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Borkent JW, Van Hout HPJ, Feskens EJM, Naumann E, de van der Schueren MAE. Diseases, Health-Related Problems, and the Incidence of Malnutrition in Long-Term Care Facilities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3170. [PMID: 36833865 PMCID: PMC9959926 DOI: 10.3390/ijerph20043170] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/06/2023] [Accepted: 02/08/2023] [Indexed: 06/18/2023]
Abstract
Certain diseases and malnutrition are known to co-occur in residents of long-term care facilities (LTCF). We assessed which diseases and health-related problems are associated with malnutrition at admission or with incident malnutrition during stays and how different definitions of malnutrition affect these associations. Data of Dutch LTCF residents were obtained from the InterRAI-LTCF instrument (2005-2020). We analyzed the association of diseases (diabetes, cancer, pressure ulcers, neurological, musculoskeletal, psychiatric, cardiac, infectious and pulmonary diseases) and health-related problems (aspiration, fever, peripheral edema, aphasia, pain, supervised/assisted eating, balance, psychiatric, GI tract, sleep, dental and locomotion problems) with malnutrition (recent weight loss (WL), low age-specific BMI (BMI), and ESPEN 2015 definition (ESPEN)) at admission (n = 3713), as well as with incident malnutrition during stay (n = 3836, median follow-up ~1 year). Malnutrition prevalence at admission ranged from 8.8% (WL) to 27.4% (BMI); incident malnutrition during stay ranged from 8.9% (ESPEN) to 13.8% (WL). At admission, most diseases (except cardiometabolic diseases) and health-related problems were associated with higher prevalence of malnutrition based on either criterion, but strongest with WL. This was also seen in the prospective analysis, but relationships were less strong compared to the cross-sectional analysis. A considerable number of diseases and health-related problems are associated with an increased prevalence of malnutrition at admission and incident malnutrition during stays in LTCFs. At admission, low BMI is a good indicator of malnutrition; during stays, we advise use of WL.
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Affiliation(s)
- Jos W. Borkent
- Department of Nutrition and Health, HAN University of Applied Sciences, Kapittelweg 33, 6525 EN Nijmegen, The Netherlands
- Division of Human Nutrition and Health, Wageningen University, Stippeneng 4, 6708 WE Wageningen, The Netherlands
| | - Hein P. J. Van Hout
- Amsterdam University Medical Center, Department of General Practice and Medicine for Older Persons, Vrije Universiteit, Van der Boechorsstraat 7, 1081 BT Amsterdam, The Netherlands
| | - Edith J. M. Feskens
- Division of Human Nutrition and Health, Wageningen University, Stippeneng 4, 6708 WE Wageningen, The Netherlands
| | - Elke Naumann
- Department of Nutrition and Health, HAN University of Applied Sciences, Kapittelweg 33, 6525 EN Nijmegen, The Netherlands
| | - Marian A. E. de van der Schueren
- Department of Nutrition and Health, HAN University of Applied Sciences, Kapittelweg 33, 6525 EN Nijmegen, The Netherlands
- Division of Human Nutrition and Health, Wageningen University, Stippeneng 4, 6708 WE Wageningen, The Netherlands
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Wang X, Shen J, Chen Q. Examining the Needs-Based Time Use of Chinese Nursing Assistants: A Time-Motion Study. J Nurs Res 2022; 30:e246. [PMID: 36201605 DOI: 10.1097/jnr.0000000000000525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND In light of the worldwide shortage of nurses and to maximize the effectiveness of the nursing care available, it is important to investigate the components of the care regularly provided by nursing assistants (NAs) to older adults. Well-organized allocation of NA care activities is directly linked to the quality of care provided to nursing home (NH) residents and their quality of life. However, relevant knowledge about the actual time allocation of NAs in this context is lacking, as previous related studies have focused only on the duration necessary for NAs to complete nursing activities. PURPOSE This study was designed to investigate the time allocation of NAs in completing job tasks necessary to meet the needs of residents in nursing care units at an NH in China. METHODS A time-motion method and nonparticipatory observations were used to collect data. Two postgraduate students observed 15 NAs' time expenditure and nursing content simultaneously during day shifts for 3 weeks as the NAs provided care to residents in four different nursing care levels. Data on nursing time and activity frequency were collected using a worklist based on the Zuluaga-Raysmith model. RESULTS The 119.6 hours of observation included 8,907 discrete observed activities. In terms of the care provided to meet the needs of residents, the most time-consuming activities were physical health care (26.8%) and communication care (18.3%), followed by mental, emotional, social, and spiritual health care (14.1%) and protection and security care (12.6%). The higher the level of care, the higher the proportion of somatic nursing time and nursing activity frequency. However, the time and frequency of psychological and spiritual care showed an opposite trend. CONCLUSIONS Because of their lack of formal nursing training and skills, NAs pay more attention to meeting the physiological needs of residents while ignoring their mental needs. Moreover, their effectiveness in providing spiritual care tends to be quite low. Furthermore, the NA nursing activity classification system based on the Zuluaga-Raysmith model developed in this study is applicable for designing nursing work tasks, organizing NH units, and improving the quality of life of residents, as this model accurately reflects the essence of NA work.
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Affiliation(s)
- Xinxia Wang
- MN, RN, MSN, School of Nursing, Chongqing Medical University, Chongqing, PRC
| | - Jun Shen
- MSN, RN, Professor, School of Nursing, Chongqing Medical University, Chongqing, PRC
| | - Qiu Chen
- MN, RN, MSN, School of Nursing, Chongqing Medical University, Chongqing, PRC
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Kato K, Yoshimi T, Aimoto K, Sato K, Itoh N, Kondo I. Reduction of multiple-caregiver assistance through the long-term use of a transfer support robot in a nursing facility. Assist Technol 2022:1-8. [PMID: 35320681 DOI: 10.1080/10400435.2022.2039324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
The long-term use of transfer support robots in nursing facilities is an important option for improving the efficiency of care work. The "Resyone" transfer support robot is a combination of an electric care bed and a wheelchair, and the wheelchair half of the bed can be detached at the touch of a button. The purpose of this study was to investigate how the long-term use of Resyone would improve the performance of transfer assists, such as reducing the need for multiple caregivers. One Resyone was installed in a nursing facility in Japan and 17 caregivers used it for more than 11 months. The time and number of caregivers required for each transfer assist were surveyed for three 1-week periods: 1 week before (Phase 1) and at 3 weeks (Phase 2) and 11 months (Phase 3) after the introduction of Resyone. In Phase 1, approximately 60% of all transfer assists were performed by two caregivers, but in Phase 2, this was reduced to approximately 20%, and finally, in Phase 3, all transfer assists were performed by a single caregiver. These results suggested that the long-term use of Resyone was associated with improved work efficiency in transfer assistance in a nursing facility.
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Affiliation(s)
- Kenji Kato
- Laboratory for Clinical Evaluation with Robotics, Assistive Robot Center, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Tatsuya Yoshimi
- Laboratory for Clinical Evaluation with Robotics, Assistive Robot Center, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Keita Aimoto
- Department of Rehabilitation Medicine, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Kenji Sato
- Department of Rehabilitation Medicine, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Naoki Itoh
- Department of Rehabilitation Medicine, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Izumi Kondo
- Department of Rehabilitation Medicine, National Center for Geriatrics and Gerontology, Obu, Japan.,Assistive Robot Center, National Center for Geriatrics and Gerontology, Obu, Japan
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Impact of COVID-19 on Relationship-Centred Residential Dining Practices. Can J Aging 2021. [DOI: 10.1017/s0714980821000568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
AbstractThis study describes changes in dining practices and provider perspectives on meal-related challenges due to the coronavirus disease (COVID-19) pandemic. An online survey was disseminated between July and September 2020 through stakeholder networks and social media with 1,036 respondents. Altered dining practices included residents eating in rooms (54.3%), spacing residents in common areas for meals (69.3%), and disposable dish use (44.9%). The most common mealtime challenges were reduced socializing opportunities at meals (29.3%), inadequate staffing (22.8%), reduced family/volunteer help (16.7%), and assisting residents to eat (10.5%). Many participants (72.2%) felt conflict balancing safety and relationship-centred care. Geographic region, home size, building age, respondent’s job title, pre-pandemic relationship-centred practices, and mealtime satisfaction, and some pandemic-initiated practices were associated with mealtime challenges and feeling conflicted in binary logistic regression analyses. Considering trade-offs between safety and relational aspects of mealtimes during the pandemic is crucial.
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Burdick R, Lin TF, Shune SE. Visual Modeling: A Socialization-Based Intervention to Improve Nutritional Intake Among Nursing Home Residents. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:2202-2213. [PMID: 34463561 DOI: 10.1044/2021_ajslp-21-00097] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Purpose Malnutrition is a widespread, dangerous, and costly condition among institutionalized older adults and can be both a contributor to and consequence of dysphagia for individuals with cognitive impairment. However, interventions to maximize intake in individuals with dementia are limited and frequently problematic, with negative implications for independence and quality of life. The goal of this study was to examine a novel, socialization-grounded intervention based on visual modeling, utilizing the theoretical underpinnings of motor resonance and mimicry. Method To examine the impact of environment on intake, data were collected from four nursing home residents (M age = 83.5 years, SD = 4.2; three women) with dementia. Weight of food and liquid intake was measured across 15 meals and three different mealtime conditions: the "baseline condition" in which the individual ate alone, the "watch condition" in which the individual ate in the company of a "mealtime buddy," and the "eat" condition in which the individual consumed a meal while the "mealtime buddy" did the same. Results Data visualization supported a weak functional relation between eating environment and amount of intake consumed across participants. Log response ratio estimates suggested a trend for increased weight of food consumed during the eat condition as compared to baseline and the eat condition as compared to the watch condition for some participants. Conclusions These results preliminarily support the benefit of a visual model for increased consumption in some individuals with dementia. The presence and magnitude of the effect across conditions varied based on individual-level factors, such as cognitive status, which has implications for implementation. Overall, this study provides initial proof of concept regarding the use of visual modeling as an intervention approach, laying the foundation for larger scale future studies.
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Affiliation(s)
- Ryan Burdick
- Genesis Rehab Services, Kennett Square, PA
- Swallowing and Salivary Bioscience Lab, Department of Medicine, University of Wisconsin-Madison
| | - Ting-fen Lin
- Communication Disorders and Sciences, University of Oregon,Eugene
- Department of Communicative Sciences and Deaf Studies, California State University, Fresno
| | - Samantha E Shune
- Communication Disorders and Sciences, University of Oregon,Eugene
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Kato K, Yoshimi T, Tsuchimoto S, Mizuguchi N, Aimoto K, Itoh N, Kondo I. Identification of care tasks for the use of wearable transfer support robots - an observational study at nursing facilities using robots on a daily basis. BMC Health Serv Res 2021; 21:652. [PMID: 34225718 PMCID: PMC8256590 DOI: 10.1186/s12913-021-06639-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 06/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To reduce the physical burden of caregivers, wearable transfer support robots are highly desirable. Although these robots are reportedly effective for specific tasks in experimental environments, there is little information about their effectiveness at nursing care facilities. The aim of this study was to identify care tasks and operations suitable for the use of these robots among caregivers in nursing facilities where these robots have been in use on a daily basis. METHODS A 1-min observational time-motion analysis was conducted to examine care tasks and operations in two nursing facilities where wearable transfer support robots, namely Muscle Suit or HAL® Lumbar Type for Care Support, have been used routinely on a daily basis for more than 24 months. RESULTS Analysis of the care tasks and their time ratio while wearing the equipment revealed that both robots were used conspicuously for direct care in over 70% of transits, especially during transfer assistance and toileting care. Furthermore, these robots were used intensively in the morning along with wake-up calls to care recipients, where pre-assigned wearers used them as part of their "routine work." CONCLUSIONS We found that these wearable transfer support robots enabled effective performance of care tasks and operations in nursing facilities where these robots have been used on a daily basis for an extended period of time. These results may lead to the effective implementation and sustained operation of other types of care robots in the future. TRIAL REGISTRATION UMIN Clinical Trials Registry no. UMIN000039204 . Trial registration date: January 21, 2020. Interventional study. Parallel, non-randomized, single blinded.
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Affiliation(s)
- Kenji Kato
- Laboratory for Clinical Evaluation with Robotics, Center of Assistive Robotics and Rehabilitation for Longevity and Good Health, National Center for Geriatrics and Gerontology, 7-430, Morioka, Obu, Aichi, 474-8511, Japan.
| | - Tatsuya Yoshimi
- Laboratory for Clinical Evaluation with Robotics, Center of Assistive Robotics and Rehabilitation for Longevity and Good Health, National Center for Geriatrics and Gerontology, 7-430, Morioka, Obu, Aichi, 474-8511, Japan
| | - Shohei Tsuchimoto
- Laboratory for Clinical Evaluation with Robotics, Center of Assistive Robotics and Rehabilitation for Longevity and Good Health, National Center for Geriatrics and Gerontology, 7-430, Morioka, Obu, Aichi, 474-8511, Japan
| | - Nobuaki Mizuguchi
- Laboratory for Clinical Evaluation with Robotics, Center of Assistive Robotics and Rehabilitation for Longevity and Good Health, National Center for Geriatrics and Gerontology, 7-430, Morioka, Obu, Aichi, 474-8511, Japan
| | - Keita Aimoto
- Department of Rehabilitation Medicine, National Center for Geriatrics and Gerontology, 7-430, Morioka, Obu, Aichi, 474-8511, Japan
| | - Naoki Itoh
- Department of Rehabilitation Medicine, National Center for Geriatrics and Gerontology, 7-430, Morioka, Obu, Aichi, 474-8511, Japan
| | - Izumi Kondo
- Department of Rehabilitation Medicine, National Center for Geriatrics and Gerontology, 7-430, Morioka, Obu, Aichi, 474-8511, Japan.,Center of Assistive Robotics and Rehabilitation for Longevity and Good Health, National Center for Geriatrics and Gerontology, 7-430, Morioka, Obu, Aichi, 474-8511, Japan
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Xavier JS, Gois ACB, Travassos LDCP, Pernambuco L. Oropharyngeal dysphagia frequency in older adults living in nursing homes: an integrative review. Codas 2021; 33:e20200153. [PMID: 34161439 DOI: 10.1590/2317-1782/20202020153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 07/13/2020] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To synthesize the scientific knowledge on the frequency of oropharyngeal dysphagia in older adults living in nursing homes. RESEARCH STRATEGIES The study question followed the PECO strategy and the search was performed in the Pubmed/Medline, Web of Science, Scopus, LILACS and SciELO databases, using keywords and specific free terms. SELECTION CRITERIA articles with no time or language restrictions that reported the frequency of oropharyngeal dysphagia in older adults living in nursing homes and the diagnostic criteria. DATA ANALYSIS it was analyzed the population characteristics, the concept of "oropharyngeal dysphagia", the methods for identifying the outcome and the frequency of oropharyngeal dysphagia. The evaluation of the methodological quality of the articles followed the criteria of Strengthening the Reporting of Observational Studies in Epidemiology (STROBE). RESULTS Fifteen articles were included. There was great variability in relation to the sample size, with a predominance of longevous old women. The concept of dysphagia, when mentioned, was heterogeneous. Diagnostic criteria were diverse and mostly comprised of questionnaires or clinical trials results. No studies used instrumental tests. The frequency of oropharyngeal dysphagia in the studied population ranged from 5.4% to 83.7%, being higher in studies that used clinical tests, but with greater precision of confidence intervals in studies that used questionnaires and large sample size. CONCLUSION The frequency of oropharyngeal dysphagia in older adults living in nursing homes has wide variability. Methodological discrepancies among studies compromise the reliability of frequency estimates and highlight the need for research with better defined and standardized methodological criteria.
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Affiliation(s)
- Jessica Soares Xavier
- Programa Associado de Pós-graduação em Fonoaudiologia, Universidade Federal da Paraíba - UFPB - João Pessoa (PB), Brasil
| | - Amanda Cibelly Brito Gois
- Programa de Pós-graduação em Saúde Coletiva, Universidade Federal do Rio Grande do Norte - UFRN - Natal (RN), Brasil
| | | | - Leandro Pernambuco
- Programa Associado de Pós-graduação em Fonoaudiologia, Universidade Federal da Paraíba - UFPB - João Pessoa (PB), Brasil.,Programa de Pós-graduação em Modelos de Decisão e Saúde, Universidade Federal da Paraíba - UFPB - João Pessoa (PB), Brasil.,Departamento de Fonoaudiologia, Universidade Federal da Paraíba - UFPB - João Pessoa (PB), Brasil
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Travers JL, Teitelman AM, Jenkins KA, Castle NG. Exploring social-based discrimination among nursing home certified nursing assistants. Nurs Inq 2019; 27:e12315. [PMID: 31398775 DOI: 10.1111/nin.12315] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 07/04/2019] [Accepted: 07/04/2019] [Indexed: 12/11/2022]
Abstract
Certified nursing assistants (CNAs) provide the majority of direct care to nursing home residents in the United States and, therefore, are keys to ensuring optimal health outcomes for this frail older adult population. These diverse direct care workers, however, are often not recognized for their important contributions to older adult care and are subjected to poor working conditions. It is probable that social-based discrimination lies at the core of poor treatment toward CNAs. This review uses perspectives from critical social theory to explore the phenomenon of social-based discrimination toward CNAs that may originate from social order, power, and culture. Understanding manifestations of social-based discrimination in nursing homes is critical to creating solutions for severe disparity problems among perceived lower-class workers and subsequently improving resident care delivery.
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Affiliation(s)
- Jasmine L Travers
- National Clinician Scholars Program, Yale University Schools of Medicine and Nursing, New Haven, CT, USA
| | - Anne M Teitelman
- Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Kevin A Jenkins
- Perelman School of Medicine, University of Pennsylvania School of Social Policy and Practice, Philadelphia, PA, USA
| | - Nicholas G Castle
- Department of Health Policy, Management and Leadership, West Virginia University, Morgantown, WV, USA
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Pfisterer KJ, Boger J, Wong A. Prototyping the Automated Food Imaging and Nutrient Intake Tracking System: Modified Participatory Iterative Design Sprint. JMIR Hum Factors 2019; 6:e13017. [PMID: 31094336 PMCID: PMC6532336 DOI: 10.2196/13017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 02/27/2019] [Accepted: 04/06/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND A total of 45% of older adults living in long-term care (LTC) have some form of malnutrition. Several methods of tracking food and fluid intake exist, but they are limited in terms of their accuracy and ease of application. An easy-to-use, objective, accurate, and comprehensive food intake system designed with LTC in mind may provide additional insights regarding nutritional support systems and nutritional interventions. OBJECTIVE The aim of this study was to conduct a multistage participatory iterative design sprint of a Goldilocks quality horizontal prototype for the Automated Food Imaging and Nutrient Intake Tracking (AFINI-T) system. Specific design objectives included the following: (1) identify practice-relevant problems and solutions through user-centered participatory design, (2) mitigate feasibility-related barriers to uptake, and (3) employ user-centered technology development. METHODS A 6-stage iterative participatory design sprint was developed and executed. A total of 38 participants and advisors representing 15 distinct roles (eg, personal support worker, nurse, and dietitian) were engaged in the design sprint. Subjective workload (Raw Task Load Index), subjective usability scales, and a modified Ravden checklist were used to assess project advisors' perceptions of the AFINI-T system prototype compared with the current method of food and fluid intake charting. RESULTS The top priorities for this system were identified as the following: ease of use, high accuracy, system reliability, ease of maintenance, and requirement of integrating with the current PointClickCare system. Data from project advisors informed design decisions leading to a Goldilocks quality horizontal prototype of the AFINI-T system. Compared with the current food and fluid intake charting system, AFINI-T was perceived to have the following: less time demands (t10.8=4.89; P<.001), less effort (t13.5=5.55; P<.001), and less frustration (t13.0=3.80; P=.002). Usability ratings of the AFINI-T prototype were high, with a subjective usability score mean of 89.2 and the highest ratings on a modified Ravden usability checklist of "very satisfactory" for 7 out of 8 sections. CONCLUSIONS The AFINI-T concept system appears to have good practice relevance as a tool for an intelligent food and fluid intake tracking system in LTC. The AFINI-T concept system may provide improvement over the current system, and advisors are keen to try the AFINI-T system. This research gives tangible examples of how the sprint method can be adapted and applied to the development of novel needs-based application-driven technology.
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Affiliation(s)
- Kaylen J Pfisterer
- Department of Systems Design Engineering, University of Waterloo, Waterloo, ON, Canada.,Schlegel-UW Research Institute for Aging, Waterloo, ON, Canada
| | - Jennifer Boger
- Department of Systems Design Engineering, University of Waterloo, Waterloo, ON, Canada.,Schlegel-UW Research Institute for Aging, Waterloo, ON, Canada
| | - Alexander Wong
- Department of Systems Design Engineering, University of Waterloo, Waterloo, ON, Canada.,Schlegel-UW Research Institute for Aging, Waterloo, ON, Canada
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Simmons SF, Coelho CS, Sandler A, Shah AS, Schnelle JF. Managing Person-Centered Dementia Care in an Assisted Living Facility: Staffing and Time Considerations. THE GERONTOLOGIST 2018; 58:e251-e259. [PMID: 28575376 DOI: 10.1093/geront/gnx089] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Indexed: 11/14/2022] Open
Abstract
Background and Objectives To describe (a) the unlicensed staff time necessary to provide quality activities of daily living (ADL) care to residents receiving dementia care within an assisted living facility and (b) a staff management approach to maintain quality ADL care. Research Design and Methods Supervisory staff used a standardized observational method to measure ADL care quality and the staff time to provide care during the morning and evening across 12 consecutive months. Staff were given individual feedback about the quality of their care provision following each observation. Results The average staff time to provide ADL care averaged 35 (± 11) minutes per resident per care episode with bathing and 18 (± 6) minutes/resident/care episode without bathing. Morning ADL care required significantly more staff time than evening care. There was not a significant relationship between residents' levels of cognitive impairment or ADL dependency and the staff time to provide ADL care. Quality ADL care was maintained for 12 months. Discussion and Implications This study provides novel data related to the amount of staff time necessary to provide quality ADL care for persons with dementia in an assisted living care setting. This study also describes a standardized approach to staff management that was effective in maintaining quality ADL care provision. Assisted living facilities should consider these data when determining the necessary unlicensed staffing level to provide person-centered ADL care and how to effectively manage direct care providers.
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Affiliation(s)
- Sandra F Simmons
- Center for Quality Aging, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.,Division of Geriatrics, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.,Geriatric Research, Education and Clinical Center (GRECC), VA Tennessee Valley Healthcare System, Nashville
| | - Chris S Coelho
- Abe's Garden®, Alzheimer's and Memory Care Center of Excellence, Nashville, Tennessee
| | - Andrew Sandler
- Abe's Garden®, Alzheimer's and Memory Care Center of Excellence, Nashville, Tennessee
| | - Avantika S Shah
- Center for Quality Aging, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.,Division of Geriatrics, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.,Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - John F Schnelle
- Center for Quality Aging, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.,Division of Geriatrics, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.,Geriatric Research, Education and Clinical Center (GRECC), VA Tennessee Valley Healthcare System, Nashville
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Evaluating the Feasibility and Validity of Using Trained Allied Health Assistants to Assist in Mealtime Monitoring of Dysphagic Patients. Dysphagia 2018; 34:350-359. [DOI: 10.1007/s00455-018-9947-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 09/17/2018] [Indexed: 10/28/2022]
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12
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ESPEN guideline on clinical nutrition and hydration in geriatrics. Clin Nutr 2018; 38:10-47. [PMID: 30005900 DOI: 10.1016/j.clnu.2018.05.024] [Citation(s) in RCA: 642] [Impact Index Per Article: 107.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 05/29/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND Malnutrition and dehydration are widespread in older people, and obesity is an increasing problem. In clinical practice, it is often unclear which strategies are suitable and effective in counteracting these key health threats. AIM To provide evidence-based recommendations for clinical nutrition and hydration in older persons in order to prevent and/or treat malnutrition and dehydration. Further, to address whether weight-reducing interventions are appropriate for overweight or obese older persons. METHODS This guideline was developed according to the standard operating procedure for ESPEN guidelines and consensus papers. A systematic literature search for systematic reviews and primary studies was performed based on 33 clinical questions in PICO format. Existing evidence was graded according to the SIGN grading system. Recommendations were developed and agreed in a multistage consensus process. RESULTS We provide eighty-two evidence-based recommendations for nutritional care in older persons, covering four main topics: Basic questions and general principles, recommendations for older persons with malnutrition or at risk of malnutrition, recommendations for older patients with specific diseases, and recommendations to prevent, identify and treat dehydration. Overall, we recommend that all older persons shall routinely be screened for malnutrition in order to identify an existing risk early. Oral nutrition can be supported by nursing interventions, education, nutritional counseling, food modification and oral nutritional supplements. Enteral nutrition should be initiated if oral, and parenteral if enteral nutrition is insufficient or impossible and the general prognosis is altogether favorable. Dietary restrictions should generally be avoided, and weight-reducing diets shall only be considered in obese older persons with weight-related health problems and combined with physical exercise. All older persons should be considered to be at risk of low-intake dehydration and encouraged to consume adequate amounts of drinks. Generally, interventions shall be individualized, comprehensive and part of a multimodal and multidisciplinary team approach. CONCLUSION A range of effective interventions is available to support adequate nutrition and hydration in older persons in order to maintain or improve nutritional status and improve clinical course and quality of life. These interventions should be implemented in clinical practice and routinely used.
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Iuglio S, Keller H, Chaudhury H, Slaughter SE, Lengyel C, Morrison J, Boscart V, Carrier N. Construct Validity of the Mealtime Scan: A Secondary Data Analysis of the Making Most of Mealtimes (M3) Study. J Nutr Gerontol Geriatr 2018; 37:82-104. [PMID: 29781782 DOI: 10.1080/21551197.2018.1461166] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Long-term care (LTC) physical and psychosocial mealtime environments have been inconsistently assessed due to the lack of a standardized measure. The purpose of this study was to examine the construct validity of a new standardized observational measure, the Mealtime Scan (MTS), using the Making Most of Mealtimes data collected on 639 residents in 82 dining rooms in 32 LTC homes. The MTS includes physical, social, and person-centered care summary scales scored from 1 to 8. Mean ratings on these summary scales were moderate for physical (5.6 SD 0.9), social (5.0 SD 0.9), and person-centered care (PCC; 5.5 SD 0.8). Regression analyses determined which items within the MTS were associated with these summary scales: physical - music (B = 0.27, p = 0.04), number of staff passing food (B = -0.11, p = 0.03), number of residents (B = -0.03, p = 0.01); social - social sound (B = 0.31 p < 0.0001), number of residents requiring eating assistance (B = 0.11, p = 0.02); PCC - lighting (B = 0.01 p = 0.04), and total excess noise (B = 0.05, p < 0.0001). The Mealtime Relational Care Checklist (M-RCC) was associated positively with ratings on all three summary scales. Correlations revealed that the MTS summary scales were associated with other constructs: Dining Environment Audit Protocol functionality scale, resident and dining room level M-RCC, Mini Nutritional Assessment- Short Form, and resident Cognitive Performance Scale. These results demonstrate that the MTS summary scales exhibit construct validity, as the ratings were associated with expected observed mealtime characteristics and correlated with dining room and resident level constructs in anticipated directions.
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Affiliation(s)
| | - Heather Keller
- b University of Waterloo ; Schlegel-UW Research Institute for Aging , Waterloo , Canada
| | | | | | | | | | - Veronique Boscart
- f Conestoga College ; Schlegel-UW Research Institute for Aging , Kitchener , Canada
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Qian S, Yu P, Hailey D. Nursing staff work patterns in a residential aged care home: a time-motion study. AUST HEALTH REV 2018; 40:544-554. [PMID: 26615222 DOI: 10.1071/ah15126] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 10/16/2015] [Indexed: 11/23/2022]
Abstract
Objective Residential aged care services are challenged by an increasing number of residents and a shortage of nursing staff. Developing strategies to overcome this challenge requires an understanding of nursing staff work patterns. The aim of the present study was to investigate the work processes followed by nursing staff and how nursing time is allocated in a residential aged care home. Methods An observational time-motion study was conducted at two aged care units for 12 morning shifts. Seven nurses were observed, one per shift. Results In all, there were 91h of observation. The results showed that there was a common work process followed by all nurse participants. Medication administration, documentation and verbal communication were the most time-consuming activities and were conducted most frequently. No significant difference between the two units was found in any category of activities. The average duration of most activities was less than 1min. There was no difference in time utilisation between the endorsed enrolled nurses and the personal carers in providing nursing care. Conclusion Medication administration, documentation and verbal communication were the major tasks in morning shifts in a residential aged care home. Future research can investigate how verbal communication supports nursing care. What is known about the topic? The aging population will substantially increase the demand for residential aged care services. There is a lack of research on nurses' work patterns in residential aged care homes. What does this paper add? The present study provides a comprehensive understanding of nurses' work patterns in a residential aged care home. There is a common work process followed by nurses in providing nursing care. Medication administration, verbal communication and documentation are the most time-consuming activities and they are frequently conducted in the same period of time. Wound care, physical review and documentation on desktop computers are arranged flexibly by the nurses. What are the implications for practitioners? When developing a task reallocation strategy to improve work efficiency, effort can be put into tasks that can be arranged more flexibly.
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Affiliation(s)
- Siyu Qian
- School of Computing and Information Technology, University of Wollongong, Northfields Avenue, Wollongong, NSW 2522, Australia.
| | - Ping Yu
- School of Computing and Information Technology, University of Wollongong, Northfields Avenue, Wollongong, NSW 2522, Australia.
| | - David Hailey
- School of Computing and Information Technology, University of Wollongong, Northfields Avenue, Wollongong, NSW 2522, Australia.
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15
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Affiliation(s)
- M Payne
- John E. Morley, MB,BCh, Division of Geriatric Medicine, Saint Louis University School of Medicine, 1402 S. Grand Blvd., M238, St. Louis, MO 63104,
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Morley JE. Editorial: Defining Undernutrition (Malnutrition) in Older Persons. J Nutr Health Aging 2018; 22:308-310. [PMID: 29484342 DOI: 10.1007/s12603-017-0991-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- J E Morley
- John E. Morley, MB,BCh, Division of Geriatric Medicine, Saint Louis University School of Medicine, 1402 S. Grand Blvd., M238, St. Louis, MO 63104,
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17
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Staffing in Ontario's Long-Term Care Homes: Differences by Profit Status and Chain Ownership. Can J Aging 2017; 35:175-89. [PMID: 27223577 DOI: 10.1017/s0714980816000192] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Ontario has the highest proportion of for-profit nursing homes in Canada. These facilities, which are known in Ontario as long-term care (LTC) homes, offer 24-hour custodial as well as nursing care to individuals who cannot live independently. Increasingly, they are also operating as members of multi-facility chains. Using longitudinal data (1996-2011) from the Residential Care Facilities Survey (n = 627), our analysis revealed discernible differences in staffing levels by profit status and chain affiliation. We found for-profit LTC homes - especially those owned by a chain organization - provided significantly fewer hours of care, after adjusting for variation in the residents' care needs. Findings from this study offer new information on the impact of organizational structure on staffing levels in Ontario's LTC homes and have implications for other jurisdictions where a growing presence of private, chain-affiliated operators has been observed.
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18
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Schnelle JF, Schroyer LD, Saraf AA, Simmons SF. Determining Nurse Aide Staffing Requirements to Provide Care Based on Resident Workload: A Discrete Event Simulation Model. J Am Med Dir Assoc 2016; 17:970-977. [DOI: 10.1016/j.jamda.2016.08.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 08/19/2016] [Indexed: 11/17/2022]
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Hollingsworth EK, Long EA, Simmons SF. Comparison Between Quality of Care Provided by Trained Feeding Assistants and Certified Nursing Assistants During Between-Meal Supplementation in Long-Term Care Settings. J Appl Gerontol 2016; 37:1391-1410. [DOI: 10.1177/0733464816669806] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The purpose of this study was to compare the quality of feeding assistance provided by trained non-nursing staff with care provided by certified nursing assistants (CNAs). Research staff provided an 8-hr training course that met federal and state requirements to non-nursing staff in five community long-term care facilities. Trained staff were assigned to between-meal supplement and/or snack delivery for 24 weeks. Using standardized observations, research staff measured feeding assistance care processes between meals across all study weeks. Trained staff, nurse aides, and upper level staff were interviewed at 24 weeks to assess staff perceptions of program impact. Trained staff performed significantly better than CNAs for 12 of 13 care process measures. Residents also consumed significantly more calories per snack offer from trained staff ( M = 130 ± 126 [ SD] kcal) compared with CNAs ( M = 77 ± 94 [ SD] kcal). The majority of staff reported a positive impact of the training program.
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Affiliation(s)
| | - Emily A. Long
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sandra F. Simmons
- Vanderbilt University Medical Center, Nashville, TN, USA
- Tennessee Valley Healthcare System, Nashville, TN, USA
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20
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Simmons SF, Keeler E, An R, Liu X, Shotwell MS, Kuertz B, Silver HJ, Schnelle JF. Cost-Effectiveness of Nutrition Intervention in Long-Term Care. J Am Geriatr Soc 2015; 63:2308-16. [PMID: 26503137 DOI: 10.1111/jgs.13709] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To determine the cost-effectiveness of two nutrition interventions on food, beverage, and supplement intake and body weight. DESIGN Randomized, controlled trial. SETTING Five skilled nursing home facilities. PARTICIPANTS Long-stay residents with orders for nutrition supplementation (N = 154). INTERVENTION Participants were randomized into a usual care control group, an oral liquid nutrition supplement (ONS) intervention group, or a snack intervention group. Research staff provided ONS, according to orders or a variety of snack foods and beverages twice per day between meals, 5 days per week for 24 weeks and assistance to promote consumption. MEASUREMENTS Research staff independently weighed residents at baseline and monthly during the 24-week intervention. Resident food, beverage and supplement intake and the amount of staff time spent providing assistance were assessed for 2 days at baseline and 2 days per month during the intervention using standardized observation and weighed intake procedures. RESULTS The ONS intervention group took in an average of 265 calories more per day and the snack intervention group an average of 303 calories more per day than the control group. Staff time required to provide each intervention averaged 11 and 14 minutes per person per offer for ONS and snacks, respectively, and 3 minutes for usual care. Both interventions were cost-effective in increasing caloric intake, but neither intervention had a significant effect on body weight, despite positive trends. CONCLUSION Oral liquid nutrition supplements and snack offers were efficacious in promoting caloric intake when coupled with assistance to promote consumption and a variety of options, but neither intervention resulted in significant weight gain.
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Affiliation(s)
- Sandra F Simmons
- Center for Quality Aging, Division of Geriatrics, Vanderbilt University, Nashville, Tennessee.,Geriatric Research Education and Clinical Center, Veterans Affairs Medical Center, Nashville, Tennessee
| | - Emmett Keeler
- Rand Corporation, Santa Monica, California.,Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, Illinois
| | - Ruopeng An
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, Illinois
| | - Xulei Liu
- Department of Biostatistics, Vanderbilt University, Nashville, Tennessee
| | - Matthew S Shotwell
- Department of Biostatistics, Vanderbilt University, Nashville, Tennessee
| | - Brittany Kuertz
- Center for Quality Aging, Division of Geriatrics, Vanderbilt University, Nashville, Tennessee
| | - Heidi J Silver
- Division of Gastroenterology, Hepatology and Nutrition, School of Medicine, Vanderbilt University, Nashville, Tennessee
| | - John F Schnelle
- Center for Quality Aging, Division of Geriatrics, Vanderbilt University, Nashville, Tennessee.,Geriatric Research Education and Clinical Center, Veterans Affairs Medical Center, Nashville, Tennessee
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21
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Lahmann NA, Tannen A, Suhr R. Underweight and malnutrition in home care: A multicenter study. Clin Nutr 2015; 35:1140-6. [PMID: 26460221 DOI: 10.1016/j.clnu.2015.09.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 07/15/2015] [Accepted: 09/14/2015] [Indexed: 01/29/2023]
Abstract
BACKGROUND & OBJECTIVES This study aimed to provide representative figures about the prevalence of underweight and malnutrition among home care clients, and to determine the associated risk factors and the provided nutritional nursing interventions. METHODS In 2012, a multicenter point prevalence study was conducted among 878 randomly selected clients from 100 randomly selected home care services across Germany. Following a standardized study protocol, demographics, nutritional assessments (Body Mass Index, Malnutrition Universal Screening Tool (MUST), Mini nutritional Assessment - short form (MNA-sf), nurses' clinical judgment on nutritional status) and interventions were assessed. Common nutritional risk factors for underweight and malnutrition were analyzed in a logistic regression model. RESULTS Malnutrition figures varied between 4.8% (MNA-sf) and 6.8% (MUST), underweight between 8.7% (BMI < 20 kg/m(2)) and 10.2% (clinical judgment). Missing values were high in both malnutrition assessments (MNA-sf 48.8%, MUST 39.1%) due to a lack of information on many clients' loss of weight within the past 3-6 months. Regular weighing was performed in 33.6-57.3% of all clients, depending on weight and nutritional status. Mental overload (OR 8.1/4.4), needs help with feeding (OR 5.0/2.8) and loss of appetite (OR 3.6/3.9) were highly associated with malnutrition/underweight. CONCLUSION Malnutrition and underweight are important issues in home care clients. Regular weighing should be performed in all home care clients so that a potential weight loss can be detected in time.
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Affiliation(s)
- Nils A Lahmann
- Department of Health and Nursing Science, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, D-13359 Berlin, Germany.
| | - Antje Tannen
- Department of Health and Nursing Science, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, D-13359 Berlin, Germany
| | - Ralf Suhr
- Centre for Quality in Care Foundation, Reinhardtstr. 45, D-10117 Berlin, Germany
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22
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Chen LL, Li H, Lin R, Zheng JH, Wei YP, Li J, Chen P, Chen HY. Effects of a feeding intervention in patients with Alzheimer's disease and dysphagia. J Clin Nurs 2015; 25:699-707. [PMID: 26420351 DOI: 10.1111/jocn.13013] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Li-Li Chen
- Fujian Medical University Affiliated Clinical Medical Institute; Fujian Provincial Hospital; Nursing School of Fujian Medical University; Fuzhou City China
| | - Hong Li
- Fujian Medical University Affiliated Clinical Medical Institute; Fujian Provincial Hospital; Nursing School of Fujian Medical University; Fuzhou City China
| | - Rong Lin
- Fujian Medical University Affiliated Clinical Medical Institute; Fujian Provincial Hospital; Nursing School of Fujian Medical University; Fuzhou City China
| | - Jian-Huang Zheng
- Fujian Medical University Affiliated Clinical Medical Institute; Fujian Provincial Hospital; Nursing School of Fujian Medical University; Fuzhou City China
- Fujian Medical University 2nd Affiliated Hospital; Quanzhou Fujian Province Fuzhou City China
| | - Yan-Ping Wei
- Fujian Medical University Affiliated Clinical Medical Institute; Fujian Provincial Hospital; Nursing School of Fujian Medical University; Fuzhou City China
| | - Jing Li
- Fujian Medical University Affiliated Clinical Medical Institute; Fujian Provincial Hospital; Nursing School of Fujian Medical University; Fuzhou City China
| | - Ping Chen
- Fujian Medical University Affiliated Clinical Medical Institute; Fujian Provincial Hospital; Nursing School of Fujian Medical University; Fuzhou City China
| | - Hui-Ying Chen
- Fujian Medical University Affiliated Clinical Medical Institute; Fujian Provincial Hospital; Nursing School of Fujian Medical University; Fuzhou City China
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23
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Douglas JW, Lawrence JC. Environmental Considerations for Improving Nutritional Status in Older Adults with Dementia: A Narrative Review. J Acad Nutr Diet 2015; 115:1815-31. [PMID: 26233887 DOI: 10.1016/j.jand.2015.06.376] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 06/17/2015] [Indexed: 11/17/2022]
Abstract
As the number of older adults in the United States continues to grow, the American health care system will face the unique challenge of providing care for these individuals, including many who will be diagnosed with some form of dementia. As dementia progresses, patients require increasing amounts of care and nutrient intake usually declines. This tends to result in weight loss, malnutrition, and increased morbidity and mortality. Various interventions have been developed with the goal of improving meal intake and reducing unintentional weight loss in patients with dementia. Several studies have shown that meal intake improves with the provision of adequate assistance, either from staff members or from volunteer feeding assistants. Some studies have focused on the method of meal service and its influence on meal intake and nutrition status. Both buffet-style and family-style dining have shown promising results in terms of improving meal intake and quality of life among older adults in long-term-care settings. Other environment-related interventions include improving lighting and visual contrast, altering the dining room to more closely resemble a home-style setting, using the aroma of food to stimulate appetite, using routine seating arrangements, and using relaxing or familiar music in the dining room to provide a calmer environment. The purpose of this review is to evaluate the research on environment-based interventions to improve nutritional status among older adults with dementia, to describe potential for practical applications, and to identify gaps in the existing literature whereon further research is warranted.
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Batchelor-Murphy M, Amella EJ, Zapka J, Mueller M, Beck C. Feasibility of a web-based dementia feeding skills training program for nursing home staff. Geriatr Nurs 2015; 36:212-8. [PMID: 25769703 DOI: 10.1016/j.gerinurse.2015.02.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 02/02/2015] [Accepted: 02/02/2015] [Indexed: 11/18/2022]
Abstract
Nursing home (NH) staff do not receive adequate training for providing feeding assistance to residents with dementia who exhibit aversive feeding behaviors (e.g., clamping mouth shut). The result is often low meal intake for these residents. This feasibility study tested a web-based dementia feeding skills program for staff in two United States NHs. Randomly assigned, the intervention staff received web-based dementia feeding skills training with coaching. Both groups participated in web-based pre-/post-tests assessing staff knowledge and self-efficacy; and meal observations measured NH staff and resident feeding behaviors, time for meal assistance, and meal intake. Aversive feeding behaviors increased in both groups of residents; however, the intervention NH staff increased the amount of time spent providing assistance and meal intake doubled. In the control group, less time was spent providing assistance and meal intake decreased. This study suggests that training staff to use current clinical practice guidelines improves meal intake.
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Affiliation(s)
- Melissa Batchelor-Murphy
- Hartford National Centers for Gerontological Nursing Excellence, USA; Duke University School of Nursing, DUMC 3322, 307 Trent Drive, Durham, NC 27710, USA.
| | - Elaine J Amella
- College of Nursing, Medical University of South Carolina, 99 Jonathan Lucas Street, Charleston, SC 29425, USA
| | - Jane Zapka
- College of Nursing, Medical University of South Carolina, 99 Jonathan Lucas Street, Charleston, SC 29425, USA
| | - Martina Mueller
- College of Nursing, Medical University of South Carolina, 99 Jonathan Lucas Street, Charleston, SC 29425, USA
| | - Cornelia Beck
- College of Medicine, Department of Geriatrics, University of Arkansas for Medical Sciences, USA; Arkansas John A. Hartford Center of Geriatric Nursing Excellence, USA
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25
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Chuang YH, Abbey JA, Yeh YC, Tseng IJ, Liu MF. As they see it: A qualitative study of how older residents in nursing homes perceive their care needs. Collegian 2015; 22:43-51. [PMID: 26285408 DOI: 10.1016/j.colegn.2013.11.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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26
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Gaff L, Jones J, Davidson IH, Bannerman E. A study of fluid provision and consumption in elderly patients in a long-stay rehabilitation hospital. J Hum Nutr Diet 2015; 28:384-9. [DOI: 10.1111/jhn.12294] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- L. Gaff
- School of Health Sciences; Queen Margaret University; Queen Margaret University Drive; Musselburgh UK
| | - J. Jones
- School of Health Sciences; Queen Margaret University; Queen Margaret University Drive; Musselburgh UK
| | - I. H. Davidson
- School of Health Sciences; Queen Margaret University; Queen Margaret University Drive; Musselburgh UK
| | - E. Bannerman
- School of Health Sciences; Queen Margaret University; Queen Margaret University Drive; Musselburgh UK
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27
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Kaehr E, Visvanathan R, Malmstrom TK, Morley JE. Frailty in Nursing Homes: The FRAIL-NH Scale. J Am Med Dir Assoc 2015; 16:87-9. [DOI: 10.1016/j.jamda.2014.12.002] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 12/01/2014] [Indexed: 10/24/2022]
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28
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Lee KM, Song JA. Factors influencing the degree of eating ability among people with dementia. J Clin Nurs 2015; 24:1707-17. [PMID: 25623819 DOI: 10.1111/jocn.12777] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2014] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To explore the degree of eating ability in people with dementia and identify what factors affect their eating ability. BACKGROUND Appropriate food consumption is important to human life. Although eating difficulties are common among people with dementia, little is known about what factors might influence their eating ability. DESIGN Descriptive, cross-sectional study. METHODS A total of 149 people with dementia residing in nursing facilities in Seoul or the Gyeonggi area of Korea were evaluated using the Korean Mini-Mental State Examination, Korean Activities of Daily Living Scale and Eating Behaviour Scale. Data were analysed using descriptive statistics, one-way analysis of variance, Pearson correlation coefficient and multiple regression analysis. RESULTS The participants showed a moderate level of dependency with respect to eating ability and were most dependent on the use of utensils. There were significant differences in eating ability according to general characteristics such as duration of residence, duration of illness, degree of visual impairment, eating place, and diet type. The eating ability of the participants was significantly correlated with cognitive function and physical function. Cognitive function, physical function, duration of illness, eating place (living room or dining room), and diet type (soft or liquid) significantly predicted eating ability in people with dementia. CONCLUSIONS The findings of this study suggest that it is necessary to thoroughly assess the eating ability of people with dementia and to develop appropriate training programs to maintain or improve their remaining eating ability. The creation of a pleasurable physical and social environment for eating might also be helpful. RELEVANCE TO CLINICAL PRACTICE These findings would be able to serve a useful basis in the development of materials for nursing intervention programs for people with dementia during mealtimes by improving the techniques and care qualities of nursing caregivers.
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Affiliation(s)
- Kyoung Min Lee
- Department of Nursing, DongKang University, Gwangju, South Korea
| | - Jun-Ah Song
- College of Nursing, Korea University, Seoul, South Korea
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29
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Bennett MK, Ward EC, Scarinci NA. Mealtime management in Australian residential aged care: Comparison of documented, reported and observed care. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2014; 17:451-459. [PMID: 25541741 DOI: 10.3109/17549507.2014.987816] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE Mealtime management in Residential aged care facilities (RACFs) should be holistic and comply with the principles of person-centred care (PCC) to ensure residents' medical, nutritional and psychosocial mealtime needs are met. However, this is not always achieved and multiple issues with mealtime management in RACFs exist. The aim of the current study was to compare documented, reported and observed mealtime management to explore factors influencing optimal mealtime care. METHOD Data were triangulated from: (a) review of 14 resident files; (b) observation of 41 mealtimes; (c) questionnaires with 14 residents; and (d) questionnaires with 29 staff. RESULT Results revealed multiple discrepancies between data sources leading to the delivery of sub-optimal mealtime care. Poor documentation impacted staff knowledge of required mealtime practices resulting in occasions of inconsistent and inappropriate care. Observational and interview data highlighted discrepancies between residents' mealtime preferences and actual practice. In many instances observed care was not holistic nor consistent with PCC. CONCLUSION Given the significant medical, nutritional and psychosocial risks associated with poor mealtime management, systematic changes in policy, staff training and multidisciplinary care are needed.
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Chang E, Brownhill S, Bidewell J, Johnson A, Ratnayake S. Focus on Feeding! Evaluation of a framework for maximizing mealtime in aged care facilities. Int J Nurs Pract 2014; 21:269-77. [PMID: 24754457 DOI: 10.1111/ijn.12260] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Unintentional weight loss is a health risk for residents of aged care facilities, a concern for families and places demands on nursing staff. An existing weight loss framework to assess and manage residents' weight developed by a multidisciplinary team was implemented and evaluated with nurses and residents in aged care facilities within an area health service of Sydney, Australia. Thematic analysis generated seven binary concepts relating to relational, procedural, behavioural, physical, psychological, environmental and temporal aspects of feeding assistance provided by nurses to residents. Theoretical sampling was applied to the literature confirming those concepts which were organized as a model of feeding assistance labelled the Focus on Feeding! Decision Model. Nurses can play a pivotal role in the assessment of feeding difficulty and implementation of innovative mealtime programs. The Model aims to promote nurses' critical thinking and decision-making to improve nutritional intake of residents and avoid preventable weight loss.
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Affiliation(s)
- Esther Chang
- School of Nursing and Midwifery, University of Western Sydney, Sydney, New South Wales, Australia
| | - Suzanne Brownhill
- School of Nursing and Midwifery, University of Western Sydney, Sydney, New South Wales, Australia
| | - John Bidewell
- School of Science and Health, University of Western Sydney, Sydney, New South Wales, Australia
| | - Amanda Johnson
- School of Nursing and Midwifery, University of Western Sydney, Sydney, New South Wales, Australia
| | - Shyama Ratnayake
- School of Nursing and Midwifery, University of Western Sydney, Sydney, New South Wales, Australia
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31
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Durkin DW, Shotwell MS, Simmons SF. The Impact of Family Visitation on Feeding Assistance Quality in Nursing Homes. J Appl Gerontol 2014; 33:586-602. [DOI: 10.1177/0733464814522126] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The purpose of this study was to determine: (a) the frequency of family visitation during mealtime and (b) whether the presence of family during meals had an impact on the quality of feeding assistance care and resident intake. Participants included 74 nursing home residents from two Veterans Affairs (VA) and four community facilities in one geographic region. Mealtime periods in which family was present were compared with mealtime periods when family was not present for the same resident. Results showed that family visitation was infrequent during mealtime; however, feeding assistance time was significantly higher when visitors were present. Despite the increase in assistance time, there was not a significant difference in intake. Strategies that encourage the involvement of family in mealtime assistance may have additional benefits not directly associated with meal consumption, including providing family members with meaningful activity during a visit and enhancing residents’ quality of life and well-being.
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Affiliation(s)
| | | | - Sandra F. Simmons
- Vanderbilt University, Nashville, TN, USA
- VA Medical Center, Nashville, TN, USA
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Bomfim FMS, Chiari BM, Roque FP. Factors associated to suggestive signs of oropharyngeal dysphagia in institutionalized elderly women. Codas 2014; 25:154-63. [PMID: 24408245 DOI: 10.1590/s2317-17822013000200011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2011] [Accepted: 02/15/2012] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To identify the factors associated to suggestive signs of oropharyngeal dysphagia (OD) in institutionalized elderly women. METHODS A cross-sectional, study with 30 institutionalized elderly women (mean age: 83,73±10,56 years) was carried out in Maceió. From August 2007 to July 2008, social, demographic and cultural data was collected, as well as data on general health and deglutition from their medical records and follow-up (both in person and by video) of one meal of each elderly woman. Those with signs suggestive of OD were compared to those with no signs of it and the factors associated with signs suggestive of orophayngeal dysphagia and changes in the feeding dynamics were considered. RESULTS Regarding the factors associated to changes in feeding dynamics, the elderly with dementia were more likely to require assistance during mealtime and to present four or more changes in feeding dynamics. The elderly that required assistance were more likely to eat in bed, at an inadequate position and to have three or more changes in feeding dynamics. CONCLUSION For institutionalized elderly women, the factors associated to signs suggestive of oropharyngeal dysphagia were use of medication, absence of depression, number of teeth and number of changes in feeding dynamics. The factors associated to changes in feeding dynamics are related to dementia and need of special care.
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Allen VJ, Methven L, Gosney M. Impact of serving method on the consumption of nutritional supplement drinks: randomized trial in older adults with cognitive impairment. J Adv Nurs 2013; 70:1323-33. [DOI: 10.1111/jan.12293] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2013] [Indexed: 11/26/2022]
Affiliation(s)
- Victoria J. Allen
- Royal Berkshire NHS Foundation Trust; Reading UK
- Clinical Health Sciences; University of Reading; UK
| | - Lisa Methven
- Food and Nutritional Sciences; University of Reading; UK
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Schnelle JF, Karuza J, Katz PR. Staffing, Quality, and Productivity in the Nursing Home. J Am Med Dir Assoc 2013; 14:784-6. [DOI: 10.1016/j.jamda.2013.08.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 08/28/2013] [Indexed: 11/30/2022]
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Abbott RA, Whear R, Thompson-Coon J, Ukoumunne OC, Rogers M, Bethel A, Hemsley A, Stein K. Effectiveness of mealtime interventions on nutritional outcomes for the elderly living in residential care: a systematic review and meta-analysis. Ageing Res Rev 2013; 12:967-81. [PMID: 23811415 DOI: 10.1016/j.arr.2013.06.002] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Revised: 06/14/2013] [Accepted: 06/17/2013] [Indexed: 11/26/2022]
Abstract
The need to improve the nutrition of the elderly living in long term care has long been recognised, but how this can best be achieved, and whether (and which) intervention is successful in reducing morbidity is less well understood. The aim of this systematic review was to determine the effectiveness of mealtime interventions for the elderly living in residential care. Mealtime interventions were considered as those that aimed to change/improve the mealtime routine, practice, experience or environment. Following comprehensive searches, review and appraisal, 37 articles were included. Inadequate reporting in over half of the articles limited data quality appraisal. Mealtime interventions were categorised into five types: changes to food service, food improvement, dining environment alteration, staff training and feeding assistance. Meta-analysis found inconsistent evidence of effects on body weight of changes to food service (0.5 kg; 95% CI: -1.1 to 2.2; p=0.51), food improvement interventions (0.4 kg; 95% CI: -0.8 to 1.7; p=0.50) or alterations to dining environment (1.5 kg; 95% CI: -0.7 to 2.8; p=0.23). Findings from observational studies within these intervention types were mixed, but generally positive. Observational studies also found positive effects on food/caloric intake across all intervention types, though meta-analyses of randomised studies showed little evidence of any effects on food/caloric intake in food improvement studies (-5 kcal; 95% CI: -36 to 26; p=0.74). There was some evidence of an effect on daily energy intakes within dining environment studies (181 kcal/day, 95% CI: -5 to 367, p=0.06). The need to improve the nutrition of the elderly living in residential long term care is well recognised. This review found some evidence that simple intervention around various aspects of mealtime practices and the mealtime environment can result in favourable nutritional outcomes. Further large scale pragmatic trials, however, are still required to establish full efficacy of such interventions.
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Buys DR, Flood KL, Real K, Chang M, Locher JL. Mealtime assistance for hospitalized older adults: a report on the SPOONS volunteer program. J Gerontol Nurs 2013; 39:18-22. [PMID: 23786182 DOI: 10.3928/00989134-20130614-01] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 02/08/2013] [Indexed: 11/20/2022]
Abstract
Mealtime assistance may be necessary to prevent declines in hospitalized older adults' nutritional well-being. This article reports the implementation of the Support for and Promotion Of Optimal Nutritional Status (SPOONS) volunteer assistance program. Patients were 65 and older, admitted to the Acute Care for Elders Unit at the University of Alabama at Birmingham Hospital, and in need of mealtime assistance. There were 236 documented patient-volunteer encounters at which social interaction (n = 217; 92%), assistance with tray set-up (n = 162; 69%), and prompting to eat (n = 161; 68%), among other activities, were performed. Mean time of interaction was 47.8 minutes, with an average estimated cost savings of $11.94 per encounter had the service been provided by a patient care technician and $26 per encounter had it been provided by an RN. This demonstration of the SPOONS program should be followed up with an evaluation of its effectiveness.
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Affiliation(s)
- David R Buys
- Agency for Healthcare Research and Quality, T32 Trainee, Center for Outcomes and Effectiveness Research and Education, Birmingham, AL 35294, USA.
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37
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Heaven B, Bamford C, May C, Moynihan P. Food work and feeding assistance on hospital wards. SOCIOLOGY OF HEALTH & ILLNESS 2013; 35:628-642. [PMID: 23009613 DOI: 10.1111/j.1467-9566.2012.01515.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Approximately 60 per cent of UK patients aged 65 years or older are at risk of malnutrition or their situation worsening while in hospital. We report the results of a qualitative study embedded in research to prevent malnutrition in older people in hospital (the mappmal study). Our aim was to understand and describe processes that promote or inhibit nutrition in hospital. Throughout 2009 we examined meal services at four UK hospital sites across two regional locations, focusing on older patients admitted with dementia, for stroke or for fractured neck of femur. Data were collected through semi-structured interviews with National Health Service staff (n = 54), stakeholders (n = 6), and a focus group with former patients and carers (n = 5). We identified ward-based food work as a technical and interpersonal challenge in narratives around malnutrition. Food work constituted two overlapping spheres of activity: interpersonal engagement through feeding assistance and reassurance and the arrangement of resources that facilitate meals such as the preparation of food trolleys. Our analysis is framed by the literature on emotional labour, dirty work and the professionalisation of nursing. We demonstrate how food work is overlooked by being conceptualised as common sense and as one of the most mundane and elementary tasks in hospitals.
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Affiliation(s)
- Ben Heaven
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.
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Habjanič A, Saarnio R, Elo S, Turk DM, Isola A. Challenges for institutional elder care in Slovenian nursing homes. J Clin Nurs 2012; 21:2579-89. [PMID: 22889448 DOI: 10.1111/j.1365-2702.2011.04044.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To investigate deficiencies in the institutional elder care that is being offered to residents of nursing homes in Slovenia. BACKGROUND Public criticism of the provision of elder care in nursing homes is growing all over the world, including in Slovenia. Many studies on this issue have been conducted, but seldom have assessed different viewpoints simultaneously. DESIGN A qualitative research design that involved individual unstructured interviews was used in 2007. The participants (n=48) comprised 16 residents, 16 relatives and 16 members of the nursing staff from four nursing homes in Slovenia. METHODS The data generated were subjected to qualitative content analysis. RESULTS The major themes that emerged from this analysis were neglect, unprofessional communication, uncomfortable physical environment and inadequate administration. CONCLUSIONS The participants of the study identified issues in institutional elder care in Slovenia that have also been highlighted by international research. Due to staff shortages, low motivation, insufficient communication skills and inexperience, members of the nursing staff reported that they were not in a position to offer the best possible quality of care. RELEVANCE TO CLINICAL PRACTICE To improve the living environment in nursing homes, it is important to consider the opinions of all those who are involved closely in institutional elder care. Correction of deficiencies should be a priority and should result in more engagement with residents.
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Affiliation(s)
- Ana Habjanič
- Faculty of Health Sciences, University of Maribor, Maribor, Slovenia.
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Sullivan DH, Johnson LE, Dennis RA, Roberson PK, Garner KK, Padala PR, Padala KP, Bopp MM. Nutrient intake, peripheral edema, and weight change in elderly recuperative care patients. J Gerontol A Biol Sci Med Sci 2012. [PMID: 23183900 DOI: 10.1093/gerona/gls234] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND It is unclear whether serial measures of body weight are valid indicators of nutritional status in older patients recovering from illness. Objectives. Investigate the relative influence of nutrient intake and changes in peripheral edema on weight change. METHODS A prospective cohort study of 404 older men (mean age = 78.7±7.5 years) admitted to a transitional care unit of a Department of Veterans Affairs nursing home. Body weight and several indicators of lower extremity edema were measured at both unit admission and discharge. Complete nutrient intake assessments were performed daily. RESULTS Over a median length of stay of 23 days (interquartile range: 15-41 days), 216 (53%) participants gained or lost more than or equal to 2.5% of their body weight. Two hundred eighty-two (70%) participants had recognizable lower extremity pitting edema at admission and/or discharge. The amount of weight change was strongly and positively correlated with multiple indicators of both nutrient intake and the change in the amount of peripheral edema. By multivariable analysis, the strongest predictor of weight change was maximal calf circumference change (partial R (2) = .35, p < .0001), followed by average daily energy intake (partial R (2) = .14, p < .0001), and the interaction of energy intake by time (partial R (2) = .02, p < .0001). CONCLUSIONS Many older patients either gain or lose a significant amount of weight after admission to a transitional care unit. Because of the apparent high prevalence of co-occurring changes in total body water, the weight changes do not necessarily represent changes in nutritional status. Although repeat calf circumference measurements may provide some indication as to how much of the weight change is due to changes in body water, there is currently no viable alternative to monitoring the nutrient intake of older recuperative care patients in order to ensure that their nutrient needs are being met.
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Affiliation(s)
- Dennis H Sullivan
- Geriatric Research Education and Clinical Center, Central Arkansas Veterans Healthcare System, Little Rock, AR 72205, USA.
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40
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A mix of bulk and ready-to-use modified-texture food: impact on older adults requiring dysphagic food. Can J Aging 2012; 31:335-48. [PMID: 22877959 DOI: 10.1017/s0714980812000268] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Ready-to-use modified-texture food (rMTF) products are commercially available and may have greater appeal than conventional in-house or commercial bulk modified-texture food (cMTF) products. A nine-month pilot study using a prospective interrupted time-series design where participants (n = 42) served as their own controls investigated the impact of cMTF + rMTF on weight goals, weight, food intake, and co-morbidity. Seventy-four per cent of participants achieved their weight goals at the end of six months on rMTF and, although insignificant, participants did have a trend towards weight gain while on rMTF (OR 3.5 p = .16). Main-plate food intake (grams) was not significantly different over time, but a downwards trajectory suggests decreased consumption that was compensated for by a significantly higher fat intake during the intervention period (p = .01). Increased co-morbidity and a decreasing volume of food consumed are common in older adults with dysphagia, and enhanced food products are needed to meet nutrient needs. Methodological issues encountered in this study can provide guidance for future work.
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Simmons SF, Sims N, Durkin DW, Shotwell MS, Erwin S, Schnelle JF. The Quality of Feeding Assistance Care Practices for Long-Term Care Veterans. J Appl Gerontol 2012; 32:669-86. [DOI: 10.1177/0733464811433487] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The primary purpose of this study was to determine the quality of feeding assistance care and identify areas in need of improvement for a sample of long-term care veterans. A secondary purpose was to compare these findings with the results of previous studies in community facilities to determine ways in which the VA sample might differ. A repeated measures observational study was conducted in two VA facilities with 200 long-stay residents. Research staff conducted standardized observations during and between meals for 3 months. There was a trend for better feeding assistance care quality during meals in the VA sample, but there were still multiple aspects of care in need of improvement both during and between meals. Higher licensed nurse staffing levels in the VA should enable effective supervision and management, but observation-based measures of care quality are necessary for accurate information about daily feeding assistance care provision.
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Affiliation(s)
- Sandra F. Simmons
- Vanderbilt University, School of Medicine, Division of General Internal Medicine and Public Health, Center for Quality Aging, Nashville, TN
- Geriatric Research, Education and Clinical Center, VA Medical Center, Nashville, TN
| | - Nichole Sims
- Vanderbilt University, School of Medicine, Division of General Internal Medicine and Public Health, Center for Quality Aging, Nashville, TN
| | - Daniel W. Durkin
- Vanderbilt University, School of Medicine, Division of General Internal Medicine and Public Health, Center for Quality Aging, Nashville, TN
| | | | - Scott Erwin
- Tennessee Valley Healthcare System, Murfreesboro, TN
| | - John F. Schnelle
- Vanderbilt University, School of Medicine, Division of General Internal Medicine and Public Health, Center for Quality Aging, Nashville, TN
- Geriatric Research, Education and Clinical Center, VA Medical Center, Nashville, TN
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Aselage MB, Amella EJ, Watson R. State of the science: Alleviating mealtime difficulties in nursing home residents with dementia. Nurs Outlook 2011; 59:210-4. [DOI: 10.1016/j.outlook.2011.05.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Revised: 05/10/2011] [Accepted: 05/15/2011] [Indexed: 11/28/2022]
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43
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Green SM, Martin HJ, Roberts HC, Sayer AA. A systematic review of the use of volunteers to improve mealtime care of adult patients or residents in institutional settings. J Clin Nurs 2011; 20:1810-23. [DOI: 10.1111/j.1365-2702.2010.03624.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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45
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Reimer HD, Keller HH. Mealtimes in nursing homes: striving for person-centered care. ACTA ACUST UNITED AC 2011; 28:327-47. [PMID: 21184376 DOI: 10.1080/01639360903417066] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Malnutrition is a common and serious problem in nursing homes. Dietary strategies need to be augmented by person-centered mealtime care practices to address this complex issue. This review will focus on literature from the past two decades on mealtime experiences and feeding assistance in nursing homes. The purpose is to examine how mealtime care practices can be made more person-centered. It will first look at several issues that appear to underlie quality of care at mealtimes. Then four themes or elements related to person-centered care principles that emerge within the mealtime literature will be considered: providing choices and preferences, supporting independence, showing respect, and promoting social interactions. A few examples of multifaceted mealtime interventions that illustrate person-centered approaches will be described. Finally, ways to support nursing home staff to provide person-centered mealtime care will be discussed. Education and training interventions for direct care workers should be developed and evaluated to improve implementation of person-centered mealtime care practices. Appropriate staffing levels and supervision are also needed to support staff, and this may require creative solutions in the face of current constraints in health care.
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Affiliation(s)
- Holly D Reimer
- Department of Family Relations and Applied Nutrition, Macdonald Institute, University of Guelph, Guelph, Ontario, Canada.
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46
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Dyck MJ, Schumacher JR. Evidence-Based Practices for the Prevention of Weight Loss in Nursing Home Residents. J Gerontol Nurs 2011; 37:22-33; quiz 34-5. [DOI: 10.3928/00989134-20110106-04] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2009] [Accepted: 06/16/2010] [Indexed: 01/04/2023]
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47
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Wylie K, Nebauer M. “The Food Here Is Tasteless!” Food taste or tasteless food? Chemosensory Loss and the Politics of Under-Nutrition. Collegian 2011; 18:27-35. [DOI: 10.1016/j.colegn.2010.03.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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48
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Zimmerman S, Cohen LW. Evidence behind The Green House and similar models of nursing home care. ACTA ACUST UNITED AC 2010. [DOI: 10.2217/ahe.10.66] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The Green House and similar models of nursing home care offer a solution to the institutional nature of nursing homes. In The Green House model, small houses are home to 6–12 residents in which care is given as much attention as treatment and is provided by a consistent, self-directed team of staff who are responsible for all care, including preparing meals in a centrally located open kitchen. Residents have private rooms and bathrooms that open onto a central living area. Although a nurse is available 24 h a day and the clinical care team is nearby and visits the home to provide care, the sense is that one is receiving care in a family-type setting. While these homes are expanding rapidly and seem to embody a better culture of nursing home care, their future growth may depend on the evidence that supports or refutes the quality of care that they provide.
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Affiliation(s)
- Sheryl Zimmerman
- Cecil G Sheps Center for Health Services Research & the School of Social Work, The University of North Carolina at Chapel Hill, 725 Martin Luther King Jr. Boulevard, Campus Box 7590, Chapel Hill, NC 27599-27590, USA
| | - Lauren W Cohen
- Cecil G Sheps Center for Health Services Research, The University of North Carolina at Chapel Hill, 725 Martin Luther King Jr. Boulevard, Campus Box 7590, Chapel Hill, NC 27599-27590, USA
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Lopez RP. Commentary on Aselage MB (2010) Measuring mealtime difficulties: eating, feeding and meal behaviour in older adults with dementia Journal of Clinical Nursing 19, 621-631. J Clin Nurs 2010; 19:2950-1. [DOI: 10.1111/j.1365-2702.2010.03464.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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50
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Morley JE. Anorexia, weight loss, and frailty. J Am Med Dir Assoc 2010; 11:225-8. [PMID: 20439039 DOI: 10.1016/j.jamda.2010.02.005] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2010] [Accepted: 02/03/2010] [Indexed: 10/19/2022]
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