Malnutrition in the institutionalized older adult

Language Variations in Describing Nutrition and Hydration Interventions in State Physician Orders for Life Sustaining Treatment Forms and the Implications for Advanced Dementia Patients

Background

Research suggests that language can impact medical decision-making, but few studies exist describing the variations in language to describe end-of-life nutrition and hydration interventions. The language contained in the Physician Orders for Life Sustaining Treatment (POLST) form varies across states, but this variation has not yet been fully analyzed. This investigation has implications for communicating with surrogates about the insertion of feeding tubes in advanced dementia patients, a common procedure in this population despite its potentially high risks and low benefits.

Objective

Identify and analyze the variations in language related to end-of-life nutrition and hydration interventions in state POLST forms.

Design

Descriptive study.

Measurements

The most up-to-date POLST forms for each of the 50 US states and the District of Columbia as of August 2022 were analyzed for their descriptions of end-of-life nutrition and hydration interventions.

Results

Fifty out of 51 (98%) forms referenced nutrition and/or hydration interventions. Four main modifiers of the word "nutrition" and/or "hydration" were identified: artificial (32%), artificially administered (56%), medically administered (14%), and assisted/medically assisted (18%). Forty-eight (96%) forms indicated an explicit option to forgo feeding tubes, and all of these forms described doing so with negatively valenced language.

Conclusions

The language describing end-of-life nutrition and hydration interventions and feeding tubes in state POLST forms is insufficiently specific and varies significantly across the country. These terms are at best ambiguous and at worst imply incorrect information. More precise language may assist in the difficult discussion between physicians and surrogates about inserting feeding tubes in advanced dementia patients.

What can we learn from the past about the future of gerontology: Using natural language processing to examine the field of gerontology

OBJECTIVES

We thematically classified all titles of eight top psychological and social gerontology journals over a period of six decades, between 1961 and February, 2020. This was done in order to provide a broad overview of the main topics that interest the scientific community over time and place.

METHODS

We used natural language processing in order to analyze the data. In order to capture the diverse thematic clusters covered by the journals, a cluster analysis, based on "topic detection" was conducted.

RESULTS

A total of 15,566 titles were classified into 38 thematic clusters. These clusters were then compared over time and geographic location. The majority of titles fell into a relatively small number of thematic clusters and a large number of thematic clusters was hardly addressed. The most frequently addressed thematic clusters were: a) Cognitive functioning, b) Long term care and formal care, c) Emotional and personality functioning, d) health and e) Family and informal care. The least frequently addressed thematic clusters were: a) Volunteering, b) Sleep, c) Addictions, d) Suicide, and e) Nutrition. There was limited variability over time and place with regard to the most frequently addressed themes.

The role of nutrition for pressure ulcer management: national pressure ulcer advisory panel, European pressure ulcer advisory panel, and pan pacific pressure injury alliance white paper

Nutrition and hydration play an important role in preserving skin and tissue viability and in supporting tissue repair for pressure ulcer (PrU) healing. The majority of research investigating the relationship between nutrition and wounds focuses on PrUs. This white paper reviews the 2014 National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel, and Pan Pacific Pressure Injury Alliance Nutrition Guidelines and discusses nutrition strategies for PrU management.

Construct validation and test-retest reliability of a mealtime satisfaction questionnaire for retirement home residents

Mealtime satisfaction is an important component of quality of life (QOL) in residential care, yet there currently is no self-administered tool described in the literature. The purpose of this study is to investigate internal and test-retest reliability, and construct validity of a mealtime satisfaction questionnaire (MSQ) designed for residential care, more specifically retirement homes. A 15-item MSQ was developed and eligible participants from four retirement homes (n = 749) were invited to participate. The participation rate was 24% and the median age was 88 years for respondents. The internal consistency of the MSQ was high (Cronbach Alpha = 0.83) and the test-retest reliability was also high (Intraclass coefficient = 0.91, P < 0.01). The MSQ was associated with a valid and reliable QOL instrument for older adults (Mann Whitney Test = 1595.5, P < 0.01). The MSQ is reliable and is content and construct valid. QOL can be enriched by improving mealtime satisfaction in retirement homes.

Predicting the outcome of long-term care by clinical and functional indices: the role of nutritional status

In elderly subjects, past researches have already underlined the role of nutritional status as a basic factor able to influence the prognosis either in acute wards or in rehabilitation and long-term care settings. Aim of the study is that of retrospectively verify, through a multivariate analysis, the factors able to condition mortality in long-term care, paying particular attention to the nutritional status.

METHODS

The survey included 513 patients aged more than 65 years admitted to a long-term care unit during a three years period. Exitus within the first three months of hospitalization was considered the outcome variable, while baseline functional, cognitive, clinical and nutritional status were considered the independent variables eventually related to mortality.

RESULTS

The univariate analysis found that some variables were significantly correlated with the outcome: comorbidity, ADL, cognitive status, pressure sores, albumin, transferrin, CRP, mucoprotein, cholesterol, cholinesterase, MAMC and MNA. The predictive value of the block model of the logistic regression analysis was 77.9% (specificity = 85.3%, sensitivity = 63.9%). With the forward stepwise analysis only MNA, cholinesterase, CRP and mucoprotein were considered in the final model. In this case the predictive value of the model was 79.3% (specificity = 84.6%, sensitivity = 69.46%).

Risk of malnutrition among Brazilian institutionalized elderly: a study with the Mini Nutritional Assessment (MNA) questionnaire

BACKGROUND

Brazilian population has passed for a process of demographic transition throughout latest years, characterized for the increase of the elderly population. Malnutrition is a serious problem to frail elderly.

OBJECTIVE

The objective of this study was o evaluate the risk of malnutrition among institutionalized elderly resident in municipal shelters in the city of Rio de Janeiro, Brazil, using the tool Mini Nutritional Assessment (MNA).

DESIGN

344 institutionalized elderly aged over 60 years old were tested in a cross-sectional study using MNA. This tool classifies the nutricional status of the elderly in three groups: malnutrition (score < 17), risk of malnutrition (score 17 - 23,5) and well-nourished (score > = 24). Anthropometric measurements such as calf circumference (CC), mid-arm circumference (MAC) and Body mass index (BMI) were also evaluated. The variables were evaluated using the chi-square or ANOVA test. To correlate it was used Pearson's Correlation Coefficient (r).

RESULTS

Mean age were 75.4 (+- 9.4) years old. Most of the elderly were female gender (59.6%). According to MNA 8.3% were with malnutrition, 55.6% at risk of malnutrition and 36.1% well-nourished. BMI classified 10.0% of the elderly as underweight. CC classified 10.0 % of them as inadequate in muscular mass. MNA was well correlated to BMI (r=0.412 p=0.000), age (r=-0.124 p=0.031), CC (r=0.399 p = 0.000) and MAC (r=0.391 p=0.000).

CONCLUSION

Risk of malnutrition was high among the institutionalized elderly from public shelters in Rio de Janeiro - Brazil. MNA is a useful diagnostic tool for the identification on the frail elderly at risk of malnutrition.

Estado nutricional e capacidade funcional na úlcera por pressão em pacientes hospitalizados

OBJETIVO: Correlacionar a incidência de úlcera por pressão com o estado nutricional e a capacidade funcional de pacientes internados. MÉTODOS: Estudo de corte transversal realizado em dois hospitais, totalizando 130 pacientes (idade mediana = 52 (14-85) anos, 77 (59,2%) homens e 53 (40,8%) mulheres), sendo 72 (55,4%) internados para tratamento clínico, 40 (30,8%) para tratamento cirúrgico e 18 (13,8%) em terapia intensiva. Os pacientes foram avaliados pela avaliação subjetiva global e classificados, de acordo com sua capacidade funcional, em acamados e não acamados. Registrou-se a presença e número de úlceras, e sua gravidade. A classificação das úlceras foi estabelecida como grave, para lesões de 3º e 4º graus, e leve, para os graus 1 e 2. RESULTADOS: A incidência de úlcera por pressão na população estudada foi de 19,2% (n=25). Não houve associação significativa com o sexo, a idade e tipo de tratamento do paciente. Os pacientes acamados apresentaram 7,5 vezes mais chance de apresentar úlceras (19/50; 38,0%) do que os que deambulavam (6/80; 7,5%; OR=7,5; IC95%: 2,7-20,7; p<0,001). A incidência de úlcera nos pacientes gravemente desnutridos (20/49; 40,8%) foi 10 vezes maior que nos pacientes considerados não gravemente desnutridos (5/81; 6,1%; OR=10,4 IC95%: 3,6-30,5; p<0,0001) Pela análise multivariada, tanto a capacidade funcional (acamado, OR=9,2; IC95%: 2,8-30,1; p<0,001) quanto o estado nutricional (desnutrido grave, OR=3,8; IC95%: 1,0-13,9; p=0,04) associaram-se com a úlcera por pressão. CONCLUSÃO: A incidência de úlcera por pressão está diretamente correlacionada com a desnutrição e com a restrição ao leito dos pacientes internados.

Nutritional status of nursing home residents in Taiwan

The purpose of this study was to explore the nutritional status of nursing home residents. A convenience sample of 111 residents from four nursing homes in Kaohsiung, Taiwan, was recruited. The residents' nutritional status was assessed on the basis of body mass index (BMI) and serum albumin level. Data on demographic characteristics, cognitive function, activities of daily living, and mode of feeding were collected and examined for association with nutritional status. Among the subjects, 41.1% had a BMI of less than 18.5 kg/m² and 18.9% had a serum albumin level of less than 3.5 g/dl. Mode of feeding was a significant predictor of malnutrition. When compared with residents on oral feedings, those on nasogastric (NG) feedings had four times the risk of a low BMI and about eight times the risk of a low albumin level. In conclusion, it is important to regularly assess the physical function and nutritional status of nursing home residents and adjust their dietary intake accordingly.

Nutrition Risk in Home-Bound Older Adults: Using Dietician-Trained and Supervised Nutrition Volunteers for Screening and Intervention

Nutrition screening and early intervention in home-bound older adults are key to preventing unfavourable health outcomes and functional decline. This pilot study's objectives were (a) to test the reliability of the Elderly Nutrition Screening Tool (ENS©) when administered by dietician-trained and supervised nutrition volunteers, and (b) to explore the feasibility of volunteers' doing nutrition screening and intervention for home-bound older adults receiving home care services. Both participating clients (n= 29) and volunteers (n= 15) were community-dwelling older adults. Volunteers met with participating clients, assessed nutritional risk with the ENS©, provided nutritional education, and developed and helped implement intervention plans. To assess ENS©inter-rater reliability, we compared results obtained by nutrition volunteers and a dietician. Agreement was high (≥80%) for most items but was higheramongvolunteers thanbetweenvolunteers and the dietician. We conclude that nutrition volunteers can assist in screening and educating older adults regarding nutritional risks, but intervention is best left to professionals.

Dining experience, foodservices and staffing are associated with quality of life in elderly nursing home residents

PURPOSE

Few studies have quantitatively investigated potential relationships between quality of life (QOL) in long term care (LTC) and foodservices.

OBJECTIVE

To investigate if dining experiences, and food and nutritional services affect elderly nursing home residents' QOL.

DESIGN AND PARTICIPANTS

A total of 395 residents in 38 nursing homes participated in this cross-sectional study.

MEASUREMENTS

Information on dining experiences and QOL was gathered by face-to-face interviews with cognitively intact residents; primary institutional caregivers completed a questionnaire for cognitively impaired residents. Additional data were also obtained from participants' medical charts and from administrators and foodservice managers. Multivariate ordinary least squares (OLS) regression was used to determine which institutional characteristics were related to QOL.

RESULTS

Number of dining companions, autonomy in relation to food, tray meal delivery service, and ratio of residents per resident assistant were significantly related to QOL in both cognitively intact and cognitively impaired residents. For cognitively intact residents, number of medical conditions, therapeutic menus, and use of china dishes were also related to QOL. For cognitively impaired residents, independence with eating and frequency of menu revision were also related to QOL.

CONCLUSION

Modifying certain aspects of food and nutritional services, as well as residents' dining experience, may improve QOL of elderly LTC residents.

Use of the mini nutritional assessment tool in elderly people from long-term institutions of southeast of Brazil

BACKGROUND

the Mini Nutritional Assessment (MNA) is a multidimensional method of nutritional evaluation that allows the diagnosis of malnutrition and risk of malnutrition in elderly people, it is important to mention that this method has not been well studied in Brazil.

OBJECTIVE

to verify the use of the MNA in elderly people that has been living in long term institutions for elderly people.

DESIGN

transversal study.

PARTICIPANTS

89 people (>/= 60 years), being 64.0% men. The average of age for both genders was 73.7 +/- 9.1 years old, being 72.8 +/- 8.9 years old for men, and 75.3 +/- 9.3 years old for women.

SETTING

long-term institutions for elderly people located in the Southeast of Brazil.

METHODS

it was calculated the sensibility, specificity, and positive and negative predictive values. It was data to set up a ROC curve to verify the accuracy of the MNA. The variable used as a "standard" for the nutritional diagnosis of the elderly people was the corrected arm muscle area because it is able to provide information or an estimative of the muscle reserve of a person being considered a good indicator of malnutrition in elderly people.

RESULTS

the sensibility was 84.0%, the specificity was 36.0%, the positive predictive value was 77.0%, and the negative predictive value was 47.0%; the area of the ROC curve was 0.71 (71.0%).

CONCLUSION

the MNA method has showed accuracy, and sensibility when dealing with the diagnosis of malnutrition and risk of malnutrition in institutionalized elderly groups of the Southeastern region of Brazil, however, it presented a low specificity.

Aging and the intestine

Over the lifetime of the animal, there are many changes in the function of the body’s organ systems. In the gastrointestinal tract there is a general modest decline in the function of the esophagus, stomach, colon, pancreas and liver. In the small intestine, there may be subtle alterations in the intestinal morphology, as well as a decline in the uptake of fatty acids and sugars. The malabsorption may be partially reversed by aging glucagon-like peptide 2 (GLP2) or dexamethasone. Modifications in the type of lipids in the diet will influence the intestinal absorption of nutrients: for example, in mature rats a diet enriched with saturated as compared with polysaturated fatty acids will enhance lipid and sugar uptake, whereas in older animals the opposite effect is observed. Thus, the results of studies of the intestinal adaptation performed in mature rats does not necessarily apply in older animals. The age-associated malabsorption of nutrients that occurs with aging may be one of the several factors which contribute to the malnutrition that occurs with aging.

Is it possible to increase weight and maintain the protein status of debilitated elderly residents of nursing homes?

BACKGROUND

The care of elderly persons in chronic care nursing wards is generally complicated by nutritional problems such as weight loss and worsening protein status. An inability or refusal of the patient to consume enough food often necessitates the use of expensive commercial formulas for nutritional support. The purpose of this study was to determine whether the use of an in-house (high-protein, milk-based) low-cost formula with added minerals and vitamins for total nutritional support would be effective in maintaining weight and protein status of patients in the long term.

METHODS

Participants were recruited from five nursing care units of a single geriatric facility. All residents who required formula feeding were followed prospectively. The formula was provided either as a pudding or a milkshake for oral feeding or as a liquid for tube feeding and served as the sole source of nutrition. Data were collected regarding the participants' weight (monthly), serum albumin level (periodically), and the manner of formula administration (oral, nasogastric, or gastrostomy tube).

RESULTS

One hundred forty-three participants who received this formula were followed for a maximum period of 6 years. Mean weight increased by 5 kg during the first year and remained stable thereafter. Those participants who died within 6 months had no increase in weight. The long-term mean serum albumin level of all participants was an acceptable 4 g/dL.

CONCLUSION

The long-term use of an inexpensive in-house formula for total nutritional support increased weight and maintained serum albumin levels in most of the chronically ill elderly nursing care patients who participated in the study.

Behavioral Disturbances, Not Cognitive Deterioration, Are Associated With Altered Food Selection in Seniors With Alzheimer's Disease

OBJECTIVE

We previously reported alterations in circadian patterns of food intake that are associated with measures of functional and cognitive deterioration in seniors with probable Alzheimer's disease (AD). This study further explored disturbed eating patterns in AD, focusing on alterations in macronutrient (protein, carbohydrate, and fat) selection, and their association with measures of functional and behavioral losses.

METHODS

Forty-nine days of food intake collections were conducted on 32 residents (26 females, 6 males; age = 88.4 +/- 4.1 years; body mass index = 24.1 +/- 4.0 kg/m(2)) with probable AD residing at a nursing home (a fully accredited geriatric teaching facility affiliated with the University of Toronto's Medical School). All residents ate their meals independently. The relationships between patterns of habitual food consumption and measures of cognitive function (Severe Impairment Battery), behavioral disturbances (Neuropsychiatric Inventory-Nursing Home Version) and behavioral function (London Psychogeriatric Rating Scale) were examined, cross-sectionally.

RESULTS

Consistent with our previous studies, breakfast intakes were not predicted by any of the measures of behavioral, cognitive, or functional deterioration, although those residents with greater functional deterioration, especially disengagement, attained lower 24-hour energy intakes. The presence of "psychomotor disturbances," including irritability, agitation, and disinhibition, were strongly associated with shifts in eating patterns toward carbohydrate and away from protein, placing individuals with these conditions at increased risk for inadequate protein intakes. Between-individual differences in intake patterns could not be explained by the use of either anorexic or orexigenic medications.

CONCLUSIONS

Behavioral, not cognitive, deterioration is associated with appetite modifications that increase risk of poor protein intake, perhaps indicating a common monoaminergic involvement.

Body Weight Changes in Elderly Psychogeriatric Nursing Home Residents

OBJECTIVE

This study was undertaken to identify predictors of body weight change in nursing home patients with possible to severe dementia.

METHODS

For 24 weeks, 108 elderly residents of a nursing home were followed. Body weight was measured every 2 weeks. Other anthropometric characteristics, dietary intake, food behavior restrictions, psychological characteristics, medical status, and use of medicines were measured at baseline. Dietary intake was measured with a combined 3-day food record and by observations during the hot meals. Food behavior restrictions were measured following the classification of Berkhout. Dependency was measured by a questionnaire (Care Index Geriatrics), which measures restrictions in cognitive, physical, and social functioning. A generalized linear mixed effects model was used to investigate weight changes over time. The model was adjusted for age and sex.

RESULTS

During the follow-up period, 26% of the participants lost and 22% gained at least 2 kg of body weight. Dependency (beta = -0.11, 95% confidence interval [CI] = -0.21, -0.01) and decreased appetite (beta = -2.17, 95% CI = -4.32, -0.01) were significantly associated with body weight loss, whereas body mass index (beta = 2.25, 95% CI = 1.98, 2.51) and intake of fat (beta = 0.07, 95% CI = 0.01, 0.15) were predictors of weight gain.

CONCLUSION

Dependency, body mass index, intake of fat, and decreased appetite are significant predictors of body weight changes.

The nutritional status of 1081 elderly people residing in publicly funded shelter homes in Peninsular Malaysia

OBJECTIVES

The aim of this study was to determine the: (1) prevalence of undernutrition as determined by the 'DETERMINE Your Nutritional Health Checklist' (NHC) and (2) factors independently associated with undernutrition among the older residents of these publicly funded shelter homes in Peninsular Malaysia.

DESIGN

A total of 1081 elderly people (59%M) over the age of 60 y were surveyed using questionnaires determining baseline demographics, nutritional and cognitive status, physical function and psychological well-being.

SETTING

Shelter homes, Peninsular Malaysia.

RESULTS

In all, 41.4% (n = 447) were nourished (score <3), 32.1% (n = 347) at moderate risk (score between 3 and 5) and 26.6% (n = 287) were at high risk of undernutrition (score>5) according to the NHC. A large proportion of subjects were underweight with 14.3% of subjects recording a low body mass index (BMI) <18.5 kg/m2 and a further 18.2% recording a BMI between 18.5 and 20 kg/m2. The residential geriatric depression score (GDS-12R) (relative risk (RR) = 1.03 (95% confidence interval (CI) 1.01-1.05); P = 0.002) and the number of illnesses (RR = 1.14 (95% CI 1.07-1.21); P < 0.001) were found to be independently associated with nutritional risk (NHC score > or = 3). Using a BMI < 18.5 kg/m2 as an objective marker for nutritional risk, the NHC was shown to have a sensitivity of 66.4% (95% CI 58.0-74.2%), specificity of 42.7% (95% CI 39.3-46.1%), positive predictive value of 16.2% (95% CI 13.3-19.5%) and a negative predictive value of 88.4% (95% CI 84.9-91.4%).

CONCLUSIONS

Many elderly people residing in publicly funded shelter homes in Malaysia may be at-risk of undernutrition, and were underweight. The NHC is better used as an awareness tool rather than as a screening tool.

Old age, malnutrition, and pressure sores: an ill-fated alliance

Wound healing is a complex, tightly regulated process, consisting of three distinct phases. In each phase of wound healing, energy and macronutrients are required. Moreover, animal studies have established a specific role for certain nutrients such as the amino acid arginine, the vitamins A, B, and C, and the elements selenium, manganese, zinc, and copper. Chronic wounds such as pressure ulcers have extensively been investigated as to the risk of development, prevention, and cure. Here, the combination of old age, malnutrition, and pressure ulcers is highly unfortunate. Energy and nutrients, such as proteins and vitamins B and C, being deficient at old age are needed in pressure ulcer healing. Malnutrition is associated with skin anergy and with immobility because of mental apathy and muscle wasting. Severe malnutrition, impaired oral intake, and the risk of pressure ulcer formation appear to be interrelated. Adequate nutrition may reverse the underfed state unless an underlying wasting disease was present and appeared to reduce the prevalence and incidence in cross-sectional and prospective observational studies. However, attempts to prevent pressure ulcers by nutritional intervention were divergent in outcome, reflecting the difficulties to meet the daily requirements in elderly persons and the lack of knowledge about true nutritional needs in wound healing. The consumption of a diet high in protein and energy may promote pressure ulcer healing. When considering nutritional support, oral supplementation should be weighted against tube feeding, as the associated morbidity of tube feeding, i.e., diarrhea, fecal incontinence, and restricted mobility being in themselves risk factors for pressure ulcers, might obscure the favorable effects of adequate nutrition. Despite the evidence in animal studies, none of the above-mentioned specific nutrients promoted the healing of pressure ulcers in humans. Therefore, the attention should be focused on early recognition of a depleted nutritional status and an adequate and supervised intake of energy (35 kcal/kg) and protein (1.5 g/kg) with provision of the recommended daily allowances of micronutrients and with correction of the nutrient deficiencies of old age.

Dementia, nutrition, and self-feeding: a systematic review of the literature

SUMMARY The outcomes of feeding training are typically evaluated in terms of feeding skills and swallowing abilities rather than the ultimate goal of feeding, namely, adequate nutritional status. To increase occupational therapy practitioners' awareness of nutritional status as an outcome of feeding training, a systematic review of the research literature was conducted to examine the relationship between nutritional status and self-feeding skills in people with dementia. Studies were evaluated by the strength of their evidence and analyzed to determine the relationships among dementia, nutritional status, and the ability to feed one's self. Results revealed that although nutritional status in people with dementia is variable, there is a tendency for lower body weight, lower measures of body composition, and lower body mass indexes in persons with dementia compared to those with no cognitive impairment. Individuals who feed themselves tend to weigh more compared to those who need assistance for feeding. There is also evidence to support that as feeding status improves or declines, body weight similarly increases or decreases.

Weight change, nutritional risk and its determinants among cognitively intact and demented elderly Canadians

Nutritional risk and its predictors were assessed by evaluating longitudinal changes in body weight using data collected from elderly community-dwelling and institutionalized Canadians who participated in both phases of the Canadian Study of Health and Aging, CSHA (n = 10,263). Change in body weight (% initial weight) was examined over a 5-year interval in 584 community and 237 institutionalized participants, and its predictors tested in multiple and logistic regression analyses. Average weight at CSHA-2 was 97% of initial weight at CSHA-1. Values were lower in those over 90 years and the demented. Increasing frailty in a 7-point scale (beta = -1.23, p = 0.04) predicted weight loss in institutional participants, as did difficulty in eating unaided (beta = 4.24, p < 0.001) and reported loss of interest in life (beta = 2.22, p < 0.001) among community subjects. Some 16% in institutions and 9% in the community were at moderate/severe nutritional risk, disproportionately represented by the oldest subjects and the demented. These analyses support the importance of assessing dietary intakes, anthropometrics, well-being and environmental predictors of aging in the elderly.

Nutritional Status of Functionally Dependent and Nonfunctionally Dependent Elderly in Taiwan

OBJECTIVE

The purpose of this study was to measure and compare nutritional status of the functionally dependent elderly with those nonfunctionally dependent elderly by assessing nutrient intake, anthropometric measurements, hematological and biochemical parameters, and the nutritional risk index (NRI).

METHODS

Ninety-six volunteers (42 functionally dependent elderly, 54 nonfunctionally dependent elderly) participated in this study. The items of activity of daily living (ADL) were assessed to determine functional status. Demographic and health data were collected at the time of interview. Subjects completed 24-hour diet recall and food frequency questionnaires. Height, weight and skinfold thickness measurements were taken. Hematological and biochemical parameters were measured. The NRI was then calculated.

RESULTS

Osteoporosis and hypertension were the most frequently reported chronic diseases. A small proportion of the elderly with functional dependence (9.5%) and with nonfunctional dependence (13%) had a body mass index (BMI) (< or = 21 kg/m2), indicating they were underweight. There were no significant differences in nutrient intake between the two groups. However, a higher percentage of the functionally dependent elderly had a nutrient intake of less than 75% of the Taiwan Recommended Daily Nutrient Allowance (RDNA). The functionally dependent group had a higher prevalence of malnutrition than the nonfunctionally dependent group (44.7% vs. 25%) based on the NRI.

CONCLUSIONS

These functionally dependent elderly people exhibited a poorer nutritional status than the nonfunctionally dependent elderly. The elderly with functional dependence were at risk for inadequate iron intake and abnormal serum triglyceride concentrations: they were also at greater risk for chronic diseases and had a greater need for medications.

Nutrient intake of nursing-home residents receiving pureed foods or a regular diet

OBJECTIVE

To evaluate (1) the nutrient content of menus planned for regular consistency meals and pureed meals in a long-term care facility and (2) to assess nutrient intakes of women consuming these meals.

DESIGN

A descriptive survey.

SETTING

A nursing home facility in central Pennsylvania.

PARTICIPANTS

Fifty-one female nursing home residents were chosen randomly. Thirty-one received a regular diet and 20 received a pureed diet.

MEASUREMENTS

Demographic and health variables were collected from medical records. Nutrient variables were calculated for regular and pureed consistency meals, as served. Nutrient intake data for each woman were based on seven consecutive days of food intake and nutrient supplement use.

MAIN RESULTS

Energy and nutrient values for regular diet menus (i.e., food served) were higher than for pureed menus, but both had values exceeding recommended allowances for most nutrients. Average energy and nutrient intakes were similar for both groups of women (t test, P < 0.05). Data showed that many women in both groups had lower than the recommended intakes of iron, zinc, calcium, and Vitamin D.

CONCLUSIONS

Both regular and pureed consistency diets provided to residents met current recommended allowances. Diet consistency did not affect nutrient intakes. Intakes were adequate overall; however, a low intake of the same nutrients generally occurred in both groups.