Low staffing level is associated with malnutrition in long-term residential care homes

Objective: To determine if staffing level is associated with poor nutrition in the long-term residential care setting, adjusting for other confounding factors. Design: Cross-sectional survey. Setting: In total, 14 residential care facilities in Hong Kong, stratified by nature ( government subvention or for-profit) to reflect the overall proportion in Hong Kong. Subjects: A total of 1914 subjects were assessed, using the Resident Assessment Instrument (RAI) 2.0. The response rate was 95% ( 1820 subjects), of which 1699 subjects had complete nutritional information. Intervention: Body mass index (BMI) was calculated by weighing and height measurement, and arm span was used if the subject could not stand. Subjects who were receiving parenteral or enteral nutrition via nasogastric of enterostomy tubes were excluded. A history of weight loss of 5% in the past month or 10% in the past 6 months, leaving 25% of food uneaten, and BMI <18.5 kg/m(2) were examined as nutritional indicators. Association with age, gender, functional disability, oral problems, taste problems, presence of physical diseases and psychological well-being was examined using chi(2)-test, and multiple logistic regression. Results: In all, 26% of residents had a BMI <18.5 kg/m(2), with a higher prevalence in the for-profit homes. History of weight loss and the record that 25% of food was left uneaten were poor indicators of low BMI. Multivariate analysis showed that having chronic obstructive airways disease, requiring help with feeding, being female, older age, were factors associated with an increased risk of poor nutrition, while being independent in activities of daily living and higher staff levels were associated with a reduced risk. Conclusion: Poor nutrition is a persistent problem in the long-term care setting, and inadequate staffing levels may be a reversible cause. However, resource limitations may render efforts at improvement difficult. Sponsorship: SK Yee Memorial Fund.