| Malnutrition in nursing home residents is a significant, but modifiable, public health problem. Little is known how prevalence of malnutrition in nursing homes differs across the rural-urban continuum. Using Rural-Urban Commuting Areas (RUCA) codes and the Minimum Data Set (MDS), Centers for Medicare and Medicaid Services (CMS) mandated: resident assessment system, a nationally representative data set of nursing home residents; this study examined the differences in prevalence of malnutrition (BMI < 18.5 kg/m2) in a random sample of 159,159 nursing home residents. In this sample, 11.7% were malnourished---measured BMI < 18.5 kg/m2; 12.5% resided in nursing homes in small towns and 8% in isolated areas. The median age was 84 years; 72.4% were females; 84.3% were non-Hispanic White; and 17.6% needed support for end-stage Activities of Daily Living (ADL)---bed mobility or eating. Using multiple logistic regression (adjusting for resident and facility characteristics), nursing home residents in isolated areas were less likely to be malnourished (OR 0.87, 95% CI 0.815--0.925) than residents in urban areas. Also, ADL dependency, drug use, chewing problems, swallowing problems, leaving 25% or more food and age 85+ were significantly associated with BMI < 18.5 kg/m2. This analysis suggests that nursing home residents in isolated areas are at decreased vulnerability for malnutrition; Future efforts should classify reasons for increased odds of undernutrition in urban nursing homes and identify strategies to improve the nutritional status and quality of life of the residents in nursing homes especially those in urban areas. |
