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Lee K, Kim S, Liu W. Assessing eating ability and mealtime behaviors of persons living with dementia: A systematic review of instruments. Geriatr Nurs 2024; 58:76-86. [PMID: 38781628 DOI: 10.1016/j.gerinurse.2024.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 04/29/2024] [Accepted: 05/06/2024] [Indexed: 05/25/2024]
Abstract
This systematic review aimed to describe the characteristics of instruments that assess eating ability and/or mealtime behaviors in persons living with dementia, and evaluate their psychometric properties. Five databases were searched for relevant records between 1/1/1980 and 5/25/2023. Records included instruments assessing eating ability and/or mealtime behaviors of people with dementia. The psychometric quality of the instruments was evaluated using the Psychometric Assessment for Self-report and Observational Tools (PAT). 45 eligible instruments were identified from 115 records. While 38 instruments were scored as having low psychometric quality, 7 had moderate quality. Edinburgh Feeding Evaluation in Dementia (EdFED), Mealtime Difficulty Scale for older adults with Dementia (MDSD), and Dementia Hyperphagic Behavior Scale (DHBS) were scored as having the highest quality (total PAT score = 9). Further refinement of existing instruments and additional psychometric testing in larger, diverse samples will improve pragmatic use in dementia mealtime care research and practice.
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Affiliation(s)
- Kyuri Lee
- University of Iowa College of Nursing, 50 Newton Road, Iowa City, Iowa 52242, United States.
| | - Sohyun Kim
- University of Texas at Arlington College of Nursing and Health Innovation, 411 S. Nedderman Drive, Arlington, Texas 76019, United States
| | - Wen Liu
- University of Iowa College of Nursing, 50 Newton Road, Iowa City, Iowa 52242, United States
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Saucedo Figueredo MC, Morilla-Herrera JC, Kaknani Uttumchandani S, Durá Pérez E, San Alberto Giraldos M, Nava Del Val MA, Hierrezuelo Martín MJ, Gómez Borrego AB, García Irazusta M, Gálvez González M, Miguel Morales-Asencio J. Longitudinal assessment of the eating pattern of people with dementia and its association with problems for feeding and malnutrition: a prospective follow-up study protocol. BMJ Open 2023; 13:e068790. [PMID: 37230516 DOI: 10.1136/bmjopen-2022-068790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
INTRODUCTION Dementia conditions the patient's nutrition from the beginning and vice versa. Generating difficulties for feeding (FEDIF) will influence its evolution. There are currently few nutritional longitudinal studies in people with dementia. Most focus on problems already established. The Edinburgh Feeding Evaluation in Dementia (EdFED) Scale identifies FEDIF of patients with dementia by studying their behaviours while eating or being fed. It also indicates areas of potential clinical interventions. METHODS AND ANALYSIS Prospective multicentre observational study carried out in nursing homes, Alzheimer's day care centres and primary healthcare centres. The study population will be dyads composed by the patient (diagnosed of dementia, over 65 years of age and who have feeding difficulties) and their family caregiver. Sociodemographic variables and nutritional status (body mass index, Mini Nutritional Assessment, blood test and calf and arm circumference) will be assessed. The Spanish version of the EdFED Scale will be completed and the presence of nursing diagnoses related to feeding behaviours will be collected. Follow-up will take place for 18 months. ETHICS AND DISSEMINATION All data will be carried out respecting European legislation 2016/679 in data protection, and the Spanish 'Organic Law 3/2018 of December 2005'. The clinical data will be kept segregated and encrypted. The informed consent has been obtained. The research has been authorised by the Costa del Sol Health Care District on 27 February 2020 and the Ethics Committee on 2 March 2021. It has obtained funding from the Junta de Andalucía on 15 February 2021. Findings of the study will be presented at provincial, national and international conferences and published in peer-reviewed journals.
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Affiliation(s)
- María Carmen Saucedo Figueredo
- Primary Health Care Costa del Sol District, Los Boliches Health Care Centre, Andalucia Health Service (SAS), Fuengirola, Andalucia, Spain
- IR Group C-13 "Chronicity, Dependency, Care and Health Services", Biomedical Research Institute of Malaga (IBIMA), Malaga, Andalucia, Spain
| | - Juan Carlos Morilla-Herrera
- IR Group C-13 "Chronicity, Dependency, Care and Health Services", Biomedical Research Institute of Malaga (IBIMA), Malaga, Andalucia, Spain
- Residences Unit, Malaga and Valle del Guadalhorce Primary Health Care District, Andalucia Health Service (SAS), Malaga, Andalucia, Spain
| | - Shakira Kaknani Uttumchandani
- IR Group C-13 "Chronicity, Dependency, Care and Health Services", Biomedical Research Institute of Malaga (IBIMA), Malaga, Andalucia, Spain
- Nursing Department, University of Malaga, Health Science Faculty, Malaga, Andalucia, Spain
| | - Elena Durá Pérez
- Andalusian Public Foundation for Research in Biomedicine and Health of Malaga, FIMABIS, Malaga, Andalucia, Spain
| | - Mercedes San Alberto Giraldos
- Primary Health Care Costa del Sol District, La Lobilla Health Care Center, Andalucia Health Service (SAS), Estepona (Málaga), Andalucia, Spain
| | - Maria Antonia Nava Del Val
- Primary Health Care Costa del Sol District, Las Albarizas Health Care Center, Andalucia Health Service (SAS), Marbella, Andalucia, Spain
| | - María Jesús Hierrezuelo Martín
- Primary Health Care Costa del Sol District, Las Lagunas Health Care Center, Servicio Andaluz de Salud, Mijas Costa, Andalucia, Spain
| | - Ana Belén Gómez Borrego
- Community Mental Health Unit, Virgen de la Victoria University Hospital, Servicio Andaluz de Salud, Estepona, Andalucia, Spain
| | - Manuela García Irazusta
- Primary Health Care Costa del Sol District, Fuengirola Oeste Health Care Center, Servicio Andaluz de Salud, Marbella, Andalucia, Spain
| | - María Gálvez González
- Primary Health Care Costa del Sol District, La Carihuela Health Care Center, Servicio Andaluz de Salud, Benalmadena, Andalucia, Spain
| | - Jose Miguel Morales-Asencio
- IR Group C-13 "Chronicity, Dependency, Care and Health Services", Biomedical Research Institute of Malaga (IBIMA), Malaga, Andalucia, Spain
- Nursing Department, University of Malaga, Málaga, Andalucia, Spain
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Factors Affecting Mealtime Difficulties in Older Adults with Dementia Living in Long-Term Care Facilities: A Multilevel Model Analysis. J Nurs Manag 2023. [DOI: 10.1155/2023/4427390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Aim(s). This study conducted a multilevel analysis of mealtime difficulties in older adults with dementia based on the social-ecological model. Background. Mealtime difficulty in this population should be examined from an extensive perspective, rather than approaching it as an individual problem. Method(s). This was a cross-sectional study involving 342 participant dyads from 57 long-term care facilities; 114 direct care workers; and 342 older adults with dementia. A multilevel regression analysis was conducted using the MPlus 8.0 program. Results. Among intrapersonal factors, age, cognitive function, activities of daily living, and number of beds in the facility were identified as affecting mealtime difficulty. Environmental factors included meal assistant education experience and whether an environment suitable for eating had been established. Conclusion(s). The results show that intrapersonal factors exert a large influence on the mealtime difficulties of older adults with dementia in long-term care facilities and support the need to improve environmental factors, which are modifiable. Implications for Nursing Management. This study provided useful information about the influence of leaders on mealtime difficulties in older adults with dementia. Leaders should establish an environment in the facility for reduced mealtime difficulties.
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Eating Difficulties and Relationship With Nutritional Status Among Patients With Dementia. THE JOURNAL OF NURSING RESEARCH : JNR 2023; 31:e260. [PMID: 36602459 DOI: 10.1097/jnr.0000000000000538] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND One of the most common behavioral problems in patients with dementia is eating problems, which are known to increase the risk of malnutrition. However, few studies have been conducted in this patient group regarding the relationship between eating difficulties and nutritional status. PURPOSE This study was designed to determine the eating difficulties faced by patients with dementia and to evaluate the relationship in this population between eating difficulties and malnutrition. METHODS This study was carried out in a dementia outpatient clinic of a university hospital in Istanbul, Turkey. This cross-sectional, case-control study included 50 patients and 50 healthy controls as participants. Participants were assessed for eating difficulties and for nutritional, cognitive, and functional statuses. RESULTS The patients with dementia had more difficulties in terms of self-feeding skills. Although problems related to manipulating food on the plate and the use of utensils were not seen in the control group, these problems were found in 30% of the participants in the dementia group ( p < .001). Moreover, 30% of the patients in the dementia group were unable to eat without assistance ( p < .001). Associations were found between eating difficulties and age, duration of illness, and cognitive and functional (basic and instrumental activities of daily living) statuses. In addition, self-feeding skills were found to be associated with nutritional status. Rate of malnutrition or risk of malnutrition was higher in patients with dementia than in those in the control group. CONCLUSIONS In this study, compared with the control group, patients with dementia had more problems in self-feeding skills such as manipulation of food on a plate, use of utensils, need for assistive tools, ability to eat without assistance, and negative eating behaviors (refusal to eat). An association was found between eating difficulties and nutritional status. Evaluating eating difficulties is recommended in patients with dementia to prevent nutritional deterioration.
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Wu XS, Miles A, Braakhuis A. Attitudes towards Freshly Made and Readily Prepared Texture-Modified Foods among Speech-Language Therapists, Dietitians, and Community-Dwelling Older Adults. Foods 2022; 11:foods11142157. [PMID: 35885400 PMCID: PMC9317743 DOI: 10.3390/foods11142157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 07/15/2022] [Accepted: 07/19/2022] [Indexed: 02/04/2023] Open
Abstract
Texture-modified foods (TMFs) are recommended for patients suffering from swallowing difficulties. Given the increasing aging population, the use of TMFs is on the rise. Research to date has focused on the nutritional value, malnutrition indices and healthcare practices in relation to TMFs, but the perception of these diets from a patient and healthcare practitioner perspective has received less consideration. This study explored how currently available TMFs (including Soft & Bite-Sized, Minced & Moist, and puree) are perceived by key stakeholders. Four types of TMFs were consumer tested: freshly made TMFs following foodservice recipes and three types of readily prepared TMFs (commercially packaged, sous-vide and hydrolysed). The selected samples were tested through five focus groups (including nine dietitians, seven speech-language therapists, and five community-dwelling older adults), which involved a sensory rating using a validated 7-point scale meal assessment tool and a semi-structured focus group discussion. Analysis was conducted using quantitative and qualitative approaches. Soft & Bite-Sized meals had significantly higher palatability ratings than others. Sous-vide meals were most suitable for Soft & Bite-Sized texture, while commercially packaged samples were most appropriate for minced moist and pureed meals. Three main themes emerged through content analysis: (1) palatability of TMFs, (2) perceived challenges with the currently available TMFs and (3) key differences in opinion between stakeholders. Freshly made TMFs were more appealing and tastier, whereas readily prepared (pre-cooked, packaged and require reheating) TMFs had a more consistent texture. The texture of all TMFs requires enhancement, particularly in pureed meals. Developing nutritious and safe TMFs for people with dysphagia requires the promotion of active insight exchange between dietitians and speech-language therapists.
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Affiliation(s)
- Xiaojing Sharon Wu
- Department of Nutrition, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1023, New Zealand;
- Correspondence: ; Tel.: +64-210-859-9592
| | - Anna Miles
- Department of Speech Science, School of Psychology, University of Auckland, Auckland 1023, New Zealand;
| | - Andrea Braakhuis
- Department of Nutrition, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1023, New Zealand;
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Jung D, Choi E, Yoo L, Lee H. Development of mealtime difficulty scale for older adults with dementia in long-term care facilities. BMC Geriatr 2022; 22:518. [PMID: 35751034 PMCID: PMC9229116 DOI: 10.1186/s12877-022-03224-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 06/13/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In older patients with dementia, functional dependence on individuals affects their eating behavior, leading to difficulties with meals. In addition to individual factors, several social, cultural, and environmental factors influence mealtime difficulties in older individuals with dementia. Therefore, a measure is required to evaluate the difficulty of eating, considering the different interacting phenomena. METHODS Mealtime Difficulties Scale for older adults with Dementia (MDSD) was developed through a literature review. A pilot test was undertaken to confirm the meaning of the items and the relevance of mealtime difficulties for older patients with dementia. A panel of six experts examined the content validity of the MDSD. Convenience sampling was used to recruit direct care workers from long-term care facilities, of which 150 were recruited for exploratory factor analysis (EFA) and 208 for confirmatory factor analysis (CFA). RESULTS The final version of the MDSD included 19 items, with a Cronbach's α of 0.91. The EFA identified three factors ("functional," "caregiving," and "behavioral") that account for 54.6% of the total variance. The CFA confirmed the validity of the instrument. CONCLUSIONS Evidence to substantiate the validity and reliability of MDSD was found. While this tool has limitations in that it does not ensure convergent validity, it can be considered significant as it can assess the mealtime difficulty among older patients with dementia from different perspectives.
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Affiliation(s)
- Dukyoo Jung
- College of Nursing, Ewha Womans University, Seoul, Republic of Korea
| | - Eunju Choi
- College of Nursing, Ewha Womans University, Seoul, Republic of Korea
| | - Leeho Yoo
- College of Nursing, Ewha Womans University, Seoul, Republic of Korea
| | - Hyesoon Lee
- Department of Nursing, Semyung University, 65, Semyeong-ro, Jecheon-si, Chungbuk 27136 Republic of Korea
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Eating Difficulties among Older Adults with Dementia in Long-Term Care Facilities: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910109. [PMID: 34639409 PMCID: PMC8508293 DOI: 10.3390/ijerph181910109] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 09/13/2021] [Accepted: 09/15/2021] [Indexed: 01/17/2023]
Abstract
This paper reports a scoping review of the literature on eating difficulties among older adults with dementia in long-term care facilities to identify key concepts, methods of measuring outcomes, interventions, and related factors. A scoping review was performed using the bibliographic databases PubMed, CINAHL, PsycINFO, and Cochrane Library. A combination of keywords and subject headings related to eating or feeding difficulties was used. Inclusion criteria were limited to materials published in English. A total of 1070 references were retrieved, of which 39 articles were selected after applying the inclusion and exclusion criteria. Articles that met the criteria were published between 1987 and 2020. “Eating disabilities” have been defined as problems related to choosing food and/or the ability to get food to one’s mouth, chew, and swallow. Interventions for eating difficulties described in the literature include spaced retrieval training, Montessori training, and feeding skill training. Intrapersonal, interpersonal, and environmental factors related to eating difficulties were identified. This scoping review will provide direct care workers, nursing educators, and administrators with an overview of eating performance and a broad understanding of eating difficulties for older adults with dementia in long-term care facilities.
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Egan A, Andrews C, Lowit A. Dysphagia and mealtime difficulties in dementia: Speech and language therapists' practices and perspectives. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2020; 55:777-792. [PMID: 32706516 DOI: 10.1111/1460-6984.12563] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 06/08/2020] [Accepted: 06/20/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND There is increasing recognition of the impact that dementia has upon swallowing and at mealtimes, and the significant effect this can have on people with dementia's health and well-being. However, there remains a paucity of evidence for assessment and intervention practices for dysphagia and mealtime difficulties. Furthermore, there is a limited understanding of how speech and language therapists (SLTs) support people with these dementia-related issues and what are the barriers and facilitators to practice. Further research is therefore needed to guide policy as well as service guideline and delivery development. AIMS To establish the current practices of SLTs managing dementia-related dysphagia and mealtime difficulties in the UK and Republic of Ireland (ROI), and to establish their opinions and experiences of what challenges or supports to practice they have encountered. METHODS & PROCEDURES An anonymous, cross-sectional web-based survey was developed and distributed to SLTs working in the UK and ROI. Respondents completed a questionnaire that consisted of open and closed questions across nine topic areas. Closed responses were evaluated using descriptive statistics; open-ended questions were analysed using conventional content analysis. OUTCOMES & RESULTS A total of 310 people accessed the survey, and 125 respondents completed it fully. While respondents agreed on their role in dysphagia management, they varied in their views on the extent of their role in managing mealtime difficulties. Additionally, their self-rated knowledge of mealtime difficulties in dementia was lower than their dysphagia knowledge. The respondents predominantly based their management decisions on their clinical experience of working with people with dementia. They primarily used compensatory strategies and frequently cited the need for family and care staff training. Respondents also highlighted barriers to effective management and training provision such as inefficient referral systems, a lack of carer knowledge and lack of SLT resources. CONCLUSIONS & IMPLICATIONS The results provide valuable insight into the issues facing SLTs practising in this area. The SLTs surveyed considered dysphagia a core part of their role when supporting people with dementia; however, respondents' views on mealtime difficulties varied. This highlights the need to establish consensus guidelines on the SLT's role in order to avoid variations in service delivery that could negatively impact the health and well-being of people with dementia. Moreover, further research to develop efficient and effective training for care staff supporting mealtime difficulties and dysphagia is essential. What this paper adds What is already known on the subject Research indicates that people with dementia develop dysphagia and mealtime difficulties as dementia progresses. SLTs often manage these, but there is no research on the effective assessment and management procedures, or guidance on best practice. What this paper adds to existing knowledge This paper provides an understanding of the variation in practice across the UK and ROI. Respondents described barriers to delivering an effective service and frequently linked these to the SLTs' resources as well as service constraints. What are the potential or actual clinical implications of this work? These findings support the need for future research to develop guidelines for SLT practice in this area. They also support the need to examine resource allocation and workforce management to enable SLTs to manage dementia-related dysphagia and mealtime difficulties effectively.
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Affiliation(s)
- Aisling Egan
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| | - Carolyn Andrews
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| | - Anja Lowit
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
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Palese A, Gonella S, Grassetti L, Longobardi M, De Caro A, Achil I, Hayter M, Watson R. What nursing home environment can maximise eating independence among residents with cognitive impairment? Findings from a secondary analysis. Geriatr Nurs 2020; 41:709-716. [PMID: 32414542 DOI: 10.1016/j.gerinurse.2020.03.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 03/23/2020] [Accepted: 03/25/2020] [Indexed: 01/09/2023]
Abstract
To explore the influence of the Nursing Home (NH) environment on eating independence while taking into account individual and nursing care factors, was the aim of the study. A secondary analysis was performed based on data collected in a multicentre prospective observational study involving 13 NHs. Residents aged >65 were included (n = 1,027). Dependence in eating was measured using the Edinburgh Feeding Evaluation in Dementia scale (EdFED, range 0-20). In addition to individual and nursing care variables, the NHs environments were assessed with the Therapeutic Environment Screening Survey for Nursing Homes (TESS-NH, range 0-149). The mean EdFED score was 2.48 (95% Confidence Interval [CI]=2.22-2.73) and the TESS-NH score was 122.19 (95% CI=115.89-128.49). A linear regression analysis explained 30.8% of the total variance in eating dependence. Alongside individual and nursing care factors, in poor NH unit environments, residents with severe cognitive impairment showed increased eating dependence; in contrast, in better environments, similar residents showed maximal eating performance.
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Affiliation(s)
- Alvisa Palese
- Associate Professor in Nursing Science, Department of Medical Science, University of Udine, Viale Ungheria 20, 33010 Udine, Italy.
| | - Silvia Gonella
- Research Assistant, Public Health Department, University of Torino, Italy
| | - Luca Grassetti
- PhD in Statistics, Lecturer, Department of Economics and Statistics, University of Udine, Italy
| | - Melania Longobardi
- Clinical Nurse, Department of Medical Science, University of Udine, Italy
| | - Alessandro De Caro
- Clinical Nurse, Department of Medical Science, University of Udine, Italy
| | - Illarj Achil
- Clinical Teacher, Department of Medical Science, University of Udine, Italy
| | - Mark Hayter
- Professor, Faculty of Health Sciences, University of Hull, UK
| | - Roger Watson
- Professor, Faculty of Health Sciences, University of Hull, UK
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Diet quality is associated with malnutrition and low calf circumference in Canadian long-term care residents. BMC Nutr 2019; 5:57. [PMID: 32153970 PMCID: PMC7050926 DOI: 10.1186/s40795-019-0314-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 10/14/2019] [Indexed: 11/27/2022] Open
Abstract
Background Older adults living in long-term care (LTC) are nutritionally vulnerable. The purpose of this study was to determine diet quality of Canadian LTC residents and its association with malnutrition and low calf circumference. Methods A cross-sectional study was undertaken in 32 LTC homes across four Canadian provinces. Nutrient adequacy ratios (NARs) were calculated for seventeen nutrients; mean adequacy ratio (MAR) was calculated to describe overall diet quality. Malnutrition risk was assessed with the Mini Nutritional Assessment-Short Form (MNA-SF) and diagnosis of protein/energy malnutrition with the Patient-Generated Subjective Global Assessment (PG-SGA). Calf circumference (CC) was also assessed. Linear and logistic regressions for these outcomes with diet quality as the predictor were conducted adjusting for covariates. Results Average MNA-SF score was 10.7 ± 2.5. Residents (43.5%) had mild/moderate to severe malnutrition based on the PG-SGA and 32.6% had a CC of < 31 cm. Mean MAR score was 0.79 ± 0.09 with significant differences between those requiring eating assistance (0.77 ± 0.11) and those that did not require assistance (0.80 ± 0.07) (p < .05). MAR score was significantly associated with malnutrition in fully adjusted models: MNA-SF scores [β = 5.34, 95% Confidence interval (CI) (2.81, 7.85)] and PG-SGA [Odds ratio (OR) = 0.49, 95% CI (0.38, 0.64)]. Those who had better diet quality were more likely to be well nourished or not at risk. Although several individual nutrients were associated with low CC (< 31 cm), there was no association between overall diet quality (MAR) and low CC. Conclusions Diet quality is associated with malnutrition and individual nutrients (NARs) with a low CC. In addition to calories and protein, nutrient dense diets that promote adequate micronutrient intake are required in LTC.
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Batchelor-Murphy M, Kennerly SM, Horn SD, Barrett R, Bergstrom N, Boss L, Yap TL. Impact of Cognition and Handfeeding Assistance on Nutritional Intake for Nursing Home Residents. J Nutr Gerontol Geriatr 2019; 38:262-276. [PMID: 31124418 PMCID: PMC7187960 DOI: 10.1080/21551197.2019.1617221] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
In nursing homes (NHs), residents are at risk for malnutrition and weight loss. The purpose of this secondary data analysis was to examine the impact of resident cognitive status and level of feeding assistance provided by NH staff on resident's daily nutritional intake and body weight. As part of a large, multisite clinical trial (N = 786), residents with and without dementia were examined according to level of feeding assistance required during mealtimes (independent, set-up only, needs help eating) over a 21-day period. Outcomes analyzed were percent of meal intake by meal type (breakfast, lunch, dinner) and overall daily intake (meals + snacks/supplements). Residents with dementia who required meal set-up assistance had significantly lower meal intake for all three meals. Residents without dementia requiring meal set-up assistance experienced significantly lower intake for breakfast and dinner, but not lunch. When snacks and supplements were offered between meals, residents with dementia consumed approximately 163 additional calories/day, and residents without dementia consumed approximately 156 additional calories/day. This study adds new evidence that residents at greatest risk for low intake are those who are only provided set-up assistance for meals and/or have cognitive impairment.
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Affiliation(s)
| | - Susan M Kennerly
- b College of Nursing, East Carolina University , Greenville , NC , USA
| | - Susan D Horn
- c School of Medicine, University of Utah , Salt Lake City , UT , USA
| | - Ryan Barrett
- d International Severity Information Systems and the Institute for Clinical Outcomes Research , Salt Lake City , UT , USA
| | - Nancy Bergstrom
- e School of Nursing, University of Texas Health Science Center at Houston , Houston , TX , USA
| | - Lisa Boss
- f Memorial Hermann Northeast Medical Center , Humble , TX , USA
| | - Tracey L Yap
- g School of Nursing, Duke University , Durham , NC , USA
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Nunes DP, Brito TRPD, Corona LP, Alexandre TDS, Duarte YADO. Elderly and caregiver demand: proposal for a care need classification. Rev Bras Enferm 2018; 71 Suppl 2:844-850. [PMID: 29791633 DOI: 10.1590/0034-7167-2017-0123] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 06/11/2017] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To propose a care need classification for elderly people by identifying their functional demands. METHOD Cross-sectional study carried out in São Paulo, in 2006, with 1,413 elderly (≥ 60 years old), participants in the Health, Well-being and Aging study (SABE - Saúde, Bem Estar e Envelhecimento). For the care need classification, we used the Guttman Scaling method e the frequency of assistance required by the elderly. RESULTS The hierarchy of activities of daily living had good internal consistency (α = 0.92) and satisfactory coefficients of reproducibility (98%), scalability (84%) and minimum marginal reproducibility (87%). Care need was categorized into: no need (requires no caregiver), minimum need (requires caregiver sporadically), moderate need (requires caregiver intermittently) and maximum need (requires full-time caregiver). CONCLUSION This classification will allow identifying elderly that need assistance in everyday activities and will orientante health professionals in the development of a line of care.
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Affiliation(s)
| | | | | | - Tiago da Silva Alexandre
- Gerontology Department, Biological and Health Sciences Center, Universidade Federal de São Carlos, São Carlos, São Paulo, Brazil
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Miura Y, Nakagami G, Yabunaka K, Tohara H, Noguchi H, Mori T, Sanada H. A Randomized Controlled Trial to Investigate the Effectiveness of the Prevention of Aspiration Pneumonia Using Recommendations for Swallowing Care Guided by Ultrasound Examination. Healthcare (Basel) 2018; 6:healthcare6010015. [PMID: 29439537 PMCID: PMC5872222 DOI: 10.3390/healthcare6010015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Revised: 01/29/2018] [Accepted: 02/08/2018] [Indexed: 12/21/2022] Open
Abstract
Prevention for aspiration pneumonia requires assessment of aspiration and adequate swallowing care. This randomized controlled trial aimed to investigate the effectiveness of ultrasound examination and recommendations for swallowing care for the reduction of aspiration and pharyngeal post-swallow residue as compared with standard swallowing care. Twenty-three participants were randomized to the intervention group and 23 to the control group. The intervention consisted of four ultrasound examinations during mealtimes and recommendations for swallowing care every 2 weeks during an 8 week period. No recommendations concerning swallowing care based on ultrasound examinations were provided to the control group. The frequency of aspiration or residue was defined as x/y × 100% when aspiration or residue were detected x times from y times concerning the total ultrasound measurements. The proportion of the residents with reduced frequency of aspiration which was detected by ultrasonography at eight weeks were 4.3% in the intervention group and 0% in the control group. The median reduction in the frequency of aspiration and residue in the intervention group was 31%, and that in the control group was 11%. In conclusion, swallowing care guided by frequent ultrasound examinations during mealtimes had a trend of reducing the frequency of aspiration and residue during an 8-week period in individuals relative to standard swallowing care alone.
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Affiliation(s)
- Yuka Miura
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
| | - Gojiro Nakagami
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
| | - Koichi Yabunaka
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
- Department of Imaging Nursing Science, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
| | - Haruka Tohara
- Gerodontology and Oral Rehabilitation, Department of Gerontology and Gerodontology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8549, Japan.
| | - Hiroshi Noguchi
- Department of Life Support Technology (Molten), Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
| | - Taketoshi Mori
- Department of Life Support Technology (Molten), Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
| | - Hiromi Sanada
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
- Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
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14
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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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15
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Zanini M, Bagnasco A, Catania G, Aleo G, Sartini M, Cristina ML, Ripamonti S, Monacelli F, Odetti P, Sasso L. A Dedicated Nutritional Care Program (NUTRICARE) to reduce malnutrition in institutionalised dysphagic older people: A quasi-experimental study. J Clin Nurs 2017; 26:4446-4455. [PMID: 28231616 DOI: 10.1111/jocn.13774] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2017] [Indexed: 10/20/2022]
Abstract
AIMS AND OBJECTIVES To assess the effects of a texture-modified food program for dysphagia on the nutritional, biochemical and functional profile in a cohort of institutionalised older people in Italy. BACKGROUND Dysphagic institutionalised older people, often also affected by dementia, are frequently exposed to malnutrition. Malnutrition in older people has negative effects on mortality, days of hospitalisation, infection, wound healing and risk of pressure injuries. Therefore, it is very important to prevent malnutrition in this frail population. DESIGN A pre-post study without a control group. METHODS The study included 479 dysphagic institutionalised older people from 20 nursing homes. Anthropometrical, biochemical, nutritional and functional parameters were collected retrospectively, 6 months before the study intervention, at time zero and, prospectively for 6 months after implementing the NUTRICARE food programme, for a total of nine evaluations. The NUTRICARE programme includes meals without nutritional supplementation, and personalised levels of density, viscosity, texture and particle size. RESULTS The total mean body mass index of our sample passed from 17.88-19.00; body weight averagely improved by 7.19%, as well as their nutritional and biochemical profiles. There was a progressive improvement of total protein and serum albumin values. Nutritional parameters (serum transferrin and lymphocytes) displayed similar changes. Plasma lymphocytes reached normal levels in 98.23% of the sample. Plasma creatinine levels remained steady throughout the study and within the normal range. No side effects were reported. CONCLUSION The NUTRICARE food programme with a adequate proteins, calories, balanced nutritional and bromatological properties, and appropriate texture and palatability significantly improved the nutritional, biochemical and functional profile in a cohort of institutionalised dysphagic older people. RELEVANCE TO CLINICAL PRACTICE The introduction of a balanced nutritional programme, using high-quality natural ingredients, appropriate texture and palatability can significantly improve health and quality of life in dysphagic older people.
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Affiliation(s)
- Milko Zanini
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | | | - Gianluca Catania
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Giuseppe Aleo
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Marina Sartini
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | | | | | - Fiammetta Monacelli
- Department of Internal Medicine & Medical Specialties, University of Genoa, Genoa, Italy
| | - Patrizio Odetti
- Department of Internal Medicine & Medical Specialties, University of Genoa, Genoa, Italy
| | - Loredana Sasso
- Department of Health Sciences, University of Genoa, Genoa, Italy
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