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Jonathan A, Reid K, Radcliffe T. Managing food waste in the inpatient population. BMJ Open Qual 2023; 12:e002436. [PMID: 38123474 DOI: 10.1136/bmjoq-2023-002436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 12/02/2023] [Indexed: 12/23/2023] Open
Abstract
INTRODUCTION For medical students, food is rarely discussed from the clinical perspective. Yet, in hospitals reduced food intake poses the risk of malnutrition, along with increased morbidity and mortality. The issue of food waste, a cause of inadequate dietary intake and a common issue within the National Health Service, is rarely addressed. The implementation of protected mealtimes has done little to solve this. This quality improvement project aimed to reduce the average amount of inpatient food waste by 20% by May 2022. METHODS A standardised meal size intervention was tested. Meals were weighed before and after meal services to collect baseline and postintervention data. The percentage consumed and the percentage wasted were then calculated. Finally, the overall average of the percentage wasted across both meal services was determined. RESULTS Quantitative data showed a change in the average amount of food waste from 70.16% to 65.75%, a decrease of 4.41%. Survey results also found an increase of 3% in patient satisfaction with meal sizes. CONCLUSION Standardising meal sizes is shown to improve inpatient food waste and may serve as a starting point for healthcare providers to devise further strategies to reduce wastage in hospitals.
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Affiliation(s)
- Adrienne Jonathan
- University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster, UK
| | - Kim Reid
- East Lancashire Hospitals NHS Trust, Blackburn, UK
| | - Tim Radcliffe
- Estates & Facilities Division, East Lancashire Hospitals NHS Trust, Blackburn, UK
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Saucedo Figueredo MC, Morilla-Herrera JC, Kaknani Uttumchandani S, Durá Pérez E, San Alberto Giraldos M, Nava Del Val MA, Hierrezuelo Martín MJ, Gómez Borrego AB, García Irazusta M, Gálvez González M, Miguel Morales-Asencio J. Longitudinal assessment of the eating pattern of people with dementia and its association with problems for feeding and malnutrition: a prospective follow-up study protocol. BMJ Open 2023; 13:e068790. [PMID: 37230516 DOI: 10.1136/bmjopen-2022-068790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
INTRODUCTION Dementia conditions the patient's nutrition from the beginning and vice versa. Generating difficulties for feeding (FEDIF) will influence its evolution. There are currently few nutritional longitudinal studies in people with dementia. Most focus on problems already established. The Edinburgh Feeding Evaluation in Dementia (EdFED) Scale identifies FEDIF of patients with dementia by studying their behaviours while eating or being fed. It also indicates areas of potential clinical interventions. METHODS AND ANALYSIS Prospective multicentre observational study carried out in nursing homes, Alzheimer's day care centres and primary healthcare centres. The study population will be dyads composed by the patient (diagnosed of dementia, over 65 years of age and who have feeding difficulties) and their family caregiver. Sociodemographic variables and nutritional status (body mass index, Mini Nutritional Assessment, blood test and calf and arm circumference) will be assessed. The Spanish version of the EdFED Scale will be completed and the presence of nursing diagnoses related to feeding behaviours will be collected. Follow-up will take place for 18 months. ETHICS AND DISSEMINATION All data will be carried out respecting European legislation 2016/679 in data protection, and the Spanish 'Organic Law 3/2018 of December 2005'. The clinical data will be kept segregated and encrypted. The informed consent has been obtained. The research has been authorised by the Costa del Sol Health Care District on 27 February 2020 and the Ethics Committee on 2 March 2021. It has obtained funding from the Junta de Andalucía on 15 February 2021. Findings of the study will be presented at provincial, national and international conferences and published in peer-reviewed journals.
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Affiliation(s)
- María Carmen Saucedo Figueredo
- Primary Health Care Costa del Sol District, Los Boliches Health Care Centre, Andalucia Health Service (SAS), Fuengirola, Andalucia, Spain
- IR Group C-13 "Chronicity, Dependency, Care and Health Services", Biomedical Research Institute of Malaga (IBIMA), Malaga, Andalucia, Spain
| | - Juan Carlos Morilla-Herrera
- IR Group C-13 "Chronicity, Dependency, Care and Health Services", Biomedical Research Institute of Malaga (IBIMA), Malaga, Andalucia, Spain
- Residences Unit, Malaga and Valle del Guadalhorce Primary Health Care District, Andalucia Health Service (SAS), Malaga, Andalucia, Spain
| | - Shakira Kaknani Uttumchandani
- IR Group C-13 "Chronicity, Dependency, Care and Health Services", Biomedical Research Institute of Malaga (IBIMA), Malaga, Andalucia, Spain
- Nursing Department, University of Malaga, Health Science Faculty, Malaga, Andalucia, Spain
| | - Elena Durá Pérez
- Andalusian Public Foundation for Research in Biomedicine and Health of Malaga, FIMABIS, Malaga, Andalucia, Spain
| | - Mercedes San Alberto Giraldos
- Primary Health Care Costa del Sol District, La Lobilla Health Care Center, Andalucia Health Service (SAS), Estepona (Málaga), Andalucia, Spain
| | - Maria Antonia Nava Del Val
- Primary Health Care Costa del Sol District, Las Albarizas Health Care Center, Andalucia Health Service (SAS), Marbella, Andalucia, Spain
| | - María Jesús Hierrezuelo Martín
- Primary Health Care Costa del Sol District, Las Lagunas Health Care Center, Servicio Andaluz de Salud, Mijas Costa, Andalucia, Spain
| | - Ana Belén Gómez Borrego
- Community Mental Health Unit, Virgen de la Victoria University Hospital, Servicio Andaluz de Salud, Estepona, Andalucia, Spain
| | - Manuela García Irazusta
- Primary Health Care Costa del Sol District, Fuengirola Oeste Health Care Center, Servicio Andaluz de Salud, Marbella, Andalucia, Spain
| | - María Gálvez González
- Primary Health Care Costa del Sol District, La Carihuela Health Care Center, Servicio Andaluz de Salud, Benalmadena, Andalucia, Spain
| | - Jose Miguel Morales-Asencio
- IR Group C-13 "Chronicity, Dependency, Care and Health Services", Biomedical Research Institute of Malaga (IBIMA), Malaga, Andalucia, Spain
- Nursing Department, University of Malaga, Málaga, Andalucia, Spain
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Factors Affecting Mealtime Difficulties in Older Adults with Dementia Living in Long-Term Care Facilities: A Multilevel Model Analysis. J Nurs Manag 2023. [DOI: 10.1155/2023/4427390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Aim(s). This study conducted a multilevel analysis of mealtime difficulties in older adults with dementia based on the social-ecological model. Background. Mealtime difficulty in this population should be examined from an extensive perspective, rather than approaching it as an individual problem. Method(s). This was a cross-sectional study involving 342 participant dyads from 57 long-term care facilities; 114 direct care workers; and 342 older adults with dementia. A multilevel regression analysis was conducted using the MPlus 8.0 program. Results. Among intrapersonal factors, age, cognitive function, activities of daily living, and number of beds in the facility were identified as affecting mealtime difficulty. Environmental factors included meal assistant education experience and whether an environment suitable for eating had been established. Conclusion(s). The results show that intrapersonal factors exert a large influence on the mealtime difficulties of older adults with dementia in long-term care facilities and support the need to improve environmental factors, which are modifiable. Implications for Nursing Management. This study provided useful information about the influence of leaders on mealtime difficulties in older adults with dementia. Leaders should establish an environment in the facility for reduced mealtime difficulties.
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Rahman M, Mim SA, Islam R, Parvez A, Islam F, Uddin MB, Rahaman S, Shuvo PA, Ahmed M, Greig NH, Kamal MA. Exploring the Recent Trends in Management of Dementia and Frailty: Focus on Diagnosis and Treatment. Curr Med Chem 2022; 29:5289-5314. [PMID: 35400321 PMCID: PMC10477961 DOI: 10.2174/0929867329666220408102051] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 09/19/2021] [Accepted: 09/19/2021] [Indexed: 02/08/2023]
Abstract
Dementia and frailty increase health adversities in older adults, which are topics of growing research interest. Frailty is considered to correspond to a biological syndrome associated with age. Frail patients may ultimately develop multiple dysfunctions across several systems, including stroke, transient ischemic attack, vascular dementia, Parkinson's disease, Alzheimer's disease, frontotemporal dementia, dementia with Lewy bodies, cortico-basal degeneration, multiple system atrophy, amyotrophic lateral sclerosis, and Creutzfeldt-Jakob disease. Patients with dementia and frailty often develop malnutrition and weight loss. Rigorous nutritional, pharmacological, and non-pharmacological interventions generally are required for these patients, which is a challenging issue for healthcare providers. A healthy diet and lifestyle instigated at an early age can reduce the risk of frailty and dementia. For optimal treatment, accurate diagnosis involving clinical evaluation, cognitive screening, essential laboratory evaluation, structural imaging, functional neuroimaging, and neuropsychological testing is necessary. Diagnosis procedures best apply the clinical diagnosis, identifying the cause(s) and the condition(s) appropriate for treatment. The patient's history, caregiver's interview, physical examination, cognitive evaluation, laboratory tests, and structural imaging should best be involved in the diagnostic process. Varying types of physical exercise can aid the treatment of these disorders. Nutrition maintenance is a particularly significant factor, such as exceptionally high-calorie dietary supplements and a Mediterranean diet to support weight gain. The core purpose of this article is to investigate trends in the management of dementia and frailty, focusing on improving diagnosis and treatment. Substantial evidence builds the consensus that a combination of balanced nutrition and good physical activity is an integral part of treatment. Notably, more evidence-based medicine knowledge is required.
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Affiliation(s)
- Mominur Rahman
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, Dhaka-1207, Bangladesh
| | - Sadia Afsana Mim
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, Dhaka-1207, Bangladesh
| | - Rezaul Islam
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, Dhaka-1207, Bangladesh
| | - Anwar Parvez
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, Dhaka-1207, Bangladesh
| | - Fahadul Islam
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, Dhaka-1207, Bangladesh
| | - Mohammad Borhan Uddin
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, Dhaka-1207, Bangladesh
| | - Saidur Rahaman
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, Dhaka-1207, Bangladesh
| | - Pollob Ahmed Shuvo
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, Dhaka-1207, Bangladesh
| | - Muniruddin Ahmed
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, Dhaka-1207, Bangladesh
| | - Nigel H. Greig
- Translational Gerontology Branch, Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, MD 21224, USA
| | - Mohammad Amjad Kamal
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, Dhaka-1207, Bangladesh
- Institutes for Systems Genetics, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
- King Fahd Medical Research Center, King Abdulaziz University, Saudi Arabia
- Enzymoics, NSW; Novel Global Community Educational Foundation, Peterlee Place, Hebersham, NSW 2770, Australia
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Visscher A, Battjes-Fries MCE, van de Rest O, Patijn ON, van der Lee M, Wijma-Idsinga N, Pot GK, Voshol P. Fingerfoods: a feasibility study to enhance fruit and vegetable consumption in Dutch patients with dementia in a nursing home. BMC Geriatr 2020; 20:423. [PMID: 33096998 PMCID: PMC7584066 DOI: 10.1186/s12877-020-01792-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 09/27/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Eating problems are highly prevalent in older patients with dementia and as a consequence, these patients are at greater risk of becoming malnourished. Fingerfoods, snacks that can be picked with thumb and forefinger, could be used to counteract malnutrition in patients with dementia. The aim of this feasibility study was to evaluate whether providing fruit and vegetable rich fingerfoods in the form of recognizable and familiar snacks on top of the normal intake was feasible for both patients with dementia and caregivers as a means to increase patients' nutritional status. METHODS Institutionalised patients with dementia (N = 15, 93% female, mean age = 85 years) were included in this feasibility study in the Netherlands. The residents received their regular diet supplemented with fingerfoods, comprising quiches and cakes rich in fruit or vegetables, for 6 weeks. Daily fingerfood consumption together with compensation behaviour at dinner of residents was administered with a checklist and food diaries at the start and end of the intervention as dose delivered. Furthermore, caregivers were asked to fill out a feedback form at the end of the intervention to measure fidelity and appreciation of the intervention. RESULTS Patients consumed on average 1.4 pieces (70 g) of fingerfoods daily, containing 41 g of fruit and/or vegetables. Fruit and vegetable consumption increased during the provision of the fingerfoods and the residents seemed not to compensate this intake during the rest of the day. The intervention was generally positively received by the majority of caregivers, depending on the type of fingerfood and state of the resident. CONCLUSION This feasibility study showed that providing recognizable fruit and vegetable rich fingerfoods to patients with dementia seems feasible for both patients and caregivers and could provide a pragmatic approach to enhance fruit and vegetable consumption and total food intake in institutionalized elderly. In an up-scaled study, effects of fingerfoods on nutritional status and quality of life should be investigated.
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Affiliation(s)
- Annemijn Visscher
- Department of Nutrition and Health, Louis Bolk Instituut, Bunnik, The Netherlands
- Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
| | | | - Ondine van de Rest
- Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
| | - Olga N. Patijn
- Department of Nutrition and Health, Louis Bolk Instituut, Bunnik, The Netherlands
| | | | | | - Gerda K. Pot
- Department of Nutrition and Health, Louis Bolk Instituut, Bunnik, The Netherlands
- Department of Nutritional Sciences, King’s College London, London, UK
| | - Peter Voshol
- Department of Nutrition and Health, Louis Bolk Instituut, Bunnik, The Netherlands
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Hong HH, Gu MO. Development and Effects of a Coping Skill Training Program for Caregivers in Feeding Difficulty of Older Adults with Dementia in Long-Term Care Facilities. J Korean Acad Nurs 2018; 48:167-181. [DOI: 10.4040/jkan.2018.48.2.167] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 03/12/2018] [Accepted: 03/14/2018] [Indexed: 11/09/2022]
Affiliation(s)
- Hyun Hwa Hong
- Department of Nursing, College of Health Sciences, Kyungnam University, Changwon, Korea
| | - Mee Ock Gu
- College of Nursing · Gerontological Health Research Center in Institute of Health Sciences, Gyeongsang National University, Jinju, Korea
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Lea EJ, Goldberg LR, Price AD, Tierney LT, McInerney F. Staff awareness of food and fluid care needs for older people with dementia in residential care: A qualitative study. J Clin Nurs 2017; 26:5169-5178. [DOI: 10.1111/jocn.14066] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2017] [Indexed: 01/11/2023]
Affiliation(s)
- Emma J Lea
- Wicking Dementia Research and Education Centre; University of Tasmania; Hobart Tas. Australia
| | - Lynette R Goldberg
- Wicking Dementia Research and Education Centre; University of Tasmania; Hobart Tas. Australia
| | - Andrea D Price
- Wicking Dementia Research and Education Centre; University of Tasmania; Hobart Tas. Australia
| | - Laura T Tierney
- Wicking Dementia Research and Education Centre; University of Tasmania; Hobart Tas. Australia
| | - Fran McInerney
- Wicking Dementia Research and Education Centre; University of Tasmania; Hobart Tas. Australia
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Whitley A, Skliros E, Graven C, McIntosh R, Lasry C, Newsome C, Bowie A. Changes in Nutritional and Functional Status in Longer Stay Patients Admitted to a Geriatric Evaluation and Management Unit. J Nutr Health Aging 2017; 21:686-691. [PMID: 28537333 DOI: 10.1007/s12603-016-0838-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES Malnutrition and functional decline are common in older inpatients admitted to subacute care settings. However the association between changes in nutritional status and relevant functional outcomes remains under-researched. This study examined changes in nutritional status, function and mobility in patients admitted to a Geriatric Evaluation and Management (GEM) unit who had a length of stay (LOS) longer than 21 days. DESIGN A prospective, observational study. SETTING Two GEM units at St Vincent's Hospital Melbourne, Australia. PARTICIPANTS Patients admitted to the GEM units who stayed longer than 21 days were included in the study. MEASUREMENTS Patients were assessed on admission and prior to discharge using the Subjective Global Assessment (SGA), Functional Independence Measure (FIM) motor domain and the Modified Elderly Mobility Scale (MEMS). RESULTS Fifty-nine patients (Mean age 84.0 ± 7 years) met the required length of stay and were included in the study. Fifty-four per cent (n=32) were malnourished on admission (SGA B/C) and 44% (n=26) were malnourished on discharge. Twenty-two per cent (n=13) improved SGA category, 75% remained stable (n=44) and 3% deteriorated (n=2) from admission to discharge. Total Motor FIM scores significantly increased from admission to discharge in both the improved (p<0.001) and stable or deteriorated (p<0.001) nutritional status groups. Subjects who improved in nutritional status had a significantly higher MEMS score at discharge (p<0.001). CONCLUSION On admission to the GEM unit, just over half the included patients were rated as malnourished defined by SGA category. Nearly one quarter of the sample had improved their nutritional status at the time of discharge. Improvement in nutritional status was associated with greater improvement in mobility scores. Further studies are required to investigate the effectiveness of nutrition interventions, which will inform models of care aiming to optimise nutritional, functional, and associated clinical outcomes in patients admitted to GEM units.
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Affiliation(s)
- A Whitley
- A. Whitley, St Vincents Hospital Melbourne, Australia,
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