Malnutrition as an independent risk factor for incident delirium in cohort of older adults receiving domiciliary care services, 2025, Bøhn et al

[Midnattsol]

Background: Malnutrition and frailty frequently affect older adults receiving domiciliary care services, increasing their vulnerability to adverse events such as delirium. Despite this, the role of malnutrition as a risk factor for delirium in this population remains under-researched. The aim of this study was to examine the relationship between nutritional status and the development of delirium over a 2-year period among older adults who received domiciliary care services.

Method: In this 2-year prospective cohort study, we included 210 participants aged 65 years or older who received domiciliary care services at least once per week. Nutritional status was assessed using the Mini Nutritional Assessment at the time of inclusion, while delirium was assessed weekly, upon admission to hospital, and upon clinical indication according to DSM-5 criteria. Logistic regression analysis was used to examine the relationship between malnutrition and delirium.

Results: Of the sample, 116 (55.2%) were malnourished/at risk of malnutrition at the time of inclusion. Over a 2-year period, 42.4% developed delirium. The odds ratio for developing delirium was 2.00 (95% CI 1.08-3.72, P = 0.028), for the group with malnutrition/risk of malnutrition, adjusted for covariates.

Conclusion: Malnutrition is an independent risk factor for delirium in older adults receiving domiciliary care services. These findings highlight the importance of regular nutritional assessments and interventions to potentially reduce the risk of delirium in this vulnerable population.

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[Midnattsol]

I wonder how much cognitive impairment could be caused by malnutrition in pwME. Being housebound could by itself be enough to put someone in the "at risk" category, so that's quite a lot of us in total.

 

[Utsikt]

Could the causality go the other way - people that are more confused are more likely to have malnutrition?

 

[Trish]

I wonder how much cognitive impairment could be caused by malnutrition in pwME. Being housebound could by itself be enough to put someone in the "at risk" category, so that's quite a lot of us in total.

Added risks for pwME of not being well enough to prepare healthy food, loss of appetite due to nausea, too tired to chew, too poor to pay for healthy food. So many reasons.

 

[Midnattsol]

Could the causality go the other way - people that are more confused are more likely to have malnutrition?

The malnutrition screening was done prior to delirium onset, so while confusion itself can definitely cause malnutrition that was not the order of events in this study. However a single measurement of nutrition status two years prior to delirium onset doesn’t say much about nutrition status at delirium onset. But delirium would not necessarily be present for long enough to cause a «at risk of malnutrition» label since it usually requires the condition to have been present for so-and-so long and to have caused so-and-so much weight loss.

Although with the terrible status of nutrition care in Norway (for individuals receiving healthcare services at home you can easily find 50-60% «at risk» of malnutrition at a given timepoint) you could argue that that it is likely the persons at risk have not received adequate help to improve their nutrition status so they would be in/out of malnutrition often depending on chance.

With the new guidelines for nutrition screening and a simplified screening method, together with improved electronic journal systems the methodology of a study like this could be greatly improved. The Mini Nutritional Assessment in the study is a tool with six questions in part one, and an additional 12 question if the person scores badly on part one, so it was often not performed as it «took too long». Now it is recommended to use the Malnutrition Screening Tool with three questions, and it should be done at least at the start of home based services and then at regular intervals depending on how the person is doing. You could potentially have multiple nutrition statuses over time to improve analysis ad the nutrition status wouldn’t be as outdated as in this case.

Added risks for pwME of not being well enough to prepare healthy food, loss of appetite due to nausea, too tired to chew, too poor to pay for healthy food. So many reasons.

Oh definitely! In Norway there is a list of conditions where a GP should do a nutritional assessment so and so often, I feel ME should be on that list due to similarities in impairments in daily living.

 

[V.R.T.]

I wonder how much cognitive impairment could be caused by malnutrition in pwME. Being housebound could by itself be enough to put someone in the "at risk" category, so that's quite a lot of us in total.

I have been lucky enough to have care from loved ones the whole time i have been severe. I have eaten quite well (apart from when i was on a low histamine diet but that was mostly fresh healthy foods) for the five years I have been severe. My cognitive issues have been atrocious the whole time.