Case studies of food shopping, cooking and eating habits in older women with Parkinson's disease

Perceptions of Dysphagia Evaluation and Treatment Among Individuals with Parkinson's Disease

Dysphagia is a leading cause of morbidity and mortality among individuals with Parkinson's disease (PD). The primary objectives of the present study were to explore patients' narrative reports focused on what information and evaluation and treatment experiences they identified as they manage dysphagia, and to identify practice patterns relevant to dysphagia management. A secondary objective was to produce an educational resource for this population that addressed their questions about dysphagia. A sample of individuals with oropharyngeal dysphagia secondary to PD (n = 25) across all regions of the United States were interviewed using open- and closed questions and a written questionnaire. Verbatim interview transcripts were interrogated using qualitative content analysis (QCA) with an inductive approach to identify themes from the participants' reported knowledge of dysphagia and experiences with swallowing evaluation and treatment. Authors developed a pamphlet addressing common questions that participants posed in the interviews and conducted a member check to revise it with their feedback. Most participants reported having been asked about their swallowing function by a healthcare professional. 60% of the sample reported having had a swallowing evaluation. Only 20% (5/25) of participants reported having completed swallowing therapy. Some participants did not know that swallowing therapy exists. Nearly all participants reported having a strong desire to know more about dysphagia and preferred a pamphlet as a resource format. Few of the study participants had received swallowing therapy, and nearly all participants were eager to learn about the nature of dysphagia, its progression, and treatment options. Given the physical, emotional, and social ramifications of living with dysphagia, access to swallowing education and treatment needs to be a stronger focus of PD management.

A Qualitative Analysis of Experiences With Food-Related Activities Among People Living With Parkinson Disease and Their Care-Partners

Objectives: The purpose of this qualitative study was to explore factors associated with the ability of people with PD to perform food-related activities (FRAs). Methods: Eleven dyads, older adults with Parkinson disease (PD) and their care-partners (n = 22), completed virtual semi-structured interviews guided by the Social Cognitive Theory (SCT) that were independently analyzed by two coders via directed content analysis. Results: The following themes were identified-(1) Personal: perception of a healthy diet, perception of how nutrition influences PD, confidence in following a healthy diet, and barriers to performing FRA; (2) Environmental: previous sources of nutrition information and willingness to changing their diet with a registered dietitian; and (3) Behavioral: modifications to FRA due to food-medication interactions, and skills necessary to maintain a healthy diet. Discussion: Findings from this study highlight the need for nutrition intervention research to inform evidence-based guidelines in order to provide tailored education for people with PD and care-partners.

Parkinson's disease: the nutrition perspective

Parkinson's disease (PD) is the second most common neurodegenerative disease after Alzheimer's disease and affects about 1% of the population over the age of 60 years in industrialised countries. The aim of this review is to examine nutrition in PD across three domains: dietary intake and the development of PD; whole body metabolism in PD and the effects of PD symptoms and treatment on nutritional status. In most cases, PD is believed to be caused by a combination of genetic and environmental factors and although there has been much research in the area, evidence suggests that poor dietary intake is not a risk factor for the development of PD. The evidence about body weight changes in both the prodromal and symptomatic phases of PD is inconclusive and is confounded by many factors. Malnutrition in PD has been documented as has sarcopaenia, although the prevalence of the latter remains uncertain due to a lack of consensus in the definition of sarcopaenia. PD symptoms, including those which are gastrointestinal and non-gastrointestinal, are known to adversely affect nutritional status. Similarly, PD treatments can cause nausea, vomiting and constipation, all of which can adversely affect nutritional status. Given that the prevalence of PD will increase as the population ages, it is important to understand the interplay between PD, comorbidities and nutritional status. Further research may contribute to the development of interventional strategies to improve symptoms, augment care and importantly, enhance the quality of life for patients living with this complex neurodegenerative disease.

Effectiveness of Interventions for Dysphagia in Parkinson Disease: A Systematic Review

PURPOSE

Dysphagia is a common sequela of Parkinson disease (PD) and is associated with malnutrition, aspiration pneumonia, and mortality. This review article synthesized evidence regarding the effectiveness of interventions for dysphagia in PD.

METHOD

Electronic searches were conducted in Ovid MEDLINE, Embase, Cochrane Central Register of Controlled Trials, CINAHL, and speechBITE. Of the 2,015 articles identified, 26 met eligibility criteria: interventional or observational studies with at least five or more participants evaluating dysphagia interventions in adults with PD-related dysphagia, with outcomes measured using videofluoroscopic swallowing study (VFSS), fiberoptic endoscopic evaluation of swallowing (FEES), or electromyography (EMG). Risk of bias (RoB) was evaluated using the Evidence Project tool and predetermined criteria regarding the rigor of swallowing outcome measures.

RESULTS

Interventions were classified as follows: pharmacological (n = 11), neurostimulation (n = 8), and behavioral (n = 7). Primary outcome measures varied across studies, including swallowing timing, safety, and efficiency, and were measured using VFSS (n = 17), FEES (n = 6), and EMG (n = 4). Critical appraisal of study findings for RoB, methodological rigor, and transparency showed the majority of studies failed to adequately describe contrast media used, signal acquisition settings, and rater blinding to time point. Low certainty evidence generally suggested improved swallow timing with exercises with biofeedback and deep brain stimulation (DBS), improved safety with DBS and expiratory muscle strength training, and improved efficiency with the Lee Silverman Voice Treatment and levodopa.

CONCLUSIONS

Studies with lower RoB and greater experimental rigor showed potential benefit in improving swallowing efficiency but not safety. Further research investigating discrete changes in swallowing pathophysiology post-intervention is warranted to guide dysphagia management in PD.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.17132162.

Acceptance and perception of digital health for managing nutrition in people with Parkinson's disease and their caregivers and their digital competence in the United States: A mixed-methods study

BACKGROUND AND AIMS

This mixed-methods study examined participants' acceptance and perception of using digital health for managing nutrition and participants' digital competence. The results will be formative for making digital nutrition education more effective and acceptable for people with Parkinson's disease (PwPD) and their informal caregivers.

METHODS

Qualitative data were collected through in-person semi-structured, dyadic interviews, and questionnaires from 20 dyads (20 PwPD and their caregivers) in the Northeastern United States and analyzed throughout the 2018 to 2019 academic year. Interview transcripts were deductively coded using the framework analysis method. Phrases related to acceptance of digital health were sub-coded into accept, neutral, or reject and those related to perceptions of digital health were sub-coded into perceived usefulness, perceived ease of use, and awareness of digital health. Quantitative data were analyzed using independent samples t tests and Fisher's exact tests. Qualitative codes were transformed into variables and compared to digital competence scores to integrate the data. An average acceptance rate for digital health was calculated through examining the mean percent of phrases coded as accept from interview transcripts.

RESULTS

Twenty-five of 40 (62.5%) participants used the internet for at least 5 health-related purposes and the average acceptance rate was 54.4%. Dyads rejected digital health devices if they did not see the added benefit. The majority of participants reported digital health to be useful, but hard to use, and about half felt they needed education about existing digital health platforms. There was no difference in digital competence scores between PwPD and their caregivers (28.6 ± 12.6).

CONCLUSION

Findings suggest that dyads accept and use technology but not to its full potential as technology can be perceived as hard to use. This finding, combined with digital competence scores, revealed that education is warranted prior to providing a digital nutrition intervention.

Trends in, and predictors of, swallowing and social eating outcomes in head and neck cancer survivors: A longitudinal analysis of head and neck 5000

OBJECTIVE

To investigate the recovery trajectory and predictors of outcome for swallowing difficulties following head and neck cancer treatment in a large prospective cohort.

MATERIALS AND METHODS

Data from 5404 participants of the Head and Neck 5000 study were collected from 2011 to 2014. Patient-reported swallowing was measured using the EORTC HN35, recorded at baseline (pre-treatment) and 4 and 12 months post-baseline. Mixed-effects linear multivariable regression was used to investigate time trends, compare cancer sites, and identify associations between clinical, socio-demographic and lifestyle variables.

RESULTS

2458 participants with non-recurrent oral (29%) oropharyngeal (46%) and laryngeal (25%) cancer were included in the analysis. There was a clinically significant deterioration in scores between baseline and four months for swallowing (11.7 points; 95% CI 10.7-12.8) and trouble with social eating (17.9 points; 95% CI 16.7-19.2), but minimal difference between baseline and 12 months. Predictors of better swallowing and social eating were participants with larynx cancer, early-stage disease, treatment type, age, gender, co-morbidity, socio-economic status, smoking behaviour and cohabitation.

CONCLUSION

Swallowing problems persist up to a year after head and neck cancer treatment. These findings identify disease and demographic characteristics for particularly vulnerable groups, supporting the need for holistic interventions to help improve swallowing outcomes. People diagnosed with head and neck cancer at risk of severe eating and drinking problems following treatment can be identified earlier in the pathway, receive more accurate information about early and late post-treatment side-effects, which can inform shared decision-making discussions.

Association between neighbourhood convenience stores and independent living in older people in Japan

OBJECTIVE

On ageing, and as physical functionality declines, shopping for food and commodities can become a challenge. In Japan, convenience stores (CVSs) play an important role in older people's daily lives. This study investigated the relationship between the geographical accessibility of CVSs, supermarkets and grocery stores and shopping independence.

METHODS

We used the administrative long-term care insurance data from a sample of 7703 older adults. The spatial coverages of the stores were calculated using a geographic information system. A multilevel regression analysis was conducted to examine the association between neighbourhood spatial coverage and individual shopping independence.

RESULTS

After adjusting for demographic characteristics, individual functioning and neighbourhood-level population density, the regression analysis revealed that the CVSs spatial coverage was negatively associated with a risk of shopping dependence (odds ratio = 0.73, P = 0.03).

CONCLUSION

The findings suggest that geographical accessibility of CVSs may be beneficial for maintaining shopping independence.

Weight Loss and Malnutrition in Patients with Parkinson's Disease: Current Knowledge and Future Prospects

Parkinson's Disease (PD) is currently considered a systemic neurodegenerative disease manifested with not only motor but also non-motor symptoms. In particular, weight loss and malnutrition, a set of frequently neglected non-motor symptoms, are indeed negatively associated with the life quality of PD patients. Moreover, comorbidity of weight loss and malnutrition may impact disease progression, giving rise to dyskinesia, cognitive decline and orthostatic hypotension, and even resulting in disability and mortality. Nevertheless, the underlying mechanism of weight loss and malnutrition in PD remains obscure and possibly involving multitudinous, exogenous or endogenous, factors. What is more, there still does not exist any weight loss and malnutrition appraision standards and management strategies. Given this, here in this review, we elaborate the weight loss and malnutrition study status in PD and summarize potential determinants and mechanisms as well. In conclusion, we present current knowledge and future prospects of weight loss and malnutrition in the context of PD, aiming to appeal clinicians and researchers to pay a closer attention to this phenomena and enable better management and therapeutic strategies in future clinical practice.

The meal as a performance: food and meal practices beyond health and nutrition

The proportion of elderly people in the population is increasing, presenting a number of new challenges in society. The purpose of this qualitative study was to investigate how elderly persons with motoric eating difficulties perceive and perform their food and meal practices in everyday life. By using Goffman's concept of performance as a theoretical framework together with Bourdieu's thinking on habitus, a deeper understanding of food and meal practices is obtained. Semi-structured interviews were conducted with 14 elderly people (aged between 67 and 87 years) and meal observations were carried out with 11 of these people. Participants were found to manage food and meal practices by continuously adjusting and adapting to the new conditions arising as a result of eating difficulties. This was displayed by conscious planning of what to eat and when, avoiding certain foods and beverages, using simple eating aids, but also withdrawing socially during the meals. All these adjustments were important in order to be able to demonstrate proper food and meal behaviour, to maintain the façade and to act according to the perceived norms. As well as being a pleasurable event, food and meals were also perceived in terms of being important for maintaining health and as ‘fuel’ where the main purpose is to sustain life. This was strongly connected to the social context and the ability to enjoy food and meals with family members and friends, which appeared to be particularly crucial due to the impending risk of failing the meal performance.

Analysis of resources assisting in coping with swallowing difficulties for patients with Parkinson's disease: a cross-sectional study

BACKGROUND

Malnutrition induced by swallowing difficulties (SD) impairs the quality of life and gives rise to SD-related costs in Parkinson's disease (PD) patients. With results of a swallowing difficulty questionnaire and data of resources specifically obtained such as SD-related costs, caregivers, and dietary therapies, this study is to suggest statistically supported ideas for improvements in arrangements for how participants cope with SD and maintain general well-being.

METHODS

We interviewed 237 PD patients. The SD-related costs involved those incurred by the provision of dietary modifications, care oriented foods, alternatives, and supplements. Dietary therapies included rice porridge and commercially available care foods. The relationships between BMI (body mass index) and the severity of SD assumed in this paper as indicators for general well-being and as resources for coping with SD for PD patients were statistically analyzed.

RESULTS

A lower BMI was found in participants eating porridge consistency rice (p = 0.003) and eating porridge rice is significantly related to the severity of SD (p < 0.0001) and PD (p = 0.002). The severity of SD increased with age and PD duration (p = 0.035, p = 0.0005). Outlays for dietary modifications are the lowest reported here (p < 0.004) but the number of participants using dietary modifications is the largest among the SD-related items (n = 58). Eating care foods were reported for 11 older participants (p < 0.0001), most female (10/11). No lower BMI was found in participants eating care foods when compared with participants eating ordinary foods. Dietary modifications were performed by caregivers (OR: 6.8, CI: 3.1-15.2, p < 0.0001) and were related to the presence of children (OR: 3.4, CI: 1.2-11.4. p = 0.024). Older participants commonly live with spouses and children.

CONCLUSIONS

Severe SD is associated with higher costs of coping with SD. A lower BMI is associated with modified foods, mostly eaten to cope with SD. Presence of caregivers and other persons residing with the participants here are related to dietary modifications but not to care food-related costs. Care foods may be effective in preventing malnutrition although the number who are able to cover the added expenses is limited because of the higher prices and shortage of information on the usefulness of care foods.

Swallowing outcome measures in head and neck cancer--How do they compare?

OBJECTIVES

Dysphagia is a common and debilitating side effect of chemoradiotherapy. Assessment is difficult; swallowing is multifactorial and studies choose from a range of dysphagia assessments. This study intended to investigate the relationship between swallowing assessments of dysphagia in a cohort of patients and to evaluate whether clinical swallowing measures can predict patient reported swallowing outcomes.

MATERIALS AND METHODS

One hundred and seventy-three head and neck cancer patients from two teaching hospitals were recruited prospectively over 25 months. At three months follow-up patients were assessed using Rosenbeck's Penetration-Aspiration Scale (PAS), The 100 ml Water Swallow Test (WST), The Performance Status Scale: Normalcy of Diet and the MD Anderson Dysphagia Inventory (MDADI).

RESULTS

The highest correlation was observed between the MDADI and Normalcy of Diet (rho 0.68) and the lowest between the MDADI and the PAS (rho 0.34). Using multiple regression the PAS and WST accounted for 44% of the variance in the MDADI scores (R2 = 0.44, F = 37.8, p < 0.001). On stepwise regression, the model only retained the Normalcy of Diet scores (R2 = 0.42, F=107.9, p < 0.001). Separating the PAS into subgroups, those with no penetration or aspiration on the PAS scored significantly higher on the MDADI (p = <0.001).

CONCLUSION

Patient reported swallowing outcomes were strongly aligned with diet restrictions but poorly aligned with clinical assessment. The WST, however, was more correlated than the PAS score, representing a more functional assessment. Clinical dysphagia, associated with significant morbidity, and patient reported dysphagia related to quality of life are not interchangeable and must be measured separately.

Olfactory Function, Eating Ability, and Visceral Obesity Associated with MMSE Three Years after Parkinson's Disease Diagnosis

OBJECTIVES

This study examines whether risk factors for poor nutrition are associated with global cognitive function three years after confirmed Parkinson's disease (PD) diagnosis.

DESIGN

The follow-up investigations for this prospective community-based study were conducted three years after PD diagnosis.

SETTING

The study participants lived in Västerbotten County, a region in northern Sweden with 142,000 inhabitants.

PARTICIPANTS

This study population consisted of 118 PD outpatients from the study of Newly Diagnosed PD in Umeå (NYPUM).

MEASUREMENTS

Global cognition was assessed with the Mini Mental State Examination (MMSE) at baseline and at follow-up. Anthropometry, nutrition (Mini Nutritional Assessment, MNA, 3-day food registration, 3-FDR), olfactory function (Brief Smell Identification Test, B-SIT), and swallowing, cutting food, and salivation (single questions from the Unified Parkinson's Disease Rating Scale, UPDRS) were used as markers for nutritional status.

RESULTS

The MMSE score decreased over three years (-1.06±3.38, p=0.001). Olfactory function at baseline was associated to MMSE at three years (B=0.365, p=0.004). Changes in waist/hip ratio (B=113.29, p=0.017), swallowing (B=1.18, P=0.033), and cutting food (B=-1.80, p=0.000) were associated with MMSE at follow-up.

CONCLUSION

This study indicates that olfactory function, cutting food, swallowing, and visceral obesity are associated with MMSE three years after PD diagnosis.

The experience of Parkinson's disease: a systematic review and meta-ethnography

There has been little attempt to summarise and synthesise qualitative studies concerning the experience and perception of living with Parkinson's disease. Bringing this information together would provide a background to understand the importance of an individual's social identity on their well-being and hope. Three primary aims were identified (a) understanding the importance of social identity and meaningful activities on individuals' well-being, (b) identifying factors and strategies that influence well-being and hope, and (c) establishing a model that relates to an individual's hope and well-being. Three stages were undertaken including a traditional electronic search, a critical appraisal of articles, and a synthesis of studies. Qualitative articles were included that considered the experience of living with Parkinson's disease. Thirty seven articles were located and included in the review. Five themes were identified and the themes were used to inform development of a new model of hope enablement. The current review furthered understanding of how physical symptoms and the experience of Parkinson's disease affect the individual's well-being and hope. Social identity was established as a key factor that influenced an individual's well-being. Being able to maintain, retain, or develop social identities was essential for the well-being and hope of individuals with Parkinson's disease. Understanding the factors which prevent or can facilitate this is essential.

Chores and sense of self: gendered understandings of voices of older married women with dementia

BACKGROUND

Marital relationships in dementia are forged between the person with dementia and the care partner, and such relationships have an impact on the way in which dementia is understood and experienced. The everyday work that underpins the relationship is usually divided between spouses and based on traditional divisions of household chores.

AIMS AND OBJECTIVES

The aim was to describe how older women with dementia express the importance of their homes and their chores in everyday life.

METHODS

Seven women with dementia, who were cohabiting with their husbands, were interviewed on up to five occasions at home during a five-to-six-year period on the following themes: the home, their dementia illness, everyday life, their relationships with their husbands and dignity and autonomy.

RESULTS

The qualitative analysis showed three different patterns in the women's narratives: keeping the core of the self through the home, keeping the self through polarising division of labour and keeping the self through (re-) negotiations of responsibilities. The feeling of one's home and home-related chores is an essential way to express who you are.

CONCLUSION

The women stated that household chores are the centre of their lives despite their dementia disease and that the home, even though it shrinks, still makes the women see themselves as an important person, namely the 'competent wife'.

IMPLICATIONS FOR PRACTICE

Nurses need to be aware that 'doing gender' may be a means of preserving personhood as well as of sustaining couplehood in dementia.

Meanings of eating deficiencies for people admitted to palliative home care

Objective:

Food and eating are embedded in people's everyday social lives: at home with family members and as part of social interactions. For people with progressive life-limiting conditions, however, eating is often obstructed. The objective of the present study was to explore the meanings of living with eating deficiencies at the end of life among people admitted to specialist palliative home care.

Method:

This qualitative inductive study employed an interpretive descriptive approach. A dozen persons, with various diagnoses and eating deficiencies, admitted to two specialist palliative home care units, participated. Data were collected through individual repeated interviews. Data collection and analysis were guided by the interpretive description method.

Results:

The results reveal that eating deficiencies among people with progressive life-limiting conditions are existentially loaded markers of impending death. Finding ways to overcome declined food intake and hampered eating enabled our participants to feel able to influence their own well-being and remain hopeful. The results also showed that the eating deficiencies influenced participants' relationships and social interactions in ways that hampered their possibilities of sharing valuable moments together with friends and family members during the final period of life.

Significance of Results:

Efforts to minimize the distress that people experience in relation to the challenges they face with eating deficiencies are important for well-being at the end of life. Person-centered approaches to acknowledge and support individuals' own ways of experiencing and dealing with their eating deficiencies are recommended that include a multidimensional perspective on food and eating.

The association of mavenism and pleasure with food involvement in older adults

Background

Food involvement is concerned with the involvement people have in the preparation and consumption of food. Little is known about older people’s food involvement or about the factors which may influence it. Therefore the main aim of this study was to examine food involvement and its associations among older Australians.

Methods

An Internet-based nationwide survey of 1,041 people aged 55 years and over (M = 66 years, SD 6.99) was conducted in 2012. Quota sampling was used to ensure that the age, gender and state of residence of the respondents were representative of the Australian population aged over 55 years. Bell and Marshall’s Food Involvement Scale was administered, along with questions pertaining to socio-demographic, social and hedonic factors.

Results

Overall predictor variables explained 45% (p = <0.0001) of variance in food involvement. Food mavenism and pleasure motivation for food were the factors most strongly associated with food involvement (β = .36; 95% CI .46, .61; p = < 0.0001 and β = .31; 95% CI .78, 1.08; p = < 0.0001, respectively). The predictive ability of demographic factors was reasonably poor.

Conclusions

Food mavenism and pleasure motivation are stronger predictors of Food Involvement than demographic factors. This suggests communication and health promotion opportunities among older people.

Motor, psychiatric and fatigue features associated with nutritional status and its effects on quality of life in Parkinson's disease patients

Objectives

Parkinson’s disease (PD) patients are more likely to develop impaired nutritional status because of the symptoms, medications and complications of the disease. However, little is known about the determinants and consequences of malnutrition in PD. This study aimed to investigate the association of motor, psychiatric and fatigue features with nutritional status as well as the effects of malnutrition on different aspects of quality of life (QoL) in PD patients.

Methods

One hundred and fifty patients with idiopathic PD (IPD) were recruited in this study. A demographic checklist, the Unified Parkinson’s Disease Rating Scale (UPDRS), the Hospital Anxiety and Depression Scale (HADS) and the Fatigue Severity Scale (FSS) were completed through face-to-face interviews and clinical examinations. The health-related QoL (HRQoL) was also evaluated by means of the Parkinson’s Disease Questionnaire (PDQ-39). For evaluation of nutritional status, the Mini Nutritional Assessment (MNA) questionnaire was applied together with anthropometric measurements.

Results

Thirty seven (25.3%) patients were at risk of malnutrition and another 3 (2.1%) were malnourished. The total score of the UPDRS scale (r = −0.613, P<0.001) and PD duration (r = −0.284, P = 0.002) had a significant inverse correlation with the total MNA score. The median score of the Hoehn and Yahr stage was significantly higher in PD patients with abnormal nutritional status [2.5 vs. 2.0; P<0.001]. More severe anxiety [8.8 vs. 5.9; P = 0.002], depression [9.0 vs. 3.6; P<0.001] and fatigue [5.4 vs. 4.2; P<0.001] were observed in PD patients with abnormal nutritional status. Except for stigma, all other domains of the PDQ-39 were significantly correlated with the total score of the MNA.

Conclusion

Our study demonstrates that disease duration, severity of motor and psychiatric symptoms (depression, anxiety) and fatigue are associated with nutritional status in PD. Different aspects of the HRQoL were affected by patients’ nutritional status especially the emotional well-being and mobility domains.

Doença de Parkinson em idosos: ingestão alimentar e estado nutricional

OBJETIVO: Avaliar o estado nutricional e ingestão alimentar dos idosos portadores da doença de Parkinson. MÉTODOS: Estudo transversal, realizado com pacientes portadores da doença de Parkinson (DP), atendidos em ambulatório. O estado nutricional foi avaliado utilizando a mini-avaliação nutricional (MAN), registro de consumo alimentar estimado de três dias e antropometria. Para avaliação da adequação de ingestão de nutrientes e energia, utilizou-se a ingestão dietética de referência, considerando valores da ingestão adequada, requerimento médio estimado e ingestão dietética recomendada. RESULTADOS: Foram avaliados 36 indivíduos, com idade média de 70,9±7,3 anos, sendo que 55% dos pacientes apresentaram risco de desnutrição de acordo com a MAN. Todavia, quando classificados pelo índice de massa corporal (IMC), 33% dos pacientes apresentaram sobrepeso e 39% não apresentaram perda nos últimos três meses. A ingestão energética foi de 1.632 e 1.840kcal/dia; proteínas, 71,2 e 61,9g/dia; ferro, 15,8 e 15,6mg/dia; sódio, 1.798 e 1.843mg/dia, para homens e mulheres, respectivamente, e ficaram acima das recomendações. Verificou-se ingestão inferior à recomendação para fibras (13,5 e 13,6g/dia), cálcio (694 e 552mg/dia) e potássio (1.637 e 1.476mg/dia). A ingestão energética apresentou correlação com ferro e proteína (r=0,581 e r=0,582) e a proteína apresentou correlação com a ingestão de ferro (r=0,600). CONCLUSÃO: Embora a ingestão energética da maioria se apresente adequada, observou-se o desequilíbrio dietético, com consumo insuficiente de fibras, cálcio e potássio. Além disso, metade da população encontrava-se em risco nutricional, segundo a MAN.

Older women's reduced contact with food in the Changes Around Food Experience (CAFE) study: choices, adaptations and dynamism

Many older women reduce the amount of cooking and food preparation they do in later life. While cooking may be seen as traditionally associated with women's family roles, little is known about the impact of such reduced engagement with food on their lives. This paper presents the findings from a one-year qualitative study (Changes Around Food Experience, CAFE) of the impact of reduced contact with preparing and cooking meals from scratch for 40 women, aged 65–95 years, living in Norfolk, United Kingdom. Data were collected through semi-structured interviews, focus groups and observations. Women's reasons for reducing food-related activities included changes in health, loss of a partner or a caring role, and new patterns of socialising. Disengagement from cooking and shopping was not found to entail predominantly negative feelings, passive acceptance or searching for forms of support to re-enable more cooking from scratch. Accounts evidenced the dynamic adaptability of older women in actively managing changed relationships with food. In exploring new meal options, older women were not simply disengaging from their environments. CAFE findings linked women's engagement with their environments to how they were using formal services and, even more, to the value they placed on social engagement and being out and about. Through the connections they fostered with friends, family and community, older women actively enabled their continued involvement in their social, public and family spheres. Reduced contact with preparing and cooking meals from scratch, therefore, did not induce or imply passivity or debility in the CAFE cohort. By contrast, it involved their exploring new means of retaining what was important to them about food in the context of their lived situation and social connections with friends, family, the community and public spheres.

Adjusting to mealtime change within the context of dementia

Little is known about how persons with dementia and their care partners respond to mealtime changes that occur throughout the dementia journey. By interviewing 27 persons living with dementia and their 28 care partners, we explored the meaning and experience of change surrounding mealtimes. Participants adjusted to mealtime change by adapting to an evolving life, as a result of a dynamic process of becoming aware of change, attaching meaning to change, and responding to change. Seminal events compounded by a sense of things being different triggered awareness of mealtime changes. Meaning was attached to mealtime changes, observed through emotions experienced and diverse strategies developed to support mealtime values. Responding to change ranged from resisting, to being in a holding pattern, to transforming and adapting. Understanding how individuals and families adjust to mealtime changes, and the strategies they develop, provides critical insights for supporting families throughout the dementia journey.

Patients' lived experiences of a reduced intake of food and drinks during illness: a literature review

AIM

This study aims to identify patients' lived experiences of having a reduced intake of food and drink during illness, through a literature review.

METHODS

Scientific studies were selected through a systematic search of CINAHL, PubMed, SweMed, British Nursing Index, Psycinfo and EMBASE. A deductive thematic analysis was performed on the studies included. The analysis provided three main themes: (i) serving of food and drink - patient experiences. (ii) Modifications related to illness - patient experiences. (iii) Nutritional care provided by healthcare professionals nutritional care - patient experiences.

FINDINGS

Generally speaking, the findings showed high satisfaction with the food served at hospitals. However, patients' individual tastes and preferences as to when and where to eat were found to affect their intake of food and drink. Physical changes because of illness were stated as the main reason for the patients' lived experiences of a reduced intake of food and drink. These experiences seemed to be related to negative feelings, such as anxiety and shame during meals. Furthermore, the literature review revealed a lack of professional assistance during meals and insufficient guidance on how to handle specific nutritional problems.

CONCLUSIONS

Patients expect committed nursing care in regard to nutritional advice during illness and assistance in meal-related situations. Nurses need to refocus on fundamental caring.

Managing mealtime tasks: told by persons with dementia

AIM

To capture the self-description of managing mealtime tasks by persons with dementia.

BACKGROUND

There are several factors that negatively affect food intake in persons with dementia that may increase the risk of developing malnutrition. Difficulties in managing daily activities increase gradually and mealtime tasks like food shopping, cooking and eating often become troublesome. Still, little is known about how persons with dementia themselves experience this issue.

DESIGN

A qualitative study with an ethnographic approach.

METHOD

Ten women and five men aged 69-86 with dementia were interviewed. Interviews were carried out in the informants' own homes and a thematic analysis was performed.

RESULTS

The informants described that they wanted to be independent and that the memory loss was not affecting them to a great extent. Old habits and routines, as well as newly developed strategies, helped them manage mealtime tasks despite the disease. Informants were satisfied with their current situation, even though it sometimes meant that they had changed their way of managing mealtime tasks, for instance receiving meals-on-wheels.

CONCLUSIONS

Persons with dementia seem to be able to manage mealtime tasks and these activities were based on old habits and routines. Independence was highly valued and managing mealtime tasks seems to be one way to appear independent.

RELEVANCE TO CLINICAL PRACTICE

It is important for caregivers to understand that persons with dementia might not express difficulties in managing mealtime tasks for fear of losing their independence. It is, therefore, important to create a trustful relationship even before problems arise to be able to support the persons when necessary.

Patients' and caregivers' experiences of the impact of Parkinson's disease on health status

BACKGROUND: Parkinson's disease (PD) is a neurodegenerative disease that significantly affects patients' quality of life. The myriad complexities of the disease, including its nonmotor manifestations, are beginning to be more fully appreciated, particularly in regard to the emotional and social effects of PD. Considering that both motor and nonmotor manifestations of PD significantly influence the health outcomes and conditions of patients, and their health-related quality of life (HRQOL), we collected qualitative data from patients with PD, as well as caregivers of persons with PD having cognitive impairment, to assess their perceptions of the impact of PD on HRQOL. METHODS: We conducted eight focus groups and five one-on-one interviews in English and in Spanish between March 2007 and February 2008. Three of the focus groups were conducted with a total of 15 caregivers; the remaining focus groups and all interviews were conducted with 48 PD patients. Study participants were asked about the challenges that PD patients may experience, particularly pertaining to physical functioning, the impact of PD on their emotional status, and social functioning. RESULTS: Based on analysis of the transcripts, we identified seven overarching domains or themes that reflect patients' perspectives on living with PD, ie, physical functioning, social and role functioning, emotional impact, fears and uncertainty about the future, stigma and other feelings about PD, coping mechanisms, and benefits of having PD. CONCLUSION: We underscore the salient aspects regarding the physical effects of PD along with its nonphysical ramifications, offering perspectives into the experience of PD and suggestions on how PD patients and their caregivers may cope with the disease.

A cross-sectional study of the nutritional status of community-dwelling people with idiopathic Parkinson's disease

BACKGROUND

Parkinson's disease (PD) patients have an increased risk of under-nutrition, but we are unaware of any population based prevalence studies of under-nutrition in PD. The main objective of this study was to identify the prevalence, and nature, of under-nutrition in a representative population of people with PD.

METHODS

People diagnosed with idiopathic PD from within two PD prevalence study sites in North-East England were asked to participate in this study. Those who participated (n = 136) were assessed using a number of standard rating scales including Hoehn & Yahr stage and Unified Parkinson's Disease Rating Scale (UPDRS). Body mass index (BMI), mid-arm circumference (MAC), triceps skin fold thickness (TSF) and grip strength were recorded together with social and demographic information.

RESULTS

BMI < 20 identified over 15% of the study group to have under-nutrition. The Malnutritional Universal Screening Tool (MUST) scoring system identified 23.5% of participants at medium or high risk of malnutrition. Low BMI, indicating under-nutrition, was associated with greater age and disease duration, lower MAC, TSF, mid-arm muscle circumference (MAMC), reduced grip strength and a report of unintentional weight loss. Problems increased with increasing age and disease duration and were greater in females.

CONCLUSIONS

Under-nutrition is a problem for around 15% of community dwelling people with PD. All PD patients should be screened for under-nutrition; the MUST score is a useful early screening tool.

Mealtimes and being connected in the community-based dementia context

Mealtimes provide an opportunity for social activity and emotional connection. This grounded theory study focused on the meaning and experience of mealtimes in families living with dementia in the community; 28 partners in care and 27 persons with dementia were interviewed together and separately. Team analysis resulted in the development of a substantive theory which explains how eating together ‘mirrors the way we are’ and reveals the essence of what it is to be human while living with dementia. Mealtimes reflect how these families were being connected, honouring identity and adapting to an evolving life. This article focuses on three ways in which Being Connected occurs at mealtimes: being face to face, participating psychologically, and getting and giving support. Understanding the role that mealtimes play in promoting improved connections and thus relationships within the dementia context has important implications for both formal and family care partners.

Retronasal olfactory function in Parkinson's disease

OBJECTIVES/HYPOTHESIS

Orthonasal olfaction is severely altered in PD patients. Retronasal olfactory function has been shown to be preserved under certain conditions even in the absence of orthonasal function. This study was undertaken to investigate retronasal versus orthonasal olfactory function in Parkinson's disease (PD).

STUDY DESIGN

Prospective study.

METHODS

A total of 45 PD patients (mean age, 61 years; range 26-82 years) underwent orthonasal olfactory testing with a standardized olfactory test (Sniffin' Sticks) and retronasal olfactory testing with a 10-item identification kit based on aromatized powders.

RESULTS

Regarding orthonasal tests, all PD patients scored within the range of hyposmia and functional anosmia. The mean correct orthonasal identification score for PD patients was 56% +/- 2.6%, and the mean retronasal identification rate was 60% +/- 3%. There was no significant difference between ortho- and retronasal odor identification (P = .15).

CONCLUSIONS

The present study shows that retronasal and orthonasal olfactory function are severely impaired in PD patients, and this impairment is of similar magnitude for both functions. The contribution of this finding to the food-intake behavior of PD patients is discussed.

Daily eating events among co-living and single-living, diseased older men

OBJECTIVES

To analyse, describe and compare the frequency and energy intake of eating events, including specific food items, among diseased older men living in ordinary housing.

DESIGN

Descriptive and explorative.

SETTING

Interviews were performed in the participants' home.

PARTICIPANTS

Thirty-five co-living and 26 single-living men, 64-88 years of age. Participants had one of three chronic diseases associated with difficulties in buying and preparing food and with difficulties related to the meal situation: Parkinson's disease, rheumatoid arthritis or stroke.

MEASUREMENTS

A repeated 24-h recall was used to assess food intake and meal patterns.

RESULTS

Eating events were distributed over a 24-h period. Co-living men had a higher (p=0.001) number of eating events/day; both hot and cold eating events were consumed more frequently. There was no difference between groups concerning energy intake. Co-living men more often had hot eating events cooked from raw ingredients (p=0.001) and a greater mix of vegetables/roots (p=0.003) included in such eating events.

CONCLUSION

Single-living men may constitute a vulnerable group from a nutritional perspective, while co-living men, besides the pleasure of eating with another person, seem to get support with food and eating events from their partners. Hence, the group of single-living men, particularly those with a disability, should receive particular attention with regard to possible food-related difficulties.

Dysphagia: implications for older people

This review opens with an outline definition of dysphagia, its causes, and why it is vital that people involved in the health care of older people should be aware of it. A brief consideration of prevalence is followed by an overview of assessment options. We conclude with a section on management.

Problems with preparing food reported by frail older women living alone at home

Although nutritional risk is a critical health concern for older persons, there are few data about day-to-day problems with nutrition-related tasks. Such data were reported by 18 frail women during a longitudinal descriptive phenomenological study of the home care experience. Six problems were understood as elements of the life-world of older women, including having trouble figuring out what to fix, having trouble getting the food cooked right, and struggling with moving and standing while cooking. The results suggest topics for research and underscore the need for partnership between frail older women and helpers relative to food preparation.

Hard to swallow: dysphagia in Parkinson's disease

BACKGROUND

swallowing changes occur from the earliest stages of Parkinson's disease (PD), even in cases asymptomatic for dysphagia. Little empirical evidence exists concerning the individual's own perception of changes, the impact these have on their life and coping strategies to deal with them.

OBJECTIVE

to establish if and how changes in swallowing impact on the lives of people with PD.

DESIGN

in-depth interviews with qualitative analysis of content.

SETTING

community.

SUBJECTS

a total of 23 men and 14 women and their carers.

METHODS

participants were purposively sampled to give a mix of men, women, family circumstances, stage and duration of PD and severity of swallowing symptoms. Individuals were interviewed at home. Interviews were transcribed. Emergent themes were identified and fed back to participants for confirmation and clarification.

RESULTS

two broad themes emerged: (i) effects on swallowing of underlying physical changes, with subthemes of oral-pharyngeal-laryngeal changes, manual changes, effects of fatigue and (ii) psychosocial impact, with subthemes of alterations to eating habits, feelings of stigma, need for social adjustment and carers' issues. Coping strategies could aid swallowing problems but often to the detriment of others in the family through altered demands on preparation and organisation. Presence of significant impact was not necessarily associated with abnormal range scores on objective swallowing assessments.

CONCLUSIONS

the psychosocial consequences of the physical changes concerned people most. The importance of the early detection of changes for health and quality of life is underlined.

Avoidance of solid food in weight losing older patients with Parkinson's disease

AIM

The aim of this paper was to investigate to what extent parkinsonian symptoms, including mild dysphagia and other eating problems, could influence the choice of consistency and the amount of food intake and if this could be related to weight loss as an expression of the underlying neurodegenerative process.

BACKGROUND

Previous studies show that patients with Parkinson's disease tend to lose body weight even early during the disease.

DESIGN

The design was a longitudinal prospective study.

METHODS

Twenty-six free-living Parkinson's disease patients and 26 age- and sex-matched controls were investigated twice, with one-year apart, with focus on Parkinson's disease symptoms, as well as swallowing function. Intake of food items and food consistency were assessed by food records, completed over three consecutive days at each investigation.

RESULTS

In patients with weight loss, motor symptoms, problems with activities of daily living and problems with eating, related to motor symptoms, increased and they had more dysphagia compared with their controls. They consumed lower amounts of fluid and solid food on both investigated occasions, compared with their controls. Multiple regression analysis showed that weight loss was associated with female gender, eating difficulties related to activities of daily living and preference towards soft food, but negatively correlated with age.

CONCLUSION

Parkinson's disease patients with weight loss seemed to avoid solid food, partly because of eating difficulties. Eating problems, as well as weight loss, could be because of the underlying disease, even when it is not at an advanced stage.

RELEVANCE TO CLINICAL PRACTICE

Caring for patients with Parkinson's disease should not only include medical treatment, but also support for adequate food intake to prevent weight loss.

Nutrition in patients receiving home care in Finland: tackling the multifactorial problem

This study describes the nutritional status of Finnish home care patients (n=178), their problems related to eating, digestion, and diet; their use of Meals on Wheels services; and informal caregivers' role in nutritional support. Half of the patients were at risk for malnutrition and 3% were malnourished according to Mini Nutritional Assessment (MNA) results. Most patients had problems with food intake, which were related to lower MNA scores. One-third of the participants had an unbalanced diet, and approximately half received assistance with shopping and food preparation from an informal caregiver. Home care patients' nutritional status, including all related aspects, such as shopping, food preparation, eating, and digestion, must be evaluated regularly and comprehensively.

Food Habits and Intake of Nutrients in Elderly Patients with Parkinson’s Disease

BACKGROUND

Weight loss is reported frequently in patients with Parkinson s disease also early during the disease.

OBJECTIVE

To investigate food habits and nutrient intake in elderly Parkinson s disease patients compared with matched controls, as well as to compare PD patients with and without weight loss.

METHODS

Twenty-six elderly free-living patients with PD, and 26 sex- and age-matched healthy controls, were assessed twice with one year interval between. All food consumed was recorded over 3 consecutive days. Food habits were assessed with the Food Based Concept for Classification of Eating Episodes and intakes of energy and nutrients were calculated. PD symptoms, olfaction, swallowing function, daily activities and serum concentration of different nutrients were investigated.

RESULTS

After 1 year, the PD patients decreased their intakes of daily high quality snacks from 0.5 +/- 0.7 to 0.3 +/- 0.3 (p < 0.05) and their prepared complete meals from 0.8 +/- 0.3 to 0.6 +/- 0.3 (p < 0.05), while their daily number of prepared incomplete meals increased from 0.2 +/- 0.2 to 0.3 +/- 0.3 (p < 0.01). PD patients with weight loss increased their daily intakes of fat by 12 +/- 34 g and their energy intake per kg body weight increased by 21 +/- 31 kJ (p < 0.05), respectively, and this was higher than in those without weight loss (p < 0.01). PD patients required more help with buying and cooking food compared with the controls.

CONCLUSIONS

PD patients' food habits changed so that they consumed a lower number of prepared complete meals. PD patients with weight loss had a higher intake of fat and energy than those without weight loss, although this was obviously not sufficient to prevent weight loss. Impaired absorption of fat in PD should be discussed.

Postmortem brain fatty acid profile of levodopa-treated Parkinson disease patients and parkinsonian monkeys

Fatty acids play a critical role in brain function but their specific role in the pathophysiology of Parkinson disease (PD) and levodopa-induced motor complications is still unknown. From a therapeutic standpoint, it is important to determine the relation between brain fatty acids and PD because the brain fatty acid content depends on nutritional intake, a readily manipulable environmental factor. Here, we report a postmortem analysis of fatty acid profile by gas chromatography in the brain cortex of human patients (12 PD patients and nine Controls) as well as in the brain cortex of monkeys (four controls, five drug-naive MPTP monkeys and seven levodopa-treated MPTP monkeys). Brain fatty acid profile of cerebral cortex tissue was similar between PD patients and Controls and was not correlated with age of death, delay to autopsy or brain pH. Levodopa administration in MPTP monkeys increased arachidonic acid content (+7%; P < 0 .05) but decreased docosahexaenoic acid concentration (-15%; P < 0.05) and total n-3:n-6 polyunsaturated fatty acids ratio (-27%; P < 0.01) compared to drug-naive MPTP animals. Interestingly, PD patients who experienced motor complications to levodopa had higher arachidonic acid concentrations in the cortex compared to Controls (+13.6%; P < 0.05) and to levodopa-treated PD patients devoid of motor complications (+14.4%; P < 0.05). Furthermore, PD patients who took an above-median cumulative dose of levodopa had a higher relative amount of saturated fatty acids but lower monounsaturated fatty acids in their brain cortex (P < 0.01). These results suggest that changes in brain fatty acid relative concentrations are associated with levodopa treatment in PD patients and in a non-human primate model of parkinsonism.

Taste responses in patients with Parkinson's disease

OBJECTIVE

Preclinical studies indicate that dopaminergic transmission in the basal ganglia may be involved in processing of both pleasant and unpleasant stimuli. Given this, the aim of the present study was to assess taste responses to sweet, bitter, sour, and salty substances in patients with Parkinson's disease (PD).

METHODS

Rated intensity and pleasantness of filter paper discs soaked in sucrose (10-60%), quinine (0.025-0.5%), citric acid (0.25-4.0%), or sodium chloride (1.25-20%) solutions was evaluated in 30 patients with PD and in 33 healthy controls. Paper discs soaked in deionised water served as control stimuli. In addition, reactivity to 100 ml samples of chocolate and vanilla milk was assessed in both groups. Taste detection thresholds were assessed by means of electrogustometry. Sociodemographic and neuropsychiatric data, including cigarette smoking, alcohol consumption, tea and coffee drinking, depressive symptoms, and cognitive functioning were collected.

RESULTS

In general, perceived intensity, pleasantness, and identification of the sucrose, quinine, citric acid, or sodium chloride samples did not differ between the PD patients and controls. Intensity ratings of the filter papers soaked in 0.025% quinine were significantly higher in the PD patients compared with the control group. No inter-group differences were found in taste responses to chocolate and vanilla milk. Electrogustometric thresholds were significantly (p = 0.001) more sensitive in the PD patients.

CONCLUSIONS

PD is not associated with any major alterations in responses to pleasant or unpleasant taste stimuli. Patients with PD may present enhanced taste acuity in terms of electrogustometric threshold.

Meals and snacks among elderly self-managing and disabled women

AIM

The aim of this study was to describe the frequency and distribution of self-managing and disabled elderly women's eating events, as well as to investigate which definition/names the women had given their different eating events and to categorise these into meals and snacks. An additional aim was to study the composition of meals and snacks, and analyse the nutritional significance of these eating events in terms of energy and macronutrients.

SUBJECTS

Elderly women, both self-managing (n=139) and disabled (n=63; with Parkinson's disease, rheumatoid arthritis or stroke), aged 64-88 years, and living at home participated.

METHODS

A repeated 24 h recall and an estimated food diary for three consecutive days were used.

RESULTS

The eating events defined by the women that were categorised as meals contributed 74% of the total daily energy intake, while snacks contributed 22-23%. The meals that the women had defined as dinner, was the most energy dense meal. The frequency of eating events not defined by the women, was 30-34%, but contributed only 3-4% of the total daily energy intake. The disabled women had a significantly lower energy content in meals and most snacks, compared to the self-managing women.

CONCLUSION

The main conclusion was that elderly women still living at home had their meals distributed during the day and that these meals were characterised by individuality and flexibility.

Attitudes of nursing staff towards nutritional nursing care

Fulfilling nutritional requirements in residents with eating problems can be a challenge for both the person in need of help and for the caregiver. In helping and supporting these residents, a positive attitude is assumed to be as important as practical skill. The aim of this study was to test the hypothesis that nutritional education and implementation of a nutritional programme would change the attitudes towards nutritional nursing care among nursing staff with daily experience of serving food and helping residents in municipal care. The study was carried out as a before and after experimental design. An attitude scale, staff attitudes to nutritional nursing care (SANN scale), was developed and used. The response on the scale gives a total SANN-score and scores in five underlying dimensions: self ability, individualization, importance of food, assessment and secured food intake. Nursing staff at eight different residential units (n = 176) responded to the attitude scale and, of these, staff at three of the units entered the study as the experimental group. After responding to the attitude scale, nutritional education was introduced and a nutritional programme was implemented in the experimental units. One year later, attitudes were measured a second time (n = 192). Of these, 151 had also responded on the first occasion. Education and implementation of a nutritional programme did not significantly change attitudes. Overall, nursing staff responded with positive attitudes towards nutritional nursing care. Most of the positive attitudes concerned items within the dimension importance of food. In contrast, items within self ability showed the lowest number of staff with positive attitudes.

Older women's perceptions of independence versus dependence in food-related work

This qualitative study aims to explore the cultural meaning of accomplishing food-related work by older women, when disease has diminished their abilities and threatens to make them dependent. Seventy-two women with stroke, rheumatoid arthritis, and Parkinson's disease, as well as women without those diseases, were interviewed. All were living at home. Results showed that older women valued independence and feared dependence when declining ability threatened performance of food-related work. They also had strong beliefs about living a "normal life," managing by oneself as long as possible, and becoming their own masters again. To remain independent, participants used three kinds of strategies: Public Health Service Support, self-managing, and adaptation. Their beliefs about dependence included not becoming a burden, retaining self-determination, and maintaining order in life. Implications for nursing include supporting independent cooking, developing care plans with the care recipient, and demonstrating respect for the women's self-determination.