Nutrition education may reduce burden in family caregivers of older adults

Family Caregivers' Role in Navigating Diet: Perspectives from Caregivers of Older Asian Americans

Family caregivers uphold significant healthcare responsibilities including language translation and diet management. This study sought to understand family caregivers' experiences and challenges navigating and managing their older Asian American relative's diet. We conducted an exploratory sequential mixed-methods study with family caregivers involving (1) qualitative interviews (n = 40) and (2) a nationwide survey (n = 100). Interviewees discussed their role and challenges with (a) applying American/Western clinical dietary recommendations to their relative's traditional meal preferences and (b) managing misalignment between their relative's traditional dietary preferences and the food offered in hospitals and long-term care environments. Survey responses triangulated; almost 65% of family caregivers prepared and brought traditional meals to healthcare facilities upon observing a lack of culturally relevant food options. Culturally relevant nutrition training for family caregivers can help them support their relative in community settings. Creating an inclusive healthcare system requires transforming the food environment within healthcare facilities.

Meta-analysis and moderator analysis of the prevalence of malnutrition and malnutrition risk among older adults with dementia

BACKGROUND

Aging and dementia are common and closely related health problems in older adults, affecting their ability to maintain a healthy diet and ultimately resulting in malnutrition.

OBJECTIVE

In this study, we estimated the global prevalence of malnutrition and malnutrition risk in older adults with dementia.

DESIGN

Meta-analysis.

DATA SOURCES

Embase, Ovid MEDLINE, PubMed, CINAHL, Scopus, and Web of Science were comprehensively searched for articles published from database inception to October 2022.

METHODS

Pooled prevalence analysis was conducted using a generalized linear mixed model and a random-effects model. I2 and Cochran's Q statistics were used for identifying heterogeneity. Publication bias was evaluated using Peters' regression test and a funnel plot. Moderator analyses were conducted to investigate variations in the prevalence estimates of the included studies. All statistical analyses were conducted using R software.

RESULTS

A total of 16 studies involving a total of 6513 older adults with dementia were included in the analysis. The results indicated that 32.52 % (95 % confidence interval: 19.55-45.49) of all included older adults with dementia had malnutrition, whereas 46.80 % (95 % confidence interval: 38.90-54.70) had a risk of malnutrition. The prevalence of malnutrition was found to be high among older patients living in institutionalized settings (46.59 %) and those with Alzheimer's disease (12.26 %). The factors moderating the prevalence of malnutrition included adequate vitamin B12 consumption, risk behaviors, medical comorbidities, and certain neuropsychiatric symptoms. The prevalence of malnutrition risk was high among women (29.84 %) and patients with Alzheimer's disease (26.29 %). The factors moderating the prevalence of malnutrition risk included total cholesterol level, vitamin B12 consumption, risk behaviors, medical comorbidities, and certain neuropsychiatric symptoms.

CONCLUSIONS

Approximately one-third of older adults with dementia are malnourished and nearly half of older adults are at a risk of malnutrition. Encouraging collaboration among health-care professionals and ensuring early assessment and effective management of malnutrition are crucial for maintaining a favorable nutritional status in older adults with dementia.

REGISTRATION

This study was registered with the International Prospective Register of Systematic Reviews (PROSPERO: CRD42022369329).

TWEETABLE ABSTRACT

Globally, approximately 32.52 % of older adults with dementia are malnourished and approximately 46.80 % are at a risk of malnutrition.

An Exploratory Study of Nutrition Knowledge and Challenges Faced by Informal Carers of Community-Dwelling People with Dementia: Online Survey and Thematic Analysis

Nutrition knowledge is a primary factor influencing food choices and the ability to identify nutritional risk for carers of people with dementia. Acquiring nutrition knowledge helps carers monitor changes in food intake and micronutrient intake, and whether a healthy and balanced diet is being consumed. This study aimed to assess the nutrition knowledge of carers in the Australian community and their experiences with nutrition education. Using a mixed-methods approach, the nutrition knowledge of informal carers was assessed using the revised General Nutrition Knowledge Questionnaire (AUS-R-NKQ), and interviews of informal carers were used to explore the perspectives in a sub-sample. A total of 57 carers (44 females; mean age of 63.0 ± 13.1) completed the survey, and 11 carers participated in follow-up interviews. The total sample scored 22.9 (±4.57) out of 38 on the AUS-R-NKQ, suggesting basic nutrition knowledge. The interviewed carers acknowledged the importance of healthy nutrition but viewed the provision of a healthy diet for a person with dementia as challenging. In both the survey and interviews, carers reported limited use and availability of dementia-specific nutrition resources. Carers were unsatisfied with the advice and number of referrals provided to improve the nutrition of the person with dementia and desired less confusing nutrition education materials adapted to their level of knowledge. The present study highlights the need for informal carers to be supported to acquire adequate nutrition knowledge.

Evaluating the healthfulness of Asian American young adult dietary behaviors and its association with family structure: Disaggregated results from NHIS 2015

Background: Asian Americans (AA) young adults face a growing non-communicable disease burden linked with poor dietary behaviors. Family plays a significant role in shaping the diet of AA young adults, although little is known on the specific types of family structures most associated with different dietary behaviors. Aim: This analysis explores the changes in dietary behaviors across different AA young adult family structural characteristics. Methods: Nationwide data of 18-35-year-old self-identified Asians surveyed in the 2015 National Health Interview Survey (NHIS) was analyzed. Family structure was measured through family size, family health, and family members in one's life. The Dietary Screener Questionnaire (DSQ) measured the average intake of 10 food and nutrient groups. Published dietary guidelines were used to calculate the number of dietary recommendations met. Results: 670 AA young adults with dietary data were analyzed (26.1% Asian Indian, 26.1% Chinese, 19.3% Filipino, 28.5% other Asian). Participants had an average family size of 2.3. In weighted analyses, 19% of AA young adults met none of the examined dietary recommendations, and only 14% met 3-4 guidelines. Living with a child was associated meeting more dietary recommendations (adjusted odds ratio [AOR]: 1.22; 95%CI: 1.05, 1.42). The adjusted association between living with an older adult and lower odds of meeting dietary recommendations approached significance (AOR: 0.70; 95%CI: 0.49, 1.00). Conclusions: Findings revealed the important role of children and older adults in influencing the diet of AA young adults. Further mixed-methods research to disentangle mechanisms behind the influence of family structure on diet is warranted.

Current Challenges in Home Nutrition Services for Frail Older Adults in Japan-A Qualitative Research Study from the Point of View of Care Managers

Preventive care for frail older adults includes providing tailor-made diet information suited to their health conditions. The present study aims to explore the current situation and challenges of home nutrition advice for Japanese frail older adults using qualitative data from a ten-person group discussion among care managers. As the results of our analysis, nine themes were identified: (1) Homebound older adults develop poor eating habits; meals turn into a lonely and unpleasant experience; (2) With age, people's eating and drinking patterns tend to deteriorate; (3) Many older adults and their family know little about food management according to condition and medication; (4) Many older adults do not understand the importance of maintaining a proper diet; (5) Many homebound older adults do not worry about oral hygiene and swallowing ability; (6) Some older adults are at high risk for food safety problems; (7) Only a limited range of boil-in-the-bag meal options are available for older adults; (8) Many older adults feel unduly confident in their own nutrition management skills; and (9) For many family caregivers, nutrition management is a burden. We conclude that the provision of tailor-made information by skilled dietitians and high-quality home-delivered meal service are essential for the successful nutrition management of the older adults.

Students meeting with caregivers of cancer patient: results of an experience-based learning project

The communication between medical students and cancer caregivers, and the problems they have experienced as well as the outcomes for their professional development before starting clinical practice was assessed in the context of a student research project. Data were collected by questionnaires or by 20 to 40-min long interviews with cancer caregivers. Their communications with physicians, hearing the bad news, and health service satisfaction were questioned. Therefore, the caregivers trusted the professional approach of their physician. However, they expected more empathic communication in the process of diagnosis and therapy. Development of empathy and trust-based communication between patients and physicians and enhancement of the quality of devoted time to cancer patients and caregivers may have an effect on the course of disease. Interviewer students mentioned that they developed communication skills about difficult clinical tasks and in delivering bad news face to face to cancer caregivers before starting their clinical education.

Position of the Academy of Nutrition and Dietetics: food and nutrition for older adults: promoting health and wellness

It is the position of the Academy of Nutrition and Dietetics that all Americans aged 60 years and older receive appropriate nutrition care; have access to coordinated, comprehensive food and nutrition services; and receive the benefits of ongoing research to identify the most effective food and nutrition programs, interventions, and therapies. Health, physiologic, and functional changes associated with the aging process can influence nutrition needs and nutrient intake. The practice of nutrition for older adults is no longer limited to those who are frail, malnourished, and ill. The population of adults older than age 60 years includes many individuals who are living healthy, vital lives with a variety of nutrition-related circumstances and environments. Access and availability of wholesome, nutritious food is essential to ensure successful aging and well-being for the rapidly growing, heterogeneous, multiracial, and ethnic population of older adults. To ensure successful aging and minimize the effects of disease and disability, a wide range of flexible dietary recommendations, culturally sensitive food and nutrition services, physical activities, and supportive care tailored to older adults are necessary. National, state, and local strategies that promote access to coordinated food and nutrition services are essential to maintain independence, functional ability, disease management, and quality of life. Those working with older adults must be proactive in demonstrating the value of comprehensive food and nutrition services. To meet the needs of all older adults, registered dietitians and dietetic technicians, registered, must widen their scope of practice to include prevention, treatment, and maintenance of health and quality of life into old age.

Nutrition education needs and resources for dementia care in the community

Nutrition problems and specificly weight loss are common in older adults with dementia living in the community. Study 1 involved interviews with 14 formal providers to identify the range of nutrition concerns they had experienced. In study 2, 74 Canadian Alzheimer Society chapters were surveyed by e-mail (23% participation rate) to determine nutrition concerns and education resources provided to clients. In all, 26 of these nutrition pamphlets or handouts were rated on content and format by 2 independent researchers using a standardized rating system. Common nutrition concerns identified in older adults with dementia living in the community include safety, weight loss, forgetting or refusing to eat, appetite, dysphagia, and unfavorable eating behaviors. Most resources provided to clients were considered low quality and did not match the nutrition concerns expressed by formal providers. Currently, there is a considerable knowledge translation gap around nutrition and dementia, and this study provides a basis for the future development of nutrition education resources.

Supportive care needs of people with brain tumours and their carers

GOALS OF WORK

The diagnosis and treatment of a brain tumour may result in long-term changes in a patient's functional and social abilities and/or in a greatly reduced life span. A qualitative investigation was conducted to examine the supportive care needs of patients with brain tumour and their carers.

MATERIALS AND METHODS

Overall, 18 patients and 18 carers participated in focus groups or telephone interviews, following a structured interview guide to elicit supportive care services of importance to these patients and carers.

MAIN RESULTS

Six major themes were identified using the framework analysis method, including needs for information and coping with uncertainty, practical support, support to return to pretreatment responsibilities or prepare for long-term care, support to deal with social isolation and organize respite care, support to overcome stigma/discrimination and support to discuss potentially reduced life expectancy.

CONCLUSIONS

Five recommendations to improve service delivery include: assignment of a dedicated member of the care team or case manager; proactive dissemination of information, education and psychosocial support; access to objective assessment of neuropsychological functioning; facilitating easier access to welfare payments; and services facilitating communication about difficult illness-related topics. Provision of services along these recommendations could improve supportive care of brain tumour patients and their carers.

Position paper of the American Dietetic Association: Nutrition across the spectrum of aging

It is the position of the American Dietetic Association that older Americans receive appropriate care; have broadened access to coordinated, comprehensive food and nutrition services; and receive the benefits of ongoing research to identify the most effective food and nutrition programs, interventions, and therapies across the spectrum of aging. Food and water and nutritional well-being are essential to the health, self-sufficiency, and quality of life for the fast growing, heterogeneous, multiracial, and ethnic populations of older adults. Many people, as they age, remain fully independent and actively engaged in their communities; however, others fare less well and need more support. A broad array of appropriate, culturally sensitive food and nutrition services, physical activities, and health and supportive care customized to the population of older adults are necessary. National, state, and local policies that promote coordination and integration of food and nutrition services into health and supportive systems are needed to maintain independence, functional ability, chronic disease management, and quality of life. Dietetics professionals can take the lead by researching and developing national, state, and local collaborative networks to incorporate effectively the food and nutrition services across the spectrum of aging.

Needs and Preference Assessment for an In-Home Nutrition Education Program Using Social Marketing Theory

Nutrition education programs for elder caregivers (CG) and their elder care recipients (CR) are important in preventing malnutrition. Using Social Marketing Theory, this study assessed the needs and preferences for nutrition education in elder CGs and their CRs in Guilford County, NC. Thirty-two pairs of community-residing elder CGs/CRs and three focus groups (FGs) participated. Health and diet questionnaires were administered to all CGs/CRs during in-home interviews. CGs/CRs and FGs evaluated nutrition education materials. Questionnaires were analyzed using SPSS v9. Ethnograph v5.0 was used to code the interviews regarding the education materials. The CGs were middle age (58.9 years), overweight (BMI = 28.8) Caucasian women. The CRs were old (79.4 years), overweight (BMI = 26.0) Caucasian women. Identified malnutrition risk factors of CGs and CRs included inadequate fluid and dietary intake, polypharmacy, and chronic disease. Identified nutrition needs and education preferences of CGs/CRs were similar. Perceived nutrition education preferences of the FGs did not reflect the interests of the CGs/CRs. This information is being used to revise the education materials and develop an in-home nutrition education program for CGs and CRs in Guilford County, NC.

Family caregivers of older adults on home enteral nutrition have multiple unmet task-related training needs and low overall preparedness for caregiving

OBJECTIVES

We used stress process theory to identify family caregiving variables that are salient to the experience of managing older adults' home enteral nutrition. In this article, we describe the specific tasks family caregivers performed and their unique training needs in the context of caregiver preparedness, competence, effectiveness, and health care use.

DESIGN

Hospital billing lists from two university-affiliated institutions in Miami, FL, were used to identify older adults who had enteral tubes placed over a 6-month period. Consent was obtained from those older adults discharged for the first time on home enteral nutrition and their family caregivers at the first scheduled outpatient visit.

SUBJECTS/SETTING

In-home interviews were conducted with a diverse sample of 30 family caregivers (14 white, 8 Hispanic, 7 African-American, 1 Asian) during their first 3 months (mean=1.83+/-0.69 months) of home enteral nutrition caregiving.

STATISTICAL ANALYSES PERFORMED

Descriptive statistics were used to summarize data for all variables; chi(2) analysis was conducted to analyze differences in categorical variables. One-way analysis of variance was used to analyze mean differences among caregivers grouped by ethnicity for total number of hours and tasks performed. Post hoc comparisons were conducted using the Tukey HSD test. The Spearman rho correlations were calculated to assess bivariate associations between quantitative variables.

RESULTS

Caregivers reported providing from 6 to 168 hours of care weekly (mean=61.87+/-49.67 hours), in which they performed an average of 19.73+/-8.09 caregiving tasks daily. Training needs identified were greatest for technical and nutrition-related tasks. Preparedness for caregiving scores were low (mean=1.72, maximum=4.0) and positively correlated with caregiver competence (P<.001) and self-rated caregiver effectiveness (P=.004). Preparedness negatively correlated with health care use (P=.03).

CONCLUSIONS

Caregivers of older adults on home enteral nutrition need training for multiple nutrition-related and caregiving tasks. Multidisciplinary interventions, involving dietitian expertise, are needed to better prepare caregivers to improve both caregiver effectiveness and enteral nutrition outcomes.

A Systematically Tested Intervention for Managing Reactive Depression

BACKGROUND

Patients and family caregivers repeatedly experience reactive depression that leads to medication errors, mismanagement of chronic disease, and poor self-care. These problems place them at high-risk for malnutrition, infection, heart diseases, and psychiatric sequelae.

OBJECTIVES

A secondary data analysis compared findings across a series of studies to evaluate the acceptability, effectiveness, and cost of a therapeutic writing intervention to reduce reactive depression, a common and frequently recurring adverse symptom.

METHODS

Secondary analysis of data from the series of studies was conducted. Data came from patients requiring lifelong, daily central intravenous catheter infusion of home total parenteral nutrition necessitated by nonmalignant bowel disease and their family caregivers who assist with this complex home care. Variables combined across the studies were pre- and postintervention scores from the Center for Epidemiological Studies-Depression Scale (CES-D), the number of weeks patients wrote in their diaries (adherence), and the written content in the diaries. Content analysis was used to analyze written data. The intervention materials and nurses' time spent were averaged across studies to determine costs.

RESULTS

The weighted average baseline CES-D scores across studies for patients (17.94) and caregivers (15.75) showed the presence of depression. After journal writing had been used for an average of 10.4 weeks across studies, the effect sizes of the between (d =.27) and within (d =.65) patient group scores indicated moderate to large improvement in depression. Themes from written diaries showed that missing out on activities, financial worries, strain related to the severe illness, and the complexity of home care were related to depression across the studies.

CONCLUSIONS

The intervention was acceptable to participants, effective for managing reactive depression, and low in cost. The next steps will address testing for the longitudinal effects of the intervention.

Family caregiver training is needed to improve outcomes for older adults using home care technologies

Family caregivers, although uncompensated, provide daily care for more than 75% of the older adults who are dependent on home care technologies such as home enteral nutrition. The high complication rates and poor outcomes seen in older adults suggest that being an effective caregiver requires specialized training in home care technologies, and dietitians need to be more actively involved in discharge planning and follow-up home care. The level of knowledge and skill mastery required for technology-dependent care, along with the chronic, intensive nature of family caregiving and the disruptions in caregivers' daily lives, lead to negative emotional and physical consequences that may interfere with caregivers' ability to do caregiving well. Recognizing that care recipients and caregivers are underserved populations, dietitians should develop their professional competencies and expand their roles in technology-dependent home care. Dietitians can thereby contribute to better outcomes for both family caregivers and older home care recipients.