Position of the American Dietetic Association: liberalized diets for older adults in long-term care

Are Therapeutic Diets in Long-Term Care Affecting Resident Food Intake and Meeting their Nutritional Goals?

Purpose: To examine health characteristics of long-term care (LTC) residents prescribed therapeutic diets (promoting or restricting intake of key food components), to determine how these diets influenced intake and whether there were differences in food intake and malnutrition risk between residents with and without restrictive diets.Methods: Secondary analysis of the Making the Most of Mealtimes Study includes 435 residents with no/mild cognitive impairment in 32 LTC homes across 4 provinces. Health records were reviewed for diet prescriptions and other characteristics. Weighed and observed food and fluid consumption over 3 nonconsecutive days determined intake. Bivariate and multivariable linear regressions identified associations between therapeutic diets and intake and key nutrients.Results: Almost half (42%) of participants were prescribed a therapeutic diet. Residents receiving restrictive diets (28%) consumed absolute calories consistent with those receiving a regular diet, but kcal/kg was significantly lower (22.1 ± 5.5 vs 23.6 ± 5.3). Low sodium and weight-promoting diets were the only therapeutic diets associated with their corresponding key nutrient profiles. Restrictive therapeutic diets were not associated with energy or protein intake when adjusting for covariates.Conclusions: Restrictive therapeutic diets among those with mild to no cognitive deficits do not appear to impair food intake.

Taste, choice and timing: Investigating resident and carer preferences for meals in aged care homes

There has been little empirical investigation of the preferences of people living in aged care homes for food services. The aim of the present study was to elicit consumer preferences and their willingness to pay for food service in aged care homes. Current residents or their family members were invited to take part in the discrete choice experiment questionnaire administered via interview. Of the 109 eligible residents and 175 eligible family members approached for consent 121 (43%) participated, including 43 residents. Participant preferences were influenced by food taste, choice in relation to serving size, timing of meal selection, visual appeal, and additional cost. Participants indicated they would be willing to pay an additional $24 (US$18.42) per week for food which tasted excellent and $8 (US$6.14) per week to have choice in serving sizes. The study found that respondents were willing to pay a premium to receive food that met their expectations of taste, and for a high level of control over serving sizes, which has implications for the funding and provision of food and dining in long-term care in the future.

Prevalence of anemia and malnutrition and their association in elderly nursing home residents

PURPOSE

Malnutrition is one of the most important geriatric syndromes in the elderly. The aim of this study was to investigate the association between anemia and malnutrition in elderly nursing home residents.

MATERIALS AND METHODS

Local nursing home residents over 60 years old in the Izmir were included in the study. Blood samples were taken from study participants for hemogram, iron, ferritin, total iron-binding capacity, vitamin B12 and folic acid analysis. WHO criteria were used to define anemia. Causes of anemia were classified as iron deficiency, vitamin B12 or folic acid deficiency, anemia of chronic disease or other hematologic causes. Anemia was defined as the dependent variable and malnutrition was defined as the independent variable. Correlation between MNA scores and Hb levels was determined using Pearson correlation analysis. The slope of causality between malnutrition and anemia was determined using the χ (2) test and logistic regression analysis.

RESULTS

The study included 257 elderly nursing home residents with a mean age of 78.5 ± 7.8 years. The overall prevalence of anemia was 54.9 %; 35.8 % of the study participants were at risk of malnutrition and 8.2 % were malnourished. Anemia risk was 2.12-fold higher in participants at risk of malnutrition and 5.05-fold higher in those with malnutrition. In the participants with malnutrition or malnutrition risk, the most common cause of anemia was anemia of chronic disease (57.1 and 46.5 %, respectively).

CONCLUSION

The prevalence of anemia among elderly nursing home residents is high in Turkey. Malnutrition and malnutrition risk increase the incidence of anemia.

Determinants of foodservice satisfaction for patients in geriatrics/rehabilitation and residents in residential aged care

BACKGROUND

Poor satisfaction with institutional food is a significant moderator of food intake in geriatrics/rehabilitation and residential aged care.

PURPOSE

To quantify the relationship between foodservice satisfaction, foodservice characteristics, demographic and contextual variables in geriatrics/rehabilitation and residential aged care.

METHODS

The Resident Foodservice Satisfaction Questionnaire was administered to 103 patients of 2 geriatrics/rehabilitation units and 210 residents of nine residential aged care facilities in Brisbane, Australia. Ordered probit regression analysis measured the association of age, gender, ethnicity and appetite, timing and amount of meal choice, menu selectivity, menu cycle, production system, meal delivery system and therapeutic diets with foodservice satisfaction.

RESULTS

Patient and resident appetite (P < 0.01), the amount and timing of meal choice (P < 0.01), self-rated health (P < 0.01), accommodation style (P < 0.05) and age (P < 0.10) significantly moderated foodservice satisfaction. High protein/high energy therapeutic diets (P < 0.01), foodservice production (P < 0.01) and delivery systems (P > 0.01) were significant moderators for those with 'fair' self-rated health.

CONCLUSIONS

Patient and resident characteristics and structural and systems-related foodservice variables were more important for influencing foodservice satisfaction than characteristics of food quality. The results suggest modifications to current menu planning and foodservice delivery methods: reducing the time-lapse between meal choice and consumption, augmenting the number of meals at which choice is offered, and revising food production and delivery systems.It is important that residents in poorer health who are a high risk of under-nutrition are provided with sufficient high protein/high energy therapeutic diets. Diets that restrict macro- and micro-nutrients should be minimized for all patients and residents.

Availability of nutrition screening parameters in New Brunswick hospitals and nursing homes

We explored the availability of parameters for a nutrition screening system among elderly people in New Brunswick (NB) health care facilities. Patients aged 65 or older were asked to participate in the study; each participant had been admitted to one of four hospitals or lived in one of six nursing homes. Availability of nutrition screening parameters (weight, height, weight change, serum albumin level, appetite, and food intake record) was assessed by auditing the participants' medical charts. When data were not available, the feasibility of obtaining them was determined. Additional data related to nutrition screening were also obtained. In total, 421 participants were recruited for the study: 140 (33.2%) who lived in nursing homes and 281 (66.8%) who were in hospitals. Parameters needed to conduct nutrition screening, such as weight upon admission, were available for 83.6% of participants; usual weight was available for 43.0%, height for 86.0%, and serum albumin level for 47.5%. Our findings show that basic parameters for nutrition screening are available, and that implementation of a nutrition screening system is feasible for patients in NB health care facilities.

Evidence behind The Green House and similar models of nursing home care

The Green House and similar models of nursing home care offer a solution to the institutional nature of nursing homes. In The Green House model, small houses are home to 6–12 residents in which care is given as much attention as treatment and is provided by a consistent, self-directed team of staff who are responsible for all care, including preparing meals in a centrally located open kitchen. Residents have private rooms and bathrooms that open onto a central living area. Although a nurse is available 24 h a day and the clinical care team is nearby and visits the home to provide care, the sense is that one is receiving care in a family-type setting. While these homes are expanding rapidly and seem to embody a better culture of nursing home care, their future growth may depend on the evidence that supports or refutes the quality of care that they provide.

Gaining entry-level clinical competence outside of the acute care setting

Traditionally, an emphasis has been placed on dietetic interns' attainment of entry-level clinical competence in acute care facilities. The perceived risks and benefits of acquiring entry-level clinical competence within long-term and acute care clinical environments were examined. The study included a purposive sample of recent graduates and dietitians (n=14) involved in an integrated internship program. Study subjects participated in in-depth individual interviews. Data were thematically analyzed with the support of data management software QSR N6. Perceived risks and benefits were associated with receiving clinical training exclusively in either environment; risks in one area surfaced as benefits in the other. Themes that emerged included philosophy of care, approach to practice, working environment, depth and breadth of experience, relationships (both client and professional), practice outcomes, employment opportunities, and attitude. Entry-level clinical competence is achievable in both acute and long-term care environments; however, attention must be paid to identified risks. Interns who consider gaining clinical competence exclusively in one area can reduce risks and better position themselves for employment in either practice area by incorporating an affiliation in the other area into their internship program.

Diabetes mellitus in older men

Most persons with diabetes mellitus are over the age of 60 years. Males develop diabetes more commonly than females. Older diabetics tend to have both impaired insulin release as well as insulin resistance. In older persons diabetes mellitus is associated with decreased functional status and cognitive dysfunction. In general, older persons with diabetes are inclined to be underdiagnosed and undertreated. Managing diabetes in older persons requires special considerations because of their differences in pathophysiology of diabetes and strong association with functional, cognitive impairments and comorbidities. The use of strict therapeutic diets is not recommended in older persons. Treatment of hypertension and hyperglycemia can improve outcomes in older persons. The interdisciplinary team approach is important for care of older diabetic persons.

Life enrichment programme; enhanced dining experience, a pilot project

PURPOSE

The purpose of this pilot project is to highlight how food intake, nutrition status and quality of life could be improved for long stay residents of a community nursing unit and demonstrate that assisted feeding can be a more dignified experience for them.

DESIGN/METHODOLOGY/APPROACH

A good dining experience involves not just the food, but also its presentation and the environment in which it is served. A review of the literature identified projects with similar objectives but differing approaches. A survey of residents informed the planning phase. A home style dining room was created with a more traditional ambiance and decoration. The pace of dining was leisurely. Personal choice and independence in eating were supported. A schedule of dining activities was delivered by two staff facilitators.

FINDINGS

Eight dining sessions facilitated 23 residents over three months. "Minced" meals were not served, help was given to cut up meat and cues or prompts offered to maximize independence and demonstrate the value of this approach to care staff.

ORIGINALITY/VALUE

The project illustrated the advantages of stepping outside the purely clinical framework in addressing issues around poor food intake. It highlighted and how small but valuable changes can be implemented even where resources and space is limited. Involvement with the project allowed staff to observe and reflect on the benefits of enhancing the social and aesthetic aspects of dining.