Nutrition at the hospital-community interface : an investigation of nutritional risk in community-dwelling older adults

Undernutrition is a predictor of morbidity and mortality in older adults and those living with conditions of accelerated aging such as COPD. Nutritional screening is recommended to identify at-risk individuals but there are concerns that this initial step in a pathway of nutritional care is not always completed or communicated. In addition, there is little research in community-dwelling older populations regarding how best to organise care at the hospital-community interface. Exploring existing pathways of nutritional care experienced by community dwelling older adults will help us to understand potential determinants of undernutrition that may influence their trajectory of recovery and highlight any gaps in care. The aim of this thesis was to examine nutritional risk, physical function and quality of life in a cohort of community-dwelling older adults. An observational prospective cohort study of community-dwelling, older adults demonstrated that individuals at medium and high risk of undernutrition were at higher risk of mortality and suffered a worse trajectory of recovery following hospital admission compared to their counterparts at low nutritional risk. However, cross-sectional analyses using data from a large cohort of COPD patients attending pulmonary rehabilitation between August 2009 and January 2015 showed that whilst medium/high nutritional risk was associated with worse strength and function prior to a period of respiratory rehabilitation, it did not influence performance, with similar benefits observed in low and medium/high nutrition risk groups. This thesis suggests that irrespective of nutritional status, older adults recently discharged from hospital or attending outpatient rehabilitation programmes exhibited reduced ability to perform activities of daily living, however, that individuals at nutritional risk experience a reduced rate of recovery, suggesting that worse nutritional status may compound adverse effects on physical function and quality of life following hospital admission. However, nutritional support may have the potential to reduce further deterioration in at risk participants.