Currently submitted to: Journal of Medical Internet Research
Date Submitted: Mar 2, 2026
Open Peer Review Period: Mar 2, 2026 - Apr 27, 2026
(currently open for review)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Determinants of Malnutrition Onset in nursing home residents: a longitudinal study
ABSTRACT
Background:
Malnutrition is a multifactorial and chronic condition, frequently developing gradually due to a combination of biological, functional, and psychosocial factors.
Objective:
This study investigates the impact of general function, oral health, and nutritional factors on the time to onset of malnutrition.
Methods:
This is a longitudinal study utilizing interRAI data from nursing home residents for the period 2020-2025. The interRAI instruments are standardized, internationally validated, and electronically supported assessment tools to facilitate real-time data capture, analysis, and clinical decision support. Cox proportional hazard models were employed to calculate the impact of several indicators on malnutrition
Results:
Baseline assessments from 1,633 residents (mean age 85.68±7.82, 65.22% female) were split into assessments with malnutrition at baseline (154 residents, 9.43%) or not (1,479, 90.57%). The samples differed significantly with higher proportions in the sub-sample with malnutrition at baseline: depressive symptoms (53%vs.34.2%, p=0.000), modified mode of nutrition (26%vs.11.6%, p=0.000), loss of appetite (22.5%vs.7.5%, p=0.000), chewing difficulties (17.5%vs.7.9%, p=0.000) and dry mouth (13.7%vs.8.0%, p=0.000). Survival analysis revealed significant results for loss of appetite (1.88; 1.24-2.83), chewing difficulty (1.803; 1.12-2.90), and cognitive impairment (1.67, 1.13-2.46). Residents with an adapted mode of nutrition also had a shorter mean time to malnutrition, although this factor was not significant in the Cox model.
Conclusions:
Survival analysis has not been applied to the study of malnutrition in older persons, although malnutrition often appears in survival models for hospitalization or morbidity. This study highlighted the critical role of modifiable risk factors, such as loss of appetite, chewing difficulties, and mode of nutritional intake, in accelerating the progression toward malnutrition among older adults in nursing homes. As these factors are preventable, timely screening using the electronic interRAI tools may foster identification of people at risk of malnutrition and prevention or treatment. Clinical Trial: not applicable
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