This study examined the relationship between financial strain, or difficulty acquiring necessities, and malnutrition risk in a community dwelling sample of frail and nonfrail women aged 70–79 in the Women’s Health and Aging Study ( ). Malnutrition risk was measured with a modified version of the Mini-Nutritional Assessment Short Form (MNA-SF) and defined as a score <11, financial strain was measured by (1) sufficiency of money on a monthly basis and (2) adequacy of income for food, and income was measured by ordinal categories. Mean (SD) modified MNA-SF score was 12.2 (1.80), and 14.7% of women had malnutrition risk. Women who usually did not have enough money to make ends meet had more than four-fold increased odds of malnutrition risk ( ; 95% CI: 2.26, 9.14) compared to their counterparts who had some money left over each month. This was only slightly attenuated after control for income and education, ( ; 95% CI: 1.95, 8.52) remaining robust. These results show an association between financial strain and malnutrition risk, independent of income, in older women. Self-reported financial strain may be preferable to income as a screener for malnutrition risk in older adults in clinical and research settings. 1. Introduction Malnutrition, which is a risk factor for disability and mortality, [1, 2] poses a burden for community dwelling older adults, particularly those of low socioeconomic status. Exact rates of this often undiagnosed condition are difficult to estimate in this population [3–5], but an estimated 9% of community dwelling older adults are malnourished and up to 45% have malnutrition risk and should have clinical diagnostic evaluation [6]. Rates are consistently higher, however, among low income compared to high income individuals [3, 7, 8]. Malnutrition is generally understood to be a deficiency of both energy and protein, combined with decreased fat-free mass [9], although older adults of low socioeconomic status can be malnourished even if consuming a high energy diet [10, 11], probably because they consume foods with lower nutrient content [10, 12]. Also, there is evidence that food insecure adults, or adults who lack regular access to food, have poorer dietary quality than food secure adults, despite similar caloric intake [11, 13–15]. Although income is associated with malnutrition, income alone may not accurately predict malnutrition in older adults, since cost of living, household size, and competing needs cause variation in the purchasing power of retirees [16]. Rising health care costs push many older adults into poverty, even if
References
[1]
Institute of Medicine, Extending Life, Enhancing Life: A National Research Agenda on Aging, National Academies Press, Washington, DC, USA, 1991.
[2]
Institute of Medicine, The Role of Nutrition in Maintaining Health in the Nation's Elderly: Evaluating Coverage of Nutrition Services for the Medicare Population, National Academies Press, Washington, DC, USA, 2000.
[3]
A. Manson and S. Shea, “Malnutrition in elderly ambulatory medical patients,” American Journal of Public Health, vol. 81, no. 9, pp. 1195–1197, 1991.
[4]
M. M. G. Wilson, S. Vaswani, D. Liu, J. E. Morley, and D. K. Miller, “Prevalence and causes of undernutrition in medical outpatients,” American Journal of Medicine, vol. 104, no. 1, pp. 56–63, 1998.
[5]
M. Elia, L. Zellipour, and R. J. Stratton, “To screen or not to screen for adult malnutrition?” Clinical Nutrition, vol. 24, no. 6, pp. 867–884, 2005.
[6]
Y. Guigoz, “The Mini Nutritional Assessment (MNA) review of the literature—what does it tell us?” Journal of Nutrition, Health and Aging, vol. 10, no. 6, pp. 466–485, 2006.
[7]
Y. Guigoz, S. Lauque, and B. J. Vellas, “Identifying the elderly at risk for malnutrition the mini nutritional assessment,” Clinics in Geriatric Medicine, vol. 18, no. 4, pp. 737–757, 2002.
[8]
M. R. Lee and E. R. Berthelot, “Community covariates of malnutrition based mortality among older adults,” Annals of Epidemiology, vol. 20, no. 5, pp. 371–379, 2010.
[9]
J. M. M. Meijers, M. A. E. van Bokhorst-de van der Schueren, J. M. G. A. Schols, P. B. Soeters, and R. J. G. Halfens, “Defining malnutrition: mission or mission impossible?” Nutrition, vol. 26, no. 4, pp. 432–440, 2010.
[10]
S. I. Kirkpatrick and V. Tarasuk, “Food insecurity is associated with nutrient inadequacies among Canadian adults and adolescents,” Journal of Nutrition, vol. 138, no. 3, pp. 604–612, 2008.
[11]
C. A. Zizza, P. A. Duffy, and S. A. Gerrior, “Food insecurity is not associated with lower energy intakes,” Obesity, vol. 16, no. 8, pp. 1908–1913, 2008.
[12]
J. S. Lee and E. A. Frongillo, “Nutritional and health consequences are associated with food insecurity among U.S. Elderly persons,” Journal of Nutrition, vol. 131, no. 5, pp. 1503–1509, 2001.
[13]
D. Rose and V. Oliveira, “Nutrient intakes of individuals from food-insufficient households in the United States,” American Journal of Public Health, vol. 87, no. 12, pp. 1956–1961, 1997.
[14]
D. Rose, “Economic determinants and dietary consequences of food insecurity in the United States,” Journal of Nutrition, vol. 129, supplement 2, pp. 517S–520S, 1999.
[15]
J. R. Sharkey, L. G. Branch, N. Zohoori, C. Giuliani, J. Busby-Whitehead, and P. S. Haines, “Inadequate nutrient intakes among homebound elderly and their correlation with individual characteristics and health-related factors,” American Journal of Clinical Nutrition, vol. 76, no. 6, pp. 1435–1445, 2002.
[16]
N. Krieger, D. R. Williams, and N. E. Moss, “Measuring social class in us public health research: concepts, methodologies, and guidelines,” Annual Review of Public Health, vol. 18, pp. 341–378, 1997.
[17]
B. A. Butrica, D. Murphy, and S. R. Zedlewski, How Many Struggle to Get by in Retirement?The Urban Institute, Washington, DC, USA, 2008.
[18]
S. L. Szanton, J. K. Allen, R. J. Thorpe, T. Seeman, K. Bandeen-Roche, and L. P. Fried, “Effect of financial strain on mortality in community-dwelling older women,” Journals of Gerontology, vol. 63, no. 6, pp. S369–S374, 2008.
[19]
L. I. Pearlin, M. A. Lieberman, E. G. Menaghan, and J. T. Mullan, “The stress process,” Journal of Health and Social Behavior, vol. 22, no. 4, pp. 337–356, 1981.
[20]
S. L. Szanton, R. J. Thorpe, and K. Whitfield, “Life-course financial strain and health in African-Americans,” Social Science and Medicine, vol. 71, no. 2, pp. 259–265, 2010.
[21]
J. E. Ferrie, P. Martikainen, M. J. Shipley, and M. G. Marmot, “Self-reported economic difficulties and coronary events in men: evidence from the Whitehall II study,” International Journal of Epidemiology, vol. 34, no. 3, pp. 640–648, 2005.
[22]
A. Georgiades, I. Janszky, M. Blom, K. D. László, and S. Ahnve, “Financial strain predicts recurrent events among women with coronary artery disease,” International Journal of Cardiology, vol. 135, no. 2, pp. 175–183, 2009.
[23]
N. Krause, “Chronic financial strain, social support, and depressive symptoms among older adults,” Psychology and Aging, vol. 2, no. 2, pp. 185–192, 1987.
[24]
A. Steptoe, L. Brydon, and S. Kunz-Ebrecht, “Changes in financial strain over three years, ambulatory blood pressure, and cortisol responses to awakening,” Psychosomatic Medicine, vol. 67, no. 2, pp. 281–287, 2005.
[25]
M. H. Hall, K. A. Matthews, H. M. Kravitz et al., “Race and financial strain are independent correlates of sleep in midlife women: the SWAN sleep study,” Sleep, vol. 32, no. 1, pp. 73–82, 2009.
[26]
D. E. Kendzor, M. S. Businelle, T. J. Costello et al., “Financial strain and smoking cessation among racially/ethnically diverse smokers,” American Journal of Public Health, vol. 100, no. 4, pp. 702–706, 2010.
[27]
The Women's Health and Aging Study: Health and Social Characteristics of Older Women with Disability, National Institute on Aging, Bathesda, Md, USA, 1995.
[28]
J. D. Kasper, S. Shapiro, J. M. Guralnik, K. J. Bandeen-Roche, and L. P. Fried, “Designing a community study of moderately to severely disabled older women: the Women's Health and Aging Study,” Annals of Epidemiology, vol. 9, no. 8, pp. 498–507, 1999.
[29]
L. P. Fried, K. Bandeen-Roche, P. H. M. Chaves, and B. A. Johnson, “Preclinical mobility disability predicts incident mobility disability in older women,” Journals of Gerontology, vol. 55, no. 1, pp. M43–M52, 2000.
[30]
L. Z. Rubenstein, J. O. Harker, A. Salvà, Y. Guigoz, and B. Vellas, “Screening for undernutrition in geriatric practice: developing the Short-Form Mini-Nutritional Assessment (MNA-SF),” Journals of Gerontology, vol. 56, no. 6, pp. M366–M372, 2001.
[31]
E. Baugher and L. Lamison-White, Poverty in the United States: 1995, Current Population Reports, Series P60-194, U.S. Bureau of the Census, Washington, DC, USA, 1996.
[32]
K. Kim and E. A. Frongillo, “Participation in food assistance programs modifies the relation of food insecurity with weight and depression in elders,” Journal of Nutrition, vol. 137, no. 4, pp. 1005–1010, 2007.
[33]
J. S. Lee and E. A. Frongillo, “Understanding needs is important for assessing the impact of food assistance program participation on nutritional and health status in U.S. elderly persons,” Journal of Nutrition, vol. 131, no. 3, pp. 765–773, 2001.
[34]
J. N. Bodor, D. Rose, T. A. Farley, C. Swalm, and S. K. Scott, “Neighbourhood fruit and vegetable availability and consumption: the role of small food stores in an urban environment,” Public Health Nutrition, vol. 11, no. 4, pp. 413–420, 2008.
[35]
D. Rose and R. Richards, “Food store access and household fruit and vegetable use among participants in the US Food Stamp Program,” Public Health Nutrition, vol. 7, no. 8, pp. 1081–1088, 2004.
[36]
StataCorp, Stata Statistical Software: Release 10, StataCorp, College Station, Tex, USA, 2007.
[37]
M. F. Folstein, S. E. Folstein, and P. R. McHugh, “'Mini mental state'. A practical method for grading the cognitive state of patients for the clinician,” Journal of Psychiatric Research, vol. 12, no. 3, pp. 189–198, 1975.
[38]
R. C. Petersen, J. C. Stevens, M. Ganguli, E. G. Tangalos, J. L. Cummings, and S. T. DeKosky, “Practice parameter: early detection of dementia: mild cognitive impairment (an evidence-based review),” Neurology, vol. 56, no. 9, pp. 1133–1142, 2001.
[39]
T. L. Brink, J. A. Yesavage, and O. Lum, “Screening tests for geriatric depression,” Clinical Gerontologist, vol. 1, no. 1, pp. 37–44, 1982.
[40]
J. A. Yesavage, T. L. Brink, and T. L. Rose, “Development and validation of a geriatric depression screening scale: a preliminary report,” Journal of Psychiatric Research, vol. 17, no. 1, pp. 37–49, 1982.
[41]
J. M. Oakes and P. H. Rossi, “The measurement of SES in health research: current practice and steps toward a new approach,” Social Science and Medicine, vol. 56, no. 4, pp. 769–784, 2003.
[42]
M. Hall, D. J. Buysse, E. A. Nofzinger et al., “Financial strain is a significant correlate of sleep continuity disturbances in late-life,” Biological Psychology, vol. 77, no. 2, pp. 217–222, 2008.
[43]
A. Rosengren, S. Hawken, S. ？unpuu et al., “Association of psychosocial risk factors with risk of acute myocardial infarction in 11 119 cases and 13 648 controls from 52 countries (the INTERHEART study): case-control study,” The Lancet, vol. 364, no. 9438, pp. 953–962, 2004.
[44]
S. V. Kasl, “Stress and health,” Annual Review of Public Health, vol. 5, pp. 319–341, 1984.
[45]
S. L. Szanton, J. M. Gill, and J. K. Allen, “Allostatic load: a mechanism of socioeconomic health disparities?” Biological Research for Nursing, vol. 7, no. 1, pp. 7–15, 2005.
[46]
V. L. Shavers, “Measurement of socioeconomic status in health disparities research,” Journal of the National Medical Association, vol. 99, no. 9, pp. 1013–1023, 2007.
[47]
E. Grundy and G. Holt, “The socioeconomic status of older adults: how should we measure it in studies of health inequalities?” Journal of Epidemiology and Community Health, vol. 55, no. 12, pp. 895–904, 2001.
[48]
S. A. Robert, D. Cherepanov, M. Palta, N. C. Dunham, D. Feeny, and D. G. Fryback, “Socioeconomic status and age variations in health-related quality of life: results from the national health measurement Study,” Journals of Gerontology, vol. 64, no. 3, pp. 378–389, 2009.
[49]
J. L. Wang, N. Schmitz, and C. S. Dewa, “Socioeconomic status and the risk of major depression: the Canadian national population health survey,” Journal of Epidemiology and Community Health, vol. 64, no. 5, pp. 447–452, 2010.
[50]
L. M. Dinour, D. Bergen, and M. C. Yeh, “The food insecurity-obesity paradox: a review of the literature and the role food stamps may play,” Journal of the American Dietetic Association, vol. 107, no. 11, pp. 1952–1961, 2007.
[51]
L. P. Fried, L. Ferrucci, J. Darer, J. D. Williamson, and G. Anderson, “Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care,” Journals of Gerontology, vol. 59, no. 3, pp. 255–263, 2004.
[52]
J. W. Rowe and R. L. Kahn, “Human aging: usual and successful,” Science, vol. 237, no. 4811, pp. 143–149, 1987.
