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PURPOSE: This study examines the direct and indirect relationships between individual components of nutritional risk and increased severity of disability among a large and diverse sample of homebound older adults. DESIGN AND METHODS: Using routinely collected nutrition and function data, structural equation modeling of recursive and nonrecursive models examined the interrelationships of nutritional risk factors, indicators of nutritional risk, and disability severity among 1,010 home-delivered meals program participants in Wake County, NC. RESULTS: The equally good fit for both the recursive and nonrecursive structural models revealed that specific nutritional risk factors were directly and indirectly associated with indicators of nutritional risk and increased severity of disability. The nonrecursive model also revealed significant reciprocal associations of increased disability with unintended weight change and medication use. IMPLICATIONS: The findings from this study acknowledge aspects of the complex direct and indirect relationships between nutrition and function among homebound older persons. This knowledge will help service providers with the development of effective elderly nutrition programs with nutritional and functional status outcomes.
Joseph R. Sharkey (Sat,) studied this question.