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Mlakar-Mastnak D, Blaž Kovač M, Terčelj M, Uhan S, Majdič N, Rotovnik Kozjek N. Effectiveness of Nutritional Intervention Led by Clinical Dietitian in Patients at Risk of Malnutrition at the Primary Healthcare Level in Slovenia - Evaluation Study. Zdr Varst 2024; 63:81-88. [PMID: 38517024 PMCID: PMC10954244 DOI: 10.2478/sjph-2024-0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 02/05/2024] [Indexed: 03/23/2024] Open
Abstract
Introduction Clinical dietitians play a crucial role in the nutritional support of patients at risk of malnutrition in primary care settings. The study aimed to evaluate the effect of an individualized nutritional intervention on clinically relevant outcomes for patients with chronic disease at nutritional risk. Methods A longitudinal evaluation study was conducted in two Slovenian primary health centres. We used pre-test and post-test design. Patients with chronic disease were screened using the Malnutrition Universal Screening Tool and additional risk factors (≥70 years and BMI <22 kg/m2; lower food intake in the last five days). Patients at nutritional risk were referred to a clinical dietitian for individual nutritional intervention. The effect of the nutritional intervention was assessed six months after the patients' first visit with a clinical dietitian. Results The sample included 94 patients. Nutritional risk was reduced significantly in high-risk and moderate-risk patients. In a subgroup of patients with a MUST score ≥1 (77 patients), body weight, BMI, Fat-Free Mass Index (FFMI), energy intake, and protein intake increased significantly (p<0.001). At the same time, the phase angle significantly increased (p<0.001), but there were no statistically significant changes in the improvement of grip strength. In a subgroup of patients with MUST score 0 (17 patients), we observed an increase in their median daily energy intake (p<0.001) and median protein intake (p=0.003). Conclusion Nutritional intervention delivered by a clinical dietitian improved patients' nutritional intake and nutritional and functional status.
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Affiliation(s)
| | - Milena Blaž Kovač
- University of Ljubljana, Medical Faculty, Vrazov trg 2, 1000Ljubljana, Slovenia
| | - Mila Terčelj
- Health Centre Žalec, Prešernova ulica 6, 3310Žalec, Slovenia
| | - Samo Uhan
- Angela Boškin Faculty of Health Care, Spodnji Plavž 3, 4270Jesenice, Slovenija
| | - Neža Majdič
- University Rehabilitation Institute Republic of Slovenia Soča, Clinical Nutrition Team, Linhartova cesta 51, 1000Ljubljana, Slovenia
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2
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Stratton RJ. Managing malnutrition and multimorbidity in primary care: dietary approaches to reduce treatment burden. Proc Nutr Soc 2024:1-9. [PMID: 38751299 DOI: 10.1017/s0029665124004695] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2024]
Abstract
There are many health and nutrition implications of suffering from multimorbidity, which is a huge challenge facing health and social services. This review focuses on malnutrition, one of the nutritional consequences of multimorbidity. Malnutrition can result from the impact of chronic conditions and their management (polypharmacy) on appetite and nutritional intake, leading to an inability to meet nutritional requirements from food. Malnutrition (undernutrition) is prevalent in primary care and costly, the main cause being disease, accentuated by multiple morbidities. Most of the costs arise from the deleterious effects of malnutrition on individual's function, clinical outcome and recovery leading to a substantially greater burden on treatment and health care resources, costing at least £19·6 billion in England. Routine identification of malnutrition with screening should be part of the management of multimorbidity together with practical, effective ways of treating malnutrition that overcome anorexia where relevant. Nutritional interventions that improve nutritional intake have been shown to significantly reduce mortality in individuals with multimorbidities. In addition to food-based interventions, a more 'medicalised' dietary approach using liquid oral nutritional supplements (ONS) can be effective. ONS typically have little impact on appetite, effectively improve energy, protein and micronutrient intakes and may significantly improve functional measures. Reduced treatment burden can result from effective nutritional intervention with improved clinical outcomes (fewer infections, wounds), reducing health care use and costs. With the right investment in nutrition and dietetic resources, appropriate nutritional management plans can be put in place to optimally support the multimorbid patient benefitting the individual and the wider society.
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Affiliation(s)
- Rebecca J Stratton
- School of Human Development and Health, Faculty of Medicine, University of Southampton, SouthamptonSO16 6YD, UK
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3
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Pedrianes Martín P, Arnás León C, Sánchez Sánchez G, Santana Ojeda B, García Puente I, Comi Díaz C, Calleja Fernández A, de Pablos Velasco PL. [Trends in the characteristics of patients treated with nutritional supplements in the Northern Area of Gran Canaria in the period 2016 -2021]. NUTR HOSP 2024. [PMID: 38450493 DOI: 10.20960/nh.04940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024] Open
Abstract
AIM assess the prescription of oral nutritional supplements (ONS) in the Northern Area of Gran Canaria in the period 2016-2021. MATERIALS AND METHODS based on electronic prescription data, the first ONS prescription during 2016-2021 was analyzed considering age, gender, nutritional requirements (NR), body mass index (BMI), percentage of weight loss (%WL), albumin and number of prescribed ONS per patient. RESULTS 10,595 prescriptions were identified corresponding to 6661 patients with the following characteristics: 46.3 % men, mean age 72.84 ± 15.93 years, BMI 20.60 ± 3.98 kg/m2, %WL 11.89 ± 8.32 %; albumin 3.08 ± 0.63 g/dl. The most frequent etiologies of DRE were: neoplasms 42.6 %; degenerative processes of the CNS 28.9 %; stroke 3.9 %; short intestine 6.9 %, and inflammatory bowel disease (IBD) 5.5 %. The percentages of NR covered by the prescribed ONS were: 100 % in 8.9 % of cases, 50 % in 36.9 %, and 25 % in 54.2 %; 40.4 % of patients received 1 unit of ONS daily, 36.3 % took 2 units of ONS, and 23 % received > 3 units of ONS per day. Greater NR were associated with a greater number of ONS (p < 0.001), but 40.8 % of patients who needed to cover > 50 % of NR received only one unit of ONS. CONCLUSION a significant percentage of patients with DRM do not receive a number of ONS according to their NR.
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Affiliation(s)
- Pablo Pedrianes Martín
- Servicio de Endocrinología y Nutrición. Hospital Universitario de Gran Canaria Doctor Negrín
| | - Claudia Arnás León
- Servicio de Endocrinología y Nutrición. Hospital Universitario de Gran Canaria Doctor Negrín
| | | | - Borja Santana Ojeda
- Servicio de Endocrinología y Nutrición. Hospital Universitario de Gran Canaria Doctor Negrín
| | - Ignacio García Puente
- Servicio de Endocrinología y Nutrición. Hospital Universitario de Gran Canaria Doctor Negrín
| | - Cristina Comi Díaz
- Servicio de Endocrinología y Nutrición. Hospital Universitario de Gran Canaria Doctor Negrín
| | | | - Pedro L de Pablos Velasco
- Servicio de Endocrinología y Nutrición. Hospital Universitario de Gran Canaria Doctor Negrín. Universidad de Las Palmas de Gran Canaria
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4
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Osório AF, Ribeiro ÉCT, Parahiba SM, Forte GC, Clausell NO, Souza GC. Prognostic value of nutritional screening tools in hospitalized patients with decompensated heart failure: A systematic review and meta-analysis. Nutr Res 2023; 120:1-19. [PMID: 37871448 DOI: 10.1016/j.nutres.2023.09.009] [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: 03/22/2023] [Revised: 09/27/2023] [Accepted: 09/27/2023] [Indexed: 10/25/2023]
Abstract
Nutritional risk screening is fundamental to prevent undesirable outcomes in heart failure (HF). Current reviews of nutritional screening tools encompass both hospitalized and outpatient settings, which may not be suitable because of different clinical manifestations. We hypothesize that multidimensional tools would better identify prognosis of decompensated patients because the tools assess more than isolated aspects. This systematic review aims to explore the association of multidimensional nutritional risk screening tools and prognosis in patients hospitalized with decompensated HF. Five databases were searched for studies that assessed nutritional risk through multidimensional screening tools and its association with prognosis in adults hospitalized with decompensated HF. The 95% confidence interval and relative risk were computed using a random-effects model. Inverse variance method was used. Thirty-eight studies were included. Most studies demonstrated higher nutritional risk was significantly associated with worse prognosis. Quantitative analysis identified higher nutritional risk by using the Mini Nutritional Assessment Short Form (MNA-SF), Controlling Nutritional Status, Geriatric Nutritional Risk Index, and Prognostic Nutritional Index to be associated with all-cause mortality. The MNA-SF demonstrated greater magnitude of association with all-cause mortality in older subjects (relative risk, 4.85; 95% confidence interval, 2.0-11.75). Higher nutritional risk was associated with poor prognosis and higher mortality in patients hospitalized with decompensated HF, especially when screened by MNA-SF. Tools were not directly compared. That might reinforce the importance of evaluating multiple aspects when screening hospitalized HF patients once symptoms associated with decompensation frequently mask the underlying nutritional status and risk. PROSPERO registration number (CRD42021256271).
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Affiliation(s)
- Amanda Farias Osório
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil; Graduate Program in Health Sciences, Cardiology and Cardiovascular Sciences, Medical School, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Édina Caroline Ternus Ribeiro
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil; Graduate Program in Health Sciences, Cardiology and Cardiovascular Sciences, Medical School, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Suena Medeiros Parahiba
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil; Graduate Program in Health Sciences, Cardiology and Cardiovascular Sciences, Medical School, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | | | - Nadine Oliveira Clausell
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil; Graduate Program in Health Sciences, Cardiology and Cardiovascular Sciences, Medical School, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Gabriela Corrêa Souza
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil; Graduate Program in Food, Nutrition and Health, Medical School, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.
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5
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Pourhassan M, Daubert D, Laurentius T, Wirth R. Optimized Refeeding vs. Standard Care in Malnourished Older Hospitalized Patients: A Prospective, Non-Randomized Cluster-Controlled Study in Geriatric Acute Care. J Clin Med 2023; 12:7274. [PMID: 38068326 PMCID: PMC10707595 DOI: 10.3390/jcm12237274] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 11/14/2023] [Accepted: 11/22/2023] [Indexed: 05/25/2024] Open
Abstract
Malnutrition is a prevalent geriatric syndrome with adverse health outcomes. This study aimed to assess the effectiveness of an optimized protocol for treatment of malnutrition in older hospitalized patients. We conducted a prospective, non-randomized cluster-controlled study with 156 malnourished patients in the intervention and 73 in the control group, determined using the Mini Nutritional Assessment-Short-Form. The intervention group received individualized nutritional care, including electrolyte and micronutrients monitoring, while the control received standard care. We primarily focused on complications such as infections, falls, unplanned hospital readmissions, and mortality, and secondarily focused on functional status and mobility improvements. Post-discharge follow-ups occurred at 3 and 6 months. Our findings demonstrated that the intervention group (age 82.3 ± 7.5 y, 69% female), exhibited greater previous weight loss (11.5 kg vs. 4.7 kg), more cognitive impairment and a longer hospital stay (19 days vs. 15 days). Binary logistic regression showed no difference in primary endpoint outcomes between groups during hospitalization. At 3- and 6-month follow-ups, the control group exhibited fewer adverse outcomes, particularly falls and readmissions. Both groups showed in-hospital functional improvements, but only controls maintained post-discharge mobility gains. The study concludes that the nutritional intervention did not outperform standard care, potentially due to study limitations and high-quality standard care in control group geriatric departments.
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Affiliation(s)
- Maryam Pourhassan
- Department of Geriatric Medicine, Marien Hospital Herne, Ruhr-Universität Bochum, 44625 Herne, Germany; (D.D.); (R.W.)
| | - Diana Daubert
- Department of Geriatric Medicine, Marien Hospital Herne, Ruhr-Universität Bochum, 44625 Herne, Germany; (D.D.); (R.W.)
| | - Thea Laurentius
- Universitätsklinikum Aachen—Standort Franziskus Anstalt des öffentlichen Rechts (AöR), 52074 Aachen, Germany;
| | - Rainer Wirth
- Department of Geriatric Medicine, Marien Hospital Herne, Ruhr-Universität Bochum, 44625 Herne, Germany; (D.D.); (R.W.)
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6
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Cawood AL, Burden ST, Smith T, Stratton RJ. A systematic review and meta-analysis of the effects of community use of oral nutritional supplements on clinical outcomes. Ageing Res Rev 2023; 88:101953. [PMID: 37182743 DOI: 10.1016/j.arr.2023.101953] [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: 11/08/2022] [Revised: 04/28/2023] [Accepted: 05/11/2023] [Indexed: 05/16/2023]
Abstract
The impact of oral nutritional supplements (ONS) on patients with complications (disease related morbidity) requires further exploration. This systematic review included 44 randomised controlled trials (RCT) (29 RCT surgical, 15 RCT medical patients) examining the effect of ONS in community settings on the incidence of complications (n = 716, mean age 67 years, range 35-87). ONS (mean intake 588 kcal/day, range 125-1750; protein 22 g/day, range 0-54; mean energy from protein 22 %, range 0-54) were prescribed for a mean 74 days, range 5-365. Most RCT (77 %) reported fewer complications in the ONS group versus control. Meta-analysis (39 RCT) showed ONS consumption reduced complications including infections, pressure ulcers, wound and fracture healing (OR 0.68, 95 % CI 0.59,0.79; p<0.001). Results showed reductions when ONS were used in hospital and community settings (OR 0.72, 95 % CI 0.59,0.87; p = 0.001) or just in the community (OR 0.65, 95 % CI 0.52, 0.80; p<0.001). Reductions in complications were only seen with high ONS adherence ≥ 80 % (OR 0.63, 95 % CI 0.48,0.83; p = 0.001) and ready-to-drink ONS (OR 0.69, 95 % CI 0.60,0.81; p<0.001). This systematic review and meta-analysis show community-based use of ONS in addition to the diet substantially reduces the incidence of complications. The diversity of ONS, patient populations and complication outcomes within the trials included in this review mean further research is warranted.
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Affiliation(s)
- A L Cawood
- Faculty of Medicine, Southampton General Hospital, Mailpoint 113, Tremona Road, Southampton SO16 6YD, UK.
| | - S T Burden
- School of Health Sciences, University of Manchester, Manchester, UK
| | - T Smith
- Department of Gastroenterology, University Hospitals Southampton, NHS Foundation Trust, Southampton General Hospital, Mailpoint 255, Tremona Road, Southampton SO16 6YD, UK
| | - R J Stratton
- Faculty of Medicine, Southampton General Hospital, Mailpoint 113, Tremona Road, Southampton SO16 6YD, UK
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7
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Bernchou TE, Rasmussen LB, Gaarde P, Færgeman K, Voltelen B, Larsen P. Home-delivered between-meal snacks for fragile older adults – A pilot study. AGING AND HEALTH RESEARCH 2023. [DOI: 10.1016/j.ahr.2023.100139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2023] Open
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8
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Holdoway A, Franklin H. Ten years of tackling malnutrition in the community. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:S6-S8. [PMID: 35797084 DOI: 10.12968/bjon.2022.31.13.s6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Anne Holdoway
- Consultant Dietitian and Chair of the Managing Adult Malnutrition in the Community panel
| | - Hilary Franklin
- Healthcare Communications Consultant and Malnutrition Pathway Co-ordinator
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9
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Payne L, Ghio D, Grey E, Slodkowska-Barabasz J, Harris P, Sutcliffe M, Green S, Roberts HC, Childs C, Robinson S, Gudgin B, Holloway P, Kelly J, Wallis K, Dean O, Aveyard P, Gill P, Stroud M, Little P, Yardley L, Morrison L. Optimising an intervention to support home-living older adults at risk of malnutrition: a qualitative study. BMC FAMILY PRACTICE 2021; 22:219. [PMID: 34758733 PMCID: PMC8580738 DOI: 10.1186/s12875-021-01572-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 10/22/2021] [Indexed: 11/17/2022]
Abstract
Background In the UK, about 14% of community-dwelling adults aged 65 and over are estimated to be at risk of malnutrition. Screening older adults in primary care and treating those at risk may help to reduce malnutrition risk, reduce the resulting need for healthcare use and improve quality of life. Interventions are needed to raise older adults’ risk awareness, offer relevant and meaningful strategies to address risk and support general practices to deliver treatment and support. Methods Using the Person-based Approach and input from Patient and Public Involvement representatives, we developed the ‘Eat well, feel well, stay well’ intervention. The intervention was optimised using qualitative data from think aloud and semi-structured process evaluation interviews with 23 and 18 older adults respectively. Positive and negative comments were extracted to inform rapid iterative modifications to support engagement with the intervention. Data were then analysed thematically and final adjustments made, to optimise the meaningfulness of the intervention for the target population. Results Participants’ comments were generally positive. This paper focuses predominantly on participants’ negative reactions, to illustrate the changes needed to ensure that intervention materials were optimally relevant and meaningful to older adults. Key factors that undermined engagement included: resistance to the recommended nutritional intake among those with reduced appetite or eating difficulties, particularly frequent eating and high energy options; reluctance to gain weight; and a perception that advice did not align with participants’ specific personal preferences and eating difficulties. We addressed these issues by adjusting the communication of eating goals to be more closely aligned with older adults’ beliefs about good nutrition, and acceptable and feasible eating patterns. We also adjusted the suggested tips and strategies to fit better with older adults’ everyday activities, values and beliefs. Conclusions Using iterative qualitative methods facilitated the identification of key behavioural and contextual elements that supported engagement, and issues that undermined older adults’ engagement with intervention content. This informed crucial revisions to the intervention content that enabled us to maximise the meaningfulness, relevance and feasibility of the key messages and suggested strategies to address malnutrition risk, and therefore optimise engagement with the intervention and the behavioural advice it provided. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-021-01572-z.
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Affiliation(s)
- Liz Payne
- School of Psychology, University of Southampton, Southampton, UK.
| | - Daniela Ghio
- Primary Care Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | | | | | - Philine Harris
- School of Psychology, University of Southampton, Southampton, UK
| | - Michelle Sutcliffe
- Dietetics Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Sue Green
- Department for Nursing Science, Bournemouth University, Poole, UK
| | - Helen C Roberts
- Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Caroline Childs
- Human Development and Health, University of Southampton, Southampton, UK
| | - Sian Robinson
- AGE Research Group, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.,NIHR Newcastle Biomedical Research Centre, Newcastle University and Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Bernard Gudgin
- Public and Patient Involvement, University of Southampton, Southampton, UK
| | - Pam Holloway
- Public and Patient Involvement, University of Southampton, Southampton, UK
| | - Jo Kelly
- Primary Care Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Kathy Wallis
- Wessex Academic Health Science Network, Southampton, UK
| | - Oliver Dean
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Paramjit Gill
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Mike Stroud
- Clinical Nutrition, University of Southampton, Southampton, UK
| | - Paul Little
- Primary Care Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Lucy Yardley
- School of Psychology, University of Southampton, Southampton, UK.,School of Psychological Science, University of Bristol, Bristol, UK
| | - Leanne Morrison
- School of Psychology, University of Southampton, Southampton, UK.,Primary Care Population Sciences and Medical Education, University of Southampton, Southampton, UK
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10
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Mikkelsen S, Geisler L, Holst M. Malnutrition measured by unintended weight loss among patients in general practice. Nutrition 2021; 96:111554. [DOI: 10.1016/j.nut.2021.111554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 10/26/2021] [Accepted: 11/19/2021] [Indexed: 11/29/2022]
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11
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Mikkelsen S, Geisler L, Holst M. Healthcare professionals' experiences with practice for managing disease-related malnutrition in general practice and proposals for improvement: A qualitative study. Scand J Caring Sci 2021; 36:717-729. [PMID: 34541700 DOI: 10.1111/scs.13033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 08/16/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND & AIM Disease-related malnutrition is prevalent in all healthcare settings, including general practice, and is associated with negative consequences for the individual and the community. The aim of this study was to investigate general practitioners and general practice nurses' perceptions of how they manage disease-related malnutrition, and their view on introducing an early intervention against disease-related malnutrition. METHODS Content analysis was used to analyse individual semi-structured interviews with the general practitioners (n = 9) and five focus group interviews with the general practice nurses (n = 21) from five general practices in Denmark. RESULTS General practice has no tradition for detection of disease-related malnutrition and find that they rarely see patients with unintended weight loss. Nutritional guidance is to a low degree and only randomly performed. Furthermore, most of the health professionals do not have access to nutritional guidance material for patients and lack information about patients' nutrition, when patients when patients receive treatment in the hospital. Suggestions for improvement were handouts with pictures and including nutritional status as a standard in the communication from hospital to general practice. An early intervention against unintended weight loss in specific groups was found feasible. Barriers and facilitators were seen as lack of time, lack of educational opportunities and skills. A financial incentive from the health authorities, and interventions adapted to the individual general practice were among suggested facilitators. CONCLUSION Disease-related malnutrition was rarely recognised and managed in general practice. The health professionals found they lacked means to perform nutritional guidance to patients with unintended weight loss. However, the health professionals had suggestions for improvement for an early intervention including handouts for patients. Further research on implementation of early intervention against unintended weight loss in general practice is needed.
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Affiliation(s)
- Sabina Mikkelsen
- Center for Nutrition and Intestinal Failure, Aalborg University Hospital, Aalborg, Denmark
| | - Lea Geisler
- Center for Nutrition and Intestinal Failure, Aalborg University Hospital, Aalborg, Denmark
| | - Mette Holst
- Center for Nutrition and Intestinal Failure, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Sciences, Aalborg University, Aalborg, Denmark
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12
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Reynolds CME, Dominguez Castro P, Geraghty AA, Browne S, Bardon LA, Corish CA. 'It takes a village': a qualitative study on malnutrition and oral nutritional supplements with older adults in Ireland. Eur J Public Health 2021; 31:1284-1290. [PMID: 34219166 DOI: 10.1093/eurpub/ckab099] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Malnutrition affects approximately 20% of older adult populations in Europe, yet their views on the condition are rarely explored. This qualitative study aimed to explore the experiences of older adults living with malnutrition and prescribed oral nutritional supplements in the community setting. METHODS Semi-structured individual interviews were used to collect data from 13 community-dwelling individuals aged ≥60 years with a current or previous prescription for oral nutritional supplements. Self-perceived health status was measured using the EuroQol EQ-5D-5L, a short questionnaire and visual analogue scale. Interviews were audio-recorded and transcribed verbatim. Interview data were organized using NVivo 12 and analyzed using inductive thematic analysis. RESULTS Median age was 80.0 (interquartile range 19.5) years, seven were male and six were female. Median health score was 60.0 (interquartile range 35.0) out of 100. Almost one-third reported severe or extreme problems with usual activities, and pain or discomfort. One main theme was identified from the interviews: 'It takes a village', with four subthemes (i) 'I get by with a little help from my friends', (ii) 'The obvious diagnosis', (iii) 'The missing T in MDT' and (iv) 'Confusion'. Participants with malnutrition reported relying on friends, family and carers with poor multidisciplinary team communication and lack of dietetic support. CONCLUSIONS Participants in this study experienced poor management of malnutrition with missing links between the hospital and community healthcare settings, and lack of dietetic services. Patient views should be used to inform public health guidelines and guide future interventions in the community to improve the health status of older adults with malnutrition.
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Affiliation(s)
- Ciara M E Reynolds
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Republic of Ireland.,UCD Institute of Food and Health, University College Dublin, Dublin, Republic of Ireland
| | - Patricia Dominguez Castro
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Republic of Ireland.,UCD Institute of Food and Health, University College Dublin, Dublin, Republic of Ireland
| | - Aisling A Geraghty
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Republic of Ireland.,UCD Institute of Food and Health, University College Dublin, Dublin, Republic of Ireland
| | - Sarah Browne
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Republic of Ireland.,UCD Institute of Food and Health, University College Dublin, Dublin, Republic of Ireland
| | - Laura A Bardon
- UCD Institute of Food and Health, University College Dublin, Dublin, Republic of Ireland.,School of Agriculture and Food Science, University College Dublin, Dublin, Republic of Ireland
| | - Clare A Corish
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Republic of Ireland.,UCD Institute of Food and Health, University College Dublin, Dublin, Republic of Ireland
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13
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Hong K, Sulo S, Wang W, Kim S, Huettner L, Taroyan R, Kerr KW, Kaloostian C. Nutrition Care for Poorly Nourished Outpatients Reduces Resource Use and Lowers Costs. J Prim Care Community Health 2021; 12:21501327211017014. [PMID: 34009072 PMCID: PMC8138290 DOI: 10.1177/21501327211017014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Background and Objectives: Over 25% of United States (US) community-dwelling, older adults are at
nutritional risk. Health and cost burdens of poor nutrition can be lowered
by nutrition programs for hospital inpatients, but few studies have looked
at the impact on outpatients. The objective of our study was to assess
outcomes of a nutrition focused quality improvement program (QIP) on
healthcare resource use and costs in poorly nourished outpatients. Methods: This pre-post QIP study was implemented at 3 US healthcare system clinics.
Included patients (n = 600) were ≥45 years old, had ≥2 chronic conditions,
and were enrolled over a 15-month interval. For comparison, historical
(n = 600) and concurrent control (n = 600) groups were used. Assessment of
poor nutritional status was performed during each patient’s baseline visit.
Healthcare resource use (hospitalizations, emergency department visits, and
outpatient clinic visits), medication use, and costs were determined for a
90-day interval. Results: QIP patients (mean age 61.6 years) were predominantly female (62.5%) and
overweight/obese (81.7%). The proportion of QIP outpatients presenting for
healthcare services was significantly reduced compared to both historical
and concurrent controls—relative risk reduction (RRR) versus historical
(11.6%, P < .001) and versus concurrent (8.9%,
P = .003). Of those who presented, RRR for healthcare
resource use by QIP was significant in comparison with historical (12.9%,
P = .022) but not concurrent controls. No significant
differences were observed for medication usage. Lower resource use among QIP
patients yielded total cost savings of $290 923 or per-patient savings of
$485. Conclusions: Nutrition QIPs in outpatient clinics are feasible and can reduce healthcare
resource use and cut costs. Such findings underscore benefits of nutritional
interventions for community-dwelling outpatients with poor nutritional
status.
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Affiliation(s)
- Kurt Hong
- University of Southern California, Los Angeles, CA, USA
| | - Suela Sulo
- Abbott Laboratories, Abbott Park, IL, USA
| | - William Wang
- University of Southern California, Los Angeles, CA, USA
| | - Susan Kim
- University of Southern California, Los Angeles, CA, USA
| | | | - Rose Taroyan
- University of Southern California, Los Angeles, CA, USA
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14
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Ready-Made Oral Nutritional Supplements Improve Nutritional Outcomes and Reduce Health Care Use-A Randomised Trial in Older Malnourished People in Primary Care. Nutrients 2020; 12:nu12020517. [PMID: 32085537 PMCID: PMC7071441 DOI: 10.3390/nu12020517] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 02/12/2020] [Accepted: 02/14/2020] [Indexed: 11/22/2022] Open
Abstract
Large trials assessing oral nutritional supplements (ONS) and dietary advice (DA) in primary care are lacking. This study examined effects of ONS + DA versus DA on intake, weight, QoL, healthcare use and satisfaction in malnourished free-living older people. Three hundred and eight people (71.5 ± 10.7y) were randomised to receive ONS + DA (n154) or DA (n154) for 12 weeks. At baseline, 4, 8, 12 weeks, intake, weight, QoL, healthcare use and satisfaction were measured. ONS + DA group (mean daily intake ONS 480 kcal; 21 g protein; 80% compliance) had significantly greater total energy and protein intakes (+401 kcal/d, p < 0.001; +15 g/d, p < 0.001) and weight gain (+0.8 kg; p < 0.001) compared to DA. QoL improved in both groups over time with a significant improvement in index with ONS + DA (p = 0.009). Significantly more participants found ONS + DA made a difference for them (p = 0.011), but no differences were found between groups using Euroqol. Compared to DA, healthcare use reduced with ONS + DA, (HCP visits by 34%, emergency admissions 50%, LOS 62%). Acceptability of both interventions was high (ONS 96%, DA 95%), with significantly more participants satisfied with ONS (89%) than DA (73%) (p = 0.009). This trial in primary care indicates that ONS are acceptable, make a difference to patients, significantly improve intake and weight, and reduce health care use with potential savings.
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