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O'Shea MC, Bauer J, Barrett C, Corones-Watkins K, Kellett U, Maloney S, Williams LT, Osadnik C, Foo J. Malnutrition Prevalence in Australian Residential Aged Care Facilities: A Cross-Sectional Study. Healthcare (Basel) 2024; 12:1296. [PMID: 38998831 PMCID: PMC11241761 DOI: 10.3390/healthcare12131296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 06/18/2024] [Accepted: 06/26/2024] [Indexed: 07/14/2024] Open
Abstract
Long-term or residential services are designed to support older people who experience challenges to their physical and mental health. These services play an important role in the health and well-being of older adults who are more susceptible to problems such as malnutrition. Estimates of the significance of malnutrition require up-to-date prevalence data to inform government strategies and regulation, but these data are not currently available in Australia. The aim of this study was to collect malnutrition prevalence data on a large sample of people living in residential aged care facilities in Australia. A secondary aim was to examine the relationship between malnutrition and anthropometry (body mass index (BMI) and weight loss). This prevalence study utilised baseline data collected as part of a longitudinal study of malnutrition in 10 Residential Aged Care facilities across three states in Australia (New South Wales, South Australia, and Queensland). The malnutrition status of eligible residents was assessed by dietitians and trained student dietitians using the Subjective Global Assessment (SGA) with residents categorised into SGA-A = well nourished, SGA-B = mildly/moderately malnourished, and SGA-C = severely malnourished. Other data were extracted from the electronic record. Of the 833 listed residents, 711 residents were eligible and had sufficient data to be included in the analysis. Residents were predominantly female (63%) with a mean (SD) age of 84 (8.36) years and a mean (SD) BMI of 26.74 (6.59) kg/m2. A total of 40% of residents were categorised as malnourished with 34% (n = 241) categorised as SGA-B, and 6% (n = 42) SGA-C. Compared to the SGA, BMI and weight loss categorisation of malnutrition demonstrated low sensitivity and high specificity. These findings provide recent, valid data on malnutrition prevalence and highlight the limitations of current Australian practices that rely on anthropometric measures that under-detect malnutrition. There is an urgent need to implement a feasible aged care resident screening program to address the highly prevalent condition of malnutrition in Australia.
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Affiliation(s)
- Marie-Claire O'Shea
- School of Health Sciences and Social Work, Griffith University, Gold Coast, QLD 4222, Australia
| | - Judy Bauer
- Department of Nutrition, Dietetics and Food, Monash University, Clayton, VIC 3800, Australia
| | - Clare Barrett
- School of Health Sciences and Social Work, Griffith University, Gold Coast, QLD 4222, Australia
| | | | - Ursula Kellett
- School of Nursing and Midwifery, Griffith University, Gold Coast, QLD 4222, Australia
| | - Stephen Maloney
- Department of Physiotherapy, Monash University, Frankston, VIC 3199, Australia
| | - Lauren T Williams
- School of Health Sciences and Social Work, Griffith University, Gold Coast, QLD 4222, Australia
| | - Christian Osadnik
- Department of Physiotherapy, Monash University, Frankston, VIC 3199, Australia
| | - Jonathan Foo
- Department of Physiotherapy, Monash University, Frankston, VIC 3199, Australia
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Mayes C, Meloni M. Forgetting how we ate: personalised nutrition and the strategic uses of history. HISTORY AND PHILOSOPHY OF THE LIFE SCIENCES 2024; 46:14. [PMID: 38453802 PMCID: PMC10920492 DOI: 10.1007/s40656-024-00613-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 02/08/2024] [Indexed: 03/09/2024]
Abstract
Personalised nutrition (PN) has emerged over the past twenty years as a promising area of research in the postgenomic era and has been popularized as the new big thing out of molecular biology. Advocates of PN claim that previous approaches to nutrition sought general and universal guidance that applied to all people. In contrast, they contend that PN operates with the principle that "one size does not fit all" when it comes to dietary guidance. While the molecular mechanisms studied within PN are new, the notion of a personal dietary regime guided by medical advice has a much longer history that can be traced back to Galen's "On Food and Diet" or Ibn Sina's (westernized as Avicenna) "Canon of Medicine". Yet this history is either wholly ignored or misleadingly appropriated by PN proponents. This (mis)use of history, we argue helps to sustain the hype of the novelty of the proposed field and potential commodification of molecular advice that undermines longer histories of food management in premodern and non-Western cultures. Moreover, it elides how the longer history of nutritional advice always happened in a heavily moralized, gendered, and racialized context deeply entwined with collective technologies of power, not just individual advice. This article aims at offering a wider appreciation of this longer history to nuance the hype and exceptionalism surrounding contemporary claims.
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Affiliation(s)
- Christopher Mayes
- School of Humanities and Social Sciences, Deakin University, Geelong, Australia.
| | - Maurizio Meloni
- School of Humanities and Social Sciences, Deakin University, Geelong, Australia
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Hoefnagels FA, Patijn ON, Meeusen MJG, Battjes-Fries MCE. The perceptions of food service staff in a nursing home on an upcoming transition towards a healthy and sustainable food environment: a qualitative study. BMC Geriatr 2023; 23:784. [PMID: 38017378 PMCID: PMC10685581 DOI: 10.1186/s12877-023-04493-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 11/20/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Healthy and sustainable food environments are urgently needed, also in nursing and residential care homes. Malnutrition in care homes is becoming an increasing problem as populations worldwide are ageing and many older people do not consume sufficient protein, fibre, fruit, and vegetables. Nursing homes also often experience a lot of food waste. A transition in the food environment like a nursing home, involves the participation of facility management and food service staff members. This study aims to map out their perceived barriers and facilitators for this transition. METHODS A qualitative study using semi-structured interviews was conducted with food service staff members (n = 16), comprising of kitchen staff (n = 4), wait staff (n = 10), and facility management (n = 2) of two nursing homes in the Netherlands. Thematic analysis was used to derive content and meaning from transcribed interviews. RESULTS Four main themes were identified. Theme 1: 'Communication, transparency and accountability in the chain', highlighting the lack of effective communication flows and a fragmented overview of the food service chain as a whole. Theme 2: 'Understanding, knowledge and ability of the concepts healthy and sustainable', revealing the gap in staff's understanding of these abstract concepts, despite perceiving themselves as having sufficient knowledge and ability. Theme 3: 'The pampering service mind-set', highlighting the contradiction in the staff's shared goal of proving the highest quality of life for residents while also pampering them in ways that may not align with promoting healthy and sustainable food choices. Theme 4: 'Transition is important but hard to realize', describing the barriers such as existing routines and a lack of resources as challenges to implementing changes in the food service. CONCLUSIONS Facilitators to transitioning nursing homes towards a healthy and sustainable food environment as perceived by staff members included transparent communication, accountability in the food supply chain, staff's perceived ability and shared goal, while barriers included lack of understanding of the concepts healthy and sustainable, the current pampering mindset, and top-down decision-making. These findings provide valuable insights for nursing homes seeking to transition towards a healthier and more sustainable food environment.
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Affiliation(s)
- Femke A Hoefnagels
- Department of Health and Nutrition, Louis Bolk Institute, Kosterijland 3-5, Bunnik, 3981 AJ, the Netherlands.
| | - Olga N Patijn
- Department IxD, University of Twente, Drienerlolaan 5, Enschede, 7522 NB, The Netherlands
| | - Marieke J G Meeusen
- Wageningen Economic Research, Wageningen University & Research, P.O. Box 29703, The Hague, 2502 LS, The Netherlands
| | - Marieke C E Battjes-Fries
- Department of Health and Nutrition, Louis Bolk Institute, Kosterijland 3-5, Bunnik, 3981 AJ, the Netherlands
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Pankhurst M, Yaxley A, Miller M. Measuring Food Service Satisfaction amongst Residents Living in Nursing Homes-A New and Valid Person-Centered Approach. Nutrients 2023; 15:nu15030508. [PMID: 36771215 PMCID: PMC9921588 DOI: 10.3390/nu15030508] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 01/09/2023] [Accepted: 01/10/2023] [Indexed: 01/21/2023] Open
Abstract
Resident satisfaction with food services contributes to health and wellbeing. Measuring resident satisfaction is important; however, the small number of existing food service satisfaction questionnaires (FSSQs) are outdated, lack rigorous psychometric testing and do not reflect the shift to person-centered care. This study aimed to develop a valid and reliable FSSQ. Content validity was established by conducting interviews with residents, a systematic literature review and consultation with an expert panel. Data from 387 residents were used to establish construct validity (Principal Components Analysis), internal consistency (Cronbach's alpha) and temporal stability (Gwet's AC). The result was a three factor, 25-item scale with good/excellent internal consistency: Factor One (13 items-good food/service, α = 0.896), Factor Two (seven items-resident choice/food availability α = 0.648) and Factor Three (five items-resident participation/staff assistance, α = 0.729). Temporal stability was good/very good (Gwet's AC 0.6242-0.9799 (p < 0.001). This is the first FSSQ available to nursing homes that meets the COSMIN® standards for excellence and incorporates person-centered care. The questionnaire is simple to use and interpret, providing food service managers with an accurate and reliable measure of resident satisfaction and assisting them in providing a meal and dining experience that supports the health and wellbeing of residents.
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Iuliano S, Poon S, Robbins J, Wang X, Bui M, Seeman E. Provision of High Protein Foods Slows the Age-Related Decline in Nutritional Status in Aged Care Residents: A Cluster-Randomised Controlled Trial. J Nutr Health Aging 2023; 27:166-171. [PMID: 36806871 DOI: 10.1007/s12603-022-1868-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVES Malnutrition, particularly protein insufficiency, is common in institutionalised older adults and increases morbidity, mortality, and costs. We aimed to determine whether 12 months supplementation using high-protein foods (milk, cheese, yoghurt) prevents malnutrition in older adults. DESIGN Cluster randomised control study. SETTING Sixty Australian aged care facilities. PARTICIPANTS Older adults living in aged care homes (n=654, mean age 86.7±7.2 years, 72% females). Intervention Facilities randomly allocated to a high-protein (n=30 intervention) or regular (n=30 controls) menu. MEASUREMENTS Nutritional status assessed using the Mini Nutrition Assessment (MNA) tool and fasting morning blood samples (n=302) assayed for haemoglobin (Hb) and albumin. Food intake was monitored 3-monthly using visual plate waste assessment. Measurements at baseline and month 12 were analysed using random effects model accounting for clustering (facility), repeated measure and confounders. RESULTS Addition of 11g of protein as 1.5 servings of high-protein foods daily preserved nutritional status that deteriorated in controls [MNA screen (-0.68, 95%CI: -1.03, -0.32, p<0.001) and total (-0.90, 95%CI: -1.45, -0.35, p=0.001) scores], resulting in group differences in MNA screen (0.62, 95%CI: 0.17, 1.06, p=0.007) and total (0.81, 95%CI: 0.11, 1.51, p=0.023) scores and group difference in Hb (3.60g/L, 95%CI: 0.18, 7.03, p=0.039), the net result of preservation with intervention (0.19g/L, 95%CI: -2.04, 2.42, p=0.896) and a decline in controls (-3.41g/L, 95%CI: -6.01, -0.82, p=0.010). No group differences were observed for serum albumin. CONCLUSION Consumption of high-protein foods is a pragmatic approach to maintaining nutritional status in older adults in aged-care.
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Affiliation(s)
- S Iuliano
- Sandra Iuliano, Department of Endocrinology, University of Melbourne / Austin Health, Heidelberg Repatriation Hospital, Waterdale Road, West Heidelberg, Victoria, Australia, 3081, , Phone: +61 438 215 615
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Alkhalaf M, Zhang Z, Chang HCR, Wei W, Yin M, Deng C, Yu P. Malnutrition and its contributing factors for older people living in residential aged care facilities: Insights from natural language processing of aged care records. Technol Health Care 2023; 31:2267-2278. [PMID: 37302059 DOI: 10.3233/thc-230229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Malnutrition is a serious health risk facing older people living in residential aged care facilities. Aged care staff record observations and concerns about older people in electronic health records (EHR), including free-text progress notes. These insights are yet to be unleashed. OBJECTIVE This study explored the risk factors for malnutrition in structured and unstructured electronic health data. METHODS Data of weight loss and malnutrition were extracted from the de-identified EHR records of a large aged care organization in Australia. A literature review was conducted to identify causative factors for malnutrition. Natural language processing (NLP) techniques were applied to progress notes to extract these causative factors. The NLP performance was evaluated by the parameters of sensitivity, specificity and F1-Score. RESULTS The NLP methods were highly accurate in extracting the key data, values for 46 causative variables, from the free-text client progress notes. Thirty three percent (1,469 out of 4,405) of the clients were malnourished. The structured, tabulated data only recorded 48% of these malnourished clients, far less than that (82%) identified from the progress notes, suggesting the importance of using NLP technology to uncover the information from nursing notes to fully understand the health status of the vulnerable older people in residential aged care. CONCLUSION This study identified 33% of older people suffered from malnutrition, lower than those reported in the similar setting in previous studies. Our study demonstrates that NLP technology is important for uncovering the key information about health risks for older people in residential aged care. Future research can apply NLP to predict other health risks for older people in this setting.
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Affiliation(s)
- Mohammad Alkhalaf
- Centre for Digital Transformation, School of Computing and Information Technology, University of Wollongong, Wollongong, Australia
- School of Computer Science, Qassim University, Buraydah, Saudi Arabia
| | - Zhenyu Zhang
- Centre for Digital Transformation, School of Computing and Information Technology, University of Wollongong, Wollongong, Australia
| | - Hui-Chen Rita Chang
- School of Nursing and Midwifery, Western Sydney University, Penrith, Australia
| | - Wenxi Wei
- School of Nursing, University of Wollongong, Wollongong, Australia
| | | | - Chao Deng
- School of Medical, Indigenous and Health Sciences, University of Wollongong, Wollongong, Australia
| | - Ping Yu
- Centre for Digital Transformation, School of Computing and Information Technology, University of Wollongong, Wollongong, Australia
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Nutritional status and quality-of-life of older adults in aged care: A systematic review and meta-analysis. Exp Gerontol 2022; 162:111764. [PMID: 35271944 DOI: 10.1016/j.exger.2022.111764] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 02/01/2022] [Accepted: 02/27/2022] [Indexed: 11/24/2022]
Abstract
The effect of malnutrition beyond morbidity and mortality has become a critical area of investigation in older people with an increased focus on quality-of-life (QoL), but as yet the relationship between malnutrition and QoL remains to be reviewed in older people from aged care settings. The current study conducted a systematic review and meta-analyses of studies published between the years 1995 and 2020 examining the relationship between nutritional status and QoL or the effects of a nutrition-based intervention on QoL in older people in residential aged care. Based on searches of the databases MEDLINE, PsycINFO, Emcare, and Embase, 21 studies were identified. Meta-analyses of the cross-sectional and quasi-experimental studies revealed a significant positive relationship between nutritional status and QoL and that nutritional intervention significantly improved QoL. By contrast, meta-analysis of randomised controlled trials revealed a non-significant but improved trend post-intervention in QoL. Although the effect sizes were small, the present findings indicate that nutrition-based interventions improve QoL in older people in residential aged care and align with previous reviews based on findings from other aged settings. Future research is needed to determine causality and to better identify and control for confounding factors which may influence both nutritional status and QoL.
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Borkent JW, van Hout HPJ, Feskens EJM, Naumann E, de van der Schueren MAE. Behavioral and Cognitive Problems as Determinants of Malnutrition in Long-Term Care Facilities, a Cross-Sectional and Prospective Study. J Nutr Health Aging 2022; 26:749-759. [PMID: 35934819 DOI: 10.1007/s12603-022-1827-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
OBJECTIVES To investigate the cross-sectional and prospective associations between behavior and cognitive problems and malnutrition in long-term care facilities (LTCF). DESIGN Cross-sectional and prospective routine care cohort study. SETTING 6874 Residents in Dutch LTCFs (period 2005-2020). PARTICIPANTS Data were obtained from the InterRAI-LTCF instrument. Cross-sectional analyses on prevalence of malnutrition at admission included 3722 residents. Prospective analyses studied incident malnutrition during stay (total follow-up time 7104 years) and included data of 1826 residents with first measurement on admission ('newly-admitted') and n=3152 with first measurement on average ~1 year after admission ('existing'). MEASUREMENTS InterRAI scales for communication problems (CS), aggressive behavior (ABS), social engagement (RISE), depressive symptoms (DRS), cognitive performance (CPS) and the total number of behavior and cognitive problems were investigated as independent variables and malnutrition (ESPEN 2015 definition) as dependent variable in regression analyses. Results were stratified for gender and group 'newly-admitted' vs. 'existing'. RESULTS On admission, 9.5% of residents was malnourished. In men, low social engagement was associated with prevalence of malnutrition. In women, all behavior and cognitive problems except depression were associated with malnutrition in the unadjusted analyses, but this attenuated in the full model taking all problems into account. The incidence of malnutrition during stay amounted to 8.9%. No significant associations of behavior and cognitive problems with malnutrition incidence were seen in 'newly-admitted' male residents while in 'existing' male residents all determinants were significantly associated. In 'newly-admitted' female residents CS, ABS and CPS, and in 'existing' female residents CS, RISE, ABS and CPS were significantly associated with incident malnutrition. All associations slightly attenuated after adjustment. Malnutrition incidence increased with increasing number of combined behavior and cognitive problems. CONCLUSION Residents with behavior and cognitive problems are at an increased risk of being malnourished at admission, or becoming malnourished during stay in a LTCF, especially residents with multiple behavior and cognitive problems.
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Affiliation(s)
- J W Borkent
- Jos W. Borkent, Wageningen University, Stippeneng 4, 6708 WE Wageningen, The Netherlands,
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Food and Nutrition Champions in Residential Aged Care Homes Are Key for Sustainable Systems Change within Foodservices; Results from a Qualitative Study of Stakeholders. Nutrients 2021; 13:nu13103566. [PMID: 34684566 PMCID: PMC8541169 DOI: 10.3390/nu13103566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 10/04/2021] [Accepted: 10/08/2021] [Indexed: 11/30/2022] Open
Abstract
The role of foodservices in aged care is difficult to understand, and strategies to improve the nutritional care of residents are often unsustainable. In particular, food-first strategies such as food fortification are poorly executed in everyday practice and its execution relies upon the foodservice system in aged care homes. The aim of this study was to explore the perspective of staff on the role of foodservices in aged care and gauge the level of skills, education, access, time, and ability to deliver food fortification. Semi-structured interviews were conducted with foodservice managers, foodservice workers, dietitians, carers, and other managers who work in aged care homes across Australia. Participants were recruited purposively through email and through snowballing. Interviews (n = 21) were recorded, transcribed verbatim, and analyzed using inductive thematic analysis. Three themes and six sub-themes were identified. The three themes include the role of foodservices being more than just serving food, teamwork between all staff to champion nutrition, and workplace culture that values continuous improvement. These themes identify how staff perceive the role of foodservices in aged care and provide an important perspective on the long-term sustainability of food fortification strategies and how to improve current practice.
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Chatindiara I, Allen J, Hettige D, Senior S, Richter M, Kruger M, Wham C. High prevalence of malnutrition and frailty among older adults at admission to residential aged care. J Prim Health Care 2021; 12:305-317. [PMID: 33349318 DOI: 10.1071/hc20042] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 12/02/2020] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Malnutrition is an under-recognised and under-treated problem often affecting older adults. AIM The aim of this study was to evaluate the prevalence of and factors associated with malnutrition and frailty among older adults at early admission to residential aged care. METHODS A cross-sectional study was undertaken among eligible older adults within the first week of admission to residential aged care. Participants were assessed for malnutrition risk using the Mini Nutritional Assessment Short Form, frailty using the Fried phenotype criterion, muscle strength using a grip strength dynamometer and gait speed using a 2.4-m walk test. A Cox regression analysis was conducted to identify factors associated with malnutrition risk and frailty status. RESULTS Of 174 participants (mean age 85.5 years, 61% women), two-thirds (66%) were admitted to residential aged care from the community. Most (93%) were either malnourished (48%) or at risk of malnutrition (45%). A total of 76% of participants were frail and 24% were pre-frail. Forty-three percent were both malnourished and frail. Low risk of malnutrition was associated with increases in muscle strength [0.96 (0.93-0.99)], gait speed [0.27 (0.10-0.73)] and pre-frailty status [0.32 (0.12-0.83)]. DISCUSSION This study provides preliminary evidence for high prevalence of malnutrition and frailty at admission to residential aged care. Almost all participants were malnourished or at nutrition risk. Findings highlight the need for strategies to prevent, detect and treat malnutrition in community health care and support nutrition screening at admission to residential aged care.
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Affiliation(s)
- Idah Chatindiara
- College of Health, Massey University, Turitea Placem Albany, Auckland, New Zealand; and Corresponding author.
| | - Jacqueline Allen
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Dushanka Hettige
- College of Health, Massey University, Turitea Placem Albany, Auckland, New Zealand
| | - Stacey Senior
- College of Health, Massey University, Turitea Placem Albany, Auckland, New Zealand
| | - Marilize Richter
- College of Health, Massey University, Turitea Placem Albany, Auckland, New Zealand
| | - Marlena Kruger
- College of Health, Massey University, Turitea Placem Albany, Auckland, New Zealand
| | - Carol Wham
- College of Health, Massey University, Turitea Placem Albany, Auckland, New Zealand
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Mathewson SL, Azevedo PS, Gordon AL, Phillips BE, Greig CA. Overcoming protein-energy malnutrition in older adults in the residential care setting: A narrative review of causes and interventions. Ageing Res Rev 2021; 70:101401. [PMID: 34237434 DOI: 10.1016/j.arr.2021.101401] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 05/10/2021] [Accepted: 07/02/2021] [Indexed: 01/06/2023]
Abstract
Malnutrition, in particular protein-energy malnutrition, is a highly prevalent condition in older adults, and is associated with low muscle mass and function, and increased prevalence of physical frailty. Malnutrition is often exacerbated in the residential care setting due to factors including lack of dentition and appetite, and increased prevalence of dementia and dysphagia. This review aims to provide an overview of the available literature in older adults in the residential care setting regarding the following: links between sarcopenia, frailty, and malnutrition (in particular, protein-energy malnutrition (PEM)), recognition and diagnosis of malnutrition, factors contributing to PEM, and the effectiveness of different forms of protein supplementation (in particular, oral nutritional supplementation (ONS) and protein-fortified foods (PFF)) to target PEM. This review found a lack of consensus on effective malnutrition diagnostic tools and lack of universal requirement for malnutrition screening in the residential care setting, making identifying and treating malnutrition in this population a challenge. When assessing the use of protein supplementation in the residential care setting, the two primary forms of supplementation were ONS and PFF. There is evidence that ONS and PFF increase protein and energy intakes in residential care setting, yet compliance with supplementation and their impact on functional status is unclear and conflicting. Further research comparing the use of ONS and PFF is needed to fully determine feasibility and efficacy of protein supplementation in the residential care setting.
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Wheeler M, Abbey KL, Capra SM. Meal choice for residential aged care is not yet defined: A scoping review of policies, standards, reports and guidelines. Nutr Diet 2021; 79:169-180. [PMID: 34448340 DOI: 10.1111/1747-0080.12700] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 07/08/2021] [Accepted: 07/26/2021] [Indexed: 11/29/2022]
Abstract
AIM For residents in residential aged care, making choices in relation to food and mealtimes are opportunities to maintain a sense of self and autonomy. It is unknown, however, whether the concept of choice is adequately addressed in texts relating to residential aged care. The purpose of this review is to examine whether residents' right to make choices regarding the meals they eat, is discussed in grey literature including, policies, standards, reports and guidelines, which all impact practice in residential aged care. METHODS Grey literature was located utilising; Google, Google Scholar and hand searching. Texts had to be in reference to residential aged care and were assessed using the Appraisal of Guidelines for Research and Evaluation II and Joanna Briggs Institute tools. RESULTS Twenty-nine texts were included in the final review, consisting of, 12 policies and standards, 12 guidelines and 5 reports. Choice was discussed broadly in the majority of texts, with no definition included for the level of choice that should be provided by residential aged care. The use of alternative meals to provide choice was discussed; however, texts varied in their requirements and recommendations as to what constituted an adequate alternative. CONCLUSIONS The ambiguity surrounding choice affects the practices within residential aged care and ultimately the service provided to residents. With most recommendations being only general in nature, residential aged care homes are not provided with sufficient guidance for meal planning. To ensure residents' right to make choices in their meals is guaranteed, more definitive requirements and recommendations are needed.
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Affiliation(s)
- Mikaela Wheeler
- School of Human Movement and Nutrition Sciences, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Karen L Abbey
- School of Human Movement and Nutrition Sciences, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Sandra M Capra
- School of Human Movement and Nutrition Sciences, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Queensland, Australia
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Scholes G. Protein-energy malnutrition in older Australians: A narrative review of the prevalence, causes and consequences of malnutrition, and strategies for prevention. Health Promot J Austr 2021; 33:187-193. [PMID: 33783903 DOI: 10.1002/hpja.489] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 03/24/2021] [Indexed: 01/13/2023] Open
Abstract
ISSUE ADDRESSED Protein-energy malnutrition (PEM) is a condition of involuntary weight and muscle loss caused by inadequate nutritional intake. In Australia, it is predominantly associated with chronic diseases, as are common in the older population. Given the ageing population of Australia, and the poor outcomes associated with PEM, there is a need to identify the contributing factors, and to explore strategies to prevent PEM. METHODS Two databases were searched for pertinent keywords, including malnutrition, Australia and elderly, with relevant articles selected for inclusion. The citations and references of these articles were also searched for further articles. RESULTS PEM is associated with increasing age and institutionalisation. The contributing factors are multifactorial, and include physiological, pathophysiological and structural causes. PEM is a significant public health issue for Australia, in terms of its consequences on both quality of life for older adults, and the burden on the healthcare system. However, there are strategies that can be implemented at the community, organisation and policy level to prevent PEM. CONCLUSION PEM is a common problem for older Australians, and this has important physiological and public health consequences, especially in the context of the ageing Australian population. However, there is significant scope for preventing PEM. SO WHAT?: Readers can be advised that PEM is a significant public health issue that will increase in importance as the population continues to age. It is important that communities, organisations and governments develop strategies to prevent PEM.
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McLaren-Hedwards T, D'cunha K, Elder-Robinson E, Smith C, Jennings C, Marsh A, Young A. Effect of communal dining and dining room enhancement interventions on nutritional, clinical and functional outcomes of patients in acute and sub-acute hospital, rehabilitation and aged-care settings: A systematic review. Nutr Diet 2021; 79:140-168. [PMID: 33416215 DOI: 10.1111/1747-0080.12650] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 10/21/2020] [Accepted: 11/04/2020] [Indexed: 11/30/2022]
Abstract
AIMS This review aimed to synthesise evidence on the impact of communal dining and/or dining room enhancement interventions on nutritional, clinical and functional outcomes of patients in hospital (acute or subacute), rehabilitation and residential aged-care facility settings. METHODS Five electronic databases were searched in March 2020. Included studies considered the impact of communal dining and/or dining room enhancements on outcomes related to malnutrition in hospital (acute or subacute), rehabilitation and residential aged care facility settings. Risk of bias was assessed using the Academy of Nutrition and Dietetics quality checklist. Overall quality was assessed using GRADEpro software. Outcome data were combined narratively for communal dining and dining room enhancements respectively. RESULTS Eighteen articles from 17 unique studies were identified. Of these studies, one was a randomised control trial (moderate quality) and 16 were observational studies (all low quality). Communal dining interventions (four studies, n = 490) were associated with greater energy and protein intake and higher measures of quality of life than non-communal mealtime settings. Dining room enhancement interventions (14 studies, n = 912), overall, contributed to increased intake of food, energy, protein and fluid. CONCLUSIONS Results indicate that communal dining and/or dining room enhancement has a positive impact on several outcomes of interest, however, most available evidence is of low quality. Therefore, there is a need for further large-scale, well-designed experimental studies to assess the potential impacts of these interventions.
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Affiliation(s)
- Taya McLaren-Hedwards
- The University of Queensland, School of Human Movement and Nutrition Sciences, Brisbane, Queensland, Australia
| | - Kelly D'cunha
- The University of Queensland, School of Human Movement and Nutrition Sciences, Brisbane, Queensland, Australia
| | - Elaina Elder-Robinson
- The University of Queensland, School of Human Movement and Nutrition Sciences, Brisbane, Queensland, Australia
| | - Claire Smith
- The University of Queensland, School of Human Movement and Nutrition Sciences, Brisbane, Queensland, Australia
| | - Cindy Jennings
- Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Abigail Marsh
- Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Adrienne Young
- The University of Queensland, School of Human Movement and Nutrition Sciences, Brisbane, Queensland, Australia.,Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
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15
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Kelly JT, Allman-Farinelli M, Chen J, Partridge SR, Collins C, Rollo M, Haslam R, Diversi T, Campbell KL. Dietitians Australia position statement on telehealth. Nutr Diet 2020; 77:406-415. [PMID: 32596950 PMCID: PMC7540717 DOI: 10.1111/1747-0080.12619] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/11/2020] [Accepted: 05/12/2020] [Indexed: 12/21/2022]
Abstract
It is the position of Dietitians Australia that clients can receive high‐quality and effective dietetic services such as Medical Nutrition Therapy (MNT) delivered via telehealth. Outcomes of telehealth‐delivered dietetic consultations are comparable to those delivered in‐person, without requiring higher levels of additional training nor compromising quality of service provision. Dietitians Australia recommends that policy makers and healthcare funders broaden the recognition for telehealth‐delivered dietetic consultations as a responsive and cost‐effective alternative or complement to traditional in‐person delivery of dietetic services. The successful implementation of telehealth can help to address health and service inequalities, improve access to effective nutrition services, and support people with chronic disease to optimise their diet‐related health and well‐being, regardless of their location, income or literacy level, thereby addressing current inequities.
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Affiliation(s)
- Jaimon T Kelly
- Menzies Health Institute Queensland, Faculty of Medicine, Griffith University, Gold Coast, Australia
| | - Margaret Allman-Farinelli
- Charles Perkins Centre, Discipline of Nutrition and Dietetics, School of Life and Environmental Sciences, The University of Sydney, Sydney, Australia
| | - Juliana Chen
- Charles Perkins Centre, Discipline of Nutrition and Dietetics, School of Life and Environmental Sciences, The University of Sydney, Sydney, Australia
| | - Stephanie R Partridge
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Clare Collins
- Priority Research Centre in Physical Activity & Nutrition and School of Health Sciences, Faculty of Health and Medicine , The University of Newcastle, Callaghan, Australia
| | - Megan Rollo
- Priority Research Centre in Physical Activity & Nutrition and School of Health Sciences, Faculty of Health and Medicine , The University of Newcastle, Callaghan, Australia
| | - Rebecca Haslam
- Priority Research Centre in Physical Activity & Nutrition and School of Health Sciences, Faculty of Health and Medicine , The University of Newcastle, Callaghan, Australia
| | | | - Katrina L Campbell
- Menzies Health Institute Queensland, Faculty of Medicine, Griffith University, Gold Coast, Australia
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16
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Sossen L, Bonham M, Porter J. Does a High-Energy High-Protein Diet Reduce Unintentional Weight Loss in Residential Aged Care Residents? J Nutr Gerontol Geriatr 2020; 39:56-68. [PMID: 31769350 DOI: 10.1080/21551197.2019.1691108] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Malnutrition and unintentional weight loss are known to occur in residential aged care facilities (RACFs). The use of oral nutritional supplements (ONS) and high-energy high-protein (HEHP) diets are two foodservice strategies that may be implemented in efforts to reduce unintentional weight loss in RACFs. This observational study aimed to determine whether incorporation of a structured high-energy high-protein diet (sHEHP) into the standard menu could reduce unintentional weight loss in RACF residents. RACFs in this study were facilities that provide long-term care to older adult residents. Weight change, body mass index and subjective global assessment scores of participants were measured at baseline and at six months across five RACFs receiving usual care with ONS or a sHEHP diet. Groups were different at baseline, with a high prevalence of severe malnutrition observed in the ONS group. Over the six-month period, there was a small but statistically significant difference in weight change within the groups: -1.64 ± 3.62 kg, ONS group; 0.56 ± 2.76 kg, sHEHP group, P = 0.0004. Both approaches investigated are feasible, however, future research using high-quality methods is needed to determine the most effective approach to deliver best practice nutrition care for residents into the future.
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Affiliation(s)
- Lisa Sossen
- Department of Nutrition, Dietetics and Food, Faculty of Medicine, Nursing and Health Sciences, Monash University, Notting Hill, VIC, Australia
| | - Maxine Bonham
- Department of Nutrition, Dietetics and Food, Faculty of Medicine, Nursing and Health Sciences, Monash University, Notting Hill, VIC, Australia
| | - Judi Porter
- Department of Nutrition, Dietetics and Food, Faculty of Medicine, Nursing and Health Sciences, Monash University, Notting Hill, VIC, Australia
- Allied Health Clinical Research Office, Eastern Health, Box Hill, VIC, Australia
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17
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Wang D, Everett B, Brunero S, Northall T, Villarosa AR, Salamonson Y. Perspectives of residents and staff regarding food choice in residential aged care: A qualitative study. J Clin Nurs 2019; 29:626-637. [PMID: 31769898 DOI: 10.1111/jocn.15115] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Revised: 10/17/2019] [Accepted: 11/10/2019] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To explore the experiences of food choice and meal service in residential aged care facilities and its impact on autonomy, self-determination and quality of life from the perspectives of both residents and staff. BACKGROUND Globally, residential aged care is a principal provider of care for older people who can no longer live independently at home. Within this setting, lack of food choice has been identified as a significant factor impacting on residents' self-determination, sense of autonomy and quality of life. DESIGN This study used an exploratory descriptive qualitative approach guided by self-determination theory. METHOD A total of 14 participants (seven residents and seven staff members) from two Australian residential aged care facilities were recruited through purposive and snowball sampling with assistance from one independent contact nurse at each facility. In-depth, semi-structured interviews were conducted, digitally recorded and transcribed. The COREQ checklist was used in this qualitative study. RESULTS Three main themes were identified from the interview data provided by residents and staff, which were as follows: (a) catering for the masses; (b) organisational barriers to providing choice; and (c) food impacts well-being. CONCLUSIONS This study explored the experiences of food choice and service in residential aged care facilities, from the perspectives of both residents and staff. Results of interviews highlighted the importance of providing adequate food choice which has become an enduring issue that requires more attention and commitment to make a positive change for residents living in residential aged care facilities. RELEVANCE TO CLINICAL PRACTICE Nurses and other staff working in residential aged care facilities need to be aware of the importance of providing adequate food choice, including for residents who require modified diets. As advocates for residents, nursing staff must address the persistent lack of food choice. However, this will require a radical change in organisational culture and strong leadership.
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Affiliation(s)
- Donna Wang
- School of Nursing and Midwifery, Western Sydney University, Penrith, NSW, Australia.,Centre for Oral Health Outcomes & Research Translation (COHORT), Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
| | - Bronwyn Everett
- School of Nursing and Midwifery, Western Sydney University, Penrith, NSW, Australia.,Centre for Oral Health Outcomes & Research Translation (COHORT), Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
| | - Scott Brunero
- School of Nursing and Midwifery, Western Sydney University, Penrith, NSW, Australia.,Prince of Wales Hospital, Randwick, NSW, Australia
| | - Tiffany Northall
- School of Nursing and Midwifery, Western Sydney University, Penrith, NSW, Australia
| | - Amy R Villarosa
- School of Nursing and Midwifery, Western Sydney University, Penrith, NSW, Australia.,Centre for Oral Health Outcomes & Research Translation (COHORT), Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia.,South Western Sydney Local Health District, Ingham Institute, Liverpool, NSW, Australia
| | - Yenna Salamonson
- School of Nursing and Midwifery, Western Sydney University, Penrith, NSW, Australia.,Centre for Oral Health Outcomes & Research Translation (COHORT), Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
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18
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Khoddam H, Eshkevarlaji S, Nomali M, Modanloo M, Keshtkar AA. Prevalence of Malnutrition Among Elderly People in Iran: Protocol for a Systematic Review and Meta-Analysis. JMIR Res Protoc 2019; 8:e15334. [PMID: 31582361 PMCID: PMC6880236 DOI: 10.2196/15334] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 08/07/2019] [Accepted: 08/13/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Malnutrition occurs following a decrease or an imbalance in the absorption of energy, protein, vitamins, and minerals because of numerous factors. Thus, it has serious and life-threatening consequences. To plan for this issue, we need information on the burden of this problem. OBJECTIVE The aim of this study is to determine the prevalence of malnutrition among elderly people in Iran. METHODS For the purpose of this study, papers, including original articles, theses, and conference proceedings on the prevalence of malnutrition among people aged 60 years and above, and have been published in national and international journals until September 2018 will be included without any language limitation. The following keywords along with their synonyms in Persian will be used in the literature search: malnutrition, elderly, and Iran. At first, the screening process will be conducted based on our inclusion and exclusion criteria. Then, the full text of the remaining articles will be read carefully, and eligible articles will be selected according to the objectives of the study. Next, the methodological quality of the selected papers will be reviewed, and the required information will be extracted from those with acceptable quality. Finally, a meta-analysis will be performed using the Stata software (version 14) when optimum criteria are met. It should be noted that all stages of screening, selection, quality assessment of primary studies, and data extraction will be performed by two reviewers independently. RESULTS This review is ongoing and will be completed at the end of 2019. CONCLUSIONS This review aims to provide comprehensive evidence about the prevalence of malnutrition among elderly people in Iran. This can help Iranian health managers and policy makers make informed decisions for preventing malnutrition and promoting the health status of elderly people. TRIAL REGISTRATION PROSPERO CRD42018115358; https://tinyurl.com/y28su47m. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/15334.
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Affiliation(s)
- Homeira Khoddam
- Nursing Research Center, Golestan University of Medical Sciences, Gorgan, Islamic Republic of Iran
| | - Sepideh Eshkevarlaji
- School of Nursing and Midwifery, Golestan University of Medical Sciences, Gorgan, Islamic Republic of Iran
| | - Mahin Nomali
- Department of Epidemiology & Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Mahnaz Modanloo
- Nursing Research Center, Golestan University of Medical Sciences, Gorgan, Islamic Republic of Iran
| | - Abbas Ali Keshtkar
- Department of Health Sciences Education Development, School of Public Health, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
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19
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Buondonno I, Sassi F, Carignano G, Dutto F, Ferreri C, Pili FG, Massaia M, Nisoli E, Ruocco C, Porrino P, Ravetta C, Riganti C, Isaia GC, D'Amelio P. From mitochondria to healthy aging: The role of branched-chain amino acids treatment: MATeR a randomized study. Clin Nutr 2019; 39:2080-2091. [PMID: 31672329 DOI: 10.1016/j.clnu.2019.10.013] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 07/17/2019] [Accepted: 10/07/2019] [Indexed: 12/16/2022]
Abstract
RATIONALE Malnutrition often affects elderly patients and significantly contributes to the reduction in healthy life expectancy, causing high morbidity and mortality. In particular, protein malnutrition is one of the determinants of frailty and sarcopenia in elderly people. METHODS To investigate the role of amino acid supplementation in senior patients we performed an open-label randomized trial and administered a particular branched-chain amino acid enriched mixture (BCAAem) or provided diet advice in 155 elderly malnourished patients. They were followed for 2 months, assessing cognitive performance by Mini Mental State Examination (MMSE), muscle mass measured by anthropometry, strength measure by hand grip and performance measured by the Timed Up and Go (TUG) test, the 30 s Chair Sit to Stand (30-s CST) test and the 4 m gait speed test. Moreover we measured oxidative stress in plasma and mitochondrial production of ATP and electron flux in peripheral blood mononuclear cells. RESULTS Both groups improved in nutritional status, general health and muscle mass, strength and performance; treatment with BCAAem supplementation was more effective than simple diet advice in increasing MMSE (1.2 increase versus 0.2, p = 0.0171), ATP production (0.43 increase versus -0.1, p = 0.0001), electron flux (0.50 increase versus 0.01, p < 0.0001) and in maintaining low oxidative stress. The amelioration of clinical parameters as MMSE, balance, four meter walking test were associated to increased mitochondrial function. CONCLUSIONS Overall, our findings show that sustaining nutritional support might be clinically relevant in increasing physical performance in elderly malnourished patients and that the use of specific BCAAem might ameliorate also cognitive performance thanks to an amelioration of mitochondria bioenergetics.
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Affiliation(s)
- Ilaria Buondonno
- Department of Medical Science, Gerontology and Bone Metabolic Diseases, University of Turin, Italy
| | - Francesca Sassi
- Department of Medical Science, Gerontology and Bone Metabolic Diseases, University of Turin, Italy
| | - Giulia Carignano
- Department of Medical Science, Gerontology and Bone Metabolic Diseases, University of Turin, Italy
| | - Francesca Dutto
- Department of Medical Science, Gerontology and Bone Metabolic Diseases, University of Turin, Italy
| | - Cinzia Ferreri
- Department of Medical Science, Gerontology and Bone Metabolic Diseases, University of Turin, Italy
| | - Fausto G Pili
- Department of Medical Science, Gerontology and Bone Metabolic Diseases, University of Turin, Italy
| | - Massimiliano Massaia
- Department of Medical Science, Gerontology and Bone Metabolic Diseases, University of Turin, Italy
| | - Enzo Nisoli
- Department of Medical Biotechnology and Translational Medicine, Centre for Study and Research on Obesity, University of Milan, Italy
| | - Chiara Ruocco
- Department of Medical Biotechnology and Translational Medicine, Centre for Study and Research on Obesity, University of Milan, Italy
| | - Paola Porrino
- Department of Medical Science, Gerontology and Bone Metabolic Diseases, University of Turin, Italy
| | - Claudia Ravetta
- Department of Medical Science, Gerontology and Bone Metabolic Diseases, University of Turin, Italy
| | | | - Giovanni C Isaia
- Department of Medical Science, Gerontology and Bone Metabolic Diseases, University of Turin, Italy
| | - Patrizia D'Amelio
- Department of Medical Science, Gerontology and Bone Metabolic Diseases, University of Turin, Italy.
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20
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Nanayakkara WS, Skidmore P, O'Brien L, Wilkinson T, Frampton C, Gearry R. From menu to mouth: the decay pathway of nutrient intake from planned menu to consumed and characteristics of residents in an aged care facility with greater nutrient decay rates: a cross-sectional study. BMJ Open 2019; 9:e024044. [PMID: 31619411 PMCID: PMC6797362 DOI: 10.1136/bmjopen-2018-024044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES To observe the cascade of nutrient loss from meals planned to those provided and subsequently consumed by older people in residential care. A secondary aim was to determine the characteristics of residents with higher nutrient loss resulting in lower intake of key nutrients. DESIGN A single-centre cross-sectional study. SETTING An aged residential care facility in Christchurch, New Zealand. PARTICIPANTS All low and high level of care residents except those who are end of life, enterally fed or on short-term stay were invited to participate in the study. 54 of 60 selected residents who consumed all three main meals (breakfast, lunch and dinner) for three non-consecutive days were included in the analyses. MAIN OUTCOME MEASURES Nutrient contents of planned menu; nutrient contents of meals served and consumed using modified 3-day diet records; and percentage of planned nutrients served and consumed. RESULTS Vitamins C, B12 and folate had the greatest total decay rates of 50% or more from that planned to be consumed to what was actually consumed, while unsaturated fats, beta carotene, iodine and zinc had the lowest decay rates of 25% or less. Male participants and lower care level residents consumed significantly more nutrients, compared with female participants and those receiving higher level care. Increased age, female gender, higher level of care, smaller meal size, pureed diet and lower body mass index were associated with larger decay rates and lower nutrient intakes. CONCLUSIONS Not all planned and served food and beverages are consumed, contributing to potential multiple nutrient deficiencies including energy and protein in the majority of aged-care residents. As a consequence, some nutrients may need to be oversupplied if consumption is to match planned intakes.
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Affiliation(s)
| | - Paula Skidmore
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
| | - Leigh O'Brien
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand
| | - Tim Wilkinson
- Department of Medicine, University of Otago, Christchurch School of Medicine, Christchurch, New Zealand
| | - Chris Frampton
- Department of Medicine, University of Otago, Christchurch School of Medicine, Christchurch, New Zealand
| | - Richard Gearry
- Department of Medicine, University of Otago, Christchurch School of Medicine, Christchurch, New Zealand
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21
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Keller H, Vucea V, Slaughter SE, Jager-Wittenaar H, Lengyel C, Ottery FD, Carrier N. Prevalence of Malnutrition or Risk in Residents in Long Term Care: Comparison of Four Tools. J Nutr Gerontol Geriatr 2019; 38:329-344. [PMID: 31335280 DOI: 10.1080/21551197.2019.1640165] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The ideal tool for determination of malnutrition risk or malnutrition in long term care (LTC) is elusive. This study compares prevalence, association with resident risk factors and sensitivity (SE) and specificity (SP) of malnutrition or risk categorization in 638 residents from 32 LTC homes in Canada using four tools: the Mini-Nutritional Assessment Short Form (MNA-SF); Patient-Generated Subjective Global Assessment (PG-SGA) Global Category Rating and the Pt-Global webtool; and the interRAI Long Term Care Facility undernutrition trigger. Prevalence was most common with MNA-SF (53.7%) and lowest with InterRAI (28.9%), while the PG-SGA Global Category Rating (44%) was higher than the Pt-Global webtool (33.4%). Tools were consistently associated with resident covariates with few exceptions. The PG-SGA Global Category Rating demonstrated the best sensitivity and specificity when compared to all other tools. Further work to determine the predictive validity of this tool in LTC residents is required.
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Affiliation(s)
- Heather Keller
- Schlegel-University of Waterloo Research Institute for Aging, University of Waterloo , Waterloo , Canada
- Faculty of Applied Health Sciences, University of Waterloo , Waterloo , ON , Canada
| | - Vanessa Vucea
- Faculty of Applied Health Sciences, University of Waterloo , Waterloo , ON , Canada
| | - Susan E Slaughter
- Faculty of Nursing, Edmonton Clinic Health Academy, University of Alberta , Edmonton , Canada
| | - Harriët Jager-Wittenaar
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences , Groningen , The Netherlands
- Department of Maxillofacial Surgery, University Medical Center Groningen, University of Groningen , Groningen , The Netherlands
| | - Christina Lengyel
- Faculty of Agricultural and Food Sciences, University of Manitoba , Winnipeg , Canada
| | - Faith D Ottery
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences , Groningen , The Netherlands
- Ottery and Associates , Vernon Hills , IL , USA
| | - Natalie Carrier
- École des sciences des aliments, de nutrition et d'études familiales, Faculté des sciences de la santé et des services communautaires, Université de Moncton , Moncton , Canada
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22
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Cave DP, Abbey KL, Capra SM. Can foodservices in aged care homes deliver sustainable food fortification strategies? A review. Int J Food Sci Nutr 2019; 71:267-275. [PMID: 31462103 DOI: 10.1080/09637486.2019.1658722] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Food fortification is used as a nutrition support strategy in aged care homes, for residents who are malnourished or at risk of malnutrition. The aim of this review was to determine the scope and strength of published works exploring relationships between food fortification strategies, mode of delivery and sustainability in aged care homes. Literature from four databases and grey literature was searched. A total of 3152 articles were screened. Seventeen studies were included. Results showed that the majority of studies used pre-made food fortification, rather than fortifying foods on-site. There was heterogeneity across studies, including the mode of delivery and ingredients used for food fortification. Only two studies measured any aspect of costs. No clear sustainable strategies for implementing food fortification in this setting could be identified. Research is required to provide further insight into the acceptability and sustainability of food fortification interventions.
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Affiliation(s)
- Danielle P Cave
- School of Human Movement and Nutrition Sciences, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia
| | - Karen L Abbey
- School of Human Movement and Nutrition Sciences, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia
| | - Sandra M Capra
- School of Human Movement and Nutrition Sciences, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia
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23
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Fleurke M, Voskuil DW, Beneken Genaamd Kolmer DM. The role of the dietitian in the management of malnutrition in the elderly: A systematic review of current practices. Nutr Diet 2019; 77:60-75. [PMID: 31157519 DOI: 10.1111/1747-0080.12546] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 04/03/2019] [Accepted: 04/07/2019] [Indexed: 01/19/2023]
Abstract
AIM The prevalence of age-related malnutrition is increasing in almost all Western countries. Because of their expertise, dietitians should have a central role in the management of malnutrition. This review aimed to synthesise the literature on the role of the dietitian in the management of malnutrition in the elderly in comparison with other health professionals. METHODS In November 2018, a search of Embase, Medline Ovid, Cinahl Ebscohost, Cochrane Central, Web of Science and Google Scholar was undertaken using 'dietitian', 'elderly' and 'malnutrition' as the main search terms. Qualitative and quantitative empirical research studies that focussed on the role of dietitians as the (main) subject of the study were included. Data extraction and data synthesis were performed by the three authors using a thematic synthesis approach. RESULTS Three themes emerged from the coding and synthesis of the 21 included studies. The first theme demonstrates that other health professionals' time for, and knowledge of, screening policies negatively affects the role of the dietitian. The second theme demonstrates that the importance of nutritional care is acknowledged. However, this does not always imply familiarity with dietetics nor does it always mean that other health professionals think involving dietitians is worth the effort. The third theme demonstrates that issues of workload appeared to be especially important in crossing or guarding role boundaries. CONCLUSIONS The role of dietitians in managing age-related malnutrition is not always clear and coherent. Therefore, how dietitians shape their role to provide optimal management of malnutrition in the elderly is open to debate.
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Affiliation(s)
- Matthijs Fleurke
- Research Group Informal Care and Department of Nutrition and Dietetics, The Hague University of Applied Sciences, The Hague, Netherlands
| | - Dorien W Voskuil
- Research Group Informal Care and Department of Nutrition and Dietetics, The Hague University of Applied Sciences, The Hague, Netherlands
| | - Deirdre M Beneken Genaamd Kolmer
- Research Group Informal Care and Department of Nutrition and Dietetics, The Hague University of Applied Sciences, The Hague, Netherlands
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24
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Jeon YH, Casey AN, Vo K, Rogers K, Poole B, Fethney J. Associations between clinical indicators of quality and aged-care residents’ needs and consumer and staff satisfaction: the first Australian study. AUST HEALTH REV 2019; 43:133-141. [DOI: 10.1071/ah17213] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 11/13/2017] [Indexed: 11/23/2022]
Abstract
Objectives
To ascertain Australian multistate prevalence and incidence of five commonly collected clinical indicators of aged-care home quality and to measure associations between these clinical indicators and levels of care needs and consumer and staff satisfaction.
Methods
A retrospective analysis of national audit data collected from 426 facilities between 2015 and 2016 was performed. Regression models were used to examine associations between five clinical indicators (falls, pressure injury, physical restraint, unplanned weight loss and polypharmacy) and level of care needs measured by the Aged Care Funding Instrument (ACFI) and consumer and care staff survey responses.
Results
With the exception of polypharmacy, commonly collected negative clinical outcomes were rare events. Compared with care homes with <25% of residents having high-level care needs (high ACFI), homes with 25<75% high-ACFI residents had more occurrences of all negative clinical outcomes except pressure injury. Homes with ≥75% high-ACFI residents reported the highest rates of polypharmacy (odds ratio 1.48, 95% confidence interval 1.39 – 1.57). Falls, unplanned weight loss and pressure injury were inversely associated with satisfaction scores adjusted for residents’ level of care needs.
Conclusions
This first Australian study of multistate clinical indicator data suggests interpretation of clinical indicators of aged-care home quality requires consideration of the level of residents’ care needs.
What is known about the topic?
Many Australian aged-care providers use quality indicators (QI) through benchmarking companies or in-house programs. The five most widely used aged-care clinical QIs in Australia are falls, pressure injury, physical restraint, unplanned weight loss and polypharmacy. Prevalence and incidence of these QIs are highly variable among Australian studies. A consistent message in the international literature is that residents’ clinical characteristics influence QI outcomes at baseline and may continue to influence outcomes over time. Study of associations between Australian aged-care home characteristics and QI outcomes has been limited.
What does this paper add?
This is the first Australian study of multistate clinical QI data. It is also the first to consider the level of resident care needs in the interpretation of clinical QI outcomes and exploration of the association between level of consumer and staff satisfaction and QI outcomes.
What are the implications for practitioners?
Understanding the connections between aged-care home characteristics, consumer and staff perceptions and clinical QIs is crucial in the meaningful interpretation of QI outcomes in context. With the recent introduction of the National Aged Care Quality Indicator Program, it is timely to review national policy, to gauge current quality of care and the measure of care quality in the sector, and to develop directions for possible research to inform and resolve debates regarding the potential influence and unplanned effects that such a program may have.
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Bunn D, Hooper L, Welch A. Dehydration and Malnutrition in Residential Care: Recommendations for Strategies for Improving Practice Derived from a Scoping Review of Existing Policies and Guidelines. Geriatrics (Basel) 2018; 3:E77. [PMID: 31011112 PMCID: PMC6371146 DOI: 10.3390/geriatrics3040077] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 11/02/2018] [Accepted: 11/04/2018] [Indexed: 01/15/2023] Open
Abstract
Preventing malnutrition and dehydration in older care home residents is a complex task, with both conditions remaining prevalent, despite numerous guidelines spanning several decades. This policy-mapping scoping review used snowballing search methods to locate publicly-available policies, reports and best practice guidelines relating to hydration and nutrition in UK residential care homes, to describe the existing knowledge base and pinpoint gaps in practice, interpretation and further investigation. The findings were synthesised narratively to identify solutions. Strategies for improvements to nutritional and hydration care include the development of age and population-specific nutrient and fluid intake guidelines, statutory regulation, contractual obligations for commissioners, appropriate menu-planning, the implementation and auditing of care, acknowledgment of residents' eating and drinking experiences, effective screening, monitoring and treatment and staff training. The considerable body of existing knowledge is failing to influence practice, relating to translational issues of implementing knowledge into care at the point of delivery, and this is where future research and actions should focus.
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Affiliation(s)
- Diane Bunn
- School of Health Sciences, Norwich Research Park, University of East Anglia, Norwich NR4 7TJ, UK.
| | - Lee Hooper
- Norwich Medical School, Norwich Research Park, University of East Anglia, Norwich NR4 7TJ, UK.
| | - Ailsa Welch
- Norwich Medical School, Norwich Research Park, University of East Anglia, Norwich NR4 7TJ, UK.
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Flentje KM, Knight CL, Stromfeldt I, Chakrabarti A, Friedman ND. Recording patient bodyweight in hospitals: are we doing well enough? Intern Med J 2018; 48:124-128. [PMID: 28589617 DOI: 10.1111/imj.13519] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 05/16/2017] [Accepted: 05/28/2017] [Indexed: 11/29/2022]
Abstract
Recording patient weight is a standard practice for all hospital admissions, with this measurement influencing other daily practices that rely on the delivery of safe and effective patient care. Patient weight is important in the areas of medication prescribing, fluid balance and assessment of nutrition. In particular, prescribing narrow therapeutic index medications may result in significant harm as a potential consequence of inaccurate dosing. Despite its importance, it is evident that bodyweight measurements are recorded in only 13.5-55% of hospital patients, in a variety of settings including the emergency department, intensive care unit, medical and surgical wards. Barriers to compliance of healthcare staff include additional workload, patient handling and availability of appropriate weighing equipment. Hospitals and patients would benefit from enhancing compliance with the systematic weighing of patients, staff training and removing barriers to performing this task.
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Affiliation(s)
- Kate M Flentje
- Department of General Medicine, University Hospital Geelong, Geelong, Victoria, Australia
| | - Colin L Knight
- Department of General Medicine, University Hospital Geelong, Geelong, Victoria, Australia
| | - Ingrid Stromfeldt
- Department of General Medicine, University Hospital Geelong, Geelong, Victoria, Australia
| | - Anindita Chakrabarti
- Department of General Medicine, University Hospital Geelong, Geelong, Victoria, Australia
| | - N Deborah Friedman
- Department of General Medicine, University Hospital Geelong, Geelong, Victoria, Australia
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Food Services Using Energy- and Protein-Fortified Meals to Assist Vulnerable Community-Residing Older Adults Meet Their Dietary Requirements and Maintain Good Health and Quality of Life: Findings from a Pilot Study. Geriatrics (Basel) 2018; 3:geriatrics3030060. [PMID: 31011097 PMCID: PMC6319248 DOI: 10.3390/geriatrics3030060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 09/03/2018] [Accepted: 09/06/2018] [Indexed: 12/20/2022] Open
Abstract
The effects of “standard (STD)” vs. “protein- and energy-enriched (HEHP)” food-service meals on the nutrient intake, nutritional status, functional capacity, and wellbeing of older adults was investigated using a 12 week, double-blinded, parallel group design. All participants received dietetics counseling and either an STD (2.3 MJ and 30 g protein per meal) or a HEHP (4.6 MJ and 60 g protein) hot lunchtime meal for at least 3 days/week; those who did not want food-service meals were included in the control group (CON). Twenty-nine participants completed the study (STD = 7; HEHP = 12; CON = 10). From baseline to week 12, the HEHP subjects increased their mean daily energy intake from 6151 ± 376 kJ to 8228 ± 642 kJ (p = 0.002 for effect of time) and protein intake from 67 ± 4 g to 86 ± 8 g (p = 0.014 for effect of time). The MNA (Mini Nutritional Assessment) score was increased significantly in HEHP by 4.0 ± 1.1 points (p = 0.001), but not in the STD and CON groups (2.8 ± 2.1 points and 1.8 ± 1.1 points, p > 0.05). No difference was found for other clinical outcomes between the groups. The findings indicate that provision of HEHP-fortified food-service meals can increase energy and protein intake and improve the nutritional status of nutritionally at-risk older people.
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Wang D, Everett B, Northall T, Villarosa AR, Salamonson Y. Access to food choices by older people in residential aged care: An integrative review. Collegian 2018. [DOI: 10.1016/j.colegn.2017.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Hugo C, Dwonczyk M, Skinner J, Isenring L. Improving the quality of life of aged care residents through the joy of food: The Lantern Project. Australas J Ageing 2018; 37:300-304. [PMID: 29573079 DOI: 10.1111/ajag.12510] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Mealtimes directly impact the quality of life of residents in aged care. The objective of The Lantern Project is to improve the dining experience of aged care residents to reduce malnutrition risk through improving dietary intake, meal. METHODS A transdisciplinary team of aged care professionals and resident advocates was formed as a collaboration collectively known as The Lantern Project. RESULTS This paper outlines the journey and timeline of The Lantern Project collaboration since its inception and the interplay between the monthly stakeholder meetings and inter-related research projects demonstrating improved outcomes. CONCLUSION Transdisciplinary collaboration offers well-grounded benefits and realistic strategies sensitive to the complexity of the aged care setting.
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Affiliation(s)
- Cherie Hugo
- Bond Institute of Health and Sport, Gold Coast, Queensland, Australia.,Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Marcia Dwonczyk
- Creativma, Gold Coast, Queensland, Australia.,The Lantern Project Collaboration, Gold Coast, Queensland, Australia
| | - Jan Skinner
- The Lantern Project Collaboration, Gold Coast, Queensland, Australia.,Arcare, Gold Coast, Queensland, Australia
| | - Liz Isenring
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
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Farrer O, Yaxley A, Walton K, Miller M. Characteristics of older adults with diabetes: What does the current aged care resident look like? Nutr Diet 2018. [PMID: 29542215 DOI: 10.1111/1747-0080.12418] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
AIM The prevalence of diabetes in older adults in residential aged care (RAC) is twice that of community dwelling older adults. Older adults with diabetes have been highlighted as being at high risk of frailty and malnutrition, particularly when managed on a therapeutic diet. However, assumptions may be based on clinical presentation of our oldest old which may be at conflict with the clinical presentation of younger older adults. The aim of this retrospective audit was to identify the characteristics of aged care residents with diabetes, their comorbidities and malnutrition risk. METHODS Residents' with diabetes paper-based records were audited for demographic data, diet code, medical and medication history, malnutrition risk screening scores and anthropometric data. RESULTS A total of 295 residents with diabetes records were audited across 13 sites in South Australia. Younger older adults (65-74 years) were generally in a healthy weight range (23-30 kg/m2 ) or obese (>30 kg/m2 ) and had gained weight since admission to RAC; whereas the oldest old were more likely to have lost weight and had a lower body mass index range 22.6-28.9 kg/m2 . An unexpected finding was the variability between RAC sites in dietary management of diabetes and potential inappropriate dietary management of malnutrition, as indicated by their food service diet codes. CONCLUSIONS Findings suggest that younger older adults in RAC are more likely to be overweight which is maintained over a typical length of stay. Study findings indicate that diabetes management is inconsistent and highlights the need for mandated RAC menu guidelines.
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Affiliation(s)
- Olivia Farrer
- Department of Nutrition and Dietetics, Flinders University, Adelaide, South Australia, Australia
| | - Alison Yaxley
- Department of Nutrition and Dietetics, Flinders University, Adelaide, South Australia, Australia
| | - Karen Walton
- Nutrition and Dietetics, School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
| | - Michelle Miller
- Department of Nutrition and Dietetics, Flinders University, Adelaide, South Australia, Australia
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Park M, Song JA, Lee M, Jeong H, Lim S, Lee H, Kim CG, Kim JS, Kim KS, Lee YW, Lim YM, Park YS, Yoon JC, Kim KW, Hong GRS. National study of the nutritional status of Korean older adults with dementia who are living in long-term care settings. Jpn J Nurs Sci 2018; 15:318-329. [PMID: 29345106 DOI: 10.1111/jjns.12203] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Revised: 08/24/2017] [Accepted: 11/06/2017] [Indexed: 01/22/2023]
Abstract
AIM To evaluate the nutritional status of older adults with dementia who were living in long-term care settings. METHODS As a secondary analysis, this study used the data from the Nationwide Survey on Dementia Care in Korea that was conducted between December 1, 2010, and August 31, 2011, which surveyed 3472 older adults with dementia, aged ≥60 years (mean age: 81.24 years), who were residing in 248 randomly selected long-term care settings in South Korea. Twenty-three different variables that related to the participants' demographics, diseases, and functional and nutritional characteristics were selected. The nutritional status was assessed by using the Mini Nutritional Assessment (MNA). Descriptive statistics, an ANOVA, and a chi-squared test were used to analyze the data. RESULTS The mean MNA score of the participants was 17.90. The malnutrition rate was 38.4% (n = 1333), with 54.7% (n = 1900) of the participants at risk for malnutrition. The largest population with malnutrition resided in long-term care hospitals (47.9%), followed by nursing homes (34.1%), and group homes (25.9%). Being older and female, while exhibiting higher cognitive impairment, more neuropsychiatric symptoms, higher functional dependency, and a higher number of disabilities, were associated with poor nutritional status. CONCLUSION The nutritional status of older adults with dementia who were living in long-term care settings in South Korea was poor and associated with multiple factors. Paying special attention to recognizing, assessing, preventing, and treating malnutrition in this population is necessary.
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Affiliation(s)
- Myonghwa Park
- College of Nursing, Chungnam National University, Daejeon, South Korea
| | - Jun-Ah Song
- College of Nursing, Korea University, Seoul, South Korea
| | - Mihyun Lee
- College of Nursing, Chungnam National University, Daejeon, South Korea
| | - Hyun Jeong
- College of Nursing, Chungnam National University, Daejeon, South Korea
| | - Soyeun Lim
- College of Nursing, Korea University, Seoul, South Korea
| | - Haejung Lee
- College of Nursing, Pusan National University, Yangsan, South Korea
| | - Chun-Gill Kim
- Division of Nursing, Hallym University, Chuncheon, South Korea
| | - Jeong S Kim
- College of Nursing, Chonnam National University, Gwangju, South Korea
| | - Kyung S Kim
- Department of Nursing, Namseoul University, Cheonan, South Korea
| | - Young W Lee
- Department of Nursing, Inha University, Incheon, South Korea
| | - Young M Lim
- Department of Nursing, Yonsei University, Wonju, South Korea
| | - Young S Park
- Department of Nursing, Kyungbok University, Namyangju, South Korea
| | - Jong C Yoon
- Department of Psychiatry, Gyeonggi Provincial Hospital for the Elderly, Yongin, South Korea
| | - Ki W Kim
- Department of Psychiatry, College of Medicine, Seoul National University, Seoul, South Korea
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Miller M, Hamilton J, Scupham R, Matwiejczyk L, Prichard I, Farrer O, Yaxley A. Development and Psychometric Testing of a Novel Food Service Satisfaction Questionnaire for Food Service Staff of Aged Care Homes. J Nutr Health Aging 2018; 22:205-215. [PMID: 29380847 DOI: 10.1007/s12603-017-0885-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Food service staff are integral to delivery of quality food in aged care homes yet measurement of their satisfaction is unable to be performed due to an absence of a valid and reliable questionnaire. The aim of this study was to develop and perform psychometric testing for a new Food Service Satisfaction Questionnaire developed in Australia specifically for use by food service staff working in residential aged care homes (Flinders FSSQFSAC). METHODS A mixed methods design utilizing both a qualitative (in-depth interviews, focus groups) and a quantitative approach (cross sectional survey) was used. Content validity was determined from focus groups and interviews with food service staff currently working in aged care homes, related questionnaires from the literature and consultation with an expert panel. The questionnaire was tested for construct validity and internal consistency using data from food service staff currently working in aged care homes that responded to an electronic invitation circulated to Australian aged care homes using a national database of email addresses. Construct validity was tested via principle components analysis and internal consistency through Cronbach's alpha. Temporal stability of the questionnaire was determined from food service staff undertaking the Flinders FSSQFSAC on two occasions, two weeks apart, and analysed using Pearson's correlations. RESULTS Content validity for the Flinders FSSQFSAC was established from a panel of experts and stakeholders. Principle components analysis revealed food service staff satisfaction was represented by 61-items divided into eight domains: job satisfaction (α=0.832), food quality (α=0.871), staff training (α=0.922), consultation (α=0.840), eating environment (α=0.777), reliability (α=0.695), family expectations (α=0.781) and resident relationships (α=0.429), establishing construct validity in all domains, and internal consistency in all (α>0.5) except for "resident relationships" (α=0.429). Test-retest reliability coefficients ranged from 0.276 to 0.826 dependent on domain, with test-retest reliability established in seven domains at r>0.4; an exception was "reliability" at r=0.276. CONCLUSIONS The newly developed Flinders FSSQFSAC has acceptable validity and reliability and thereby the potential to measure satisfaction of food service staff working in residential aged care homes, identify areas for strategic change, measure improvements and in turn, improve the satisfaction and quality of life of both food service staff and residents of aged care homes.
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Affiliation(s)
- M Miller
- M Miller, Flinders University, Australia,
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Lea EJ, Goldberg LR, Price AD, Tierney LT, McInerney F. Staff awareness of food and fluid care needs for older people with dementia in residential care: A qualitative study. J Clin Nurs 2017; 26:5169-5178. [DOI: 10.1111/jocn.14066] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2017] [Indexed: 01/11/2023]
Affiliation(s)
- Emma J Lea
- Wicking Dementia Research and Education Centre; University of Tasmania; Hobart Tas. Australia
| | - Lynette R Goldberg
- Wicking Dementia Research and Education Centre; University of Tasmania; Hobart Tas. Australia
| | - Andrea D Price
- Wicking Dementia Research and Education Centre; University of Tasmania; Hobart Tas. Australia
| | - Laura T Tierney
- Wicking Dementia Research and Education Centre; University of Tasmania; Hobart Tas. Australia
| | - Fran McInerney
- Wicking Dementia Research and Education Centre; University of Tasmania; Hobart Tas. Australia
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Bailey A, Bailey S, Bernoth M. 'I'd rather die happy': residents' experiences with food regulations, risk and food choice in residential aged care. A qualitative study. Contemp Nurse 2017; 53:597-606. [PMID: 28758840 DOI: 10.1080/10376178.2017.1361334] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Food regulations exist to protect older people in residential aged care, leading to the restriction of potentially hazardous foods. The impacts of malnutrition, resident centred care and the importance of maintaining individual autonomy for older people are well documented. By contrast, there is scant literature describing residents' perceptions of food regulations and food risks in the residential aged care setting. AIMS The aim of this study is to explore resident perceptions of food choice and food restrictions in residential aged care. METHODS Using a qualitative, hermeneutic phenomenological design, semi-structured interviews were conducted with six participants recruited from two residential aged care facilities. Interviews were audio-taped, transcribed verbatim and thematically analysed. RESULTS The following key themes emerged in this study: participants were largely unaware of food regulations and risks, yet expressed the desire to make their own choices. Participants provided contradictory accounts of their experiences with food in residential aged care, which emphasises the ongoing challenge of meeting individual preferences. CONCLUSION These themes warrant further investigation, particularly in relation to the impact of food regulations on food choice and the meaning of risk to older people in residential aged care. This research provides new insight into the perceptions of residents regarding their individual autonomy and independence against legislated risk minimization strategies. Impact statement This article raises the issue of risk taking and food choices from the perspective of residents in a residential aged care facility.
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Affiliation(s)
- Andrew Bailey
- a Autumn Lodge, Nambucca Valley Care , Macksville , NSW , Australia
| | - Sherryn Bailey
- b Southern Cross University , Coffs Harbour , NSW , Australia
| | - Maree Bernoth
- c SNMIH, Charles Sturt University , Wagga Wagga , NSW , Australia
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Burch E, Crowley J, Laur C, Ray S, Ball L. Dietitians' Perspectives on Teaching Nutrition to Medical Students. J Am Coll Nutr 2017. [DOI: 10.1080/07315724.2017.1318316] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Emily Burch
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Jennifer Crowley
- Discipline of Nutrition and Dietetics, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
- NNEdPro Global Centre for Nutrition and Health (Affiliated with Cambridge University Health Partners, Wolfson College Cambridge and the British Dietetic Association), St. John's Innovation Centre, Cambridge, United Kingdom
| | - Celia Laur
- NNEdPro Global Centre for Nutrition and Health (Affiliated with Cambridge University Health Partners, Wolfson College Cambridge and the British Dietetic Association), St. John's Innovation Centre, Cambridge, United Kingdom
- Faculty of Applied Health Sciences, School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Sumantra Ray
- NNEdPro Global Centre for Nutrition and Health (Affiliated with Cambridge University Health Partners, Wolfson College Cambridge and the British Dietetic Association), St. John's Innovation Centre, Cambridge, United Kingdom
| | - Lauren Ball
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
- NNEdPro Global Centre for Nutrition and Health (Affiliated with Cambridge University Health Partners, Wolfson College Cambridge and the British Dietetic Association), St. John's Innovation Centre, Cambridge, United Kingdom
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Agarwal E, Marshall S, Miller M, Isenring E. Optimising nutrition in residential aged care: A narrative review. Maturitas 2016; 92:70-78. [DOI: 10.1016/j.maturitas.2016.06.013] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 06/13/2016] [Accepted: 06/22/2016] [Indexed: 01/04/2023]
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Stegemann S. Towards better understanding of patient centric drug product development in an increasingly older patient population. Int J Pharm 2016; 512:334-342. [DOI: 10.1016/j.ijpharm.2016.01.051] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 01/19/2016] [Indexed: 01/08/2023]
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Stroebele-Benschop N, Depa J, de Castro JM. Environmental Strategies to Promote Food Intake in Older Adults: A Narrative Review. J Nutr Gerontol Geriatr 2016; 35:95-112. [PMID: 27153250 DOI: 10.1080/21551197.2016.1173614] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Aging is often accompanied by lower intakes of food energy and consequent negative effects on health. To some extent this is due to declines in physiological ability, including the sensory responsiveness to regulate food intake. Fortunately, environmental factors may still influence food intake in older adults. Factors such as social facilitation, modeling, and nutrition knowledge and skills have been shown to stimulate their food intake. While environmental factors such as the eating location, portion size, food presentation, and labeling are known to influence eating behavior, their effectiveness in stimulating food intake in older persons is not well delineated. It is suggested that improving the environmental stimuli that promote food intake is a viable strategy to overcome age-related declines in nutrient intakes. This strategy is so promising that further research is warranted.
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Affiliation(s)
| | - Julia Depa
- a Institute of Nutritional Medicine , University of Hohenheim , Stuttgart , Germany
| | - John M de Castro
- b Department of Psychology , Sam Houston University , Huntsville , Texas , USA
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Abstract
ABSTRACTA number of studies stress the importance of positive mealtime experiences for nursing home residents. However, the components that comprise an ideal nursing home meal remain unclear, reflecting the ambiguity of whether nursing homes should be framed as institutions, domestic settings or a type of hotel. In this study, nursing home meals were viewed as situations that the involved parties could continuously modify and ‘work on’. The aim was to analyse how the staff and residents shaped mealtimes by initiating frames and acting according to established social scripts. The study was based on semi-structured interviews with staff and residents and on ethnographic data, consisting of 100 hours of observations at two nursing home settings in Sweden. The analysis revealed how staff and residents interactively shaped meals using institutional, private or restaurant frames. There were three important findings: (a) an institutional meal frame was dominant; (b) there were substantial difficulties in introducing private frames and established private scripts for meals, since such meal versions are personal and not easy to transport into collective settings; (c) successful creation of private or home-like meal situations illustrates an often overlooked skill in care work. Making meals as ‘care-free’ as possible can be viewed as a way to operationalise the goal of providing a non-institutional environment in nursing homes.
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40
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Klemm HJ, Bailey JK, Desneves KJ, Crowe TC. Can early dietetic intervention improve outcomes in patients with hip fracture? Nutr Diet 2016. [DOI: 10.1111/1747-0080.12242] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Haydn J. Klemm
- School of Exercise and Nutrition Sciences; Deakin University; Burwood Victoria Australia
| | - Jacqueline K. Bailey
- Department of Nutrition and Dietetics; Austin Health; Heidelberg Victoria Australia
| | | | - Timothy C. Crowe
- School of Exercise and Nutrition Sciences; Deakin University; Burwood Victoria Australia
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Kellett J, Kyle G, Itsiopoulos C, Naunton M. Nutrition Screening Practices amongst Australian Residential Aged Care Facilities. J Nutr Health Aging 2016; 20:1040-1044. [PMID: 27925144 DOI: 10.1007/s12603-015-0693-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVES To determine the proportion of Residential Aged Care Facilities (RACFs) in Australia who use a nutrition screening tool on residents to identify those at risk of malnutrition, and to review practice following identification of residents as being at high risk of malnutrition. DESIGN Multi-center, cross sectional observational study. SETTING Residential Aged Care Facilities. PARTICIPANTS The Director of Nursing at each site was contacted by telephone and asked questions relating to current nutrition screening practices at their residential aged care facility. MEASUREMENTS Data was collected from a stratified sample of 229 residential aged care facilities in each state and territory in Australia. RESULTS 82% of RACFs (n = 188) use a nutrition screening tool on residents to identify those at risk of malnutrition, however only 52% of RACFs (n = 119) used a screening tool which is validated in the residential aged care setting. There was a significant association between facilities using a nutrition screening tool and the staff members being trained to conduct nutrition screening (p < 0.001). Facilities that employed a dietitian were more likely to use a validated nutrition screening tool (p < 0.005). The most frequently used nutrition screening tool was the 'Mini Nutritional Assessment - Short Form (MNA-SF)', which was used by 32% (n = 60) of the RACFs, followed by the 'Malnutrition Universal Screening Tool (MUST)' (15%, n = 29). CONCLUSION We found that the majority of RACFs in Australia use a nutrition screening tool, however many of these RACFs use a tool which has not been validated in the RACF setting. This study highlights the need for greater dietetic advocacy in using validated nutrition screening tools to ensure malnutrition is identified.
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Affiliation(s)
- J Kellett
- Jane Kellett, University of Canberra, Australia,
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van Nie-Visser NC, Meijers JM, Schols JM, Lohrmann C, Spreeuwenberg M, Halfens RJ. To what extent do structural quality indicators of (nutritional) care influence malnutrition prevalence in nursing homes? Clin Nutr 2015; 34:1172-6. [DOI: 10.1016/j.clnu.2014.12.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2013] [Revised: 07/17/2014] [Accepted: 12/04/2014] [Indexed: 10/24/2022]
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Dupuy C, de Souto Barreto P, Ghisolfi A, Guyonnet S, Dorigny B, Vellas B, Rolland Y. Indicators of oral nutritional supplements prescription in nursing home residents: A cross-sectional study. Clin Nutr 2015; 35:1047-52. [PMID: 26243061 DOI: 10.1016/j.clnu.2015.07.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 06/21/2015] [Accepted: 07/15/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND & AIMS Identifying factors associated with oral nutritional supplement (ONS) prescription in nursing homes (NH) may help to treat malnutrition in this very old and vulnerable population. OBJECTIVES The aim of the study was to investigate if resident-related and NH-related characteristics were associated with ONS prescription. DESIGN Cross-sectional study using medical and demographic data from 6275 NH residents and data on the structure and organization (e.g., presence of a dietitian, organization of the meal) of 175 NHs in southwestern France. The main outcome measure was ONS prescription (dichotomous variable: yes/no). RESULTS ONS were prescribed for 7.8% (n = 489) of NH residents. In a multivariate binary logistic regression, resident-related factors associated with the prescription of ONS were age, clinical markers of undernutrition (body mass index and weight loss), disability in activities of daily living, pain, pressure sores, and hospitalization in the last 12 months. NH-related factors associated with ONS prescription were: presence of a dietitian (Odds Ratio (OR): 1.46, 95% Confidence Interval: 1.18-1.88), NH coordinating physician with specific training in geriatrics (OR: 2.58, 95% CI: 1.48-4.49), organization of evening snack (OR: 1.63, 95% CI: 1.28-2.07), number of general practitioners per NH bed (OR: 0.49, 95% CI: 0.38-0.64 intermediate tertile; OR:0.77, 95% CI:0.59-1.06 highest tertile. Reference category: lowest tertile) and number of drug prescriptions (OR: 0.97, 95% CI: 0.94-0.99). CONCLUSIONS Both resident's characteristics and NH characteristics were associated with ONS prescription independently of each other. Our results showed that NH organizational aspects are associated with ONS prescribing, suggesting that modifiable aspects may contribute to achieve optimal nutritional status in the NH setting.
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Affiliation(s)
- Charlotte Dupuy
- Gérontopôle, Department of Internal Medicine and Geriatrics, Toulouse University Hospital, Toulouse, F-31059, France; INSERM U1027, University of Toulouse III, Toulouse, France.
| | - Philipe de Souto Barreto
- Gérontopôle, Department of Internal Medicine and Geriatrics, Toulouse University Hospital, Toulouse, F-31059, France; INSERM U1027, University of Toulouse III, Toulouse, France
| | - Anne Ghisolfi
- Gérontopôle, Department of Internal Medicine and Geriatrics, Toulouse University Hospital, Toulouse, F-31059, France; INSERM U1027, University of Toulouse III, Toulouse, France
| | - Sophie Guyonnet
- Gérontopôle, Department of Internal Medicine and Geriatrics, Toulouse University Hospital, Toulouse, F-31059, France; INSERM U1027, University of Toulouse III, Toulouse, France
| | - Béatrice Dorigny
- Nutricia Advanced Medical Nutrition, Danone Research, Saint-Ouen, France
| | - Bruno Vellas
- Gérontopôle, Department of Internal Medicine and Geriatrics, Toulouse University Hospital, Toulouse, F-31059, France; INSERM U1027, University of Toulouse III, Toulouse, France
| | - Yves Rolland
- Gérontopôle, Department of Internal Medicine and Geriatrics, Toulouse University Hospital, Toulouse, F-31059, France; INSERM U1027, University of Toulouse III, Toulouse, France
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Farrer O, Olsen C, Mousley K, Teo E. Does presentation of smooth pureed meals improve patients consumption in an acute care setting: A pilot study. Nutr Diet 2015. [DOI: 10.1111/1747-0080.12198] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Olivia Farrer
- School of Health Sciences; Flinders University; Adelaide South Australia Australia
| | - Carla Olsen
- Ashford Hospital; Adelaide South Australia Australia
| | - Kate Mousley
- School of Pharmacy and Medical Sciences; University of South Australia; Adelaide South Australia Australia
| | - Emily Teo
- Food Service Department; Royal Adelaide Hospital; Adelaide South Australia Australia
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Silva JL, Marques APDO, Leal MCC, Alencar DL, Melo EMDA. Fatores associados à desnutrição em idosos institucionalizados. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2015. [DOI: 10.1590/1809-9823.2015.14026] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Trata-se de artigo de revisão integrativa da literatura com o objetivo de analisar as evidências científicas que retratam os fatores associados à desnutrição em idosos institucionalizados. A busca de artigos foi realizada nas bases de dados LILACS, MEDLINE e IBECS, sendo incluídas as publicações referentes ao período de 2000 a novembro de 2012. Os artigos foram submetidos a dois instrumentos de avaliação, no intuito de verificar a qualidade metodológica dos estudos. Os resultados mostraram que os fatores psicológicos (depressão e demência) e funcionais (dependência) foram os principais aspectos relacionados à desnutrição, uma vez que a institucionalização favorece o isolamento e a inatividade física e mental, podendo comprometer a qualidade de vida do idoso. A desnutrição, apesar de associada ao aumento da morbi-mortalidade em geral, não é avaliada de forma rotineira nas instituições. Considerando as especificidades do segmento mais envelhecido, se faz necessário realizar avaliações multidimensionais da condição de saúde do idoso para possibilitar uma intervenção mais efetiva e integral.
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Bernoth MA, Dietsch E, Davies C. 'Two dead frankfurts and a blob of sauce': the serendipity of receiving nutrition and hydration in Australian residential aged care. Collegian 2015; 21:171-7. [PMID: 25632710 DOI: 10.1016/j.colegn.2013.02.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND This paper explores the serendipity of residents accessing adequate food and fluids in aged care facilities. It draws on the findings of two discrete but interrelated research projects conducted in 2009 and 2011 relating to the experience of living in, or having a friend or family member living in, residential aged care. METHODS Participants were recruited through media outlets. Indepth interviews with participants were audiotaped, transcribed verbatim and thematically analysed. FINDINGS This paper discusses a theme that was iterated by participants in both projects that is, the difficulty residents in aged care facilities experienced in receiving adequate and acceptable food and fluids. Unacceptable dining room experiences, poor quality food and excessive food hygiene regulations contributed to iatrogenic malnutrition and dehydration. Implications for staffing, clinical supervision, education of carers and the impact of negative attitudes to older people are discussed. CONCLUSION The inability of dependent residents in aged care facilities to receive adequate nourishment and hydration impacts on their health and their rights as a resident, and is an ongoing issue in Australian residential aged care.
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Vahabi M, Schindel Martin L. Food security: who is being excluded? A case of older people with dementia in long-term care homes. J Nutr Health Aging 2014; 18:685-91. [PMID: 25226107 DOI: 10.1007/s12603-014-0501-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES PURPOSE To explore the extent of food security among older people, particularly those with cognitive impairments residing in Canadian long-term care homes (LTCHs) through a focused review of literature. METHOD Databases including Medline, Nursing and Health Sciences (SAGE), Psych Info, Social Sciences Abstract, the Cumulative Index of Nursing and Allied Health Literature (CINAHL) and HealthSTAR were searched for peer-reviewed articles related to food experiences of older individuals in industrialized countries including Canada. Only articles that were published in English between 1997-2012 were included. RESULTS Sixty two studies met the inclusion criteria. Of those 17 focused on older adults in LTCHs. The review found that food security has rarely been examined among older persons living in LTCHs, and has never been examined within the context of cognitive impairment. While a few studies have focused on residents' satisfaction with foods that are provided to them in LTCHs, none have explored the extent of food security in this population. Furthermore, food satisfaction surveys in the LTCH are limited to the assessment of foods that are served to residents, and do not capture residents' food accessibility beyond the food dispensing routines of the organization. Thus, food quality, food preferences, and the traditional meanings and rituals associated with food consumption are not purposefully evaluated. In addition, LTCHs are not required to monitor residents' food satisfaction using a consistent, regular, and standardized approach and there is no regulation in the LTCH Act that requires LTCHs to assess their residents' food security. CONCLUSIONS The findings highlight the need for: 1) expansion of food security research to non-community-based settings including LTCHs; 2) re-conceptualization of food security and modification of measurement tools to assess the extent and determinants of food security among older adults in LTCHs; 3) mandatory monitoring of food security via standardized and regular surveys tailored to meet the unique preferences and needs of the older population, particularly those with dementia; and 4) education of healthcare professionals regarding food security and its assessment in LTCHs.
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Affiliation(s)
- M Vahabi
- Mandana Vahabi, Ph.D., Ryerson University, 350 Victoria Street, Toronto, Ontario, M5B 2K3, Telephone: (416) 979-5000, Ext. 2725, Fax Number: (416) 979-5332, E-mail address:
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Jefferies D, Johnson M, Langdon R. Rekindling the role of nurses in patients' oral nutrition. Int J Nurs Pract 2014; 21:286-96. [DOI: 10.1111/ijn.12269] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Diana Jefferies
- School of Nursing and Midwifery; University of Western Sydney; Sydney New South Wales Australia
| | - Maree Johnson
- School of Nursing and Midwifery; University of Western Sydney; Sydney New South Wales Australia
- Centre for Applied Nursing Research, South Western Sydney Local Health District & School of Nursing and Midwifery; University of Western Sydney; Sydney New South Wales Australia
| | - Rachel Langdon
- SWS Centre for Applied Nursing Research; University of Western Sydney; Sydney New South Wales Australia
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Which characteristics of nursing home residents influence differences in malnutrition prevalence? An international comparison of The Netherlands, Germany and Austria. Br J Nutr 2013; 111:1129-36. [DOI: 10.1017/s0007114513003541] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Prevalence rates of malnutrition vary considerably internationally, partly due to differences in measurement methodology and instruments. In the present study, the same measurement methodology and instruments were used in The Netherlands, Germany and Austria. The aim of the present study was to investigate whether resident characteristics influence possible differences in malnutrition prevalence between countries. The study followed a cross-sectional, multi-centre design that measured malnutrition in nursing home residents from The Netherlands, Germany and Austria. Resident data were gathered using a standardised questionnaire. Malnutrition was operationalised using BMI, unintentional weight loss and nutritional intake. Data were analysed using an association model. The prevalence rates of malnutrition in The Netherlands, Germany and Austria were 18·3, 20·1 and 22·5 %, respectively. The multivariate generalised estimating equation (GEE) logistic regression analysis showed that sex, age, care dependency, the mean number of diseases and some specific diseases were influencing factors for whether the resident was malnourished or not. The OR of malnutrition in the three countries declined after including the influencing factors resulting from the multivariate GEE analysis. The present study reveals that differences in the prevalence rates of malnutrition in nursing homes in The Netherlands, Germany and Austria are influenced by different resident characteristics. Since other country-related factors could also play an important role in influencing differences in the prevalence rates of malnutrition between the countries (structural and process factors of malnutrition care policy). We recommend the investigation of these factors in future studies.
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