The nutritional status and energy and protein intakes of MOW clients and the need for further targeted strategies to enhance intakes

Frailty and Nutrition Risk Predict Falls and Emergency Department Visits in Home-Delivered Meal Clients

Home-delivered meal programs improve health outcomes for older adults who are homebound, yet some clients need additional services and support to maintain independence. This study sought to identify program clients at the highest risk for adverse outcomes. Nutrition risk and Frailty Index scores were used to predict client-reported falls, emergency department visits, and hospitalizations over a six-month period for 258 Meals on Wheels clients in one Midwestern community. A multivariate binomial logistic regression model adjusting for both Frailty Index and nutrition risk scores with age, gender, poverty, and race accounted for 13.2% of the variation in falls and 22% of the variation in emergency department visits. Neither study variable was predictive of hospitalizations. Nutrition risk and Frailty Index scores, together, produced a more robust picture of client risk than with either score alone; these tools could be used by service providers to prioritize additional support services.

Implementing a Community-Based Initiative to Improve Nutritional Intake among Home-Delivered Meal Recipients

Home-delivered meal (HDM) recipients are a highly vulnerable group of older adults at risk for malnutrition and subsequent health decline. To help HDM recipients increase their nutritional intake, HDM agencies may provide expanded meal options that allow older adults to have greater autonomy over their meal selection; however, the extent to which recipients are able to select nutritious meals that are responsive to their health complexities is unknown. This study examined the nutritional content of meals selected by HDM recipients enrolled in an expanded menu plan through a large HDM agency. Data were drawn from a retrospective chart review of 130 HDM recipients who had the option of selecting their own HDM meals and frequency of meal delivery. Findings indicate that older adults who selected their own meals chose meals that were significantly lower in protein, potassium, fat, and calories. The lack of these nutrients suggests that older adults enrolled in expanded menu plans should be referred to registered dietitian nutritionists who can provide skilled guidance in meal selection. To address this need, we also describe and provide preliminary data representing a referral program designed to connect HDM recipients to dietetic services with the goal of optimizing older adult nutrition and health-related outcomes.

Prevalence of malnutrition risk among older French adults with culinary dependence

OBJECTIVE

The term 'culinary dependence' denotes a situation in which someone delegates all or part of their daily meal-related activities to a third party. The present study aimed to explore nutritional risk among older people (≥65 years) with culinary dependence.

METHOD

The first survey included 559 people either living at home without help, with help unrelated to food activities, with help related to food activities or living in nursing home. The second survey included 319 people with food help provided by a caregiver, by meals-on-wheels or by a nursing home. Nutritional status was assessed with the Mini-Nutritional Assessment. Sociological background and wellness variables (health, cognitive and mental status) were collected.

RESULTS

The first survey found a strong association between culinary dependence and nutritional risk. About half of the people who delegated their food-related activities were malnourished or at risk of malnutrition compared with only 4% for people with no help and 12% for people with help unrelated to food activity. According to the second survey, this prevalence varied slightly depending on who the tasks were delegated to (46% for those who had the support of a caregiver; 60% for those who used a meals-on-wheels service; 69% for those living in nursing home). According to multivariate analyses, dependence categories, depressive symptoms and cognitive status were identified as independent determinants of malnutrition.

CONCLUSION

Without inferring a causal relationship between dependence and malnutrition, there is a strong need for care structures to take into account the issue of malnutrition when developing services targeting older people.

Identifying and Managing Malnutrition, Frailty and Sarcopenia in the Community: A Narrative Review

Malnutrition, frailty and sarcopenia are becoming increasingly prevalent among community-dwelling older adults; yet are often unidentified and untreated in community settings. There is an urgent need for community-based healthcare professionals (HCPs) from all disciplines, including medicine, nursing and allied health, to be aware of, and to be able to recognise and appropriately manage these conditions. This paper provides a comprehensive overview of malnutrition, frailty and sarcopenia in the community, including their definitions, prevalence, impacts and causes/risk factors; and guidance on how these conditions may be identified and managed by HCPs in the community. A detailed description of the care process, including screening and referral, assessment and diagnosis, intervention, and monitoring and evaluation, relevant to the community context, is also provided. Further research exploring the barriers/enablers to delivering high-quality nutrition care to older community-dwelling adults who are malnourished, frail or sarcopenic is recommended, to inform the development of specific guidance for HCPs in identifying and managing these conditions in the community.

Home-Delivered Meals: Characterization of Food Intake in Elderly Beneficiaries

Objective. In this study, we focus on elderly people (≥70 years old) benefiting from a home delivery meal service as part of a social welfare program. We aimed to: (i) assess the gap between the recommended and actual nutritional intake in this population and (ii) study the relationship between the intake of nutrients and the variables characterizing the participants’ health and nutritional status. Design. A dietary survey (24-hour record) was conducted during a home interview, with 64 people receiving a home delivery meal service (75% women; 70–97 years old). At the same time, the participants answered questionnaires assessing their nutritional and health status. Results. Our data showed that the consumption of 70 to 80% participants was not sufficient for reaching the nutritional recommendations for energy and macronutrients. Additionally, the data showed that the lower the energy and protein intakes, the higher the risk of malnutrition. In addition, one third of the participants were both overweight or obese and at risk of undernutrition or undernourished. Our study demonstrated that the heavier the person, the more difficult it was for them to meet the nutritional recommendations based on kilograms of body weight. Finally, individuals receiving two to three delivered meals per day had higher energy and protein intakes than those receiving a single meal. Conclusion. These results suggest that it is important that home meal delivery companies improve the quality of their meals and service so that their recipients can better meet nutritional recommendations.

Protein-energy malnutrition in older Australians: A narrative review of the prevalence, causes and consequences of malnutrition, and strategies for prevention

ISSUE ADDRESSED

Protein-energy malnutrition (PEM) is a condition of involuntary weight and muscle loss caused by inadequate nutritional intake. In Australia, it is predominantly associated with chronic diseases, as are common in the older population. Given the ageing population of Australia, and the poor outcomes associated with PEM, there is a need to identify the contributing factors, and to explore strategies to prevent PEM.

METHODS

Two databases were searched for pertinent keywords, including malnutrition, Australia and elderly, with relevant articles selected for inclusion. The citations and references of these articles were also searched for further articles.

RESULTS

PEM is associated with increasing age and institutionalisation. The contributing factors are multifactorial, and include physiological, pathophysiological and structural causes. PEM is a significant public health issue for Australia, in terms of its consequences on both quality of life for older adults, and the burden on the healthcare system. However, there are strategies that can be implemented at the community, organisation and policy level to prevent PEM.

CONCLUSION

PEM is a common problem for older Australians, and this has important physiological and public health consequences, especially in the context of the ageing Australian population. However, there is significant scope for preventing PEM. SO WHAT?: Readers can be advised that PEM is a significant public health issue that will increase in importance as the population continues to age. It is important that communities, organisations and governments develop strategies to prevent PEM.

The Nutritional Issue of Older People Receiving Home-Delivered Meals: A Systematic Review

Background: Setting up a home-delivered meal service often allows older people suffering from physical and/or cognitive disabilities to stay at home. However, older people who delegate their food activities (food purchasing, cooking…) have been reported to have a worse nutritional status than people who take care of their food activities. In this context, we will conduct a systematic review of all studies related to the nutritional issue in home-delivered meal older recipients. Methods: In June 2020, we searched 3 databases (Pubmed, Web of Science, EMBASE) to identify studies from all years on older adults at home and receiving home-delivered meal services (population). The following outcomes were considered: nutritional status (Body Mass Index, weight, undernutrition) and nutritional intake. Any nutritional intervention, comparator, and study design were relevant for inclusion. Results: Forty-eight original studies met the inclusion criteria, most of them being published after the year 2000 (n = 34) and undertaken in the USA (n = 32). The selection includes 30 cross-sectional and 18 longitudinal studies. The main findings of this review are the following: (1) home-delivery meal older recipients are at high risk of undernutrition; (2) providing home-delivery meals may improve the nutritional status and nutrient intake; (3) this improvement is even higher when the home-delivery meal service is improved, for instance by providing dietetic counseling or adding supplementary snacks/meals or enriched food. However, even an improved service does not allow all the older recipients meeting their recommended nutritional allowance. Conclusion: This review reveals a need to further develop strategies allowing home-delivery meal older recipients to fulfill their nutritional needs. From a methodological point of view, there is a need to describe in more detail the home-delivered services provided to studies' participants to better consider meal frequency and meal content in the results.

The views, experiences and expectations of Australian Meals on Wheels customers: A national survey

OBJECTIVE

To investigate views and expectations of Australian Meals on Wheels (MOW) customers to inform the development of National Meal Guidelines and improve current services.

METHODS

A survey was designed through literature review and consultations with key stakeholders. National convenience sampling returned  337 surveys. Descriptive statistics and chi-squared analyses were applied to the survey data.

RESULTS

Meals on Wheels customers reported satisfaction with their current service, with the meal itself found to be the most valuable aspect. People living in small country towns were more likely to value the social contact provided by MOW than those in major cities (P = .001). Delivery of pantry items was the most popular additional option for future services.

CONCLUSION

Valuable information for inclusion in the development of the National Meal Guidelines was provided: nutritional content of meals, meal variety, packaging and presentation, opportunities for nourishing snacks and pantry items, and social contact.

Development of the Australian National Meal Guidelines for home-delivered and centre-based meal programs for older adults

ISSUE ADDRESSED

This research aimed to develop and disseminate National Meal Guidelines for Australian home-delivered and centre-based meal programs.

METHODS

Development was led by a project group of dietitians and a steering group of representatives from the Australian Meals on Wheels Association. The process framework included three phases: (1) Review of existing standards and guidelines and systematic literature review (SLR), (2) stakeholder consultation conducted via six workshops, across six states (N = 212) and surveys with service providers, health professionals (N = 289) and customers (N = 337) and (3) review of the draft guidelines by stakeholders.

RESULTS

The final guidelines address: nutritional needs of older adults; meal and menu planning including nutrient requirements for meal components; presentation and meal enjoyment; special diets; and enhancing the meal service.

CONCLUSION

These guidelines provide consistent guidance to services providing home-delivered and centre-based meal programs. Further evaluation of their uptake and impact on service practices and customer nutrition and satisfaction is required. SO WHAT?: The National Meal Guidelines provide nationally consistent, evidence-based guidance on menu planning and nutritional quality of meals to services providing home-delivered and centre-based meal programs. The guideline development framework outlined here also provides a process for future food service guideline development.

Tracking and treating malnutrition: a retrospective observational study of the nutritional status of vulnerable people accessing a meals-on-wheels (MOW) service

AIM

The aims of the study were to describe the characteristics of meals-on-wheels (MOW) recipients, including prevalence of malnutrition amongst those who have received input from the Nutrition and Wellbeing Service (NWS) and to explore whether the NWS had an impact on the nutritional status (malnutrition risk) of recipients over time.

BACKGROUND

Support services, for example, MOW, play an important role in the prevention and treatment of malnutrition in the community. In the UK, MOW services are under threat. However, little is known about how they support the health and well-being of older people. This study reports on the characteristics of MOW recipients and investigates change in nutritional status over time.

METHODS

A retrospective study of MOW recipients of nutritional concern who were offered a check through the NWS was conducted. Demographic, social and health information were gathered at the initial visit. Nutritional status (risk of malnutrition) was obtained using the validated Malnutrition Universal Screening Tool (MUST), at the initial and subsequent visits. Changes over time were investigated for recipients receiving at least two follow-up visits.

FINDINGS

An initial visit was made to 399 MOW recipients, and 148 recipients had two or more follow-up visits. At initial screening, 177 (44%) of recipients were at medium or high risk of malnutrition. Frailty was significantly related to malnutrition risk (P = 0.049). At follow-up, there was a reduction in malnutrition risk.

CONCLUSIONS

The MOW service was associated with a reduction in malnutrition risk. By offering well-being visits within a MOW service, malnutrition can be identified early. Future studies into how MOW services might delay or prevent the need for support from acute health services and social care are warranted.

The impact of home-delivered meal services on the nutritional intake of community living older adults: a systematic literature review

BACKGROUND

There is a global increase in populations aged over 65 years. Physiological changes that occur during ageing may increase the nutritional risk for older adults. To avoid malnutrition and address some of the barriers to obtain an adequate food supply, home-delivered meals services provide meals in the home or in congregate settings for older adults who require nutritional support.

METHODS

This systematic literature review explored whether nutritional intake is improved in community-living older adults when receiving meal services compared to when meal services are not received. Four electronic databases were searched up to 31 January 2019. In total, 13 original studies were included in this analysis with the components: intervention of home-delivered meal or congregate meal services to older adults; comparison with groups not receiving meal services or days not receiving the meal service; and nutritional intake as an outcome measured by food history, dietary recall and/or food frequency questionnaire.

RESULTS

The results supported a beneficial effect of home-delivered meals on dietary intake of energy, protein and/or certain micronutrients in older adults.

CONCLUSIONS

The increased total energy intake is a positive influence on malnutrition risk in frail older adults and the increased protein intake supports good health, promotes recovery from illness and assists in maintaining functionality in older adults. Additionally, there was a particular increase in calcium intake, which is relevant in ageing, especially for bone health.