1
|
Munoz N, Litchford M. Nutritional Aspects of Wound Care. Clin Geriatr Med 2024; 40:481-500. [PMID: 38960539 DOI: 10.1016/j.cger.2023.12.005] [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] [Indexed: 07/05/2024]
Abstract
Malnutrition is a collective term that includes both undernutrition and malnutrition. Malnutrition presents with and without inflammation, is reported in underweight, normal weight, and overweight individuals, and is associated with undesirable alterations in body composition, and diminished functional status. Older adults commonly experience dwindling nutritional status as evidenced by insidious weight loss, insufficient dietary intake, loss of muscle mass, quality, and strength, declining functional status, and other physical and emotional decline indicators. Sustained pressure, acute trauma, malnutrition, and inflammatory-driven chronic conditions increase the risk for skin integrity issues.
Collapse
Affiliation(s)
- Nancy Munoz
- Chief Nutrition and Food Service, VA Southern Nevada Healthcare System, Las Vegas, NV, USA.
| | - Mary Litchford
- Case Software, 5601 Forest Manor Drive, Greensboro, NC 27410, USA
| |
Collapse
|
2
|
Riddle E, Munoz N, Clark K, Collins N, Coltman A, Nasrallah L, Nishioka S, Scollard T, Simon JR, Moloney L. Prevention and Treatment of Malnutrition in Older Adults Living in Long-Term Care or the Community: An Evidence-Based Nutrition Practice Guideline. J Acad Nutr Diet 2024; 124:896-916.e24. [PMID: 38583584 DOI: 10.1016/j.jand.2024.03.013] [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: 03/13/2024] [Accepted: 03/27/2024] [Indexed: 04/09/2024]
Abstract
Malnutrition in older adults can decrease quality of life and increase risk of morbidities and mortality. Accurate and timely identification of malnutrition, as well as subsequent implementation of effective interventions, are essential to decrease poor outcomes associated with malnutrition in older adults. The Academy of Nutrition and Dietetics Evidence Analysis Center conducted a systematic review of the literature to develop an evidence-based nutrition practice guideline for the prevention and treatment of malnutrition in older adults. The objective of this guideline was to provide evidence-based recommendations to identify, prevent, or treat protein-energy malnutrition in older adults (mean age ≥65 years) living in long-term care and community settings. This guideline provides 11 nutrition recommendations to inform shared decision making among dietitians, members of the health care team, family members or caregivers, and older adults living in long-term care or the community to prevent or treat malnutrition. Topics include dietitian effectiveness, nutrition assessment tools, oral nutrition supplements, food fortification, and home-delivered and congregate meals. Guideline implementation should include consideration of the importance of comprehensive individualized nutrition care for older adults. Future research is needed to address gaps that were identified related to the validity, reliability, and feasibility of nutrition assessment tools, as well as the effectiveness of dietitian interventions on outcomes of interest in older adults living in long-term care and the community.
Collapse
Affiliation(s)
- Emily Riddle
- State University of New York at Oneonta, Oneonta, New York
| | - Nancy Munoz
- Veterans Affairs Southern Nevada Healthcare System, Las Vegas, Nevada
| | | | | | - Anne Coltman
- Commission on Dietetic Registration, Chicago, Illinois
| | - Lamia Nasrallah
- Outpatient Nutrition Services, University of North Carolina Hospitals, Chapel Hill, North Carolina
| | - Shinta Nishioka
- Department of Clinical Nutrition and Food Services, Nagasaki Rehabilitation Hospital, Nagasaki, Japan
| | | | - Judy R Simon
- Nutrition and Health Promotion Consultant, Easton, Maryland
| | - Lisa Moloney
- Academy of Nutrition and Dietetics, Chicago, Illinois.
| |
Collapse
|
3
|
Nishioka S, Kokura Y, Momosaki R, Taketani Y. Measures for Identifying Malnutrition in Geriatric Rehabilitation: A Scoping Review. Nutrients 2024; 16:223. [PMID: 38257116 PMCID: PMC10820477 DOI: 10.3390/nu16020223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/08/2024] [Accepted: 01/09/2024] [Indexed: 01/24/2024] Open
Abstract
Malnutrition is a common condition in geriatric rehabilitation settings; however, the accuracy and predictive validity of the measures to identify malnutrition have not been established. The current scoping review followed the Joanna Briggs Institute's evidence synthesis manual and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews checklist. Literature published through September 2023 was searched using MEDLINE and CINAHL. The inclusion criteria selected studies reporting malnutrition measures, which include static body weight and weight loss. Identified tools were classified as nutritional screening tools, nutritional assessment tools, or diagnostic criteria. The domains of each tool/criterion and their accuracy and predictive validity were extracted. Fifty-six articles fulfilled the inclusion criteria, and six nutritional screening tools, three nutritional assessment tools, and three diagnostic criteria for malnutrition were identified. These measures consisted of various phenotypes, e.g., weight loss, causes such as inflammation/disease, and risk factors of malnutrition, e.g., functional impairment. The predictive validity of nutritional screening tools (n = 6) and malnutrition diagnostic criteria (n = 5) were inconsistently reported, whereas those for nutritional assessment tools were scarce (n = 1). These findings highlight the need to distinguish the functional impairment of nutritional origin from that of non-nutritional origin in nutritional assessment procedures, and the need to study the accuracy and the predictive validity of these measures in geriatric rehabilitation patients.
Collapse
Affiliation(s)
- Shinta Nishioka
- Department of Clinical Nutrition and Food Service, Nagasaki Rehabilitation Hospital, 4-11, Gin-yamachi, Nagasaki 850-0854, Japan
- Department of Clinical Nutrition and Food Management, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Kuramoto-cho, Tokushima 770-8503, Japan;
| | - Yoji Kokura
- Department of Nutrition Management, Keiju Hatogaoka Integrated Facility for Medical and Long-Term Care, 15-39-8, Mugigaura, Anamizu, Hosu-gun 927-0023, Japan;
| | - Ryo Momosaki
- Department of Rehabilitation Medicine, Mie University Graduate School of Medicine, 2-174, Edobashi, Tsu 514-8507, Mie, Japan;
| | - Yutaka Taketani
- Department of Clinical Nutrition and Food Management, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Kuramoto-cho, Tokushima 770-8503, Japan;
| |
Collapse
|
4
|
Visser M, Mendonça N, Avgerinou C, Cavdar S, Cederholm T, Cruz-Jentoft AJ, Kiesswetter E, Siebentritt HM, Sieber C, Torbahn G, Volkert D. A Core Outcome Set for nutritional intervention studies in older adults with malnutrition and those at risk: a study protocol. BMC Geriatr 2023; 23:221. [PMID: 37024825 PMCID: PMC10080774 DOI: 10.1186/s12877-023-03832-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 02/16/2023] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND Malnutrition (i.e., protein-energy malnutrition) in older adults has severe negative clinical consequences, emphasizing the need for effective treatments. Many, often small, randomized controlled trials (RCTs) testing the effectiveness of nutritional interventions for the treatment of malnutrition showed mixed results and a need for meta-analyses and data pooling has been expressed. However, evidence synthesis is hampered by the wide variety of outcomes and their method of assessment in previous RCTs. This paper describes the protocol for developing a Core Outcome Set (COS) for nutritional intervention studies in older adults with malnutrition and those at risk. METHODS The project consists of five phases. The first phase consists of a scoping review to identify frequently used outcomes in published RCTs and select additional patient-reported outcomes. The second phase includes a modified Delphi Survey involving experienced researchers and health care professionals working in the field of malnutrition in older adults, followed by the third phase consisting of a consensus meeting to discuss and agree what critical outcomes need to be included in the COS. The fourth phase will determine how each COS outcome should be measured based on a systematic literature review and a second consensus meeting. This will be followed by a dissemination and implementation phase. Patient and Public Involvement (PPI) representatives will contribute to study design, oversight, consensus, and dissemination. CONCLUSIONS The result of this project is a COS that should be included in any RCT evaluating the effect of nutritional interventions in older adults with malnutrition and those at risk. This COS will facilitate comparison of RCT results, will increase efficient use of research resources and will reduce bias due to measurement of the outcome and publication bias. Ultimately, the COS will support clinical decision making by identifying the most effective approaches for treating and preventing malnutrition in older adults.
Collapse
Affiliation(s)
- Marjolein Visser
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, De Boelelaan 1085, Amsterdam, 1081 HV, the Netherlands.
| | - Nuno Mendonça
- EpiDoC Unit, CEDOC, NOVA Medical School, Universidade Nova de Lisboa, Rua do Instituto Bacteriológico n°5, Lisbon, 1150-082, Portugal
- Comprehensive Health Research Centre (CHRC), NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Christina Avgerinou
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Sibel Cavdar
- Division of Geriatrics, Department of Internal Medicine, Ege University Hospital, Izmir, Turkey
- Ege University Hospital, Kazımdirik, University Street. No:9, Bornova/İzmir, 35100, Turkey
| | - Tommy Cederholm
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden
| | - Alfonso J Cruz-Jentoft
- Servicio de Geriatría, Hospital Universitario Ramón y Cajal (IRYCIS), Ctra. Colmenar km 9.1, Madrid, 28034, Spain
| | - Eva Kiesswetter
- Institute for Evidence in Medicine, Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str. 86, Freiburg, 79110, Germany
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Kobergerstr. 60, Nürnberg, 90408, Germany
| | - Hanna M Siebentritt
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Kobergerstr. 60, Nürnberg, 90408, Germany
| | - Cornel Sieber
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Kobergerstr. 60, Nürnberg, 90408, Germany
- Department of Medicine, Kantonsspital Winterthur, Brauerstrasse 15, Postfach 834, Winterthur, Zurich, 8401, Switzerland
| | - Gabriel Torbahn
- Department of Pediatrics, Paracelsus Medical University, Nuremberg, Germany
| | - Dorothee Volkert
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Kobergerstr. 60, Nürnberg, 90408, Germany
| |
Collapse
|
5
|
Dent E, Wright ORL, Woo J, Hoogendijk EO. Malnutrition in older adults. Lancet 2023; 401:951-966. [PMID: 36716756 DOI: 10.1016/s0140-6736(22)02612-5] [Citation(s) in RCA: 103] [Impact Index Per Article: 103.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 11/15/2022] [Accepted: 12/01/2022] [Indexed: 01/29/2023]
Abstract
Malnutrition is a highly prevalent condition in older adults, and poses a substantial burden on health, social, and aged-care systems. Older adults are vulnerable to malnutrition due to age-related physiological decline, reduced access to nutritious food, and comorbidity. Clinical guidelines recommend routine screening for malnutrition in all older adults, together with nutritional assessment and individually tailored nutritional support for older adults with a positive screening test. Nutritional support includes offering individualised nutritional advice and counselling; oral nutritional supplements; fortified foods; and enteral or parenteral nutrition as required. However, in clinical practice, the incorporation of nutritional guidelines is inadequate and low-value care is commonplace. This Review discusses the current evidence on identification and treatment of malnutrition in older adults, identifies gaps between evidence and practice in clinical care, and offers practical strategies to translate evidence-based knowledge into improved nutritional care. We also provide an overview of the prevalence, causes, and risk factors of malnutrition in older adults across health-care settings.
Collapse
Affiliation(s)
- Elsa Dent
- Research Centre for Public Health, Equity & Human Flourishing, Torrens University Australia, Adelaide, SA, Australia.
| | - Olivia R L Wright
- School of Human Movement and Nutrition Sciences, The University of Queensland, St. Lucia, QLD, Australia
| | - Jean Woo
- Department of Medicine and Therapeutics and Centre for Nutritional Studies, Faculty of Medicine, The Chinese University of Hong Kong, Ma Liu Shui, Hong Kong Special Administrative Region, China
| | - Emiel O Hoogendijk
- Department of Epidemiology & Data Science and Department of General Practice, Location VU University Medical Center, Amsterdam UMC, Amsterdam, Netherlands; Amsterdam Public Health research institute and Ageing & Later Life Research Program, Amsterdam UMC, Amsterdam, Netherlands; Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| |
Collapse
|
6
|
Rivero-Mendoza D, Caldwell CL, Cooper H, Goldberg J, Lamothe M, Logan S, Smith EB, Torna E, Zeldman JA, Dahl WJ. Recommending ultra-processed oral nutrition supplements for unintentional weight loss: Are there risks? Nutr Clin Pract 2023; 38:88-101. [PMID: 36286334 PMCID: PMC10092420 DOI: 10.1002/ncp.10921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 09/01/2022] [Accepted: 09/24/2022] [Indexed: 01/11/2023] Open
Abstract
Oral nutrition supplements (ONS) are widely recommended for the management of unintentional weight loss in patient populations, long-term care residents, and community-dwelling older adults. Most marketed ONS are ultra-processed, with precision nutrition and aseptic composition, as well as convenience and availability, driving their selection. However, therapeutic effectiveness is mixed and the potential health risks of consuming ultra-processed ONS long-term in lieu of less-processed foods have received little attention. A diverse and balanced microbiota supporting immunity and wellness is maintained by a diet rich in plant-sourced foods. The implications of ultra-processed ONS displacing plant-sourced foods, and specifically the potential for undesirable impacts on the gut microbiota, require consideration. Most ONS are either devoid of fiber or are supplemented with isolated or purified fibers that may contribute to adverse gastrointestinal symptoms and appetite suppression. In contrast, the diversity of microbial-available, nondigestible carbohydrates, together with the array of phytochemicals found in plant-sourced foods, support microbial diversity and its resiliency. This review outlines the clinical dilemma of recommending commercial ultra-processed ONS vs nutritionally adequate (eg, high-energy/high-protein) foods and beverages that contribute to diet quality, maintenance of a diverse and stable gut microbiota composition, and support nutrition status and health. Ultra-processed ONS may fall short of expected health benefits, and overreliance may potentially contribute to the risk for patient and older adult populations because of the displacement of a variety of healthful foods.
Collapse
Affiliation(s)
- Daniela Rivero-Mendoza
- Department of Food Science and Human Nutrition, University of Florida, Gainesville, Florida, USA
| | - Cecelia L Caldwell
- Department of Food Science and Human Nutrition, University of Florida, Gainesville, Florida, USA.,Department of Food and Nutrition Services, Ascension Sacred Heart Pensacola Hospital, Pensacola, Florida, USA
| | - Hannah Cooper
- Department of Food Science and Human Nutrition, University of Florida, Gainesville, Florida, USA.,MRM Nutrition, San Diego, California, USA
| | - Jessica Goldberg
- Department of Food Science and Human Nutrition, University of Florida, Gainesville, Florida, USA.,Veritas Collaborative, Atlanta, Georgia, USA
| | - Meagan Lamothe
- Department of Food Science and Human Nutrition, University of Florida, Gainesville, Florida, USA.,Department of Food and Nutrition Services, University of Florida Health Shands Hospital, Gainesville, Florida, USA
| | - Sarah Logan
- Department of Food Science and Human Nutrition, University of Florida, Gainesville, Florida, USA.,Lake Nona Performance Club, Orlando, Florida, USA
| | - Elena B Smith
- Department of Food Science and Human Nutrition, University of Florida, Gainesville, Florida, USA
| | - Elena Torna
- Department of Food Science and Human Nutrition, University of Florida, Gainesville, Florida, USA
| | - Jamie A Zeldman
- Department of Food Science and Human Nutrition, University of Florida, Gainesville, Florida, USA.,Department of Health Education and Behavior, College of Health and Human Performance, University of Florida, Gainesville, Florida, USA
| | - Wendy J Dahl
- Department of Food Science and Human Nutrition, University of Florida, Gainesville, Florida, USA
| |
Collapse
|
7
|
Smith R, Clegg M, Methven L. Review of protein intake and suitability of foods for protein-fortification in older adults in the UK. Crit Rev Food Sci Nutr 2022; 64:3971-3988. [PMID: 36271698 DOI: 10.1080/10408398.2022.2137777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Protein is a vital dietary component for combating negative health outcomes associated with malnutrition in older adults, including sarcopenia, functional decline and reduced quality of life. Yet, recommended daily protein intake is consistently unmet, as evidenced in the literature and reaffirmed in this review. Poor appetite is recognized as a major determinant of protein-energy undernutrition and thus fortification of regular food or drinks provides a flexible and relevant approach for older adults with reduced appetite. To increase the likelihood of fortified products being successfully incorporated into the diets of older adults, they must be adaptable to older adults eating patterns, cater for their preferences and take the specific age-related problems that complicate food intake into account. This paper aims to highlight older adults' current sources of protein, shopping habits, typical eating patterns and commonly consumed foods, and hence consider appropriate carriers for protein enrichment. Data were reanalyzed from a combination of freely available UK datasets, including the National Dietary and Nutrition Survey and the Food and You Survey, alongside data purchased from market research consultancy, Kantar. These insights draw attention to the potential suitability of foods for fortification purposes, with the ultimate objective to promote eating pleasure and prevent malnutrition.
Collapse
Affiliation(s)
- Rachel Smith
- Department of Food and Nutritional Sciences, School of Chemistry, Food and Pharmacy, University of Reading, Reading, UK
| | - Miriam Clegg
- Department of Food and Nutritional Sciences, School of Chemistry, Food and Pharmacy, University of Reading, Reading, UK
| | - Lisa Methven
- Department of Food and Nutritional Sciences, School of Chemistry, Food and Pharmacy, University of Reading, Reading, UK
| |
Collapse
|
8
|
Sowards DB, McCauley SM, Munoz N. Impacting Malnutrition, Food Insecurity, and Health Equity: An Overview of Academy of Nutrition and Dietetics Priorities and Future Opportunities. J Acad Nutr Diet 2022; 122:S7-S11. [PMID: 36122962 DOI: 10.1016/j.jand.2022.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 06/22/2022] [Indexed: 11/30/2022]
|
9
|
Juckett LA, Hariharan G, Dodonova DC, Klaus J, Rowe M, Burak E, Mason B, Bunck L. Implementing a Community-Based Initiative to Improve Nutritional Intake among Home-Delivered Meal Recipients. Nutrients 2022; 14:944. [PMID: 35267919 PMCID: PMC8912420 DOI: 10.3390/nu14050944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/16/2022] [Accepted: 02/17/2022] [Indexed: 11/27/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Lisa A. Juckett
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH 43210-2205, USA
| | - Govind Hariharan
- Coles College of Business, Kennesaw State University, Kennesaw, GA 30144-0405, USA; (G.H.); (D.C.D.)
| | - Dimitri Camargo Dodonova
- Coles College of Business, Kennesaw State University, Kennesaw, GA 30144-0405, USA; (G.H.); (D.C.D.)
| | - Jared Klaus
- Lifecare Alliance, Columbus, OH 43223-1809, USA; (J.K.); (M.R.); (E.B.); (B.M.); (L.B.)
| | - Melinda Rowe
- Lifecare Alliance, Columbus, OH 43223-1809, USA; (J.K.); (M.R.); (E.B.); (B.M.); (L.B.)
| | - Elana Burak
- Lifecare Alliance, Columbus, OH 43223-1809, USA; (J.K.); (M.R.); (E.B.); (B.M.); (L.B.)
| | - Benetta Mason
- Lifecare Alliance, Columbus, OH 43223-1809, USA; (J.K.); (M.R.); (E.B.); (B.M.); (L.B.)
| | - Leah Bunck
- Lifecare Alliance, Columbus, OH 43223-1809, USA; (J.K.); (M.R.); (E.B.); (B.M.); (L.B.)
| |
Collapse
|