Nutritional status and loneliness impact functional status in community-dwelling older adults

AIM: This study aimed to understand how modifiable behavioural health determinants (HD), such as the quality of sleep, oral health, nutritional risk, and loneliness, affect the association between activity and functional status in community-dwelling older adults. METHODS: Physical activity (PA) and sedentary behaviour (SB) were measured using seven days of accelerometry data from 53 community-dwelling older adults (79.8 ± 6.1 yrs, 71.7 % females). Volume, pattern and variability of walking, upright, sitting and lying bouts were extracted. Measures include Nottingham Extended Activities of Daily Living (NEADL) for functional status (FS), Pittsburgh Sleep Quality Index (PSQI) for sleep, Oral-health-related quality of life and self-reported oral health (OHIP-14) for oral health, Seniors in the community: risk evaluation for eating and nutrition, Version II (SCREENII) for nutritional risk and the University of California, Los Angeles (UCLA) 3-item scale for loneliness. Linear regression models investigated the direct association between FS and activity. The impact of HD on the direct relationship between FS and activity was investigated by entering each HD as a covariate and an interaction term. RESULTS: FS was high for this sample (median [IQR]: 20 [19.0, 21.0]). PSQI was 6.0 [3.0, 8.0], OHIP-14 was 1.0 [0.0, 3.0], SCREENII was 48.5 [44.0, 52.0] and UCLA-3-item was 3.0 [3.0, 6.5]. FS was associated with daily total walk duration (p = 0.008), number of daily walking bouts (p = 0.010), number of daily steps (p = 0.007) and pattern of upright bouts [Alpha Upright] (p = 0.010). FS was not associated (p > 0.05) with any of the sedentary behaviour measures. The quality of oral health significantly (p = 0.037) improved the strength of association between FS and Alpha Upright. Those who reported greater nutritional risk (SCREENII <50) reported higher FS when they accumulated bouts that consisted of more uninterrupted time on their feet [Alpha Upright] (p = 0.046). Those who reported less loneliness (UCLA <5) reported higher FS with greater number of daily walking bouts (p = 0.025). Neither the quality of sleep nor oral health moderated the association between FS and activity. CONCLUSION: Nutritional risk and loneliness affect the relationship between activity and functional status. Older adults, particularly those with higher nutritional risk or lower loneliness, may benefit from more walking or upright activities.