Original Communication
European Journal of Clinical Nutrition (2005) 59, 474–479. doi:10.1038/sj.ejcn.1602096 Published online 2 February 2005
Low staffing level is associated with malnutrition in long-term residential care homes
Guarantor: J Woo.
Contributors: JW designed the study, organized the execution, arranged data analysis and wrote the paper. IC provided the major input in computerizing the RAI so that data entry could be carried out in the field and arranged data entry. EH and FC arranged and carried out the field study. AS analyzed the data.
J Woo1,2, I Chi3, E Hui1, F Chan4 and A Sham2
- 1Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong
- 2Department of Community & Family Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
- 3Department of Social Work & Social Administration, University of Hong Kong, Shatin, Hong Kong
- 4Fung Yiu King Hospital, Hong Kong
Correspondence: J Woo, Department of Medicine & Therapeutics, Prince of Wales Hospital, Shatin, N.T. Hong Kong. E-mail: jeanwoowong@cuhk.edu.hk
Received 17 February 2004; Revised 21 September 2004; Accepted 15 October 2004; Published online 2 February 2005.
Abstract
Objective:
To determine if staffing level is associated with poor nutrition in the long-term residential care setting, adjusting for other confounding factors.
Design:
Cross-sectional survey.
Setting:
In total, 14 residential care facilities in Hong Kong, stratified by nature (government subvention or for-profit) to reflect the overall proportion in Hong Kong.
Subjects:
A total of 1914 subjects were assessed, using the Resident Assessment Instrument (RAI) 2.0. The response rate was 95% (1820 subjects), of which 1699 subjects had complete nutritional information.
Intervention:
Body mass index (BMI) was calculated by weighing and height measurement, and arm span was used if the subject could not stand. Subjects who were receiving parenteral or enteral nutrition via nasogastric of enterostomy tubes were excluded. A history of weight loss of 5% in the past month or 10% in the past 6 months, leaving 25% of food uneaten, and BMI <18.5 kg/m2 were examined as nutritional indicators. Association with age, gender, functional disability, oral problems, taste problems, presence of physical diseases and psychological well-being was examined using 
2-test, and multiple logistic regression.
Results:
In all, 26% of residents had a BMI <18.5 kg/m2, with a higher prevalence in the for-profit homes. History of weight loss and the record that 25% of food was left uneaten were poor indicators of low BMI. Multivariate analysis showed that having chronic obstructive airways disease, requiring help with feeding, being female, older age, were factors associated with an increased risk of poor nutrition, while being independent in activities of daily living and higher staff levels were associated with a reduced risk.
Conclusion:
Poor nutrition is a persistent problem in the long-term care setting, and inadequate staffing levels may be a reversible cause. However, resource limitations may render efforts at improvement difficult.
Sponsorship:
SK Yee Memorial Fund.
Keywords:
malnutrition, residential care homes, elderly, staff levels, resource
