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Poor Nutrition as a Risk Factor for Depression and Disability


Am Fam Physician. 2000 Feb 15;61(4):1139.

Malnutrition is associated with increased mortality, cost, physician visits, hospital admissions and length of hospital stay. Boult and associates tested a nutritional checklist to determine if it could provide information about future disability, depression and mortality among elderly patients who were known to be at risk for hospitalization.

The self-administered DETERMINE checklist (see accompanying table) has been validated in some populations (although not in the elderly) to screen for nutritional risk. This study sought to use the checklist as a secondary screening tool to stratify high-risk elderly patients and identify those who were at particularly high risk of functional disability and depression. Patients were recruited by mail and were included if they were at least 70 years of age and had a calculated probability of repeat hospital admission (based on a questionnaire) of at least 0.4. Patients with this high probability were then randomized to receive six months of routine care or an outpatient geriatric evaluation and management protocol. The protocol included a telephone interview (with questions about general health, functional status and symptoms of depression), an in-home interview (where the checklist was completed) and a history and physical examination. One year after the start of the study, function, depression and mortality were assessed.

The DETERMINE Checklist

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Of the 2,286 patients who were determined to be at high risk for hospital admission, 251 were enrolled (the others were unwilling or unable to participate). Most of the checklist scores (over 90 percent) were lower than 8 (zero = lowest risk, 21 = highest risk). Patients with high checklist scores had lower functional ability, more depressive symptoms, lower cognitive status scores and more chronic diseases. Overall, checklist scores greater than 4 were associated with higher rates of disability and depression after 12 months. The checklist did not predict mortality.

The authors conclude that a DETERMINE checklist score of at least 4 was associated with more symptoms of depression and lower functional ability. However, poor nutrition in and of itself is not an independent predictor of these outcomes. A higher score on this checklist may enable the physician to target patients who are most likely to have certain problems, such as depression and decreased function, one year later.

Boult C, et al. The validity of nutritional status as a marker for future disability and depressive symptoms among high-risk older adults. J Am Geriatr Soc. August 1999;47:995–9.



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