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Nutritional risk has been associated with various negative health outcomes among older people. Limited longitudinal research has examined the relationship between nutritional risk and hospitalization and death in community-dwelling older people.

Data and methods

Data from the 2008/2009 Canadian Community Health Survey–Healthy Aging (CCHS–HA) linked to the Discharge Abstract Database and the Canadian Mortality Database were used to estimate the prevalence of nutritional risk among seniors and examine its relationship with acute care hospitalization and death during the 25- to 36-month period following the CCHS–HA interview. Multivariate Cox proportional hazards models were used to identify important covariates, while adjusting for demographic and socioeconomic characteristics, health status, and lifestyle factors.


A third (34%; 979,000) of Canadians aged 65 or older living in 9 provinces (excluding Quebec) were at nutritional risk in 2008/2009. These seniors had a higher risk of an acute care hospitalization (hazard ratio (HR) 1.2; 95% CI: 1.1 to 1.4) or death (HR 1.6; 95% CI: 1.3 to 2.0) during the follow-up period, even when potential confounders were taken into account. Seniors at nutritional risk in 2008/2009 were more likely than those not at nutritional risk to die during follow-up (9% versus 5%) and averaged shorter survival times: 498 days (95% CI: 462 to 534) compared with 538 days (95% CI: 501 to 574).


Based on an analysis of data from a large population-based survey linked to routinely collected hospital and death data, nutritional risk is independently associated with acute care hospitalization and mortality. Results highlight the importance of monitoring seniors for nutritional risk.


Data linkage, diet, eating, food intake, malnutrition, morbidity, nutrition assessment, seniors


Advancing age may bring diet-related challenges. Among seniors, chronic conditions and the medications used to treat them can interfere with appetite, the taste and enjoyment of food, and the absorption of nutrients. Impaired mobility and dexterity, declining health, and lack of transportation can be barriers to purchasing and preparing food. Poor oral health may also hinder eating. Some older people live in “food deserts” devoid of supermarkets and characterized by convenience stores and fast-food outlets with “empty calorie” choices. Changes in living arrangements due to the loss of a spouse can affect seniors’ diets through loneliness and the logistics of cooking for one. [Full Text]


Pamela L. Ramage-Morin (Pamela.Ramage-Morin@canada.ca), Heather Gilmour and Michelle Rotermann are with the Health Analysis Division at Statistics Canada, Ottawa, Ontario, K1A 0T6.

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What is already known on this subject?

  • About a third of community-dwelling Canadian seniors are at nutritional risk.
  • Nutritional risk has been associated with poor health outcomes among seniors, but studies of community-living seniors have been limited by small samples, lack of representativeness, or restricted subpopulations.

What does this study add?

  • Results of a large, population-based study show that compared with those at low nutritional risk, acute care hospitalization within 25 to 36 months of the survey interview was more likely among seniors at nutritional risk.
  • As well, seniors at nutritional risk in 2008/2009 had a 60% increased risk of dying over a 25- to 36-month follow-up period, even when socio-demographic characteristics, health status, and health behaviours were taken into account.

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