As people age, difficulties in maintaining a proper diet may arise, even as certain specific nutritional needs increase. When individuals lose their independence—which can happen with certain forms of cognitive decline—their nutritional status can be significantly compromised…

The Anaïs Study: Diet, Nutritional Status, and Mental Health of Older Adults in Care Facilities

Improving the prevention, screening, and mitigation of malnutrition among older adults, on the one hand, and their calcium and vitamin D status, on the other, are among the specific objectives of the National Nutrition and Health Program (PNNS) launched in 2001.
In fact, approximately 6 million people aged 75 and older (including 700,000 living in care facilities) currently reside in France, representing 9% of the population. According to INSEE projections, this proportion is expected to reach 13.6% by 2035. This demographic shift has numerous implications for the supply and demand of housing for older adults: increased capacity in long-term care facilities and the growing medicalization of these institutions.
The institutionalization of older adults is also accompanied by specific problems such as malnutrition (affecting between 20% and 60% of older adults living in institutions, according to estimates) and anxiety and depressive disorders (affecting approximately 45% of older adults in institutions). In light of this, a 20% reduction in the prevalence of malnutrition among older adults aged 70 and older, both at home and in institutions, was included among the 100 objectives of Law No. 2004-806 of August 9, 2004, on public health policy.

Launch of a study on the nutritional status and mental health of older adults living in care facilities

As part of their mission to monitor vulnerable populations, and following a request from the State Secretariat for Solidarity, the nutritional surveillance program and the mental health program of Santé publique France have joined forces to launch a study that will describe the nutritional status and mental health of older adults living in institutions. More specifically, this study aims to:

• Describe the dietary intake and physical activity of older adults living in care facilities;

• Describe their nutritional status (prevalence of malnutrition);

• Determine the prevalence of anxiety and depressive disorders, sleep disorders, and cognitive disorders;

• Describe their medication use, particularly that of psychotropic drugs;

• Describe the associations between depressive status and nutritional status.

This descriptive cross-sectional study would be conducted among a random sample of older adults living in long-term geriatric care facilities (assisted living facilities, nursing homes for dependent older adults—Ehpad—and long-term care units—USLD—) in mainland France. Data collection would focus on dietary intake, nutritional status, mental health, anthropometric measurements, and blood pressure, as well as a section on “biological markers of nutritional status” including measurements of biological markers of malnutrition (albumin, prealbumin, orosomucoid, and CRP), vitamin status (A, B9, B12, C, D, E, and carotenoids), and mineral status (calcium, zinc, selenium, potassium).
In preparation for this project, a scientific committee was established, bringing together hospital federations (FHF, Fehap), professional unions (AD-PA, FFAMCO-Ehpad, Synerpa), and the French Society of Geriatrics and Gerontology (SFGG).

Pilot study conducted in 2010

From April to September 2010, a feasibility study was conducted with a sample of 63 residents from 6 long-term care facilities for the elderly (2 assisted living facilities, 3 nursing homes, and 1 long-term care unit) in the Indre-et-Loire department. The residents included in the study—or their caregivers for those with limited independence—were interviewed about daily life in the facility, their mental well-being, medical history, and current medication regimens. Residents’ food intake was also recorded over two days. Anthropometric measurements and blood pressure readings were also taken. For half of the residents included in the study, blood samples were collected and levels of inflammatory markers (C-reactive protein and orosomucoid) and malnutrition markers (albumin and prealbumin) were measured.