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Marne-Ortega A, Corral-Gudino L, Miramontes-González P, Gabella-Martín M. How does the risk of malnutrition evolve in elderly patients one year after hospital discharge? Results of a prospective cohort. Rev Clin Esp 2024:S2254-8874(24)00097-3. [PMID: 39002611 DOI: 10.1016/j.rceng.2024.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/15/2024]
Affiliation(s)
- A Marne-Ortega
- Departamento de Medicina, Dermatología y Toxicología, Facultad de Medicina, Universidad de Valladolid, Spain
| | - L Corral-Gudino
- Departamento de Medicina, Dermatología y Toxicología, Facultad de Medicina, Universidad de Valladolid, Servicio de Medicina Interna, Hospital Universitario Río Hortega de Valladolid, Valladolid, IBioVALL (Instituto de Investigación Biosanitaria de Valladolid), Spain.
| | - P Miramontes-González
- Departamento de Medicina, Dermatología y Toxicología, Facultad de Medicina, Universidad de Valladolid, Servicio de Medicina Interna, Hospital Universitario Río Hortega de Valladolid, Valladolid, IBioVALL (Instituto de Investigación Biosanitaria de Valladolid), Spain
| | - M Gabella-Martín
- Servicio de Medicina Interna, Hospital Universitario Río Hortega, Valladolid, Spain
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2
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Pemau RC, González-Palacios P, Kerr KW. How quality of life is measured in studies of nutritional intervention: a systematic review. Health Qual Life Outcomes 2024; 22:9. [PMID: 38267976 PMCID: PMC10809546 DOI: 10.1186/s12955-024-02229-y] [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: 10/10/2023] [Accepted: 01/03/2024] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Nutrition care can positively affect multiple aspects of patient's health; outcomes are commonly evaluated on the basis of their impact on a patient's (i) illness-specific conditions and (ii) health-related quality of life (HRQoL). Our systematic review examined how HRQoL was measured in studies of nutritional interventions. To help future researchers select appropriate Quality of Life Questionnaires (QoLQ), we identified commonly-used instruments and their uses across populations in different regions, of different ages, and with different diseases. METHODS We searched EMCare, EMBASE, and Medline databases for studies that had HRQoL and nutrition intervention terms in the title, the abstract, or the MeSH term classifications "quality of life" and any of "nutrition therapy", "diet therapy", or "dietary supplements" and identified 1,113 studies for possible inclusion.We then reviewed titles, abstracts, and full texts to identify studies for final inclusion. RESULTS Our review of titles, abstracts, and full texts resulted in the inclusion of 116 relevant studies in our final analysis. Our review identified 14 general and 25 disease-specific QoLQ. The most-used general QoLQ were the Short-Form 36-Item Health Survey (SF-36) in 27 studies and EuroQol 5-Dimension, (EQ-5D) in 26 studies. The European Organization for Research and Treatment of Cancer Quality of life Questionnaire (EORTC-QLQ), a cancer-specific QoLQ, was the most frequently used disease-specific QoLQ (28 studies). Disease-specific QoLQ were also identified for nutrition-related diseases such as diabetes, obesity, and dysphagia. Sixteen studies used multiple QoLQ, of which eight studies included both general and disease-specific measures of HRQoL. The most studied diseases were cancer (36 studies) and malnutrition (24 studies). There were few studies focused on specific age-group populations, with only 38 studies (33%) focused on adults 65 years and older and only 4 studies focused on pediatric patients. Regional variation in QoLQ use was observed, with EQ-5D used more frequently in Europe and SF-36 more commonly used in North America. CONCLUSIONS Use of QoLQ to measure HRQoL is well established in the literature; both general and disease-specific instruments are now available for use. We advise further studies to examine potential benefits of using both general and disease-specific QoLQ to better understand the impact of nutritional interventions on HRQoL.
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Affiliation(s)
| | - Patricia González-Palacios
- Department of Nutrition and Food Science, University of Granada, Granada, Spain
- Biomedical Research Institute (IBS), Granada, Spain
| | - Kirk W Kerr
- Abbott Nutrition, 2900 Easton Square Place, Columbus, OH, 43219, USA.
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3
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Ng DHL, Koh FHX, Yeong HEL, Huey TCW, Chue KM, Foo FJ, Chew STH. Nutrition Care after Hospital Discharge in Singapore: Evidence-Based Best-Practice Recommendations. Nutrients 2023; 15:4492. [PMID: 37960145 PMCID: PMC10650134 DOI: 10.3390/nu15214492] [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: 09/12/2023] [Revised: 10/11/2023] [Accepted: 10/18/2023] [Indexed: 11/15/2023] Open
Abstract
The nutritional status of hospitalised patients is often at risk or compromised and predisposed to further deterioration after discharge, leading to poor clinical outcomes, high healthcare costs, and poor quality of life. This paper aims to provide evidence-based best-practice recommendations to address this, supported by a national survey of healthcare professionals in Singapore and reviewed by a multidisciplinary expert panel under the Sarcopenia Interest Group of Society of Parenteral and Enteral Nutrition Singapore (SingSPEN). We advocate screening all patients with a validated tool which includes a disease activity/burden component, an easily accessible dietitian referral pathway for patients at risk of malnutrition, and an individualised nutrition care plan formulated and delivered using a multidisciplinary team approach for patients at risk or with malnutrition. A comprehensive team would include not only dietitians but also physicians, nurses, physiotherapists, speech therapists, and medical social workers working together towards a common goal. Information on why nutrition is important for good health and how it can be achieved should also be provided to all patients and their caregivers before and after hospital discharge. With the above recommendations, we seek to improve upon the current nutrition care processes at discharge for healthcare institutions in Singapore.
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Affiliation(s)
- Doris Hui Lan Ng
- Department of Gastroenterology and Hepatology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore;
| | - Frederick Hong Xiang Koh
- Department of General Surgery, Sengkang General Hospital, 110 Sengkang East Way, Singapore 544886, Singapore; (F.H.X.K.); (K.M.C.)
| | - Hazel Ee Ling Yeong
- Department of Nutrition and Dietetics, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore 768828, Singapore;
| | - Terence Cheong Wei Huey
- Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore;
| | - Koy Min Chue
- Department of General Surgery, Sengkang General Hospital, 110 Sengkang East Way, Singapore 544886, Singapore; (F.H.X.K.); (K.M.C.)
| | - Fung Joon Foo
- Department of General Surgery, Sengkang General Hospital, 110 Sengkang East Way, Singapore 544886, Singapore; (F.H.X.K.); (K.M.C.)
| | - Samuel Teong Huang Chew
- Department of Geriatric Medicine, Changi General Hospital, 2 Simei St 3, Singapore 529889, Singapore;
- SingHealth Duke-NUS Medicine Academic Clinical Programme, 8 College Road, Singapore 169857, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597, Singapore
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4
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Kukafka R, Gupta A, Gilbert C, Huggins CE, Browning C, Chapman W, Haines T, Peeters A. Virtual Care Initiatives for Older Adults in Australia: Scoping Review. J Med Internet Res 2023; 25:e38081. [PMID: 36652291 PMCID: PMC9892987 DOI: 10.2196/38081] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 05/03/2022] [Accepted: 09/26/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND There has been a rapid shift toward the adoption of virtual health care services in Australia. It is unknown how widely virtual care has been implemented or evaluated for the care of older adults in Australia. OBJECTIVE We aimed to review the literature evaluating virtual care initiatives for older adults across a wide range of health conditions and modalities and identify key challenges and opportunities for wider adoption at both patient and system levels in Australia. METHODS A scoping review of the literature was conducted. We searched MEDLINE, Embase, PsycINFO, CINAHL, AgeLine, and gray literature (January 1, 2011, to March 8, 2021) to identify virtual care initiatives for older Australians (aged ≥65 years). The results were reported according to the World Health Organization's digital health evaluation framework. RESULTS Among the 6296 documents in the search results, we identified 94 that reported 80 unique virtual care initiatives. Most (69/80, 89%) were at the pilot stage and targeted community-dwelling older adults (64/79, 81%) with chronic diseases (52/80, 65%). The modes of delivery included videoconference, telephone, apps, device or monitoring systems, and web-based technologies. Most initiatives showed either similar or better health and behavioral outcomes compared with in-person care. The key barriers for wider adoption were physical, cognitive, or sensory impairment in older adults and staffing issues, legislative issues, and a lack of motivation among providers. CONCLUSIONS Virtual care is a viable model of care to address a wide range of health conditions among older adults in Australia. More embedded and integrative evaluations are needed to ensure that virtually enabled care can be used more widely by older Australians and health care providers.
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Affiliation(s)
| | - Adyya Gupta
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Cecily Gilbert
- Centre for Digital Transformation of Health, University of Melbourne, Melbourne, Australia
| | - Catherine E Huggins
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Colette Browning
- Health Innovation and Transformation Centre, Federation University, Ballarat, Australia.,Institute of Health and Wellbeing, Federation University, Ballarat, Australia
| | - Wendy Chapman
- Centre for Digital Transformation of Health, University of Melbourne, Melbourne, Australia
| | - Terry Haines
- National Centre for Healthy Ageing, Monash University, Frankston, Australia.,School of Primary and Allied Health Care, Monash University, Frankston, Australia
| | - Anna Peeters
- Institute for Health Transformation, Deakin University, Geelong, Australia
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5
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Radhakrishnan NS, Lukose K, Cartwright R, Sleiman A, Matey N, Lim D, LeGault T, Pollard S, Gravina N, Southwick FS. Prospective application of the interdisciplinary bedside rounding checklist 'TEMP' is associated with reduced infections and length of hospital stay. BMJ Open Qual 2022; 11:bmjoq-2022-002045. [PMID: 36588303 PMCID: PMC9723909 DOI: 10.1136/bmjoq-2022-002045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 11/05/2022] [Indexed: 12/09/2022] Open
Abstract
Protocols that enhance communication between nurses, physicians and patients have had a variable impact on the quality and safety of patient care. We combined standardised nursing and physician interdisciplinary bedside rounds with a mnemonic checklist to assure all key nursing care components were modified daily. The mnemonic TEMP allowed the rapid review of 11 elements. T stands for tubes assuring proper management of intravenous lines and foleys; E stands for eating, exercise, excretion and sleep encouraging a review of orders for diet, exercise, laxatives to assure regular bowel movements, and inquiry about sleep; M stands for monitoring reminding the team to review the need for telemetry and the frequency of vital sign monitoring as well as the need for daily blood tests; and P stands for pain and plans reminding the team to discuss pain medications and to review the management plan for the day with the patient and family. Faithful implementation eliminated central line-associated bloodstream infections and catheter-associated urinary tract infections and resulted in a statistically significant reduction in average hospital length of stay of 13.3 hours, one unit achieving a 23-hour reduction. Trends towards reduced 30-day readmissions (20% down to 10%-11%) were observed. One unit improved the percentage of patients who reported nurses and doctors always worked together as a team from a 56% baseline to 75%. However, the combining of both units failed to demonstrate statistically significant improvement. Psychologists well versed in implementing behavioural change were recruiting to improve adherence to our protocols. Following training physicians and nurses achieved adherence levels of over 70%. A high correlation (r2=0.69) between adherence and reductions in length of stay was observed emphasising the importance of rigorous training and monitoring of performance to bring about meaningful and reliable improvements in the efficiency and quality of patient care.
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Affiliation(s)
- Nila S Radhakrishnan
- Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Kiran Lukose
- Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Richard Cartwright
- Office of Clinical Quality and Patient Safety, University of Florida Health, Gainesville, Florida, USA
| | - Andressa Sleiman
- Department of Psychology, University of Florida, Gainesville, Florida, USA
| | - Nicholas Matey
- Department of Psychology, University of Florida, Gainesville, Florida, USA
| | - Duke Lim
- Department of Nursing, University of Florida Health, Gainesville, Florida, USA
| | - Tiffany LeGault
- Department of Nursing, University of Florida Health, Gainesville, Florida, USA
| | - Sapheria Pollard
- Department of Nursing, University of Florida Health, Gainesville, Florida, USA
| | - Nicole Gravina
- Department of Psychology, University of Florida, Gainesville, Florida, USA
| | - Frederick S Southwick
- Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
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6
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Rattray M, Roberts S. Dietitians’ Perspectives on the Coordination and Continuity of Nutrition Care for Malnourished or Frail Clients: A Qualitative Study. Healthcare (Basel) 2022; 10:healthcare10060986. [PMID: 35742038 PMCID: PMC9223016 DOI: 10.3390/healthcare10060986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 05/20/2022] [Accepted: 05/24/2022] [Indexed: 01/27/2023] Open
Abstract
Malnutrition and frailty are common conditions that impact overall health and function. There is limited research exploring the barriers and enablers to providing coordinated nutrition care to malnourished or frail clients in the community (including transitions from hospital). This study aimed to explore dietitians’ experiences and perspectives on providing coordinated nutrition care for frail and malnourished clients identified in the community or being discharged from hospital. Semi-structured interviews with clinical/acute, community, and aged care dietitians across Australia and New Zealand were conducted. Interviews were 23–61 min long, audio recorded and transcribed verbatim. Data were analysed using inductive thematic analysis. Eighteen dietitians participated in interviews, including five clinical, eleven community, and two residential aged care dietitians. Three themes, describing key factors influencing the transition and coordination of nutrition care, emerged from the analysis: (i) referral and discharge planning practices, processes, and quality; (ii) dynamics and functions within the multidisciplinary team; and (iii) availability of community nutrition services. Guidelines advising on referral pathways for malnourished/frail clients, improved communication between acute and community dietitians and within the multidisciplinary team, and solutions for community dietetic resource shortages are required to improve the delivery of coordinated nutrition care to at-risk clients.
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Affiliation(s)
- Megan Rattray
- School of Health Sciences and Social Work, Griffith University, Gold Coast 4222, Australia;
- College of Medicine & Public Health, Flinders University, Adelaide 5042, Australia
- Correspondence:
| | - Shelley Roberts
- School of Health Sciences and Social Work, Griffith University, Gold Coast 4222, Australia;
- Allied Health Research, Gold Coast Hospital and Health Service, Gold Coast 4215, Australia
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7
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Singh H, Tang T, Steele Gray C, Kokorelias K, Thombs R, Plett D, Heffernan M, Jarach CM, Armas A, Law S, Cunningham HV, Nie JX, Ellen ME, Thavorn K, Nelson MLA. Recommendations for the Design and Delivery of Transitions-Focused Digital Health Interventions: Rapid Review. JMIR Aging 2022; 5:e35929. [PMID: 35587874 PMCID: PMC9164100 DOI: 10.2196/35929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 04/06/2022] [Indexed: 12/02/2022] Open
Abstract
Background Older adults experience a high risk of adverse events during hospital-to-home transitions. Implementation barriers have prevented widespread clinical uptake of the various digital health technologies that aim to support hospital-to-home transitions. Objective To guide the development of a digital health intervention to support transitions from hospital to home (the Digital Bridge intervention), the specific objectives of this review were to describe the various roles and functions of health care providers supporting hospital-to-home transitions for older adults, allowing future technologies to be more targeted to support their work; describe the types of digital health interventions used to facilitate the transition from hospital to home for older adults and elucidate how these interventions support the roles and functions of providers; describe the lessons learned from the design and implementation of these interventions; and identify opportunities to improve the fit between technology and provider functions within the Digital Bridge intervention and other transition-focused digital health interventions. Methods This 2-phase rapid review involved a selective review of providers’ roles and their functions during hospital-to-home transitions (phase 1) and a structured literature review on digital health interventions used to support older adults’ hospital-to-home transitions (phase 2). During the analysis, the technology functions identified in phase 2 were linked to the provider roles and functions identified in phase 1. Results In phase 1, various provider roles were identified that facilitated hospital-to-home transitions, including navigation-specific roles and the roles of nurses and physicians. The key transition functions performed by providers were related to the 3 categories of continuity of care (ie, informational, management, and relational continuity). Phase 2, included articles (n=142) that reported digital health interventions targeting various medical conditions or groups. Most digital health interventions supported management continuity (eg, follow-up, assessment, and monitoring of patients’ status after hospital discharge), whereas informational and relational continuity were the least supported. The lessons learned from the interventions were categorized into technology- and research-related challenges and opportunities and informed several recommendations to guide the design of transition-focused digital health interventions. Conclusions This review highlights the need for Digital Bridge and other digital health interventions to align the design and delivery of digital health interventions with provider functions, design and test interventions with older adults, and examine multilevel outcomes. International Registered Report Identifier (IRRID) RR2-10.1136/bmjopen-2020-045596
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Affiliation(s)
- Hardeep Singh
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,March of Dimes Canada, Toronto, ON, Canada.,Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Terence Tang
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Carolyn Steele Gray
- Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Kristina Kokorelias
- St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Rachel Thombs
- Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, ON, Canada
| | - Donna Plett
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Matthew Heffernan
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Carlotta M Jarach
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Alana Armas
- March of Dimes Canada, Toronto, ON, Canada.,Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, ON, Canada
| | - Susan Law
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | | | - Jason Xin Nie
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
| | - Moriah E Ellen
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Department of Health Policy and Management, Guilford Glazer Faculty of Business and Management and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Kednapa Thavorn
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Michelle LA Nelson
- March of Dimes Canada, Toronto, ON, Canada.,Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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8
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Risk factors for malnutrition among hospitalized gastroenterological patients. VOJNOSANIT PREGL 2022. [DOI: 10.2298/vsp200605085r] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background/Aim. Risk factors for malnutrition of patients during hospitalization have not been precisely deter-mined. The aim of the study was to determine these factors in hospitalized gastroenterological patients. Methods. Nutritional status (NS) of 650 gastroenterological patients was assessed at the hospital admission and at discharge by the six parameters: unintentional weight loss, lymphocyte count, serum albumin concentration, body mass index, triceps skinfold thickness, and mid-upper arm muscle circumference. The influence on NS at discharge was tested for ten factors: gender, age, affected organ, the nature, severity, and complications of the disease, the length of hospitalization, mobility worsening during hospitalization, Karnofsky score, and NS on admission. Primary and secondary risk factors were defined among the factors significantly influencing malnutrition. Results. Seven factors were found to be the independent predictors for malnutrition in hospitalized gastroenterological patients. NS at admission was considered as a primary risk factor (Forward: Wald multivariate logistic regression analysis, p < 0.001 for five applied assessment parameters). The other six factors, obtained in the evaluation according to 1-3 assessment parameters, were considered as secondary risk factors: severe disease activity, malignancy, the existence of complications, male gender, hospitalization > 14 days, and mobility worsening during the hospitalization (Forward: Wald multivariate logistic regression analysis, p from 0.001 to 0.027). Conclusion. There are seven risk factors for malnutrition among gastroenterological patients during hospitalization. Timely nutritional support in these patients can prevent the development of intrahospital malnutrition and its negative influence on the clinical outcome.
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9
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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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10
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Guigoz Y, Vellas B. Nutritional Assessment in Older Adults : MNA® 25 years of a Screening Tool and a Reference Standard for Care and Research; What Next? J Nutr Health Aging 2021; 25:528-583. [PMID: 33786572 DOI: 10.1007/s12603-021-1601-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A tool to assess nutritional status in older persons was really needed. It took 5 years to design the MNA® (Mini Nutrition Assessment) tool, complete the first validations studies both in Europe and in the U.S. and to publish it. After the full MNA®, the MNA® short form and the self-MNA® have been validated. As well as Chinese and other national MNA® forms. Now more than 2000 clinical research have used the MNA® all over the world from community care to hospital. At least 22 Expert groups included the MNA® in new clinical practice guidelines, national or international registries. The MNA® is presently included in almost all geriatric and nutrition textbook and part of the teaching program for medicine and other health care professional worldwide. The urgent need is to target the frail older adults more likely to have weight loss and poor appetite and to prevent frailty and weight loss in the robust. We present in this paper the review of 25 years of clinical research and practice using the MNA® worldwide.
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Affiliation(s)
- Y Guigoz
- Yves Guigoz, Chemin du Raidillon, CH-1066 Epalinges, Switzerland.
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11
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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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12
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Thirsk J. Knowledge translation. Nutr Diet 2019; 75:341-344. [PMID: 30240105 DOI: 10.1111/1747-0080.12466] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 07/20/2018] [Accepted: 07/20/2018] [Indexed: 11/29/2022]
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13
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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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