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Volkert D, Beck AM, Faxén-Irving G, Frühwald T, Hooper L, Keller H, Porter J, Rothenberg E, Suominen M, Wirth R, Chourdakis M. ESPEN guideline on nutrition and hydration in dementia - Update 2024. Clin Nutr 2024; 43:1599-1626. [PMID: 38772068 DOI: 10.1016/j.clnu.2024.04.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 04/16/2024] [Accepted: 04/30/2024] [Indexed: 05/23/2024]
Abstract
BACKGROUND & AIMS Dementia is accompanied by a variety of changes that result in an increased risk of malnutrition and low-intake dehydration. This guideline update aims to give evidence-based recommendations for nutritional care of persons with dementia in order to prevent and treat these syndromes. METHODS The previous guideline version was reviewed and expanded in accordance with the standard operating procedure for ESPEN guidelines. Based on a systematic search in three databases, strength of evidence of appropriate literature was graded by use of the SIGN system. The original recommendations were reviewed and reformulated, and new recommendations were added, which all then underwent a consensus process. RESULTS 40 recommendations for nutritional care of older persons with dementia were developed and agreed, seven at institutional level and 33 at individual level. As a prerequisite for good nutritional care, organizations caring for persons with dementia are recommended to employ sufficient qualified staff and offer attractive food and drinks with choice in a functional and appealing environment. Nutritional care should be based on a written care concept with standardized operating procedures. At the individual level, routine screening for malnutrition and dehydration, nutritional assessment and close monitoring are unquestionable. Oral nutrition may be supported by eliminating potential causes of malnutrition and dehydration, and adequate social and nursing support (including assistance, utensils, training and oral care). Oral nutritional supplements are recommended to improve nutritional status but not to correct cognitive impairment or prevent cognitive decline. Routine use of dementia-specific ONS, ketogenic diet, omega-3 fatty acid supplementation and appetite stimulating agents is not recommended. Enteral and parenteral nutrition and hydration are temporary options in patients with mild or moderate dementia, but not in severe dementia or in the terminal phase of life. In all stages of the disease, supporting food and drink intake and maintaining or improving nutrition and hydration status requires an individualized, comprehensive approach. Due to a lack of appropriate studies, most recommendations are good practice points. CONCLUSION Nutritional care should be an integral part of dementia management. Numerous interventions are available that should be implemented in daily practice. Future high-quality studies are needed to clarify the evidence.
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Affiliation(s)
- Dorothee Volkert
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany.
| | - Anne Marie Beck
- Dietetic and Nutritional Research Unit, Herlev and Gentofte University Hospital, Herlev, Denmark
| | - Gerd Faxén-Irving
- Division of Clinical Geriatrics, Department of Neurobiology, Care Science and Society, Karolinska Institutet, Stockholm, Sweden
| | - Thomas Frühwald
- Department of Geriatric Acute Care, Hietzing Municipal Hospital, Vienna, Austria
| | - Lee Hooper
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Heather Keller
- Department of Kinesiology & Health Sciences, Faculty of Health, University of Waterloo, Waterloo, Canada; Schlegel-UW Research Institute for Aging, Waterloo, Canada
| | - Judi Porter
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Elisabet Rothenberg
- Department of Nursing and Integrated Health Sciences, Faculty of Health Sciences, Kristianstad University, Kristianstad, Sweden
| | - Merja Suominen
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
| | - Rainer Wirth
- Department of Geriatric Medicine, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | - Michael Chourdakis
- School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece
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Antasouras G, Vasios GK, Kontogiorgis C, Ioannou Z, Poulios E, Deligiannidou GE, Troumbis AY, Giaginis C. How to improve food waste management in hospitals through focussing on the four most common measures for reducing plate waste. Int J Health Plann Manage 2023; 38:296-316. [PMID: 36193027 DOI: 10.1002/hpm.3586] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 09/16/2022] [Accepted: 09/26/2022] [Indexed: 11/07/2022] Open
Abstract
Hospitals have a responsibility to link human health and the environment, but food waste in hospitals has traditionally been much higher than in other areas of food supply. The cause of this situation has many negative impacts on health, economy, society, and environment. As a result, food waste has become a topic of discussion in hospital food departments. Part of this problem is plate waste, the served food that remains uneaten by patients. Given the magnitude of the food problem, this systematic review is aimed to identify the most common measures used to reduce plate waste in hospitals. PubMed, Scopus, and Google Scholar databases were comprehensively searched to identify food waste studies worldwide using related search terms. Many approaches have been recommended to increase patient food intake and minimise plate waste in hospitals. Up to date, the four most common include flexible portion sizes, increased food choices through selective menus, additional nutritional support and a better ordering and delivery system. Among them, the most used and effective are flexible portion sizes which may increase the ability of patients choosing their menus and upgrade ordering and delivery system by electronic format. In most studies, plate waste covers the most significant percentage of food waste produced in hospitals, while more than one approach is recommended to minimise it. In this aspect, further well-design, multicenter, clinical studies are strongly required to highlight and establish novel and effective approaches for improving food waste management in hospitals by reducing plate waste.
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Affiliation(s)
- Georgios Antasouras
- Department of Food Science and Nutrition, School of Environment, University of the Aegean, Lemnos, Greece
| | - Georgios K Vasios
- Department of Food Science and Nutrition, School of Environment, University of the Aegean, Lemnos, Greece
| | - Christos Kontogiorgis
- Laboratory of Hygiene and Environmental Protection, Department of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Zacharias Ioannou
- Department of Food Science and Nutrition, School of Environment, University of the Aegean, Lemnos, Greece
| | - Efthymios Poulios
- Department of Food Science and Nutrition, School of Environment, University of the Aegean, Lemnos, Greece
| | - Georgia-Eirini Deligiannidou
- Laboratory of Hygiene and Environmental Protection, Department of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Andreas Y Troumbis
- Department of the Environment, School of Environment, University of the Aegean, Lesvos, Greece
| | - Constantinos Giaginis
- Department of Food Science and Nutrition, School of Environment, University of the Aegean, Lemnos, Greece
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Liquori G, De Leo A, De Nuzzo D, D’Inzeo V, Arancio RM, Di Simone E, Dionisi S, Giannetta N, Ricciardi F, Fabbian F, Orsi GB, Di Muzio M, Napoli C. Management Strategies and Nursing Activities for Nutritional Care in Hospitalized Patients with Cognitive Decline: A Scoping Review. Nutrients 2022; 14:nu14194036. [PMID: 36235687 PMCID: PMC9573259 DOI: 10.3390/nu14194036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/25/2022] [Accepted: 09/26/2022] [Indexed: 11/16/2022] Open
Abstract
Cognitive impairment and dementia can negatively impact the nutritional capacities of older people. Malnutrition is common in hospitalized frail elderly people with cognitive impairment and negatively affects prognosis. Malnutrition worsens the quality of life and increases morbidity and mortality. This scoping review aimed to identify factors affecting the risk of malnutrition and preventive strategies in hospitalized patients with cognitive impairment, focusing on nursing interventions. The authors researched population, context, and concept in international databases of nursing interest. Full texts that met the inclusion criteria were selected and reviewed. The extracted data were subject to thematic analysis. A five-stage approach, already reported in the scientific literature, was utilized in the following scoping review. Of 638 articles yielded, 9 were included. Two focus areas were identified as follows: (1) prevalence and risk factors of malnutrition in older patients with cognitive decline; (2) nursing strategies used to enhance clinical outcomes. Nursing health interventions aim to recognize and reduce malnutrition risk, positively impacting this phenomenon. A multidisciplinary team is essential to meet the nutritional needs of these patients.
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Affiliation(s)
- Gloria Liquori
- Department of Biomedicine and Prevention, Tor Vergata University of Rome, 00133 Rome, Italy
| | - Aurora De Leo
- Department of Biomedicine and Prevention, Tor Vergata University of Rome, 00133 Rome, Italy
- Nursing, Technical, Rehabilitation, Assistance and Research Direction—IRCCS Istituti Fisioterapici Ospitalieri—IFO, 00144 Rome, Italy
| | - Daniele De Nuzzo
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00185 Rome, Italy
| | - Victoria D’Inzeo
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00185 Rome, Italy
| | - Rosario Marco Arancio
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00185 Rome, Italy
| | - Emanuele Di Simone
- Nursing, Technical, Rehabilitation, Assistance and Research Direction—IRCCS Istituti Fisioterapici Ospitalieri—IFO, 00144 Rome, Italy
| | - Sara Dionisi
- Department of Biomedicine and Prevention, Tor Vergata University of Rome, 00133 Rome, Italy
| | - Noemi Giannetta
- School of Nursing, UniCamillus—Saint Camillus International University of Health and Medical Sciences, 00131 Rome, Italy
| | - Francesco Ricciardi
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00185 Rome, Italy
| | - Fabio Fabbian
- Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy
| | - Giovanni Battista Orsi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Roma, Italy
| | - Marco Di Muzio
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00185 Rome, Italy
| | - Christian Napoli
- Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Rome, 00185 Rome, Italy
- Correspondence: ; Tel.: +39-06-3377-5529
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So BPH, Lai DKH, Cheung DSK, Lam WK, Cheung JCW, Wong DWC. Virtual Reality-Based Immersive Rehabilitation for Cognitive- and Behavioral-Impairment-Related Eating Disorders: A VREHAB Framework Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19105821. [PMID: 35627357 PMCID: PMC9141870 DOI: 10.3390/ijerph19105821] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/07/2022] [Accepted: 05/09/2022] [Indexed: 11/16/2022]
Abstract
Virtual reality (VR) technology is one of the promising directions for rehabilitation, especially cognitive rehabilitation. Previous studies demonstrated successful rehabilitation in motor, cognitive, and sensorial functions using VR. The objective of this review is to summarize the current designs and evidence on immersive rehabilitation interventions using VR on cognitive- or behavioral-related eating disorders, which was mapped using a VREHAB framework. Two authors independently searched electronic databases, including PubMed, Web of Science, Scopus, CINAHL, EMBASE, and Cochrane Library. Ten (n = 10) articles were eligible for review. Treatments for anorexia nervosa and binge eating disorder/bulimia nervosa were reported through enhanced/experimental cognitive behavior therapy (ECT), cue exposure therapy (CET), and body exposure therapy (BET) via the virtual environment. Some studies reported that the VR effects were superior or comparable to traditional treatments, while the effects may last longer using VR technology. In addition, VR was perceived as acceptable and feasible among patients and therapists and could be valuable for supplementing existing therapies, relieving manpower and caregiver burdens. Future studies may consider incorporating haptic, smell, and biofeedback to improve the experience, and thus the effects of the treatments for the users.
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Affiliation(s)
- Bryan Pak-Hei So
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong 999077, China;
| | - Derek Ka-Hei Lai
- Department of Computing, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong 999077, China;
| | - Daphne Sze-Ki Cheung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong 999077, China;
- Research Institute of Smart Ageing, The Hong Kong Polytechnic University, Hong Kong 999077, China
- Centre for Gerontological Nursing, School of Nursing, The Hong Kong Polytechnic University, Hong Kong 999077, China
| | - Wing-Kai Lam
- Sports Information and External Affairs Centre, Hong Kong Sports Institute, Hong Kong 999077, China;
| | - James Chung-Wai Cheung
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong 999077, China;
- Research Institute of Smart Ageing, The Hong Kong Polytechnic University, Hong Kong 999077, China
- Correspondence: (J.C.-W.C.); (D.W.-C.W.); Tel.: +852-2766-7673 (J.C.-W.C.); +852-2766-7669 (D.W.-C.W.)
| | - Duo Wai-Chi Wong
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong 999077, China;
- Correspondence: (J.C.-W.C.); (D.W.-C.W.); Tel.: +852-2766-7673 (J.C.-W.C.); +852-2766-7669 (D.W.-C.W.)
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Latif J, Dabbous M, Weekes CE, Baldwin C. The effectiveness of trained volunteer delivered interventions in adults at risk of malnutrition: A systematic review and meta-analysis. Clin Nutr 2021; 40:710-727. [DOI: 10.1016/j.clnu.2020.06.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/06/2020] [Accepted: 06/09/2020] [Indexed: 01/07/2023]
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McLaren-Hedwards T, D'cunha K, Elder-Robinson E, Smith C, Jennings C, Marsh A, Young A. Effect of communal dining and dining room enhancement interventions on nutritional, clinical and functional outcomes of patients in acute and sub-acute hospital, rehabilitation and aged-care settings: A systematic review. Nutr Diet 2021; 79:140-168. [PMID: 33416215 DOI: 10.1111/1747-0080.12650] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 10/21/2020] [Accepted: 11/04/2020] [Indexed: 11/30/2022]
Abstract
AIMS This review aimed to synthesise evidence on the impact of communal dining and/or dining room enhancement interventions on nutritional, clinical and functional outcomes of patients in hospital (acute or subacute), rehabilitation and residential aged-care facility settings. METHODS Five electronic databases were searched in March 2020. Included studies considered the impact of communal dining and/or dining room enhancements on outcomes related to malnutrition in hospital (acute or subacute), rehabilitation and residential aged care facility settings. Risk of bias was assessed using the Academy of Nutrition and Dietetics quality checklist. Overall quality was assessed using GRADEpro software. Outcome data were combined narratively for communal dining and dining room enhancements respectively. RESULTS Eighteen articles from 17 unique studies were identified. Of these studies, one was a randomised control trial (moderate quality) and 16 were observational studies (all low quality). Communal dining interventions (four studies, n = 490) were associated with greater energy and protein intake and higher measures of quality of life than non-communal mealtime settings. Dining room enhancement interventions (14 studies, n = 912), overall, contributed to increased intake of food, energy, protein and fluid. CONCLUSIONS Results indicate that communal dining and/or dining room enhancement has a positive impact on several outcomes of interest, however, most available evidence is of low quality. Therefore, there is a need for further large-scale, well-designed experimental studies to assess the potential impacts of these interventions.
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Affiliation(s)
- Taya McLaren-Hedwards
- The University of Queensland, School of Human Movement and Nutrition Sciences, Brisbane, Queensland, Australia
| | - Kelly D'cunha
- The University of Queensland, School of Human Movement and Nutrition Sciences, Brisbane, Queensland, Australia
| | - Elaina Elder-Robinson
- The University of Queensland, School of Human Movement and Nutrition Sciences, Brisbane, Queensland, Australia
| | - Claire Smith
- The University of Queensland, School of Human Movement and Nutrition Sciences, Brisbane, Queensland, Australia
| | - Cindy Jennings
- Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Abigail Marsh
- Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Adrienne Young
- The University of Queensland, School of Human Movement and Nutrition Sciences, Brisbane, Queensland, Australia.,Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
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Abstract
BACKGROUND Fundamental aspects of patient experience have been reported as substandard in emergency departments. Hospital volunteers can improve the patient experience in inpatient settings. However, evidence is limited on their impact in emergency departments. AIMS To determine whether emergency department volunteers could enhance patient experience through assisting with the psychological aspect of patient care and patients' nutritional needs. METHODS Patients attending an emergency department responded to a questionnaire as part of a cross-sectional study. Comparisons were made between when the volunteer scheme was running and when there were no volunteers. Outcomes included patient experience of emotional support from staff and access to food and drink. RESULTS Patients present when the volunteer scheme was running reported obtaining food and drink more often (96/124 vs 20/39, % rate difference 26, 95% CI 10-42, P=0.002) and that a member of staff offered them something to eat and drink more frequently (96/146 vs 19/52, % rate difference 29, 95% CI 14-45, P<0.001). There was no difference between patient responses when the volunteer scheme was running and not for emotional support from staff (49/68 vs 14/21, % rate difference 5, 95% CI -17-28, P=0.63). CONCLUSIONS Hospital volunteers made a substantial contribution to providing food and drink to patients in the emergency department. Emotional support from volunteers was limited.
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Affiliation(s)
- Freya Mehta
- MSc Graduate, Department of Health Sciences, University of Southampton
| | - Peter Griffiths
- Professor, Chair of Health Services Research, Department of Health Sciences, University of Southampton
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8
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Diet quality is associated with malnutrition and low calf circumference in Canadian long-term care residents. BMC Nutr 2019; 5:57. [PMID: 32153970 PMCID: PMC7050926 DOI: 10.1186/s40795-019-0314-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 10/14/2019] [Indexed: 11/27/2022] Open
Abstract
Background Older adults living in long-term care (LTC) are nutritionally vulnerable. The purpose of this study was to determine diet quality of Canadian LTC residents and its association with malnutrition and low calf circumference. Methods A cross-sectional study was undertaken in 32 LTC homes across four Canadian provinces. Nutrient adequacy ratios (NARs) were calculated for seventeen nutrients; mean adequacy ratio (MAR) was calculated to describe overall diet quality. Malnutrition risk was assessed with the Mini Nutritional Assessment-Short Form (MNA-SF) and diagnosis of protein/energy malnutrition with the Patient-Generated Subjective Global Assessment (PG-SGA). Calf circumference (CC) was also assessed. Linear and logistic regressions for these outcomes with diet quality as the predictor were conducted adjusting for covariates. Results Average MNA-SF score was 10.7 ± 2.5. Residents (43.5%) had mild/moderate to severe malnutrition based on the PG-SGA and 32.6% had a CC of < 31 cm. Mean MAR score was 0.79 ± 0.09 with significant differences between those requiring eating assistance (0.77 ± 0.11) and those that did not require assistance (0.80 ± 0.07) (p < .05). MAR score was significantly associated with malnutrition in fully adjusted models: MNA-SF scores [β = 5.34, 95% Confidence interval (CI) (2.81, 7.85)] and PG-SGA [Odds ratio (OR) = 0.49, 95% CI (0.38, 0.64)]. Those who had better diet quality were more likely to be well nourished or not at risk. Although several individual nutrients were associated with low CC (< 31 cm), there was no association between overall diet quality (MAR) and low CC. Conclusions Diet quality is associated with malnutrition and individual nutrients (NARs) with a low CC. In addition to calories and protein, nutrient dense diets that promote adequate micronutrient intake are required in LTC.
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Saunders R, Seaman K, Graham R, Christiansen A. The effect of volunteers' care and support on the health outcomes of older adults in acute care: A systematic scoping review. J Clin Nurs 2019; 28:4236-4249. [PMID: 31429987 PMCID: PMC7328779 DOI: 10.1111/jocn.15041] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 06/14/2019] [Accepted: 08/03/2019] [Indexed: 01/03/2023]
Abstract
Aim To examine the available evidence on the effects of care and support provided by volunteers on the health outcomes of older adults in acute care services. Background Acute hospital inpatient populations are becoming older, and this presents the potential for poorer health outcomes. Factors such as chronic health conditions, polypharmacy and cognitive and functional decline are associated with increased risk of health care‐related harm, such as falls, delirium and poor nutrition. To minimise the risk of health care‐related harm, volunteer programmes to support patient care have been established in many hospitals worldwide. Design A systematic scoping review. Methods The review followed the PRISMA Extension for Scoping Reviews (PRISMA‐ScR) (File S1). Nine databases were searched (CINAHL, MEDLINE, EMBASE, Cochrane, Scopus, Web of Science, PubMed, ScienceDirect and JBI) using the following key terms: ‘hospital’, ‘volunteer’, ‘sitter’, ‘acute care’, ‘older adults’, ‘confusion’, ‘dementia’ and ‘frail’. The search was limited to papers written in English and published from 2002–2017. Inclusion criteria were studies involving the use of hospital volunteers in the care or support of older adult patients aged ≥ 65 years, or ≥ 50 years for Indigenous peoples, with chronic health conditions, cognitive impairment and/or physical decline or frailty, within the acute inpatient settings. Results Of the 199 articles identified, 17 articles that met the inclusion criteria were critically appraised for quality, and 12 articles were included in the final review. Conclusions There is evidence that the provision of volunteer care and support with eating and drinking, mobilising and therapeutic activities can impact positively upon patient health outcomes related to nutrition, falls and delirium. Further robust research is needed to determine the impact of volunteers in acute care and the specific care activities that can contribute to the best outcomes for older adults. Relevance to clinical practice Volunteers can play a valuable role in supporting care delivery by nurses and other health professionals in acute care services, and their contribution can improve health outcomes for older adults in this setting.
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Affiliation(s)
- Rosemary Saunders
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia
| | - Karla Seaman
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia
| | - Renée Graham
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia
| | - Angela Christiansen
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia
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Dowson B, McDermott O, Schneider J. What indicators have been used to evaluate the impact of music on the health and wellbeing of people with dementia? A review using meta-narrative methods. Maturitas 2019; 127:26-34. [DOI: 10.1016/j.maturitas.2019.06.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 05/17/2019] [Accepted: 06/03/2019] [Indexed: 01/17/2023]
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Hurst A, Coyne E, Kellett U, Needham J. Volunteers motivations and involvement in dementia care in hospitals, aged care and resident homes: An integrative review. Geriatr Nurs 2019; 40:478-486. [DOI: 10.1016/j.gerinurse.2019.03.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 02/21/2019] [Accepted: 03/01/2019] [Indexed: 10/27/2022]
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Investigating the safety and efficacy of nabilone for the treatment of agitation in patients with moderate-to-severe Alzheimer's disease: Study protocol for a cross-over randomized controlled trial. Contemp Clin Trials Commun 2019; 15:100385. [PMID: 31338476 PMCID: PMC6627000 DOI: 10.1016/j.conctc.2019.100385] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 05/03/2019] [Accepted: 05/22/2019] [Indexed: 12/14/2022] Open
Abstract
Agitation is a prevalent and difficult-to-treat symptom in patients with moderate-to-severe Alzheimer's disease (AD). Though there are nonpharmacological and pharmacological interventions recommended for the treatment of agitation, the efficacy of these are modest and not always consistent. Furthermore, the safety profiles of currently prescribed medications are questionable. Nabilone, a synthetic cannabinoid, has a distinct pharmacological profile that may provide a safer and more effective treatment for agitation, while potentially having benefits for weight and pain. Additionally, emerging evidence suggests nabilone may have neuroprotective effects. We describe a clinical trial investigating the safety and efficacy of nabilone for the treatment of agitation in patients with moderate-to-severe AD. This will be a double-blind, randomized cross-over study comparing 6 weeks of nabilone (0.5-2 mg) and placebo, with a 1-week washout preceding each phase. Study outcomes will be measured at baseline and end of treatment for each treatment phase. The primary outcome measure will be agitation as assessed by the Cohen-Mansfield Agitation Inventory. The secondary outcomes include safety, behaviour (Neuropsychiatric Inventory), cognition (standardized Mini Mental Status Exam and either Severe Impairment Battery or Alzheimer's disease Assessment Scale-Cognitive subscale) and global impression (Clinician's Global Impression of Change). Exploratory outcomes include pain (Pain Assessment in Advanced AD), nutritional status (Mini-Nutritional Assessment-Short Form), caregiver distress (NPI caregiver distress), and blood-based biomarkers. A safe and efficacious pharmacological intervention for agitation, with effects on pain and weight loss in patients with moderate-to-severe AD could increase quality-of-life, reduce caregiver stress and avoid unnecessary institutionalization and related increases in health care costs. Clinical trials number NCT02351882.
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Key Words
- AD, Alzheimer's disease
- Agitation
- Alzheimer's disease
- CB, cannabinoids
- CB1, cannabinoid receptor 1
- CB2, cannabinoid receptor 2
- CGIC, Clinician's Global Impression of Change
- CMAI, Cohen Mansfield Agitation Inventory
- Cannabinoid
- Clinical trial
- EC50, half maximal effective concentration
- FDA, Food and Drug Administration
- IPA, International Psychogeriatric Association
- LTC, long-term care
- MAR, Medication Administration Record
- MNA-SF, Mini-Nutritional Assessment-Short form
- NPI-NH, Neuropsychiatric Inventory-Nursing home version
- NPS, neuropsychiatric symptoms
- Neuropsychiatric symptoms
- PAINAD, Pain Assessment in Advanced AD
- RCT, randomized controlled trial
- SIB, Severe Impairment Battery
- THC, tetrahydrocannabinol
- sMMSE, standardized Mini-Mental Status Examination
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13
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ESPEN guideline on clinical nutrition and hydration in geriatrics. Clin Nutr 2018; 38:10-47. [PMID: 30005900 DOI: 10.1016/j.clnu.2018.05.024] [Citation(s) in RCA: 652] [Impact Index Per Article: 108.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 05/29/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND Malnutrition and dehydration are widespread in older people, and obesity is an increasing problem. In clinical practice, it is often unclear which strategies are suitable and effective in counteracting these key health threats. AIM To provide evidence-based recommendations for clinical nutrition and hydration in older persons in order to prevent and/or treat malnutrition and dehydration. Further, to address whether weight-reducing interventions are appropriate for overweight or obese older persons. METHODS This guideline was developed according to the standard operating procedure for ESPEN guidelines and consensus papers. A systematic literature search for systematic reviews and primary studies was performed based on 33 clinical questions in PICO format. Existing evidence was graded according to the SIGN grading system. Recommendations were developed and agreed in a multistage consensus process. RESULTS We provide eighty-two evidence-based recommendations for nutritional care in older persons, covering four main topics: Basic questions and general principles, recommendations for older persons with malnutrition or at risk of malnutrition, recommendations for older patients with specific diseases, and recommendations to prevent, identify and treat dehydration. Overall, we recommend that all older persons shall routinely be screened for malnutrition in order to identify an existing risk early. Oral nutrition can be supported by nursing interventions, education, nutritional counseling, food modification and oral nutritional supplements. Enteral nutrition should be initiated if oral, and parenteral if enteral nutrition is insufficient or impossible and the general prognosis is altogether favorable. Dietary restrictions should generally be avoided, and weight-reducing diets shall only be considered in obese older persons with weight-related health problems and combined with physical exercise. All older persons should be considered to be at risk of low-intake dehydration and encouraged to consume adequate amounts of drinks. Generally, interventions shall be individualized, comprehensive and part of a multimodal and multidisciplinary team approach. CONCLUSION A range of effective interventions is available to support adequate nutrition and hydration in older persons in order to maintain or improve nutritional status and improve clinical course and quality of life. These interventions should be implemented in clinical practice and routinely used.
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Lea EJ, Goldberg LR, Price AD, Tierney LT, McInerney F. Staff awareness of food and fluid care needs for older people with dementia in residential care: A qualitative study. J Clin Nurs 2017; 26:5169-5178. [DOI: 10.1111/jocn.14066] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2017] [Indexed: 01/11/2023]
Affiliation(s)
- Emma J Lea
- Wicking Dementia Research and Education Centre; University of Tasmania; Hobart Tas. Australia
| | - Lynette R Goldberg
- Wicking Dementia Research and Education Centre; University of Tasmania; Hobart Tas. Australia
| | - Andrea D Price
- Wicking Dementia Research and Education Centre; University of Tasmania; Hobart Tas. Australia
| | - Laura T Tierney
- Wicking Dementia Research and Education Centre; University of Tasmania; Hobart Tas. Australia
| | - Fran McInerney
- Wicking Dementia Research and Education Centre; University of Tasmania; Hobart Tas. Australia
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15
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Hall CL, Brooke J, Pendlebury ST, Jackson D. What is the Impact of Volunteers Providing Care and Support for People with Dementia in Acute Hospitals? A Systematic Review. DEMENTIA 2017; 18:1410-1426. [PMID: 28587482 DOI: 10.1177/1471301217713325] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A quarter of acute hospital beds are occupied by people with dementia, and a hospital stay may impact negatively on their health and wellbeing. The development and implementation of volunteers to provide social, activity-based, one-to-one support for people with dementia in acute hospitals has become routine practice. However, the evidence to support this practice has not been identified or evaluated. This systematic review considers the effect of volunteers on the care and experience of people with co-morbid cognitive impairment/dementia in acute hospitals. The systematic search identified 444 papers, although only three papers included specific analysis relating to the impact of volunteers. The evidence suggests volunteers may have potential to enhance the experiences of people with dementia in acute hospitals; however, there is currently a marked lack of evidence to support the widespread implementation of volunteers. There is therefore an urgent need for multi-site robust research to provide evidence of the impact of volunteers supporting people with cognitive impairment/dementia during an acute hospital stay.
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Affiliation(s)
- Claire L Hall
- Oxford Institute for Nursing, Midwifery and Allied Health Research (OxINMAHR), Oxford Brookes University, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Joanne Brooke
- Oxford Institute for Nursing, Midwifery and Allied Health Research (OxINMAHR), Oxford Brookes University, Oxford, UK
| | - Sarah T Pendlebury
- Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK; the Oxford NIHR Biomedical Research Centre and the Departments of General Medicine and Geratology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Debra Jackson
- Oxford Institute for Nursing, Midwifery and Allied Health Research (OxINMAHR), Oxford Brookes University, Oxford, UK; Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Assistance at mealtimes in hospital settings and rehabilitation units for patients (>65 years) from the perspective of patients, families and healthcare professionals: A mixed methods systematic review. Int J Nurs Stud 2017; 69:100-118. [DOI: 10.1016/j.ijnurstu.2017.01.013] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 01/26/2017] [Accepted: 01/26/2017] [Indexed: 11/23/2022]
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17
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Murphy JL, Holmes J, Brooks C. Nutrition and dementia care: developing an evidence-based model for nutritional care in nursing homes. BMC Geriatr 2017; 17:55. [PMID: 28196475 PMCID: PMC5309970 DOI: 10.1186/s12877-017-0443-2] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Accepted: 02/07/2017] [Indexed: 12/26/2022] Open
Abstract
Background There is a growing volume of research to offer improvements in nutritional care for people with dementia living in nursing homes. Whilst a number of interventions have been identified to support food and drink intake, there has been no systematic research to understand the factors for improving nutritional care from the perspectives of all those delivering care in nursing homes. The aim of this study was to develop a research informed model for understanding the complex nutritional problems associated with eating and drinking for people with dementia. Methods We conducted nine focus groups and five semi-structured interviews with those involved or who have a level of responsibility for providing food and drink and nutritional care in nursing homes (nurses, care workers, catering assistants, dietitians, speech and language therapists) and family carers. The resulting conceptual model was developed by eliciting care-related processes, thus supporting credibility from the perspective of the end-users. Results The seven identified domain areas were person-centred nutritional care (the overarching theme); availability of food and drink; tools, resources and environment; relationship to others when eating and drinking; participation in activities; consistency of care and provision of information. Conclusions This collaboratively developed, person-centred model can support the design of new education and training tools and be readily translated into existing programmes. Further research is needed to evaluate whether these evidence-informed approaches have been implemented successfully and adopted into practice and policy contexts and can demonstrate effectiveness for people living with dementia.
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Affiliation(s)
- Jane L Murphy
- Faculty of Health and Social Sciences, Royal London House, Bournemouth University, Christchurch Road, Bournemouth, BH1 3LT, UK.
| | - Joanne Holmes
- Faculty of Health and Social Sciences, Royal London House, Bournemouth University, Christchurch Road, Bournemouth, BH1 3LT, UK
| | - Cindy Brooks
- Faculty of Health and Social Sciences, Royal London House, Bournemouth University, Christchurch Road, Bournemouth, BH1 3LT, UK
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18
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Howson FFA, Sayer AA, Roberts HC. The Impact of Trained Volunteer Mealtime Assistants on Dietary Intake and Satisfaction with Mealtime Care in Adult Hospital Inpatients: A Systematic Review. J Nutr Health Aging 2017; 21:1038-1049. [PMID: 29083446 DOI: 10.1007/s12603-016-0847-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Malnutrition is common in hospital inpatients and is associated with increased morbidity and mortality. Insufficient assistance at mealtimes can contribute to this and therefore trained volunteer mealtime assistants may be of benefit. OBJECTIVES To identify and review the current evidence for the impact of trained volunteer mealtime assistants on dietary intake and satisfaction with mealtime care in adult hospital inpatients. METHODS A systematic search of Medline, Embase and CINAHL was conducted to identify relevant articles. Articles of any methodology were considered. Quality assessment and data extraction were carried out by two reviewers independently. PARTICIPANTS Participants were inpatients in a hospital setting, including rehabilitation units. Participants in long term care facilities were excluded. INTERVENTION Articles that examined the effect of trained volunteer mealtime assistants on nutritional outcomes or satisfaction with mealtime care were included. RESULTS 5576 articles were identified, of which 14 were included in the review. Nine were small research studies and five were quality improvement initiatives. The quality of eight studies was moderate, with one study being of lower quality. Eight articles reported dietary intake and seven demonstrated an improvement, with protein intakes at volunteer mealtimes increasing by 4.3g-10.1g and energy intakes by 44-105kcal. Ten articles reported positive staff, patient and volunteer feedback. No adverse events were reported. CONCLUSION There is evidence from small studies and improvement projects that trained volunteer mealtime assistants are safe and improve satisfaction with mealtime care in hospital inpatients, although evidence for an effect on dietary intake was less consistent. Larger studies with robust methodology are required to confirm this.
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Affiliation(s)
- F F A Howson
- F.F.A. Howson, University Hospital Southampton, Medicine for Older People, Tremona Rd, Southampton, Hants SO16 6YD, United Kingdom,
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Edwards D, Carrier J, Hopkinson J. Mealtime assistance for older adults in hospital settings and rehabilitation units from the perspective of patients, families and healthcare professionals: a mixed methods systematic review. JBI DATABASE OF SYSTEMATIC REVIEWS AND IMPLEMENTATION REPORTS 2016; 14:261-357. [PMID: 27755326 DOI: 10.11124/jbisrir-2016-003100] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
BACKGROUND The prevalence of malnutrition for older adults (>65 years) in hospital and rehabilitation units has been reported as being as high as 60%; some older patients with good appetites do not receive sufficient nourishment because of inadequate feeding assistance. Mealtime assistance can therefore enhance nutritional intake, clinical outcomes and patient experience. OBJECTIVES This mixed methods review sought to develop an aggregated synthesis of quantitative and qualitative data on assistance at mealtimes for older adults in hospital settings and rehabilitation units to determine current practices, what practices work, and the perceptions of patients, families, and healthcare professionals of mealtime assistance. INCLUSION CRITERIA TYPES OF PARTICIPANTS: Participants included older adults (65 years and over) in hospital settings, including rehabilitation units. TYPES OF INTERVENTION(S)/PHENOMENA OF INTEREST The review focused on interventions for mealtime assistance, observed mealtime assistance, or discussed experiences of mealtime assistance with patients, families and healthcare professionals. TYPES OF STUDIES The review included qualitative, quantitative and mixed methods studies. OUTCOMES The outcomes of interest were the effectiveness of mealtime assistance initiatives and experiences of assistance at mealtimes. SEARCH STRATEGY The search strategy identified studies from seven databases published between 1998 and 2015. METHODOLOGICAL QUALITY Methodological quality of studies was independently assessed by two reviewers using standardized Joanna Briggs Institute critical appraisal instruments. DATA EXTRACTION Standardized Joanna Briggs Institute data extraction tools were used. DATA SYNTHESIS Synthesis of the findings was reached through discussion. The results of quantitative studies could not be statistically pooled because of heterogeneity and are presented in narrative form. The results are presented as three aggregated mixed methods syntheses. RESULTS A total of 21 publications (19 studies) were included: 11 quantitative, five qualitative and three mixed method studies. Two studies were conducted in rehabilitation units, and 17 in hospital wards. Eight qualitative studies (nine papers) considered extrinsic and intrinsic factors that influence mealtime support. Evidence for the effectiveness of interventions was limited to eight studies (nine papers); the remaining quantitative studies included two cross-sectional studies, three descriptive evaluations (four papers) and one observational/case study. The following are the aggregated mixed methods syntheses: CONCLUSION: No firm conclusions can be drawn with respect to the most effective initiatives. Initiatives with merit include those that encourage social interaction, either through the use of a dining room, or employed staff or volunteers, relatives or visitors supporting the older patient during mealtimes. Volunteers value training and support and clarification of their roles and responsibilities.
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Affiliation(s)
- Deborah Edwards
- 1The Wales Centre for Evidence-based Care, a Joanna Briggs Institute Centre of Excellence 2School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
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20
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Bunn DK, Abdelhamid A, Copley M, Cowap V, Dickinson A, Howe A, Killett A, Poland F, Potter JF, Richardson K, Smithard D, Fox C, Hooper L. Effectiveness of interventions to indirectly support food and drink intake in people with dementia: Eating and Drinking Well IN dementiA (EDWINA) systematic review. BMC Geriatr 2016; 16:89. [PMID: 27142469 PMCID: PMC4855348 DOI: 10.1186/s12877-016-0256-8] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 04/13/2016] [Indexed: 12/15/2022] Open
Abstract
Background Risks and prevalence of malnutrition and dehydration are high in older people but even higher in older people with dementia. In the EDWINA (Eating and Drinking Well IN dementiA) systematic review we aimed to assess effectiveness of interventions aiming to improve, maintain or facilitate food/drink intake indirectly, through food service or dining environment modification, education, exercise or behavioural interventions in people with cognitive impairment or dementia (across all settings, levels of care and support, types and degrees of dementia). Methods We comprehensively searched Medline and twelve further databases, plus bibliographies, for intervention studies with ≥3 cognitively impaired adult participants (any type/stage). The review was conducted with service user input in accordance with Cochrane Collaboration’s guidelines. We duplicated assessment of inclusion, data extraction, and validity assessment, tabulating data. Meta-analysis (statistical pooling) was not appropriate so data were tabulated and synthesised narratively. Results We included 56 interventions (reported in 51 studies). Studies were small and there were no clearly effective, or clearly ineffective, interventions. Promising interventions included: eating meals with care-givers, family style meals, soothing mealtime music, constantly accessible snacks and longer mealtimes, education and support for formal and informal care-givers, spaced retrieval and Montessori activities, facilitated breakfast clubs, multisensory exercise and multicomponent interventions. Conclusions We found no definitive evidence on effectiveness, or lack of effectiveness, of specific interventions but studies were small and short term. A variety of promising indirect interventions need to be tested in large, high-quality RCTs, and may be approaches that people with dementia and their formal or informal care-givers would wish to try. Trial registration The systematic review protocol was registered (CRD42014007611) and is published, with the full MEDLINE search strategy, on Prospero (http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42014007611). Electronic supplementary material The online version of this article (doi:10.1186/s12877-016-0256-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Diane K Bunn
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norfolk, NR4 7TJ, UK
| | - Asmaa Abdelhamid
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norfolk, NR4 7TJ, UK.,Present address: Royal College of Paediatrics and Child Health, 5-11 Theobalds Road, London, WC1X 8SH, UK
| | - Maddie Copley
- Age UK Norfolk, 300 St Faith's Road, Old Catton, Norwich, NR6 7BJ, UK
| | - Vicky Cowap
- NorseCare, Lancaster House, 16 Central Avenue, St Andrew's Business Park, Norwich, NR7 0HR, UK
| | - Angela Dickinson
- School of Health and Social Work, University of Hertfordshire, Hatfield, Hertfordshire, AL10 9AB, UK
| | - Amanda Howe
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norfolk, NR4 7TJ, UK
| | - Anne Killett
- School of Health Sciences, University of East Anglia, Norwich Research Park, Norfolk, NR4 7TJ, UK
| | - Fiona Poland
- School of Health Sciences, University of East Anglia, Norwich Research Park, Norfolk, NR4 7TJ, UK
| | - John F Potter
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norfolk, NR4 7TJ, UK.,Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY, UK
| | - Kate Richardson
- Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY, UK
| | - David Smithard
- King's College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK
| | - Chris Fox
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norfolk, NR4 7TJ, UK.,Norfolk and Suffolk NHS Foundation Trust, Hellesdon Hospital, Drayton High Road, Norwich, NR6 5BE, UK
| | - Lee Hooper
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norfolk, NR4 7TJ, UK.
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21
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Nell D, Neville S, Bellew R, O'Leary C, Beck KL. Factors affecting optimal nutrition and hydration for people living in specialised dementia care units: A qualitative study of staff caregivers' perceptions. Australas J Ageing 2016; 35:E1-E6. [DOI: 10.1111/ajag.12307] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Debra Nell
- Institute of Food, Nutrition & Human Health; Massey University; Auckland New Zealand
| | | | - Roana Bellew
- Senior Living and Private Hospitals; Compass Group NZ Ltd; Auckland New Zealand
| | - Catherine O'Leary
- Senior Living and Private Hospitals; Compass Group NZ Ltd; Auckland New Zealand
| | - Kathryn Louise Beck
- Institute of Food, Nutrition & Human Health; Massey University; Auckland New Zealand
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22
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Morilla-Herrera JC, Martín-Santos FJ, Caro-Bautista J, Saucedo-Figueredo C, García-Mayor S, Morales-Asencio JM. Effectiveness of Food-Based Fortification in Older People. A Systematic Review and Meta-Analysis. J Nutr Health Aging 2016; 20:178-84. [PMID: 26812514 DOI: 10.1007/s12603-015-0591-z] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Early intervention with nutritional support has been found to stop weight loss in older people malnourished or at risk of malnutrition. Enriched food could be a more attractive alternative to improve meals, than conventional oral nutritional supplements. AIMS To determine the effectiveness of food-based fortification to prevent risk of malnutrition in elderly patients in community or institutionalized elderly patients. METHODS A systematic review was conducted of randomized controlled trials, quasi-experimental, and interrupted time series including a longitudinal analysis. PARTICIPANTS Elderly patients who are institutionalized, hospitalized or community-dwelling, with a minimum average age of 65 years. All type of patient groups, with the exception of people in critical care, or those who were recovering from cancer treatment, were included. INTERVENTION Studies had to compare food-based fortification against alternatives. Studies that used oral nutritional supplementation such as commercial sip feeds, vitamin or mineral supplements were excluded. The search was conducted in Cochrane, CINAHL, PubMed, EMBASE, LILACS, and Cuiden. An independent peer review was carried out. RESULTS From 1011 studies obtained, 7 were included for the systematic review, with 588 participants. It was possible to perform meta-analysis of four studies that provided results on caloric and protein intake. Food-based fortification yielded positive results in the total amount of ingested calories and protein. Nevertheless, due to the small number of participants and the poor quality of some studies, further high quality studies are required to provide reliable evidence. IMPLICATIONS FOR PRACTICE Despite the limited evidence, due to their simplicity, low cost, and positive results in protein and calories intake, simple dietary interventions based on the food-based fortification or densification with protein or energy of the standard diet could be considered in patients at risk of malnutrition.
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Affiliation(s)
- J C Morilla-Herrera
- Dr Jose Miguel Morales Asencio.C/ Arquitecto Francisco Peñalosa, 3. 29071 Malaga, Spain,
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Abdelhamid A, Bunn D, Copley M, Cowap V, Dickinson A, Gray L, Howe A, Killett A, Lee J, Li F, Poland F, Potter J, Richardson K, Smithard D, Fox C, Hooper L. Effectiveness of interventions to directly support food and drink intake in people with dementia: systematic review and meta-analysis. BMC Geriatr 2016; 16:26. [PMID: 26801619 PMCID: PMC4722767 DOI: 10.1186/s12877-016-0196-3] [Citation(s) in RCA: 104] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Accepted: 01/12/2016] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Eating and drinking difficulties are recognised sources of ill health in people with dementia. In the EDWINA (Eating and Drinking Well IN dementiA) systematic review we aimed to assess effectiveness of interventions to directly improve, maintain or facilitate oral food and drink intake, nutrition and hydration status, in people with cognitive impairment or dementia (across all settings, levels of care and support, types and degrees of dementia). Interventions included oral nutrition supplementation, food modification, dysphagia management, eating assistance and supporting the social element of eating and drinking. METHODS We comprehensively searched 13 databases for relevant intervention studies. The review was conducted with service user input in accordance with Cochrane Collaboration's guidelines. We duplicated assessment of inclusion, data extraction, and validity assessment, tabulating data, carrying out random effects meta-analysis and narrative synthesis. RESULTS Forty-three controlled interventions were included, disappointingly none were judged at low risk of bias. Oral nutritional supplementation studies suggested small positive short term but unclear long term effects on nutritional status. Food modification or dysphagia management studies were smaller and of low quality, providing little evidence of an improved nutritional status. Eating assistance studies provided inconsistent evidence, but studies with a strong social element around eating/drinking, although small and of low quality provided consistent suggestion of improvements in aspects of quality of life. There were few data to address stakeholders' questions. CONCLUSIONS We found no definitive evidence on effectiveness, or lack of effectiveness, of specific interventions but studies were small and short term. People with cognitive impairment and their carers have to tackle eating problems despite this lack of evidence, so promising interventions are listed. The need remains for high quality trials tailored for people with cognitive impairment assessing robust outcomes. SYSTEMATIC REVIEW REGISTRATION The systematic review protocol was registered (CRD42014007611) and is published, with the full MEDLINE search strategy, on Prospero.
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Affiliation(s)
- Asmaa Abdelhamid
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norfolk, NR4 7TJ, UK.
- Present address: Royal College of Paediatrics and Child Health, 5-11 Theobalds Road, London, WC1X 8SH, UK.
| | - Diane Bunn
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norfolk, NR4 7TJ, UK.
| | - Maddie Copley
- Age UK Norfolk, 300 St Faith's Road, Old Catton, Norwich, NR6 7BJ, UK.
| | - Vicky Cowap
- NorseCare, Lancaster House 16 Central Avenue St Andrew's Business Park, Norwich, NR7 0HR, UK.
| | - Angela Dickinson
- School of Health and Social Work, University of Hertfordshire, Hatfield, Hertfordshire, AL10 9AB, UK.
| | - Lucy Gray
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norfolk, NR4 7TJ, UK.
| | - Amanda Howe
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norfolk, NR4 7TJ, UK.
| | - Anne Killett
- School of Health Sciences, University of East Anglia, Norwich Research Park, Norfolk, NR4 7TJ, UK.
| | - Jin Lee
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norfolk, NR4 7TJ, UK.
| | - Francesca Li
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norfolk, NR4 7TJ, UK.
| | - Fiona Poland
- School of Health Sciences, University of East Anglia, Norwich Research Park, Norfolk, NR4 7TJ, UK.
| | - John Potter
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norfolk, NR4 7TJ, UK.
- Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY, UK.
| | - Kate Richardson
- Norfolk and Norwich University Hospital, Colney Lane, Norwich, NR4 7UY, UK.
| | - David Smithard
- King's College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK.
| | - Chris Fox
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norfolk, NR4 7TJ, UK.
- Norfolk and Suffolk NHS Foundation Trust, Hellesdon Hospital, Drayton High Road, Norwich, NR6 5BE, UK.
| | - Lee Hooper
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norfolk, NR4 7TJ, UK.
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Liu W, Galik E, Boltz M, Nahm ES, Lerner N, Resnick B. Factors associated with eating performance for long-term care residents with moderate-to-severe cognitive impairment. J Adv Nurs 2015; 72:348-60. [DOI: 10.1111/jan.12846] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2015] [Indexed: 01/26/2023]
Affiliation(s)
- Wen Liu
- The University of Iowa College of Nursing; Iowa USA
| | - Elizabeth Galik
- University of Maryland School of Nursing; Baltimore Maryland USA
| | - Marie Boltz
- Boston College Connell School of Nursing; Chestnut Hill Massachusetts USA
| | - Eun-Shim Nahm
- University of Maryland School of Nursing; Baltimore Maryland USA
| | - Nancy Lerner
- University of Maryland School of Nursing; Baltimore Maryland USA
| | - Barbara Resnick
- University of Maryland School of Nursing; Baltimore Maryland USA
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Edwards D, Carrier J, Hopkinson J. Assistance at mealtimes in hospital settings and rehabilitation units for older adults from the perspective of patients, families and healthcare professionals: a mixed methods systematic review protocol. ACTA ACUST UNITED AC 2015; 13:17-32. [DOI: 10.11124/jbisrir-2015-2425] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Volkert D, Chourdakis M, Faxen-Irving G, Frühwald T, Landi F, Suominen MH, Vandewoude M, Wirth R, Schneider SM. ESPEN guidelines on nutrition in dementia. Clin Nutr 2015; 34:1052-73. [PMID: 26522922 DOI: 10.1016/j.clnu.2015.09.004] [Citation(s) in RCA: 225] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 09/10/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND Older people suffering from dementia are at increased risk of malnutrition due to various nutritional problems, and the question arises which interventions are effective in maintaining adequate nutritional intake and nutritional status in the course of the disease. It is of further interest whether supplementation of energy and/or specific nutrients is able to prevent further cognitive decline or even correct cognitive impairment, and in which situations artificial nutritional support is justified. OBJECTIVE It is the purpose of these guidelines to cover these issues with evidence-based recommendations. METHODS The guidelines were developed by an international multidisciplinary working group in accordance with officially accepted standards. The GRADE system was used for assigning strength of evidence. Recommendations were discussed, submitted to Delphi rounds and accepted in an online survey among ESPEN members. RESULTS 26 recommendations for nutritional care of older persons with dementia are given. In every person with dementia, screening for malnutrition and close monitoring of body weight are recommended. In all stages of the disease, oral nutrition may be supported by provision of adequate, attractive food in a pleasant environment, by adequate nursing support and elimination of potential causes of malnutrition. Supplementation of single nutrients is not recommended unless there is a sign of deficiency. Oral nutritional supplements are recommended to improve nutritional status but not to correct cognitive impairment or prevent cognitive decline. Artificial nutrition is suggested in patients with mild or moderate dementia for a limited period of time to overcome a crisis situation with markedly insufficient oral intake, if low nutritional intake is predominantly caused by a potentially reversible condition, but not in patients with severe dementia or in the terminal phase of life. CONCLUSION Nutritional care and support should be an integral part of dementia management. In all stages of the disease, the decision for or against nutritional interventions should be made on an individual basis after carefully balancing expected benefit and potential burden, taking the (assumed) patient will and general prognosis into account.
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Affiliation(s)
- Dorothee Volkert
- Institute for Biomedicine of Aging (IBA), Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Nuremberg, Germany.
| | - Michael Chourdakis
- Department of Medicine, Aristotle University of Thessaloniki (AUTH), Greece
| | - Gerd Faxen-Irving
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Thomas Frühwald
- Department of Geriatric Acute Care, Krankenhaus Hietzing, Vienna, Austria
| | - Francesco Landi
- Department of Geriatrics, Neurosciences and Orthopedics, Catholic University of the Sacred Heart, Rome, Italy
| | - Merja H Suominen
- Unit of Primary Health Care, Helsinki University Central Hospital, Helsinki, Finland
| | - Maurits Vandewoude
- Department of Geriatrics, Medical School, University of Antwerp, Belgium
| | - Rainer Wirth
- Institute for Biomedicine of Aging (IBA), Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Nuremberg, Germany; St. Marien-Hospital Borken, Department for Internal Medicine and Geriatrics, Borken, Germany
| | - Stéphane M Schneider
- Nutritional Support Unit, Centre Hospitalier Universitaire de Nice, Nice, France
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Kimber K, Gibbs M, Weekes CE, Baldwin C. Supportive interventions for enhancing dietary intake in malnourished or nutritionally at-risk adults: a systematic review of nonrandomised studies. J Hum Nutr Diet 2015; 28:517-45. [DOI: 10.1111/jhn.12329] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- K. Kimber
- Barts Health NHS Trust; Newham University Hospital; Plaistow London UK
| | - M. Gibbs
- Diabetes and Nutritional Sciences Division; King's College London; London UK
| | - C. E. Weekes
- Department of Nutrition & Dietetics; Guy's & St Thomas NHS Foundation Trust; London UK
| | - C. Baldwin
- Diabetes and Nutritional Sciences Division; King's College London; London UK
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Jansen S, Ball L, Desbrow B, Morgan K, Moyle W, Hughes R. Nutrition and dementia care: Informing dietetic practice. Nutr Diet 2014. [DOI: 10.1111/1747-0080.12144] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Sarah Jansen
- Centre for Health Practice Innovation Griffith University Australia
| | - Lauren Ball
- Centre for Health Practice Innovation Griffith University Australia
| | - Ben Desbrow
- Centre for Health Practice Innovation Griffith University Australia
| | | | - Wendy Moyle
- Centre for Health Practice Innovation Griffith University Australia
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Liu W, Cheon J, Thomas SA. Interventions on mealtime difficulties in older adults with dementia: A systematic review. Int J Nurs Stud 2014; 51:14-27. [DOI: 10.1016/j.ijnurstu.2012.12.021] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2012] [Revised: 12/12/2012] [Accepted: 12/28/2012] [Indexed: 12/21/2022]
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What is the evidence to guide best practice for the management of older people with cognitive impairment presenting to emergency departments? A systematic review. Adv Emerg Nurs J 2013; 35:154-69. [PMID: 23636047 DOI: 10.1097/tme.0b013e31828c7f4a] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The aim of this study was to conduct a systematic literature review of research-based studies to identify practices designed to meet the specific care needs of older cognitively impaired patients in emergency departments (ED). A systematic literature review of studies was completed using PRIMSA methodology. The search criteria included articles from both emergency and acute care settings. A total of 944 articles were screened, and a total of 43 articles were identified as eligible. The review found a number of intervention studies to improve quality of care for older persons with cognitive impairment carried out or commenced in emergency settings, including interventions to improve cognitive impairment recognition (n = 9) and clinical approaches to reduce falls (n = 1) and both delirium incidence and prevalence (n = 2). Relevant studies carried out in acute care settings regarding cognitive impairment recognition (n = 4) and primary and secondary prevention of delirium (n = 18) and intervention studies that reduced the prescription of deliriogenic drugs (n = 1), reduced behavioral symptoms and discomfort (n = 7), and improved nutritional intake (n = 1) in hospitalized older persons with dementia were also identified. There is limited research available that reports interventions that improve the quality of care of older ED patients with cognitive impairment. Although this review found evidence obtained from the acute care setting, additional research is needed to identify whether these interventions are beneficial in fast-paced emergency settings.
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Salvà A, Andrieu S, Fernandez E, Schiffrin EJ, Moulin J, Decarli B, Rojano-i-Luque X, Guigoz Y, Vellas B. Health and nutrition promotion program for patients with dementia (NutriAlz): cluster randomized trial. J Nutr Health Aging 2011; 15:822-30. [PMID: 22159768 DOI: 10.1007/s12603-011-0363-3] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
OBJECTIVE To assess the effectiveness of health and nutrition program (NutriAlz) versus usual care on functional level in elderly people with dementia living at home, as well as on clinical practice related to nutrition and on the caregiver's burden. DESIGN Cluster randomized multi-centre study with one-year follow-up. SETTING 11 Alzheimer outpatients and day care centres (Barcelona, Spain). PARTICIPANTS Nine hundred and forty six home-living Alzheimer patients with identified caregiver were consecutively recruited (intervention group: 6 centres, 448 patients vs control group: 5 centres, 498 patients). INTERVENTION The intervention was a teaching and training intervention on health and nutrition program, NutriAlz, directed both to physician and main caregiver, as well as persons affected by Alzheimer's disease or other dementias, including a standardised protocol for feeding and nutrition. MAIN OUTCOME MEASURES The main outcome measure was the reduction in the loss of autonomy (Activities of daily living (ADL/IADL) scales) assessed at 6 and 12 months. Secondary outcomes measures were Improvement in nutritional status (Mini Nutritional Assessment (MNA), BMI, and weight changes), and caregiver burden (Zarit scale). RESULTS The one-year assessment was completed for 293 patients (65.4%) in the intervention group and 363 patients (72.9%) in the control group (usual care). The annual rate of ADL change was -0.83 vs -0.62 (p=0.984), and the caregiver's subjective burden 0.59 vs 2.36 (p=0.681) in intervention and control group, respectively. MNA, however, showed an improvement (+0.46 vs -0.66, p=0.028), suggesting an effective nutritional behaviour. CONCLUSION The NutriAlz program had no effect on functional decline in Alzheimer disease patients living at home over one year, but reduced the risk for malnutrition, as recommendations concerning diet and exercise were provided.
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Affiliation(s)
- A Salvà
- Institut de l'Envelliment, Universitat Autònoma de Barcelona, Institute of Biomedical Research (IIB Sant Pau), Barcelona, Spain.
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Dow B, Meyer C. Caring and Retirement: Crossroads and Consequences. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2010; 40:645-65. [DOI: 10.2190/hs.40.4.e] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
As older workers move closer to retirement, they are more likely to take on caring roles. This may affect their health, retirement plans, and income security. Retired men and women experience the caring role differently, with men less likely to be adversely affected and more likely to accept services and to derive satisfaction from caring. Carers make an important contribution to the lives of the people they care for and to the community. Caring is a productive role that can be sustained into older age, as long as the carer's health and well-being are maintained. More research is needed on the relationship between retirement and caring, to explore the extent of caring and its impact on retirement plans, income, and the physical and mental health of retired carers. This information could then be built into retirement planning to better prepare older workers for this important role. Caring roles and retirement intersect in several ways. About 6 million Americans, 2.6 million Australians, and 6 million people in the United Kingdom are informal carers. People (especially men) are more likely to take on caring roles as they get older and leave the paid workforce. The need to care for a spouse or older relative can be an unanticipated outcome or a precipitator of retirement. Retirement may coincide with illness or disability of a parent or spouse, or may be forced by the demands of caring. Caring may bring about major changes to retirement plans. The financial impact of having been a carer during one's working life may also be felt most keenly on retirement, through the lack of opportunities for savings and retirement fund co-contributions.
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Abstract
With the aging of the world's population there has become a major need for the development of nursing homes throughout the world. While some countries provide high quality care for the disabled elderly, in others this is not the case. Education of a medical director has been shown to improve the quality of the nursing home. Physicians need to have knowledge of how to implement continuous quality improvement and culture change. Key medical issues include moving to a restraint free environment, subsyndromal delirium, behavioral disturbances, weight loss, pain management, pressure ulcers, falls, hip fractures, polypharmacy, depression and frailty.
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Affiliation(s)
- J E Morley
- Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, MO 63104, USA.
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