Nutritional risk and loneliness affect the relationship between activity and functional status, such that older adults with higher nutritional risk or lower loneliness may benefit from more walking or upright activities.
Key Findings
Results
Functional status in community-dwelling older adults was associated with multiple walking-related activity measures but not with any sedentary behaviour measures.
Sample consisted of 53 community-dwelling older adults (mean age 79.8 ± 6.1 years, 71.7% females) with high functional status (median [IQR]: 20 [19.0, 21.0] on NEADL).
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 sedentary behaviour measures.
Physical activity and sedentary behaviour were measured using seven days of accelerometry data.
Results
Those with greater nutritional risk reported higher functional status when they accumulated more uninterrupted time on their feet.
Nutritional risk was assessed using the SCREENII scale; median score was 48.5 [44.0, 52.0].
Participants with SCREENII < 50 (indicating greater nutritional risk) showed a significant interaction between Alpha Upright (pattern of uninterrupted upright bouts) and functional status (p = 0.046).
Nutritional risk moderated the association between upright activity patterns and functional status.
This suggests that uninterrupted standing/upright time may be particularly beneficial for functionally for those at higher nutritional risk.
Results
Less lonely older adults reported higher functional status in association with a greater number of daily walking bouts.
Loneliness was measured using the UCLA 3-item scale; median score was 3.0 [3.0, 6.5].
Participants reporting less loneliness (UCLA < 5) showed a significant positive association between number of daily walking bouts and functional status (p = 0.025).
Loneliness moderated the association between walking bout frequency and functional status.
The interaction term for loneliness and walking bouts was statistically significant.
Results
Oral health quality significantly improved the strength of association between functional status and Alpha Upright, but neither sleep quality nor oral health moderated the overall activity–functional status relationship.
Oral health was assessed using OHIP-14; median score was 1.0 [0.0, 3.0].
Quality of oral health significantly improved the strength of association between FS and Alpha Upright when entered as a covariate (p = 0.037).
However, neither sleep quality (PSQI, median 6.0 [3.0, 8.0]) nor oral health moderated (via interaction term) the association between FS and activity.
Sleep quality and oral health were therefore not identified as moderators of the activity–functional status relationship.
Results
The study sample had relatively high functional status, moderate sleep disturbance, minimal oral health impact, borderline nutritional risk, and low loneliness at baseline.
NEADL median score was 20 [19.0, 21.0], indicating high functional status.
PSQI median was 6.0 [3.0, 8.0], suggesting moderate sleep quality issues (scores >5 indicate poor sleep).
OHIP-14 median was 1.0 [0.0, 3.0], indicating minimal impact of oral health on quality of life.
SCREENII median was 48.5 [44.0, 52.0], near the threshold of 50 that indicates nutritional risk.
UCLA 3-item loneliness scale median was 3.0 [3.0, 6.5], indicating generally low loneliness in the sample.
What This Means
This research suggests that among older adults living independently in the community, how much and how they walk is linked to their ability to carry out daily activities, while time spent sitting or lying down is not. Specifically, total walking time per day, the number of walking bouts, total daily steps, and spending longer uninterrupted periods on their feet were all associated with better functional ability. Importantly, two modifiable health factors — nutritional risk and loneliness — changed how strongly physical activity was related to functional status.
This research suggests that older adults who are at greater nutritional risk (scoring below 50 on the SCREENII tool) appear to gain more functional benefit from spending uninterrupted time upright, while those who feel less lonely show a stronger benefit from taking more walking bouts throughout the day. This means that the relationship between being physically active and maintaining functional independence is not the same for everyone — it depends on factors like nutrition and social connection.
Practically, this research suggests that interventions designed to support independence in older adults should consider not just increasing physical activity but also addressing nutritional risk and social isolation. Screening for these factors could help identify which older adults might benefit most from tailored walking programs or upright activity strategies. The findings also highlight that sedentary behavior alone may be less important than the quality and pattern of active time in this age group.
Abdul Jabbar K, Kerse N, Lord S, Del Din S, Teh R. (2026). Nutritional status and loneliness impact functional status in community-dwelling older adults.. Clinical nutrition ESPEN. https://doi.org/10.1016/j.clnesp.2026.102937