided care for older adults not fully independent, including care provided through senior and adult day centers), and/or primary care.…”

“…Food, diet, and nutrition can play critical roles in many of these domains, especially in the “social connection” domain because eating has a strong social as well as health aspect 10 . Arensberg et al recently conducted a scoping review to identify nutrition and QoL research specifically in older adults living in the community and published since 2000 11 . The researchers reported various QoL instruments were used, making it difficult to compare the results between studies.…”

“…Our study helps fill this void by characterizing the intersections between QoL instruments and nutrition screening tools. Such instruments and tools are often used in nutrition and QoL research 11 and in evaluating community nutrition programs and services 4 . Specifically, we used the QoL domains described by Siette et al 8 to review the overlaps and gaps in previously identified and validated QoL instruments 8 and nutrition screening tools 13 for community-living older adults.…”