*Boston University Medical Center Schools of Public Health, Medicine, and Dentistry, Boston, MA. **Department of Mathematics, Boston University, Boston, MA. ***School of Medicine, University of Louisville, Louisville, KY. ****Baystate Medical Center, Springfield, MA. Correspondence: Dr. Barbara E. Millen, Professor of Public Health and Medicine, Boston University School of Public Health, 715 Albany Street, Talbot 259W, Boston, Massachusetts 02118. Telephone: 617-414-1362; FAX: 617-414-1390. E-mail: bmillen@bu.edu

Abstract: Purpose: To establish the prevalence of nutritional problems and their related socio-demographic and health-related risk factors in the homebound elderly population. Methods: Subjects included 239 men and women, ages 65 to 105 years. Trained, two-person field teams conducted comprehensive in-home assessments. Medical record reviews assessed co-morbidity and medication use. Results: The majority of these urban study subjects are of very advanced age (mean age 81 years), female (72%), non-white (73%), living alone (51%), of low income (76%), and somewhat socially isolated (26% had no weekly social contact). More older women than men were widowed (60 vs. 33%, respectively) and poor (80 vs. 67%). The disease burden and functional dependency were both high in men and women; 77% had three or more chronic medical conditions; 76% were functionally dependent in one or more ADL's and 95% in one or more IADL's. Poor dietary quality was universal in these older men and women; half or more consumed diets that deviated from recommended standards for at least 13 of the 24 nutritional guidelines studied. Five percent of subjects were underweight (Body Mass Index (BMI) <18.5); 22% were overweight (BMI 25.0-29.9); and 33% were obese (BMI >30.0). Fasting albumin, hemoglobin, and absolute lymphocyte concentrations were borderline to very low in 18-32%. Dyslipidemia was more common in women; however, men and women had similar Total:HDL cholesterol ratios. Conclusions: Nutritional status is poor in homebound persons of very advanced age with substantial co-morbidity and functional dependency. The complexities of nutritional risk necessitate multi-disciplinary and individualized nutritional intervention strategies.

Keywords: Aging, elderly, malnutrition, obesity, homebound, preventive home health services.