Assessing the nutritional status and antimicrobial resistance of the elderly in Ghanaian care homes: a cross-sectional study

Background: The elderly population in Ghana is rapidly increasing, with individuals in care homes facing heightened risks of malnutrition and antimicrobial resistance (AMR). This study assessed the nutritional status and AMR patterns among elderly residents in Ghanaian care homes, exploring the relationship between nutritional deficiency and AMR. Methods: This cross-sectional study was conducted between November 2022 and April 2023 among 118 elderly residents in five nursing care homes across two districts in Greater Accra, Ghana. Nutritional status was assessed using the Mini Nutritional Assessment (MNA) tool, including anthropometric measurements, Activities of Daily Living (ADL), Dietary Diversity Score (DDS), and Body Mass Index (BMI). Early morning mid-stream urine samples were cultured for the isolation Escherichia coli, followed by antimicrobial susceptibility testing and PCR screening for ten extended-spectrum beta-lactamase (ESBL) genes. Results: The mean age of participants was 71.3 years, with 71.2% being female. The average BMI was 25.45 ± 5.23 kg/m², with 14.4% underweight, 41.5% normal weight, 19.5% overweight, and 24.6% obese. The mean DDS was 2.69 ± 0.6, indicating suboptimal dietary diversity. Based on MNA scores, 42.4% of participants were malnourished, 27.9% were at risk of malnutrition, and only 29.7% were well-nourished. Malnutrition increased significantly with age (p < 0.05) and was more prevalent among males (76.5%) than females (67.9%). E. coli was isolated from 41 participants (34.7%), with all isolates harbouring at least one ESBL gene (total 195 genes). High AMR rates were observed for cefepime (65.9%) and cefotaxime (56.1%), with 46.3% of isolates being multidrug-resistant. Malnourished individuals had significantly higher prevalence of E. coli (48.9%) and ESBL genes (61.5%) compared to well-nourished individuals (14.5% and 15.4%, respectively). A moderate positive correlation was found between DDS and BMI (R = 0.494). Study participants who suffer from skin ulcer are 3.42 times more likely to harbor ESBL genes (p = 0.026). Conclusion: Malnutrition is highly prevalent among elderly residents in Ghanaian care homes, with more than two-thirds either malnourished or at risk. Malnourished individuals demonstrated significantly higher carriage of AMR genes, suggesting a critical link between nutritional status and AMR. These findings underscore the urgent need for integrated interventions addressing both nutritional health and antimicrobial stewardship in elderly care settings.