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Papoutsakis C, Sundar C, Woodcock L, Abram JK, Lamers-Johnson E. Translating malnutrition care from the hospital to the community setting. Nutr Clin Pract 2024. [PMID: 39105676 DOI: 10.1002/ncp.11197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 06/20/2024] [Accepted: 07/16/2024] [Indexed: 08/07/2024] Open
Affiliation(s)
- Constantina Papoutsakis
- Data Science Center, Research, International, and Scientific Affairs (RISA), Academy of Nutrition and Dietetics, Chicago, Illinois, USA
| | - Charanya Sundar
- Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia, USA
| | - Lindsay Woodcock
- Data Science Center, Research, International, and Scientific Affairs (RISA), Academy of Nutrition and Dietetics, Chicago, Illinois, USA
| | - Jenica K Abram
- Nutrition Research Network, Research, International, and Scientific Affairs (RISA), Academy of Nutrition and Dietetics, Chicago, Illinois, USA
| | - Erin Lamers-Johnson
- Nutrition Research Network, Research, International, and Scientific Affairs (RISA), Academy of Nutrition and Dietetics, Chicago, Illinois, USA
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2
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Weng V, Wiles N, Jenkins D, Amanatidis S, Kidd JC, Walsh JA, Baillie AJ, Naganathan V. The effectiveness of a home-based dietetic intervention for community-dwelling older adults. Australas J Ageing 2024; 43:297-305. [PMID: 38217875 DOI: 10.1111/ajag.13264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 11/02/2023] [Accepted: 11/19/2023] [Indexed: 01/15/2024]
Abstract
OBJECTIVES The aim of this study was to describe the characteristics of clients receiving home-based dietetic intervention and to evaluate the effectiveness of these interventions in improving nutritional status, functional status, and quality of life in a culturally and socioeconomically diverse client group. METHODS Participants referred to a home-based dietetic service were recruited to this prospective cohort study. Dietetic interventions were recommended at baseline and reviewed at 3-month follow-up. Assessment of nutritional, functional and quality of life markers was measured using the Mini Nutritional Assessment (MNA), Timed Up and Go (TUG) and EQ-5D-5L, respectively, at baseline and after home-based dietetic intervention. RESULTS Participants (n = 99) were recruited from consecutive referrals. Participant's weight, body mass index (BMI), total daily energy and protein intake, MNA total score, and TUG significantly improved after a 3-month nutrition intervention (effect sizes 0.257, 0.257, 0.580, 0.533, 0.577 and 0.281, respectively). The most common interventions dietitians utilised were nutrition education, use of oral nutritional supplements (ONS) and meal fortification. In total, 339 dietetic interventions were recommended to participants at baseline with 197 (58.11%) implemented at 3 months, with meal planning and referral to other relevant allied health or Commonwealth Home Support Program (CHSP) services the most implemented interventions. CONCLUSIONS Home-based dietetic intervention improves nutritional status, functional status and quality of life in community-dwelling older adults referred for dietetic input. Improvements observed in nutritional and functional status were consistent with benchmarks of change from published literature.
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Affiliation(s)
- Vicky Weng
- Community Nutrition, Primary and Community Health, South Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Nicole Wiles
- Home Based Therapy, Aged Health Chronic Care and Rehabilitation, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Deanna Jenkins
- Home Based Therapy, Aged Health Chronic Care and Rehabilitation, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Sue Amanatidis
- Home Based Therapy, Aged Health Chronic Care and Rehabilitation, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Joanna C Kidd
- Department of Speech Pathology, Campbelltown Hospital, South Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Jessica A Walsh
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Sydney Local Health District, Sydney, New South Wales, Australia
| | - Andrew J Baillie
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Sydney Local Health District, Sydney, New South Wales, Australia
| | - Vasi Naganathan
- Home Based Therapy, Aged Health Chronic Care and Rehabilitation, Sydney Local Health District, Sydney, New South Wales, Australia
- Concord Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Clotet-Vidal S, Saez Prieto ME, Duch Llorach P, Gutiérrez ÁS, Casademont Pou J, Torres Bonafonte OH. Malnutrition, Functional Decline, and Institutionalization in Older Adults after Hospital Discharge Following Community-Acquired Pneumonia. Nutrients 2023; 16:11. [PMID: 38201841 PMCID: PMC10780721 DOI: 10.3390/nu16010011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/13/2023] [Accepted: 12/15/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND AND AIMS Community-acquired pneumonia (CAP) is a major threat to older adults, but mid-term implications are poorly described. The aim was to analyze functional decline, institutionalization, malnutrition, and risk factors after hospital admission for CAP. METHODS This prospective observational study included patients over 65 years discharged after CAP between May 2019 and July 2021. We performed a comprehensive geriatric assessment and a general nutritional assessment 30-60 days after CAP. This included the MNA and blood test with trace elements and vitamins. The main outcomes were functional decline, institutionalization, and malnutrition. Multivariate logistic regression was used for the analyses. RESULTS In total, 144 patients of 77.15 ± 7.91 years, 55.6% male, and 9% previously institutionalized were analyzed. At hospital admission, the Charlson Comorbidity Index (CCI) was 1.5 ± 1.6, the Pneumonia Severity Index was 98.1 ± 25.9, and the previous Barthel Index (BI) was 93.06 ± 17.13. Hospital stay was 9.72 ± 7.88 days. After 44.6 ± 14.4 days, 48.6% patients showed functional decline and 19.4% were institutionalized. Age (OR 1.17; CI 95% 1.09-1.26), previous institutionalization (29.1; 3.7-224.7), BI (1.09; 1.05-1.14), CCI (1.5; 1.1-2.1), and length of stay (1.1, 1.02-1.18) were independently associated with functional decline. The only predictors of new institutionalization were previous BI (0.96; 0.93-0.99) and length of stay (1.06; 1.00-1.13). The MNA indicated malnutrition in 28% of the community-dwelling patients and 67.9% of those institutionalized, with risk of malnutrition being 45.7% and 9.5%, respectively, after an average of 44.6 days of CAP diagnosis. The predictors of malnutrition were previous institutionalization (10.62; 2.20-51.21), BI (0.95; 0.92-0.98), and length of stay (1.12; 1.04-1.20). Micronutrient deficiencies were mainly zinc (61.8%), vitamin D (54.5%), and vitamin C (45.1%). An MNA score < 17 points or hypoalbuminemia showed good specificity to identify these deficiencies. CONCLUSIONS After CAP admission, functional decline, institutionalization, and malnutrition rates were high. Longer hospital stay was a common risk factor for all outcomes. The presence of hypoalbuminemia or an MNA < 17 in older patients should prompt suspicion of deficiencies in micronutrients, such as vitamin D, C, and zinc.
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Affiliation(s)
- Sandra Clotet-Vidal
- Internal Medicine Department, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain;
- Medicine Department, Universitat Autònoma de Barcelona, 08913 Barcelona, Spain;
| | - M. Encarna Saez Prieto
- Geriatrics Unit, Internal Medicine Department, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain; (M.E.S.P.); (Á.S.G.)
| | - Pol Duch Llorach
- Infectious Diseases Unit, Internal Medicine Department, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain;
| | - Álvaro Santos Gutiérrez
- Geriatrics Unit, Internal Medicine Department, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain; (M.E.S.P.); (Á.S.G.)
| | - Jordi Casademont Pou
- Internal Medicine Department, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain;
- Medicine Department, Universitat Autònoma de Barcelona, 08913 Barcelona, Spain;
- Biomedical Research Institute Sant Pau (IIB Sant Pau), 08041 Barcelona, Spain
| | - Olga H. Torres Bonafonte
- Medicine Department, Universitat Autònoma de Barcelona, 08913 Barcelona, Spain;
- Geriatrics Unit, Internal Medicine Department, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain; (M.E.S.P.); (Á.S.G.)
- Biomedical Research Institute Sant Pau (IIB Sant Pau), 08041 Barcelona, Spain
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Baldwin C, de van der Schueren MA, Kruizenga HM, Weekes CE. Dietary advice with or without oral nutritional supplements for disease-related malnutrition in adults. Cochrane Database Syst Rev 2021; 12:CD002008. [PMID: 34931696 PMCID: PMC8691169 DOI: 10.1002/14651858.cd002008.pub5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Disease-related malnutrition has been reported in 10% to 55% of people in hospital and the community and is associated with significant health and social-care costs. Dietary advice (DA) encouraging consumption of energy- and nutrient-rich foods rather than oral nutritional supplements (ONS) may be an initial treatment. OBJECTIVES To examine evidence that DA with/without ONS in adults with disease-related malnutrition improves survival, weight, anthropometry and quality of life (QoL). SEARCH METHODS We identified relevant publications from comprehensive electronic database searches and handsearching. Last search: 01 March 2021. SELECTION CRITERIA Randomised controlled trials (RCTs) of DA with/without ONS in adults with disease-related malnutrition in any healthcare setting compared with no advice, ONS or DA alone. DATA COLLECTION AND ANALYSIS Two authors independently assessed study eligibility, risk of bias, extracted data and graded evidence. MAIN RESULTS We included 94, mostly parallel, RCTs (102 comparisons; 10,284 adults) across many conditions possibly explaining the high heterogeneity. Participants were mostly older people in hospital, residential care and the community, with limited reporting on their sex. Studies lasted from one month to 6.5 years. DA versus no advice - 24 RCTs (3523 participants) Most outcomes had low-certainty evidence. There may be little or no effect on mortality after three months, RR 0.87 (95% confidence interval (CI) 0.26 to 2.96), or at later time points. We had no three-month data, but advice may make little or no difference to hospitalisations, or days in hospital after four to six months and up to 12 months. A similar effect was seen for complications at up to three months, MD 0.00 (95% CI -0.32 to 0.32) and between four and six months. Advice may improve weight after three months, MD 0.97 kg (95% CI 0.06 to 1.87) continuing at four to six months and up to 12 months; and may result in a greater gain in fat-free mass (FFM) after 12 months, but not earlier. It may also improve global QoL at up to three months, MD 3.30 (95% CI 1.47 to 5.13), but not later. DA versus ONS - 12 RCTs (852 participants) All outcomes had low-certainty evidence. There may be little or no effect on mortality after three months, RR 0.66 (95% CI 0.34 to 1.26), or at later time points. Either intervention may make little or no difference to hospitalisations at three months, RR 0.36 (95% CI 0.04 to 3.24), but ONS may reduce hospitalisations up to six months. There was little or no difference between groups in weight change at three months, MD -0.14 kg (95% CI -2.01 to 1.74), or between four to six months. Advice (one study) may lead to better global QoL scores but only after 12 months. No study reported days in hospital, complications or FFM. DA versus DA plus ONS - 22 RCTs (1286 participants) Most outcomes had low-certainty evidence. There may be little or no effect on mortality after three months, RR 0.92 (95% CI 0.47 to 1.80) or at later time points. At three months advice may lead to fewer hospitalisations, RR 1.70 (95% CI 1.04 to 2.77), but not at up to six months. There may be little or no effect on length of hospital stay at up to three months, MD -1.07 (95% CI -4.10 to 1.97). At three months DA plus ONS may lead to fewer complications, RR 0.75 (95% CI o.56 to 0.99); greater weight gain, MD 1.15 kg (95% CI 0.42 to 1.87); and better global QoL scores, MD 0.33 (95% CI 0.09 to 0.57), but this was not seen at other time points. There was no effect on FFM at three months. DA plus ONS if required versus no advice or ONS - 31 RCTs (3308 participants) Evidence was moderate- to low-certainty. There may be little or no effect on mortality at three months, RR 0.82 (95% CI 0.58 to 1.16) or at later time points. Similarly, little or no effect on hospitalisations at three months, RR 0.83 (95% CI 0.59 to 1.15), at four to six months and up to 12 months; on days in hospital at three months, MD -0.12 (95% CI -2.48 to 2.25) or for complications at any time point. At three months, advice plus ONS probably improve weight, MD 1.25 kg (95% CI 0.73 to 1.76) and may improve FFM, 0.82 (95% CI 0.35 to 1.29), but these effects were not seen later. There may be little or no effect of either intervention on global QoL scores at three months, but advice plus ONS may improve scores at up to 12 months. DA plus ONS versus no advice or ONS - 13 RCTs (1315 participants) Evidence was low- to very low-certainty. There may be little or no effect on mortality after three months, RR 0.91 (95% CI 0.55 to 1.52) or at later time points. No study reported hospitalisations and there may be little or no effect on days in hospital after three months, MD -1.81 (95% CI -3.65 to 0.04) or six months. Advice plus ONS may lead to fewer complications up to three months, MD 0.42 (95% CI 0.20 to 0.89) (one study). Interventions may make little or no difference to weight at three months, MD 1.08 kg (95% CI -0.17 to 2.33); however, advice plus ONS may improve weight at four to six months and up to 12 months. Interventions may make little or no difference in FFM or global QoL scores at any time point. AUTHORS' CONCLUSIONS We found no evidence of an effect of any intervention on mortality. There may be weight gain with DA and with DA plus ONS in the short term, but the benefits of DA when compared with ONS are uncertain. The size and direction of effect and the length of intervention and follow-up required for benefits to emerge were inconsistent for all other outcomes. There were too few data for many outcomes to allow meaningful conclusions. Studies focusing on both patient-centred and healthcare outcomes are needed to address the questions in this review.
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Affiliation(s)
- Christine Baldwin
- Department of Nutritional Sciences, Facutly of Life Sciences & Medicine, King's College London, London, UK
| | - Marian Ae de van der Schueren
- Department of Nutrition, Dietetics and Lifestyle, HAN University of Applied Sciences, Nijmegen, Netherlands
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, Netherlands
| | - Hinke M Kruizenga
- Department of Nutrition and Dietetics, VU University Medical Center, Amsterdam, Netherlands
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Roberts S, Collins P, Rattray M. Identifying and Managing Malnutrition, Frailty and Sarcopenia in the Community: A Narrative Review. Nutrients 2021; 13:nu13072316. [PMID: 34371823 PMCID: PMC8308465 DOI: 10.3390/nu13072316] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 06/29/2021] [Accepted: 06/30/2021] [Indexed: 12/29/2022] Open
Abstract
Malnutrition, frailty and sarcopenia are becoming increasingly prevalent among community-dwelling older adults; yet are often unidentified and untreated in community settings. There is an urgent need for community-based healthcare professionals (HCPs) from all disciplines, including medicine, nursing and allied health, to be aware of, and to be able to recognise and appropriately manage these conditions. This paper provides a comprehensive overview of malnutrition, frailty and sarcopenia in the community, including their definitions, prevalence, impacts and causes/risk factors; and guidance on how these conditions may be identified and managed by HCPs in the community. A detailed description of the care process, including screening and referral, assessment and diagnosis, intervention, and monitoring and evaluation, relevant to the community context, is also provided. Further research exploring the barriers/enablers to delivering high-quality nutrition care to older community-dwelling adults who are malnourished, frail or sarcopenic is recommended, to inform the development of specific guidance for HCPs in identifying and managing these conditions in the community.
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Affiliation(s)
- Shelley Roberts
- School of Health Sciences and Social Work, Griffith University, Gold Coast 4222, Australia;
- Menzies Health Institute Queensland, Griffith University, Gold Coast 4222, Australia
- Allied Health Research, Gold Coast Hospital and Health Service, Gold Coast 4219, Australia
- Correspondence: ; Tel.: +61-7-5552-9557
| | - Peter Collins
- Dietetics and Food Services, Mater Health, Brisbane 4101, Australia;
- Mater Research Institute, University of Queensland, Brisbane 4101, Australia
| | - Megan Rattray
- School of Health Sciences and Social Work, Griffith University, Gold Coast 4222, Australia;
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Keller H, Donnelly R, Laur C, Goharian L, Nasser R. Consensus-Based Nutrition Care Pathways for Hospital-to-Community Transitions and Older Adults in Primary and Community Care. JPEN J Parenter Enteral Nutr 2021; 46:141-152. [PMID: 33417240 DOI: 10.1002/jpen.2068] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/10/2020] [Accepted: 01/05/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Practical guidance for providers on preventing, detecting, and treating malnutrition in primary care (PC) and the community is limited. The purpose of this study was to develop nutrition care pathways for adult patients (aged ≥18 years) transitioning from hospital to community and community-dwelling older adults (aged ≥65 years) who are at risk for malnutrition. METHODS A review of best-practice nutrition evidence and guidelines published between 2009 and 2019 was performed using PubMed and CINAHL. Findings were summarized into two draft care pathways by the Primary Care Working Group of the Canadian Malnutrition Task Force. Diverse stakeholders (n = 21) reviewed and suggested revisions at a 1-day meeting. Revisions were made and an online survey was conducted to determine the relevance and importance of discrete care practices, and to establish consensus for which practices should be retained in the pathways. Providers (e.g., dietitians, physicians, nurses; n = 291) across healthcare settings completed the survey. Consensus on relevance and importance of practices was set at ≥80%. RESULTS One hundred twenty-eight resources were identified and used to develop the draft pathways. Survey participants assigned ratings of ≥80% for relevance and importance for all nutrition care practices, except community service providers monitoring patient weight and appetite. CONCLUSION These evidence- and consensus-based nutrition pathways offer guidance to healthcare and service providers on how to deliver nutrition care during hospital-to-community transitions for malnourished adult patients and community-dwelling older adults at risk for malnutrition. These pathways are flexible for diverse PC and community models.
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Affiliation(s)
- Heather Keller
- Department of Kinesiology, University of Waterloo, 200 University Ave W, Waterloo, Ontario, N2L 3G1, Canada.,Schlegel-University of Waterloo Research Institute for Aging, 250 Laurelwood Dr, Waterloo, Ontario, N2J 0E2, Canada
| | - Rachael Donnelly
- Department of Kinesiology, University of Waterloo, 200 University Ave W, Waterloo, Ontario, N2L 3G1, Canada
| | - Celia Laur
- Women's College Hospital Institute for Health System Solutions and Virtual Care and Women's College Research Institute, Women's College Hospital, 76 Grenville St, Toronto, Ontario, M5S 1B2, Canada.,NNEdPro Global Centre for Nutrition and Health, St John's Innovation Centre, Cowley Road, Cambridge, CB4 0WS, United Kingdom
| | - Leila Goharian
- Evergreen Community Health Centre, Vancouver Coastal Health, 3425 Crowley Dr, Vancouver, British Columbia, V5R 6G3, Canada
| | - Roseann Nasser
- Nutrition and Food Services, Pasqua Hospital, 4101 Dewdney Ave, Regina, Saskatchewan, S4T 1A5, Canada
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Keller HH, Laur C, Dhaliwal R, Allard JP, Clermont-Dejean N, Duerksen DR, Elias E, Gramlich L, Lakananurak N, Laporte M. Trends and Novel Research in Hospital Nutrition Care: A Narrative Review of Leading Clinical Nutrition Journals. JPEN J Parenter Enteral Nutr 2020; 45:670-684. [PMID: 33236411 DOI: 10.1002/jpen.2047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 11/10/2020] [Accepted: 11/16/2020] [Indexed: 01/04/2023]
Abstract
Hospital malnutrition is a longstanding problem that continues to be underrecognized and undertreated. The aim of this narrative review is to summarize novel, solution-focused, recent research or commentary to update providers on the prevention of iatrogenic malnutrition as well as the detection and treatment of hospital malnutrition. A narrative review was completed using the top 11 clinically relevant nutrition journals. Of the 13,850 articles and editorials published in these journals between 2013 and 2019, 511 were related to hospital malnutrition. A duplicate review was used to select (n = 108) and extract key findings from articles and editorials. Key criteria for selection were population of interest (adult hospital patients, no specific diagnostic group), solution-focused, and novel perspectives. Articles were categorized (6 classified in >1 category) as Screening and Assessment (n = 17), Standard (n = 25), Advanced (n = 12) and Specialized Nutrition Care (n = 8), Transitions (n = 15), Multicomponent (n = 21), Education and Empowerment (n = 9), Economic Impact (n = 3), and Guidelines (n = 4) for summarizing. Research advances in screening implementation, standard nutrition care, transitions, and multicomponent interventions provide new strategies to consider for malnutrition prevention (iatrogenic), detection, and care. However, several areas requiring further research were identified. Specifically, larger and more rigorous studies that examine health outcomes and economic analyses are urgently needed.
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Affiliation(s)
- Heather H Keller
- Schlegel-University of Waterloo Research institute for Aging, Waterloo, Ontario, Canada
| | - Celia Laur
- Women's College Hospital Institute for Health System Solutions and Virtual Care, and Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.,NNEdPro Global Centre for Nutrition and Health, Cambridge, UK
| | - Rupinder Dhaliwal
- Canadian Malnutrition Task Force, Canadian Nutrition Society, Ottawa, Ontario, Canada
| | - Johane P Allard
- Department of Medicine, University of Toronto, Toronto General Hospital, University Health Network Toronto, Toronto, Ontario, Canada
| | - Nayima Clermont-Dejean
- Clinical Nutrition, Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Donald R Duerksen
- Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Evan Elias
- Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Leah Gramlich
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Narisorn Lakananurak
- Department of Medicine, University of Alberta, Edmonton, Canada.,Division of Clinical Nutrition, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Manon Laporte
- Department of Clinical Nutrition, Réseau de santé Vitalité Health Network, Campbellton Regional Hospital, New Brunswick, Canada
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Winterton R, Hodgkin S, Clune SJ, Brasher K. Age-friendly care for older adults within rural Australian health systems: An integrative review. Australas J Ageing 2020; 40:16-34. [PMID: 33739600 DOI: 10.1111/ajag.12834] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 06/14/2020] [Accepted: 06/23/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To identify the core elements of interventions and models that facilitate age-friendly care for older adults within rural Australian health systems, and assess the extent to which these align with core elements of the Institute for Health Improvement's (IHI) Age-Friendly Health Systems 4Ms Model. METHODS Peer-reviewed journal articles examining core elements of Australian rural geriatric care models were collected and analysed using an integrative review methodology. RESULTS Identified models and interventions addressed all four core elements of the IHI model-what matters, medications, mobility and mentation. There was more evidence relating to mobility and mentation, with lesser evidence relating to medications and what matters. A series of core elements not aligned with the model were also identified. CONCLUSION The IHI 4Ms Model appears to be applicable in the rural Australian context. More high-quality, systematic evidence is needed to investigate the core elements of age-friendly care across diverse rural contexts.
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Affiliation(s)
- Rachel Winterton
- John Richards Centre for Rural Ageing Research, La Trobe Rural Health School, La Trobe University, Wodonga, Victoria, Australia
| | - Suzanne Hodgkin
- John Richards Centre for Rural Ageing Research, La Trobe Rural Health School, La Trobe University, Wodonga, Victoria, Australia
| | - Samantha Jane Clune
- John Richards Centre for Rural Ageing Research, La Trobe Rural Health School, La Trobe University, Wodonga, Victoria, Australia
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Collins RA, Baker B, Coyle DH, Rollo ME, Burrows TL. Dietary Assessment Methods in Military and Veteran Populations: A Scoping Review. Nutrients 2020; 12:E769. [PMID: 32183380 PMCID: PMC7146105 DOI: 10.3390/nu12030769] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 03/06/2020] [Accepted: 03/10/2020] [Indexed: 12/20/2022] Open
Abstract
Optimal dietary intake is important for the health and physical performance of military personnel. For military veterans, the complex nature of transition into civilian life and sub-optimal dietary intake is a leading contributor to the increased burden of disease. A scoping review was undertaken to determine what is known about the assessment and reporting of dietary intakes within both military and veteran populations. In addition, this review determines if studies reporting on the dietary intake of military personnel or veterans include comparisons with dietary guidelines. Six databases were searched to identify papers published from the database inception to April 2019. Observational and intervention studies were searched to identify if they assessed and reported whole dietary intake data, reported data exclusively for a military or veteran population, and included only healthy populations. A total of 89 studies were included. The majority of studies used one dietary assessment method (n = 76, 85%) with fewer using multiple methods (n = 13, 15%). The most frequent methodology used was food frequency questionnaires (FFQ) (n = 40, 45%) followed by 24-hour recalls (n = 8, 9%) and food records (n = 8, 9%). The main dietary outcomes reported were macronutrients: carbohydrate, protein, fat, and alcohol (n = 66, 74%) with total energy intake reported in n = 59 (66%). Fifty four (61%) studies reported a comparison with country-specific dietary guidelines and 14 (16%) reported a comparison with the country-specific military guidelines. In conclusion, dietary intake in military settings is most commonly assessed via FFQs and 24-hour recalls. Dietary intake reporting is mainly focused around intakes of energy and macronutrients. Most studies compare against dietary guidelines, however, comparison to specific military dietary guidelines is minimal.
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Affiliation(s)
- Rebecca A. Collins
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan 2308, Australia; (R.A.C.); (M.E.R.)
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan 2308, Australia
| | - Bradley Baker
- Food and Nutrition, Land Division, Defence Science and Technology Group, Scottsdale 7260, Australia;
| | - Daisy H. Coyle
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan 2308, Australia; (R.A.C.); (M.E.R.)
- The George Institute for Global Health, University of New South Wales, Sydney 2042, Australia
| | - Megan E. Rollo
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan 2308, Australia; (R.A.C.); (M.E.R.)
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan 2308, Australia
| | - Tracy L. Burrows
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan 2308, Australia; (R.A.C.); (M.E.R.)
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan 2308, Australia
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Sheean P, Farrar IC, Sulo S, Partridge J, Schiffer L, Fitzgibbon M. Nutrition risk among an ethnically diverse sample of community-dwelling older adults. Public Health Nutr 2019; 22:894-902. [PMID: 30396375 PMCID: PMC6521784 DOI: 10.1017/s1368980018002902] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 09/14/2018] [Accepted: 09/25/2018] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To assess the prevalence of nutritional risk among an ethnically diverse group of urban community-dwelling older adults and to explore if risk varied by race/ethnicity. DESIGN Demographic characteristics, Katz's activities of daily living and health-care resource utilization were ascertained cross-sectionally via telephone surveys with trained interviewers. Nutrition risk and nutrition symptomology were assessed via the abridged Patient Generated Subjective Global Assessment (abPG-SGA); scores of ≥6 points delineated 'high' nutrition risk. Descriptive statistics and logistic regression analyses were conducted. SETTING Urban.ParticipantsWhite, Black or Hispanic community-dwelling adults, ≥55 years of age, fluent in English or Spanish, residing in the city limits of Chicago, IL, USA. RESULTS A total of 1001 participants (37 % white, 37 % Black, 26 % Hispanic) were surveyed. On average, participants were 66·9 years old, predominantly female and overweight/obese. Twenty-six per cent (n 263) of participants were classified as 'high' nutrition risk with 24, 14 and 31 % endorsing decreased oral intake, weight loss and compromised functioning, respectively. Black respondents constituted the greatest proportion of those with high risk scores, yet Hispanic participants displayed the most concerning nutrition risk profiles. Younger age, female sex, Black or Hispanic race/ethnicity, emergency room visits, eating alone and taking three or more different prescribed or over-the-counter drugs daily were significantly associated with high risk scores (P<0·05). CONCLUSIONS One in four older adults living in an urban community prone to health disparities was classified as 'high' nutrition risk. Targeted interventions to promote healthy ageing are needed, especially for overweight/obese and minority community members.
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Affiliation(s)
- Patricia Sheean
- Marcella Niehoff School of Nursing, Loyola University Chicago, 2160 South First Avenue, Building 120, Room 4527, Maywood, IL60153, USA
| | - Isabel C Farrar
- Survey Research Laboratory, University of Illinois at Chicago, Chicago, IL, USA
| | - Suela Sulo
- Abbott Nutrition Research & Development, Columbus, OH, USA
| | | | - Linda Schiffer
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL, USA
| | - Marian Fitzgibbon
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL, USA
- Department of Pediatrics, College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
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Byrnes A, Worrall J, Young A, Mudge A, Banks M, Bauer J. Early post-operative diet upgrade in older patients may improve energy and protein intake but patients still eat poorly: an observational pilot study. J Hum Nutr Diet 2018; 31:818-824. [DOI: 10.1111/jhn.12572] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- A. Byrnes
- School of Human Movement and Nutrition Sciences; The University of Queensland; St Lucia QLD Australia
- Department of Nutrition and Dietetics; Royal Brisbane and Women's Hospital; Herston QLD Australia
| | - J. Worrall
- School of Human Movement and Nutrition Sciences; The University of Queensland; St Lucia QLD Australia
| | - A. Young
- Department of Nutrition and Dietetics; Royal Brisbane and Women's Hospital; Herston QLD Australia
- School of Exercise and Nutrition Sciences; Queensland University of Technology; Kelvin Grove QLD Australia
| | - A. Mudge
- Internal Medicine and Aged Care; Royal Brisbane and Women's Hospital; Herston QLD Australia
- Institute for Health and Biomedical Innovation; Queensland University of Technology; Kelvin Grove QLD Australia
- School of Medicine; The University of Queensland; St Lucia QLD Australia
| | - M. Banks
- School of Human Movement and Nutrition Sciences; The University of Queensland; St Lucia QLD Australia
- Department of Nutrition and Dietetics; Royal Brisbane and Women's Hospital; Herston QLD Australia
| | - J. Bauer
- School of Human Movement and Nutrition Sciences; The University of Queensland; St Lucia QLD Australia
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12
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Young AM, Mudge AM, Banks MD, Rogers L, Demedio K, Isenring E. Improving nutritional discharge planning and follow up in older medical inpatients: Hospital to Home Outreach for Malnourished Elders. Nutr Diet 2018; 75:283-290. [DOI: 10.1111/1747-0080.12408] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 12/07/2017] [Accepted: 12/20/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Adrienne M. Young
- Department of Nutrition and Dietetics; Royal Brisbane and Women’s Hospital; Brisbane Queensland Australia
| | - Alison M. Mudge
- Department of Internal Medicine and Aged Care; Royal Brisbane and Women’s Hospital; Brisbane Queensland Australia
| | - Merrilyn D. Banks
- Department of Nutrition and Dietetics; Royal Brisbane and Women’s Hospital; Brisbane Queensland Australia
| | - Lauren Rogers
- Department of Nutrition and Dietetics; Royal Brisbane and Women’s Hospital; Brisbane Queensland Australia
| | - Kristen Demedio
- Department of Nutrition and Dietetics; The Prince Charles Hospital; Brisbane Queensland Australia
| | - Elisabeth Isenring
- Faculty of Health Science and Medicine; Bond University; Brisbane Queensland Australia
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13
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Nutrition Care after Discharge from Hospital: An Exploratory Analysis from the More-2-Eat Study. Healthcare (Basel) 2018; 6:healthcare6010009. [PMID: 29361696 PMCID: PMC5872216 DOI: 10.3390/healthcare6010009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 01/08/2018] [Accepted: 01/17/2018] [Indexed: 12/21/2022] Open
Abstract
Many patients leave hospital in poor nutritional states, yet little is known about the post-discharge nutrition care in which patients are engaged. This study describes the nutrition-care activities 30-days post-discharge reported by patients and what covariates are associated with these activities. Quasi-randomly selected patients recruited from 5 medical units across Canada (n = 513) consented to 30-days post-discharge data collection with 48.5% (n = 249) completing the telephone interview. Use of nutrition care post-discharge was reported and bivariate analysis completed with relevant covariates for the two most frequently reported activities, following recommendations post-discharge or use of oral nutritional supplements (ONS). A total of 42% (n = 110) received nutrition recommendations at hospital discharge, with 65% (n = 71/110) of these participants following those recommendations; 26.5% (n = 66) were taking ONS after hospitalization. Participants who followed recommendations were more likely to report following a special diet (p = 0.002), different from before their hospitalization (p = 0.008), compared to those who received recommendations, but reported not following them. Patients taking ONS were more likely to be at nutrition risk (p < 0.0001), malnourished (p = 0.0006), taking ONS in hospital (p = 0.01), had a lower HGS (p = 0.0013; males only), and less likely to believe they were eating enough to meet their body’s needs (p = 0.005). This analysis provides new insights on nutrition-care post-discharge.
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14
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Agarwal E. Disease-related malnutrition in the twenty-first century: From best evidence to best practice. Nutr Diet 2017; 74:213-216. [DOI: 10.1111/1747-0080.12364] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Ekta Agarwal
- Master of Nutrition and Dietetic Practice Program; Bond University; Gold Coast Queensland Australia
- Honorary Research Fellow, Department of Nutrition and Dietetics; The Princess Alexandra Hospital; Brisbane Queensland Australia
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