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Chung E, Park Y, Lee HJ, Kang YA. Usefulness of the mini nutritional assessment short-form for evaluating nutritional status in patients with nontuberculous mycobacterial pulmonary disease: a prospective cross-sectional study. BMC Infect Dis 2024; 24:604. [PMID: 38898397 PMCID: PMC11186144 DOI: 10.1186/s12879-024-09499-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 06/12/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Although the Mini Nutritional Assessment (MNA) is recognized as a useful tool for evaluating nutritional status in patients with various diseases, its applicability in patients with nontuberculous mycobacterial pulmonary disease (NTM-PD) remains undetermined. METHODS We designed a prospective cross-sectional study to investigate whether the MNA Short-Form (MNA-SF) score can serve as a screening tool to assess the nutritional status of patients with NTM-PD. The MNA-SF was conducted upon patient enrollment, and correlation analyses were performed to compare MNA-SF scores with other nutritional measurements and disease severity. Multivariable logistic regression analyses were conducted to evaluate the association between MNA-SF scores and NTM-PD severity. RESULTS The 194 patients with NTM-PD included in the analysis had a median age of 65.0 (59.0-69.0) years; 59.3% (n = 115) had low MNA-SF scores (< 12). The low MNA-SF group exhibited a lower body mass index (19.7 vs. 22.4 kg/m2, p < 0.001) and fat-free mass index (14.7 vs. 15.6 kg/m2, p < 0.001) than the normal MNA-SF group, as well as higher incidences of sarcopenia (20.0% vs. 6.3%, p = 0.008) and adipopenia (35.7% vs. 5.1%, p < 0.001). However, no significant differences in calorie and protein intakes were observed between the two groups. Low MNA-SF scores were associated with radiographic severity (adjusted odds ratio 2.72, 95% confidence interval 1.38-5.36) but not with forced vital capacity. CONCLUSIONS The MNA-SF can effectively assess the nutritional status of patients with NTM-PD and can serve as an important clinical indicator in NTM-PD where treatment timing is determined by clinical judgment.
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Affiliation(s)
- Eunki Chung
- Division of Pulmonology, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
- Yonsei University Graduate School of Medicine, Seoul, Republic of Korea
| | - Youngmok Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Hye-Jeong Lee
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young Ae Kang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
- Institute for Immunology and Immunological Disease, Yonsei University College of Medicine, Seoul, Republic of Korea.
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2
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Hetherington MM, Thomas JM, McLeod CJ. "I see it very much as an end-of-life food" - Barriers to oral nutritional supplement adherence, views from healthy older adults. Appetite 2024; 197:107327. [PMID: 38555018 DOI: 10.1016/j.appet.2024.107327] [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: 01/15/2024] [Revised: 03/15/2024] [Accepted: 03/26/2024] [Indexed: 04/02/2024]
Abstract
Malnutrition affects approximately one quarter of UK adults aged 65 years and over. As the global demographic shift continues, malnutrition is expected to increase. Oral nutritional supplements (ONS) are used both to prevent and to treat malnutrition. However, their effectiveness is compromised by poor adherence, and it is not well understood what contributes to this. Therefore, the current research was designed to explore ONS adherence from the parallel perspectives of ONS as a prescribed "medication" and as a food supplement/substitute. Eighteen older adults (13F, 5M; mean age = 73.4 yr; range: 70-80 yr) participated in focus groups (three in-person and one online), to investigate experiences of taking prescribed medications, including dietary supplements, and what should be factors to consider in supporting regular intake of ONS for trial development, as well as any potential improvements to products. Focus group sessions were recorded and then transcribed. Thematic Analysis was applied to the transcripts by the first author, and themes were discussed in depth, using exemplar quotes from participants. Five dominant themes were identified from the data: Disgust, Palatability and Acceptance; End-of-Life Care; Resistance to Medicines; Rituals and Reminders; and Real Food Displacement. Nutritional supplements were characterised as "disgusting", "manufactured", and associated with serious, chronic illness, as well as end-of-life care, in contrast to probiotics which were linked with health and wellness. The sweet taste of ONS was identified as a barrier to intake, given that it is generally associated with a signal to stop eating, and low hunger. As a group, participants tried to "avoid taking medicines", and viewed the need to have them negatively, yet most regularly took prescribed medication and/or vitamin supplements. Participants identified several, rituals and reminders to take medicines, including meal-based, or time-of-day-based prompts (e.g., before, with or after meals). To improve adherence, savoury products were suggested, as well as a more person-centred approach to individual nutritional needs and preferences. Overall, the group discussion mainly identified barriers to intake, but that improving taste, adding to "real food" (not replacing meals), and offering variety of flavour and form (e.g., savoury soups as well as sweet drinks) could be included in future trials to improve appeal and therefore intake. Future work should continue to explore how best to formulate, market and/or prescribe ONS, and how this might vary for malnutrition prevention vs treatment strategies.
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Affiliation(s)
| | - Jason M Thomas
- School of Psychology, College of Health and Life Sciences, Aston University, Birmingham, B4 7ET, UK
| | - Chris J McLeod
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, LE11 3TU, UK
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3
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Geary R, Mantik J, Moore V, Schuller J, Fedoruk R, Atkins M, Chan CB. COMmunity-Based Nutrition RISK Screening in Older Adults Living Independently (COMRISK): Feasibility, Acceptability, and Appropriateness of Community Partnership Models in Alberta, Canada. Can J Aging 2024; 43:287-296. [PMID: 37811554 DOI: 10.1017/s0714980823000582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023] Open
Abstract
This feasibility study of routine nutrition risk screening in community-dwelling older adults using a partnership between health care and community-based organizations (CBO) aimed to (1) evaluate the ability of community-based partnerships to provide screening for nutrition risk, and appropriately refer at-risk individuals for follow-up care and (2) determine the barriers to and facilitators of screening. Adults 65 years of age and older were screened by staff in two primary care and one CBO setting using the Seniors in the Community: Risk Evaluation for Eating and Nutrition (SCREEN)-8 nutrition risk screening tool. Screeners, organization administrators, and registered dietitians responded to surveys regarding SCREEN-8 administration, referral processes, and partnership interactions. All found the SCREEN-8 initiative feasible, acceptable, and appropriate. Sustainability requires strengthening of community resources, referral processes, and telephone assessments. The partnership added value despite limitations in communications. We conclude that broader implementation of this program using community-based partnerships has the potential to aid in the prevention of malnutrition in older adults.
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Affiliation(s)
- Rebecca Geary
- Department of Agricultural, Food and Nutritional Science, Li Ka Shing Centre of Health Innovation, University of Alberta, Edmonton, AB, Canada
| | - Jessica Mantik
- Department of Agricultural, Food and Nutritional Science, Li Ka Shing Centre of Health Innovation, University of Alberta, Edmonton, AB, Canada
| | - Valerie Moore
- Department of Agricultural, Food and Nutritional Science, Li Ka Shing Centre of Health Innovation, University of Alberta, Edmonton, AB, Canada
| | - Jessica Schuller
- Department of Agricultural, Food and Nutritional Science, Li Ka Shing Centre of Health Innovation, University of Alberta, Edmonton, AB, Canada
| | - Rani Fedoruk
- Department of Agricultural, Food and Nutritional Science, Li Ka Shing Centre of Health Innovation, University of Alberta, Edmonton, AB, Canada
| | - Marlis Atkins
- Nutrition Services, Alberta Health Services, Edmonton, AB, Canada
| | - Catherine B Chan
- Department of Agricultural, Food and Nutritional Science, Li Ka Shing Centre of Health Innovation, University of Alberta, Edmonton, AB, Canada
- Department of Physiology, University of Alberta, Edmonton, AB, Canada
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4
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Weng V, Wiles N, Jenkins D, Amanatidis S, Kidd JC, Walsh JA, Baillie AJ, Naganathan V. The effectiveness of a home-based dietetic intervention for community-dwelling older adults. Australas J Ageing 2024; 43:297-305. [PMID: 38217875 DOI: 10.1111/ajag.13264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 11/02/2023] [Accepted: 11/19/2023] [Indexed: 01/15/2024]
Abstract
OBJECTIVES The aim of this study was to describe the characteristics of clients receiving home-based dietetic intervention and to evaluate the effectiveness of these interventions in improving nutritional status, functional status, and quality of life in a culturally and socioeconomically diverse client group. METHODS Participants referred to a home-based dietetic service were recruited to this prospective cohort study. Dietetic interventions were recommended at baseline and reviewed at 3-month follow-up. Assessment of nutritional, functional and quality of life markers was measured using the Mini Nutritional Assessment (MNA), Timed Up and Go (TUG) and EQ-5D-5L, respectively, at baseline and after home-based dietetic intervention. RESULTS Participants (n = 99) were recruited from consecutive referrals. Participant's weight, body mass index (BMI), total daily energy and protein intake, MNA total score, and TUG significantly improved after a 3-month nutrition intervention (effect sizes 0.257, 0.257, 0.580, 0.533, 0.577 and 0.281, respectively). The most common interventions dietitians utilised were nutrition education, use of oral nutritional supplements (ONS) and meal fortification. In total, 339 dietetic interventions were recommended to participants at baseline with 197 (58.11%) implemented at 3 months, with meal planning and referral to other relevant allied health or Commonwealth Home Support Program (CHSP) services the most implemented interventions. CONCLUSIONS Home-based dietetic intervention improves nutritional status, functional status and quality of life in community-dwelling older adults referred for dietetic input. Improvements observed in nutritional and functional status were consistent with benchmarks of change from published literature.
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Affiliation(s)
- Vicky Weng
- Community Nutrition, Primary and Community Health, South Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Nicole Wiles
- Home Based Therapy, Aged Health Chronic Care and Rehabilitation, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Deanna Jenkins
- Home Based Therapy, Aged Health Chronic Care and Rehabilitation, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Sue Amanatidis
- Home Based Therapy, Aged Health Chronic Care and Rehabilitation, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Joanna C Kidd
- Department of Speech Pathology, Campbelltown Hospital, South Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Jessica A Walsh
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Sydney Local Health District, Sydney, New South Wales, Australia
| | - Andrew J Baillie
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Sydney Local Health District, Sydney, New South Wales, Australia
| | - Vasi Naganathan
- Home Based Therapy, Aged Health Chronic Care and Rehabilitation, Sydney Local Health District, Sydney, New South Wales, Australia
- Concord Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Idsøe-Jakobsen I, Dombestein H, Brønnick KK, Wiig S. Exploring Norwegian homecare healthcare professionals' perceptions of risk and the link to high-quality care: a qualitative multiple case study. BMJ Open 2024; 14:e080769. [PMID: 38490664 PMCID: PMC10946383 DOI: 10.1136/bmjopen-2023-080769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 02/22/2024] [Indexed: 03/17/2024] Open
Abstract
OBJECTIVES Homecare is a critical component of the ongoing restructuring of healthcare worldwide, given the shift from institution- to home-based care. The homecare evidence base still contains significant gaps: There is a lack of knowledge regarding quality and safety work and interventions. This study explores how home healthcare professionals perceive and use the concept of risk to guide them in providing high-quality healthcare while maintaining resilience. DESIGN The study design is a qualitative multiple case study. The phenomena explored were risk perception, sensemaking and adaptations of care delivered to patients in their homes. Inductive content analysis was conducted. SETTING The study was conducted in three Norwegian municipalities. Each municipality was defined as a single case. PARTICIPANTS Interviews with healthcare professionals were performed both individually and in focus groups of three to five persons. 19 interviews with 35 informants were conducted: 11 individual semistructured interviews and 8 focus groups. RESULTS Four themes were identified: 'professionalism is constantly prioritising and aligning care based on here-and-now observations' 'teamwork feels safe and enhances quality' 'taking responsibility for system risk' and 'reluctantly accepting the extended expectations from society'. CONCLUSIONS To make sense of risk when aspiring for high-quality care in everyday work, the healthcare professionals in this sample mainly used their clinical gaze, gut feeling and experience to detect subtle changes in the patients' condition. Assessing risk information, not only individually but also as a team, was reportedly crucial for high-quality care. Healthcare professionals emphasised the well-being, safety and soundness of the patients when acting on risk information. They felt obliged to act on their gut feeling, moral compass and clinical understanding of quality.
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Affiliation(s)
| | - Heidi Dombestein
- University of Stavanger Faculty of Health Sciences, Stavanger, Norway
| | | | - Siri Wiig
- University of Stavanger Faculty of Health Sciences, Stavanger, Norway
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6
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Visser M, Sealy MJ, Leistra E, Naumann E, De van der Schueren MAE, Jager-Wittenaar H. The Malnutrition Awareness Scale for community-dwelling older adults: Development and psychometric properties. Clin Nutr 2024; 43:446-452. [PMID: 38181522 DOI: 10.1016/j.clnu.2023.12.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 12/18/2023] [Accepted: 12/29/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND & AIMS Qualitative studies suggest that malnutrition awareness is poor in older adults. The aim of this study was to develop a questionnaire to quantitatively assess malnutrition awareness in community-dwelling older adults aged 60+ years. METHODS The Malnutrition Awareness Scale (MAS) was developed based on the awareness phase of the Integrated-Change model, and included four domains: knowledge, perceived cues, risk perceptions, and cognizance. Twenty-six scale items were developed using results from mainly qualitative research and the expertise of the authors. Items were piloted in 10 Dutch older adults using the Thinking Aloud method to optimize wording. In a feasibility study, annoyance, difficulty and time to complete the MAS and its comprehensibility were tested. After final revisions, the MAS was applied to a large sample to test its psychometric properties (i.e., inter-item correlations, Cronbach's alpha, score distribution) and relevance of the items was rated on a 5-point scale by 12 experts to determine content validity. RESULTS The feasibility study (n = 42, 55 % women, 19 % 80+ y) showed that the MAS took 12 ± 6 min to complete. Most participants found it not (at all) annoying (81 %) and not (at all) difficult (79 %) to complete the MAS, and found it (very) comprehensible (83 %). Psychometric analyses (n = 216, 63 % women, 28 % 80+ y) showed no redundant items, but two items correlated negatively with other items, and one correlated very low. After removal, the final MAS consists of 23 items with a min-max scoring range from 0 to 22 (with higher scores indicating higher awareness) and an overall Cronbach's alpha of 0.67. The mean MAS score in our sample (n = 216) was 14.8 ± 3.2. The lowest obtained score was 6 (n = 3) and the highest 22 (n = 1), indicating no floor or ceiling effects. Based on the relevance rating, the overall median across all 22 items was 4.0 with IQR 4.0-5.0. CONCLUSION The Malnutrition Awareness Scale is a novel, feasible and reliable tool with good content validity to quantitively assess malnutrition awareness in community-dwelling older adults. The scale is now ready to identify groups with poor malnutrition awareness, as a basis to start interventions to increase malnutrition knowledge and awareness.
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Affiliation(s)
- M Visser
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands.
| | - M J Sealy
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Petrus Driessenstraat 3, 9714 CA Groningen, The Netherlands.
| | - E Leistra
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands.
| | - E Naumann
- Department of Nutrition, Dietetics and Lifestyle, HAN University of Applied Sciences, Postbus 6960, 6503 GL Nijmegen, The Netherlands; Dutch Malnutrition Center of Expertise, The Netherlands.
| | - M A E De van der Schueren
- Department of Nutrition, Dietetics and Lifestyle, HAN University of Applied Sciences, Postbus 6960, 6503 GL Nijmegen, The Netherlands; Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands.
| | - H Jager-Wittenaar
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Petrus Driessenstraat 3, 9714 CA Groningen, The Netherlands; Department of Gastroenterology, Dietetics, Radboud University Medical Center, Nijmegen, The Netherlands; Research Unit Experimental Anatomy, Faculty of Physical Education and Physiotherapy, Department of Physiotherapy and Human Anatomy, Vrije Universiteit Brussel, Brussels, Belgium.
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7
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Tesfaye BT, Yizengaw MA, Birhanu TE, Bosho DD. Nutritional status of hospitalized elderly patients in Ethiopia: a cross-sectional study of an important yet neglected problem in clinical practice. Front Nutr 2024; 10:1227840. [PMID: 38260070 PMCID: PMC10800825 DOI: 10.3389/fnut.2023.1227840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 12/12/2023] [Indexed: 01/24/2024] Open
Abstract
Background Malnutrition is a common geriatric syndrome affecting approximately half of the older population with a more pronounced occurrence rate in those hospitalized. It affects the physiology, and results in poor humanistic and clinical outcomes. In Africa, particularly in Ethiopia, albeit multiple studies are available on malnutrition in non-hospitalized older population, similar studies in inpatient settings are scarce. Therefore, this study was conducted with the intention to quantify the prevalence of malnutrition in older patients on inpatient admission and determine its associated factors. Methods A total of 157 older inpatients aged 60 years and above were included in the present study. The data collection format was developed after an in-depth review of relevant literatures. The full Mini-Nutritional Assessment (MNA) tool was employed to assess the nutritional status on admission. Data completeness was checked thoroughly. Descriptive statistics and logistic regression analysis were conducted using STATA 15.0. The area under the receiver operating characteristic curve (ROC), Hosmer-Lemeshow test, and classification table were computed to evaluate the final model goodness-of-fit. Results Of the total study subjects, 81% were malnourished (MNA score <17) and 17% were at risk for malnutrition (MNA score of 17.5-23.5). However, upon review of the patients' medical charts, malnutrition diagnosis was recorded in only two patients. Rural residence (AOR = 2.823, 95%CI: 1.088, 7.324), self-reported financial dependence for expenses (AOR = 4.733, 95%CI: 1.011, 22.162), and partial dependence in functional autonomy on admission (AOR = 3.689, 95%CI: 1.190, 11.433) significantly increased the risk of malnutrition. The area under the ROC curve (0.754) and the Hosmer-Lemeshow test (p = 0.7564) indicated that the final model reasonably fits the data. The model`s sensitivity is 96.85%. Conclusion In the present study, an alarmingly high prevalence of malnutrition was identified older inpatients. The problem went undiagnosed in a similar percentage of patients. Several available literatures indicate the presence of an association between nutritional status and patient outcomes, thus strict nutritional screening at inpatient admission and intervention are recommended with special emphasis for those from rural areas, with financial dependence, and with functional impairment on admission.
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Affiliation(s)
- Behailu Terefe Tesfaye
- Department of Clinical Pharmacy, School of Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Mengist Awoke Yizengaw
- Department of Clinical Pharmacy, School of Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Tesema Etefa Birhanu
- Human Anatomy Unit, Department of Biomedical Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Dula Dessalegn Bosho
- Department of Clinical Pharmacy, School of Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia
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8
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Fisher R, Martyn K, Romano V, Smith A, Stennett R, Ayyad S, Ray S. Improving the assessment of older adult's nutrition in primary care: recommendations for a proactive, patient-centred and aetiology approach. BMJ Nutr Prev Health 2023; 6:402-406. [PMID: 38618534 PMCID: PMC11009540 DOI: 10.1136/bmjnph-2023-000661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 08/22/2023] [Indexed: 04/16/2024] Open
Affiliation(s)
- Rebecca Fisher
- NHS London Procurement Partnership, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Kathy Martyn
- School of Sport and Health Science, University of Brighton, Brighton, UK
- NNEdPro Global Centre for Nutrition and Health, St John’s Innovation Centre, Cambridge, UK
| | | | - Alison Smith
- Hertfordshire and West Essex Integrated Care Board, Hertfordshire, UK
| | | | - Sally Ayyad
- NNEdPro Global Centre for Nutrition and Health, St John’s Innovation Centre, Cambridge, UK
| | - Sumantra Ray
- NNEdPro Global Centre for Nutrition and Health, St John’s Innovation Centre, Cambridge, UK
- School of Biomedical Sciences, Ulster University, Coleraine, UK
- Fitzwilliam College, University of Cambridge, Cambridge, UK
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9
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Roberts S, Gomes K, Rattray M. Dietitians' perceptions of identifying and managing malnutrition and frailty in the community: A mixed-methods study. Nutr Diet 2023; 80:511-520. [PMID: 36843203 DOI: 10.1111/1747-0080.12799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 01/08/2023] [Accepted: 01/15/2023] [Indexed: 02/28/2023]
Abstract
AIM This study aimed to explore dietitians' perceptions of their current practice for identifying and managing malnutrition/frailty in the community, to fill an evidence gap. METHODS This mixed-methods study involved an online survey distributed to dietitians practising in Australia and New Zealand, and semi-structured interviews with a subset of survey participants. The 34-item survey and interviews explored dietitians' practices for identifying/managing malnutrition and frailty, focusing on the community setting. Survey data were analysed descriptively and some simple association tests were conducted using statistical software. Interview data were analysed thematically. RESULTS Of the 186 survey respondents, 18 also participated in an interview. Screening and assessment for malnutrition varied in the community and occurred rarely for frailty. Dietitians reported practising person-centred care by involving clients/carers/family in setting goals and selecting nutrition interventions. Key barriers to providing nutrition care to community-dwelling adults included a lack of awareness/understanding of nutrition by clients and other health professionals (leading to them not participating in or valuing nutrition care), lack of time and resources in the community, and client access to foods/supplements. Enablers included engaging family members/carers and coordinating with other health professionals in nutrition care planning. CONCLUSION Reported practices for identifying malnutrition and frailty vary in the community, suggesting guidance may be needed for health professionals in this setting. Dietitians reported using person-centred care with malnourished and frail clients but encountered barriers in community settings. Engaging family members/carers and multidisciplinary colleagues may help overcome some of these barriers.
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Affiliation(s)
- Shelley Roberts
- School of Health Sciences and Social Work, Griffith University, Gold Coast, Australia
- Allied Health Research, Gold Coast Hospital and Health Service, Gold Coast, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Kristin Gomes
- School of Health Sciences and Social Work, Griffith University, Gold Coast, Australia
| | - Megan Rattray
- School of Health Sciences and Social Work, Griffith University, Gold Coast, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
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10
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Zanetti M, Veronese N, Riso S, Boccardi V, Bolli C, Cintoni M, Francesco VD, Mazza L, Onfiani G, Zenaro D, Pilotto A. Polypharmacy and malnutrition in older people: A narrative review. Nutrition 2023; 115:112134. [PMID: 37453210 DOI: 10.1016/j.nut.2023.112134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 06/05/2023] [Accepted: 06/13/2023] [Indexed: 07/18/2023]
Abstract
Polypharmacy is the simultaneous use of multiple medicines, usually more than five. Polypharmacy is highly prevalent among older individuals and is associated with several adverse health outcomes, including frailty. The role of polypharmacy in nutritional status seems to be crucial: although a clear association between polypharmacy and malnutrition has been widely reported in older people, the magnitude of the effect of increased number of drugs in combination with their type on the risk for malnutrition remains to be largely explored. Therefore, this review aims to discuss the association between polypharmacy and malnutrition in older people and to provide suggestions for its management. Polypharmacy is prevalent among malnourished frail patients, and the relative contribution of comorbidities and polypharmacy to malnutrition is difficult to be determined. Several mechanisms by which commonly used medications have the potential to affect nutritional status have been identified and described. Deprescribing (i.e., a systematic process of identification and discontinuation of drugs or a reduction of drug regimens) could be an essential step for minimizing the effects of polypharmacy on malnutrition. In this regard, the literature suggests that in older patients taking several medications, the best method to solve this problem is the comprehensive geriatric assessment, based on a holistic approach, including drug review, to find potential unnecessary and inappropriate medications. Nutritional and deprescribing interventions must be tailored to patient needs and to the local context to overcome barriers when applied in different settings.
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Affiliation(s)
- Michela Zanetti
- Geriatric Clinic, Maggiore Hospital of Trieste, Azienda Sanitaria Universitaria Integrata Giuliano Isontina, Trieste, Italy; Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy.
| | - Nicola Veronese
- Department of Internal Medicine and Geriatrics, University of Palermo, Palermo, Italy
| | - Sergio Riso
- Clinical Nutrition and Dietetics Unit, Maggiore della Carità Hospital, University of Eastern Piedmont, Novara, Italy
| | - Virginia Boccardi
- Institute of Gerontology and Geriatrics, Department of Medicine and Surgery, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | - Carolina Bolli
- Clinical Nutrition Unit, Presidio Ospedaliero "San Filippo Neri", Rome, Italy
| | - Marco Cintoni
- Clinical Nutrition Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | | | - Liliana Mazza
- Department of Integration, Azienda USL di Bologna, Bologna, Italy
| | - Giovanna Onfiani
- Clinical Nutrition Unit, Complex Structure of Endocrinology, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Davide Zenaro
- Direzione Tecnica Socio Sanitaria Coopselios, Reggio Emilia, Italy
| | - Alberto Pilotto
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Galliera Hospital, Genoa, Italy; Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", Bari, Italy
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11
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LoBuono DL, Milovich M. A Scoping Review of Nutrition Health for Older Adults: Does Technology Help? Nutrients 2023; 15:4402. [PMID: 37892477 PMCID: PMC10609927 DOI: 10.3390/nu15204402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/05/2023] [Accepted: 10/12/2023] [Indexed: 10/29/2023] Open
Abstract
The technological developments in healthcare may help facilitate older adult nutritional care. This scoping review includes research in technology and nutrition to (1) explain how technology is used to manage nutrition needs and (2) describe the forms of technology used to manage nutrition. Five major databases were the foundation for papers published from January 2000 to December 2020. The most common type of technology used is software to (1) "track, plan, and execute" nutrition management and for (2) "assessing" technology use. "Track, plan, and execute" includes tracking food intake, planning for changes, and executing a plan. "Assessing" technology use is collecting nutrition data from a provider's or an older adult's self-use of technology to understand dietary intake. Hardware is the second most type of technology used, with tablet computers for software and internet access. The findings reveal that software for older adults lacks standardization, the Internet of Things is a promising area, the current device emphasis is the tablet computer, and broadband internet access is essential for nutrition care. Only 38 studies were published in the last five years, indicating that nutrition management for older adults with hardware or software has not reached a significant research mass.
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Affiliation(s)
- Dara L. LoBuono
- Department of Health and Exercise Science, School of Nursing and Health Professions, Rowan University, James Hall Room 1035, 201 Mullica Hill Road, Glassboro, NJ 08028, USA
| | - Michael Milovich
- Department of Marketing and Business Information Systems, Rohrer College of Business, Rowan University, Business Hall Room 316, 201 Mullica Hill Road, Glassboro, NJ 08028, USA;
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12
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Eglseer D. Development and evaluation of a Massive Open Online Course (MOOC) for healthcare professionals on malnutrition in older adults. NURSE EDUCATION TODAY 2023; 123:105741. [PMID: 36746061 DOI: 10.1016/j.nedt.2023.105741] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 12/19/2022] [Accepted: 01/26/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Education about malnutrition in older adults is often lacking in the curricula of healthcare professionals. Massive open online courses (MOOCs) are an innovative form of education that can potentially improve the knowledge of healthcare professionals. OBJECTIVES (1) to describe the development of a MOOC on malnutrition in older adults and (2) to evaluate the MOOC on the basis of knowledge gained. DESIGN The MOOC was developed by following a structured approach. For the evaluation of the MOOC, a cross-sectional descriptive study was conducted. PARTICIPANTS Overall, 1288 nurses, dietitians, medical doctors and other healthcare professionals participated in the evaluation study. METHODS After performing a comprehensive literature review, two dietitians specialised in geriatrics developed a summary of potentially important content of the MOOC. Nine European malnutrition experts from different professional areas were then asked to contribute their expertise. The specific MOOC content was developed based on the recent literature and evidence-based guidelines. For the evaluation of the MOOC, a questionnaire with 41 questions was developed. Results were analysed using descriptive statistics and chi-square tests. RESULTS The final MOOC consists of five modules with 15 learning videos and supplementary material. The percentage of persons with good malnutrition knowledge increased from 76.1 % to 89.9 % (p < 0.001), while the percentage of persons with fair or little malnutrition knowledge decreased (p < 0.001). The course significantly improved the participants' knowledge of specific malnutrition topics, namely, methods and instruments to determine the nutritional status of older people, interventions to improve oral intake, medical nutrition and multidisciplinary cooperation (p < 0.001). Overall, 91.5 % of the participants rated the quality of the course as very good or good. CONCLUSION MOOCs may be an effective tool that can be used to improve knowledge in healthcare professionals. This provides new opportunities for successful multidisciplinary malnutrition management in clinical practice.
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Affiliation(s)
- D Eglseer
- Medical University of Graz, Institute of Nursing Science, Universitätsplatz 4; A, 8010 Graz, Austria.
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13
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Dent E, Wright ORL, Woo J, Hoogendijk EO. Malnutrition in older adults. Lancet 2023; 401:951-966. [PMID: 36716756 DOI: 10.1016/s0140-6736(22)02612-5] [Citation(s) in RCA: 62] [Impact Index Per Article: 62.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 11/15/2022] [Accepted: 12/01/2022] [Indexed: 01/29/2023]
Abstract
Malnutrition is a highly prevalent condition in older adults, and poses a substantial burden on health, social, and aged-care systems. Older adults are vulnerable to malnutrition due to age-related physiological decline, reduced access to nutritious food, and comorbidity. Clinical guidelines recommend routine screening for malnutrition in all older adults, together with nutritional assessment and individually tailored nutritional support for older adults with a positive screening test. Nutritional support includes offering individualised nutritional advice and counselling; oral nutritional supplements; fortified foods; and enteral or parenteral nutrition as required. However, in clinical practice, the incorporation of nutritional guidelines is inadequate and low-value care is commonplace. This Review discusses the current evidence on identification and treatment of malnutrition in older adults, identifies gaps between evidence and practice in clinical care, and offers practical strategies to translate evidence-based knowledge into improved nutritional care. We also provide an overview of the prevalence, causes, and risk factors of malnutrition in older adults across health-care settings.
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Affiliation(s)
- Elsa Dent
- Research Centre for Public Health, Equity & Human Flourishing, Torrens University Australia, Adelaide, SA, Australia.
| | - Olivia R L Wright
- School of Human Movement and Nutrition Sciences, The University of Queensland, St. Lucia, QLD, Australia
| | - Jean Woo
- Department of Medicine and Therapeutics and Centre for Nutritional Studies, Faculty of Medicine, The Chinese University of Hong Kong, Ma Liu Shui, Hong Kong Special Administrative Region, China
| | - Emiel O Hoogendijk
- Department of Epidemiology & Data Science and Department of General Practice, Location VU University Medical Center, Amsterdam UMC, Amsterdam, Netherlands; Amsterdam Public Health research institute and Ageing & Later Life Research Program, Amsterdam UMC, Amsterdam, Netherlands; Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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14
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Geraghty AA, Dominguez Castro P, Reynolds CM, Browne S, Bourke F, Bradley C, Finnigan K, Clarke S, Clyne B, Bury G, Perrotta C, Kennelly S, Corish CA. Impact of malnutrition management e-learning module on GPs' knowledge: a pilot study. BJGP Open 2023; 7:BJGPO.2022.0111. [PMID: 36410769 DOI: 10.3399/bjgpo.2022.0111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 10/04/2022] [Accepted: 10/10/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Malnutrition is underdiagnosed in primary care. GPs are key healthcare contacts for older adults at risk of protein-energy malnutrition; however, lack of knowledge and confidence in its diagnosis and treatment is often reported. AIM To evaluate the impact of a bespoke online education module on GP malnutrition knowledge and management. DESIGN & SETTING A prospective pre-post pilot study with 23 GPs and eight GP trainees in the Republic of Ireland. METHOD The module included units on the following: 'malnutrition definition, prevalence, and latest evidence'; 'identifying malnutrition in clinical practice'; 'food-first advice'; 'reviewing malnutrition'; and 'oral nutritional supplements'. Participant knowledge was measured using a multiple choice questionnaire (MCQ) before and after the module (n = 31), and 6 weeks following completion (n = 11). Case studies assessing identification and management of malnutrition were evaluated by a clinical specialist dietitian with expertise in managing malnutrition. Changes in assessment performance were calculated using paired t-tests. Acceptability was evaluated using a questionnaire. RESULTS Post-training, 97% of GPs increased MCQ scores from baseline (+25%, P<0.001), with the greatest improvement in 'identifying malnutrition in clinical practice' (mean increase 47%, P<0.001). Eleven GPs completed the 6-week MCQ with scores remaining significantly higher than baseline (mean increase 15%, P = 0.005); 'identifying malnutrition in clinical practice' remained the most highly scored (mean increase 40%, P<0.001). Seventeen GPs completed the case studies; 76% at baseline and 88% post-module correctly calculated malnutrition risk scores. Appropriate malnutrition management improved for 47% of GPs after module completion. CONCLUSION This e-learning module improved malnutrition knowledge, with good short-term retention in a small cohort. Development of online evidence-based nutrition education may improve GP nutrition care.
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Affiliation(s)
- Aisling A Geraghty
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Republic of Ireland
- UCD Institute of Food and Health, University College Dublin, Dublin, Republic of Ireland
| | - Patricia Dominguez Castro
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Republic of Ireland
- UCD Institute of Food and Health, University College Dublin, Dublin, Republic of Ireland
| | - Ciara Me Reynolds
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Republic of Ireland
- UCD Institute of Food and Health, University College Dublin, Dublin, Republic of Ireland
| | - Sarah Browne
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Republic of Ireland
- UCD Institute of Food and Health, University College Dublin, Dublin, Republic of Ireland
| | - Frank Bourke
- Irish Institute of Pharmacy, Royal College of Surgeons in Ireland, Dublin, Republic of Ireland
| | - Catriona Bradley
- Irish Institute of Pharmacy, Royal College of Surgeons in Ireland, Dublin, Republic of Ireland
| | - Karen Finnigan
- Health Service Executive Medicines Management Programme, Trinity Centre for Health Sciences, St James's Hospital, Dublin, Republic of Ireland
| | - Sarah Clarke
- Health Service Executive Medicines Management Programme, Trinity Centre for Health Sciences, St James's Hospital, Dublin, Republic of Ireland
| | - Barbara Clyne
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Republic of Ireland
| | - Gerard Bury
- School of Medicine, University College Dublin, Dublin, Republic of Ireland
| | - Carla Perrotta
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Republic of Ireland
- UCD Institute of Food and Health, University College Dublin, Dublin, Republic of Ireland
| | - Sharon Kennelly
- National Primary Care Division, Community Funded Schemes Service Improvement, County Laois, Republic of Ireland
| | - Clare A Corish
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Republic of Ireland
- UCD Institute of Food and Health, University College Dublin, Dublin, Republic of Ireland
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15
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Physicians' Perception of Oral Nutritional Supplement Acceptance and Tolerability in Malnourished Outpatients: PerceptiONS Study. Nutrients 2023; 15:nu15051219. [PMID: 36904218 PMCID: PMC10005370 DOI: 10.3390/nu15051219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 02/22/2023] [Accepted: 02/24/2023] [Indexed: 03/05/2023] Open
Abstract
Malnutrition is a common condition associated with various pathologies such as infections, neoplasms and digestive system disorders. Patients can be managed using different strategies, which include dietary modifications or oral nutritional supplements (ONS). It is important to promote good ONS adherence in order to attain clinical efficacy and cost-effectiveness. Several factors (amount, type, duration and tolerability) may have an impact on ONS adherence. PerceptiONS is a descriptive, cross-sectional observational study based on an ad hoc electronic survey designed to explore physicians' perception of malnourished outpatients prescribed ONS. The survey considered adherence, acceptance/satisfaction, tolerability and benefits within the context of Spain's healthcare system. The perceptions of 548 physicians regarding the experience of 2516 patients were analyzed. From the physicians' perspective, 57.11% of patients adhered to over 75% of the prescribed ONS. The organoleptic properties of ONS represented the aspect with the most positive impact on adherence, with smell (43.72%) ranking as the top characteristic. In general, patients were satisfied (90.10%) with the ONS, with their related benefits (88.51%) and their organoleptic properties (90.42%), and accepted ONS in their daily diet (88.63%). ONS improved patients' general condition (87.04%), quality of life (QoL) (81.96%) and vitality/energy (81.28%). Physicians would prescribe the same ONS again in 96.4% of the cases.
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16
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Lombardo J, Schmucker AM, Keith SW, Ronghe A, Smith A, Ali AS, Niazi M, Denton M, Swartz K, Chapman A, Simone NL. Markers and associations of nutrition identified in a senior adult oncology clinic. J Geriatr Oncol 2023; 14:101388. [PMID: 36253248 DOI: 10.1016/j.jgo.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 08/01/2022] [Accepted: 10/07/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Joseph Lombardo
- Department of Radiation Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Abigail M Schmucker
- Department of Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Scott W Keith
- Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Ashwini Ronghe
- Department of Radiation Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Alexandria Smith
- Department of Radiation Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Ayesha S Ali
- Department of Radiation Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Muneeb Niazi
- Department of Radiation Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Melissa Denton
- Department of Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Kristine Swartz
- Jefferson Senior Adult Oncology Center, Sidney Kimmel Cancer Center, Jefferson Health, Philadelphia, PA, USA
| | - Andrew Chapman
- Jefferson Senior Adult Oncology Center, Sidney Kimmel Cancer Center, Jefferson Health, Philadelphia, PA, USA
| | - Nicole L Simone
- Department of Radiation Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA.
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17
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Holdoway A. Nutrition in palliative care: issues, perceptions and opportunities to improve care for patients. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:S20-S27. [PMID: 36416622 DOI: 10.12968/bjon.2022.31.21.s20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Dietary advice, the provision of timely nutritional support and the alleviation of diet-related issues, should be an essential component of a holistic approach to palliative and end-of-life care, adjusted to account for the stage in the patient's journey, including prognosis. With an ageing population and increasing numbers of people living with not just one life-limiting disease but several, the dietary management of these patients is becoming more complex. This article considers the issues patients and families experience, how nurses can play a key role in identifying and alleviating nutrition- and diet-related issues in palliative care, including the use of tools to screen, assess and guide nutrition conversations and interventions. The content of the article is mostly drawn from the literature relating to palliative cancer care, knowledge derived from stakeholder engagement, clinical observations in a dietetic role in a hospice setting and qualitative research on the role of diet in palliative care as perceived by patients, carers, and health professionals.
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Affiliation(s)
- Anne Holdoway
- Consultant Dietitian, The Bath Clinic, Bath; Chair, Managing Adult Malnutrition in the Community Panel; Education Officer, British Association for Parenteral and Enteral Nutrition
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18
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Liljeberg E, Nydahl M, Lövestam E, Andersson A. 'Between foods and medicines': A qualitative interview study of patient experiences of the meaning and usage of oral nutritional supplements. Appetite 2022; 178:106163. [PMID: 35863507 DOI: 10.1016/j.appet.2022.106163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 07/03/2022] [Accepted: 07/08/2022] [Indexed: 11/02/2022]
Abstract
The aim of this study was to deepen the understanding of what oral nutritional supplements mean to patients and how this meaning connects to supplement usage, by exploring patient experiences of such supplements. Qualitative interviews were conducted in June 2019-March 2020 with ten patients with malnutrition or at nutritional risk, prescribed oral nutritional supplements by dietitians. Data were thematically analysed using systematic text condensation. Two final categories were identified: 'Oral nutritional supplements are a one-dimensional remedy' and 'Everyday oral nutritional supplement usage is regulated autonomously'. The patients described the meaning of oral nutritional supplements as nutrition. While the supplements could compensate for nutrients not eaten or be part of a helpful compensation strategy, they could not lessen the burden of altered eating. Supplement usage was described as dependent on the acceptance of taste and the priority given to nutrition in everyday life. Usage was greater when nutrients were perceived as needed, such as when striving for higher bodyweight or disease recovery. Usage was lower when a patient's own goals were not increased nutrient intake or bodyweight or when other activities were perceived as more important. Patient experiences indicated that oral nutritional supplements could serve as a remedy for malnutrition, but not for a situation of altered eating. Supplement usage was described as being regulated autonomously based on patient views on the importance of nutrition. Those views were diverse, highlighting the importance of supplement prescribers discussing treatment goals with each patient. A deeper understanding of the meaning of oral nutritional supplements and reasons for their usage from a patient perspective is crucial in order for healthcare to provide appropriate, effective nutrition therapy for malnutrition.
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Affiliation(s)
- Evelina Liljeberg
- Department of Food Studies, Nutrition and Dietetics, Uppsala University, S-752 37, Uppsala, Sweden; Medical Unit Clinical Nutrition, Women's Health and Allied Health Professionals Theme, Karolinska University Hospital, Norrbacka S1:04, S-171 76, Stockholm, Sweden.
| | - Margaretha Nydahl
- Department of Food Studies, Nutrition and Dietetics, Uppsala University, S-752 37, Uppsala, Sweden.
| | - Elin Lövestam
- Department of Food Studies, Nutrition and Dietetics, Uppsala University, S-752 37, Uppsala, Sweden.
| | - Agneta Andersson
- Department of Food Studies, Nutrition and Dietetics, Uppsala University, S-752 37, Uppsala, Sweden.
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19
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Advances in knowledge of screening practices and their use in clinical practice to prevent malnutrition. Proc Nutr Soc 2022; 81:41-48. [DOI: 10.1017/s0029665121003670] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Malnutrition is common among older adults and is associated with a progressive decline in overall health and increased mortality. With a rapidly ageing population, the detection, prevention and management of malnutrition require urgent attention within health service planning and delivery. Routine screening for malnutrition among older adults in community settings, which addresses aetiological as well as phenotypic factors, is considered an important step for prevention and early intervention. The aim of this review is to summarise current malnutrition screening literature and highlight research that seeks to understand and address community-based approaches to malnutrition screening and management. Key healthcare professionals (HCPs) that encounter community-dwelling older adults include general practitioners (GPs), community-based nurses, community pharmacists and a range of other health and social care professionals including dietitians, physiotherapists, speech and language therapists, and occupational therapists. The key barriers to implementing screening in primary care include lack of knowledge about malnutrition among non-dietetic HCPs, lack of resources allocated to managing malnutrition, lack of access to dietetic services, and poor GP knowledge about oral nutritional supplement prescribing. In addition, older adults have poor insight into the clinical condition and the associated negative health implications. Investment in education among HCPs and public awareness is required, as well as accompanying resources to successfully implement malnutrition screening programmes for community-dwelling older adults.
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20
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Fan Y, Yao Q, Liu Y, Jia T, Zhang J, Jiang E. Underlying Causes and Co-existence of Malnutrition and Infections: An Exceedingly Common Death Risk in Cancer. Front Nutr 2022; 9:814095. [PMID: 35284454 PMCID: PMC8906403 DOI: 10.3389/fnut.2022.814095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/24/2022] [Indexed: 12/16/2022] Open
Abstract
In nutrition science, malnutrition is a state of imbalance between intake and the needs of the organism, leading to metabolic changes, impaired physiological functions, and weight loss. Regardless of the countless efforts being taken and researched for years, the burden of malnutrition is still alarming and considered a significant agent of mortality across the globe. Around 45% of 12 million children deaths (0–5 years old) annually are due to malnutrition, mostly from developing countries. Malnutrition develops associations with other infections and leads to substantial clinical outcomes, such as mortality, more visits to hospitals, poor quality of life and physical frailty, and socioeconomic issues. Here, in this review, we intend to provide an overview of the current burden, underlying risk factors, and co-existence of malnutrition and other infections, such as cancer. Following the rising concern of the vicious interplay of malnutrition and other medical illnesses, we believed that this narrative review would highlight the need to re-make and re-define the future strategies by giving comprehensive and sustainable programs to alleviate poverty and combat the rampant infectious diseases and those nutrition-related health problems. Furthermore, the study also raises the concern for hospitalized malnourished cancer patients as it is crucially important to knowledge the caregiver healthcare staff for early interventions of providing nutritional support to delay or prevent the onset of malnutrition.
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Affiliation(s)
- Yuanyuan Fan
- School of Life Sciences, Henan University, Kaifeng, China
| | - Qianqian Yao
- Institute of Nursing and Health, Henan University, Kaifeng, China
| | - Yufeng Liu
- Institute of Nursing and Health, Henan University, Kaifeng, China
| | - Tiantian Jia
- Institute of Nursing and Health, Henan University, Kaifeng, China
- DeDepartment of Orthopedics, Henan Provincial People's Hospital, Zhengzhou, China
| | - Junjuan Zhang
- DeDepartment of Orthopedics, Henan Provincial People's Hospital, Zhengzhou, China
- Junjuan Zhang
| | - Enshe Jiang
- Institute of Nursing and Health, Henan University, Kaifeng, China
- Henan International Joint Laboratory for Nuclear Protein Regulation, Henan University, Kaifeng, China
- *Correspondence: Enshe Jiang
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21
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Krzymińska-Siemaszko R, Deskur-Śmielecka E, Kaluźniak-Szymanowska A, Kaczmarek B, Kujawska-Danecka H, Klich-Rączka A, Mossakowska M, Małgorzewicz S, Dworak LB, Kostka T, Chudek J, Wieczorowska-Tobis K. Socioeconomic Risk Factors of Poor Nutritional Status in Polish Elderly Population: The Results of PolSenior2 Study. Nutrients 2021; 13:4388. [PMID: 34959940 PMCID: PMC8703724 DOI: 10.3390/nu13124388] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/06/2021] [Accepted: 12/07/2021] [Indexed: 01/03/2023] Open
Abstract
Poor nutritional status (PNS) threatens successful aging. Identifying potentially modifiable predictors of PNS is essential for elaborating a preventive strategy for the population at risk. To assess the prevalence of PNS in the Polish elderly population and analyze its socioeconomic correlates based on the data from the nationwide PolSenior2 project. Special emphasis was put on potentially modifiable factors among the identified PNS predictors. Nutritional status was assessed in 5698 community-dwelling older adults with the Mini Nutritional Assessment-Short Form. We evaluated the effect of age, sex, level of education, marital status, place of residence, subjective loneliness, and self-reported poverty on the nutritional status of the studied subjects. PNS was found in 25.3% of studied subjects (27.7% women and 21.9% men; p < 0.001). Female sex, older age, unmarried status (in men), subjective loneliness, and self-reported poverty were independent correlates of PNS. The two last above-mentioned predictors were identified as potentially modifiable. Based on our results, we recommend preventive interventions (e.g., performing regular screening), particularly in unmarried (men), poorly educated individuals, self-reporting poverty, complaining of loneliness, and the oldest old. PNS preventive strategies should include social support (both emotional and instrumental) to reduce the effect of poverty and subjective loneliness.
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Affiliation(s)
- Roma Krzymińska-Siemaszko
- Department of Palliative Medicine, Poznan University of Medical Sciences, 61-245 Poznan, Poland; (E.D.-Ś.); (A.K.-S.); (B.K.); (K.W.-T.)
| | - Ewa Deskur-Śmielecka
- Department of Palliative Medicine, Poznan University of Medical Sciences, 61-245 Poznan, Poland; (E.D.-Ś.); (A.K.-S.); (B.K.); (K.W.-T.)
| | - Aleksandra Kaluźniak-Szymanowska
- Department of Palliative Medicine, Poznan University of Medical Sciences, 61-245 Poznan, Poland; (E.D.-Ś.); (A.K.-S.); (B.K.); (K.W.-T.)
| | - Beata Kaczmarek
- Department of Palliative Medicine, Poznan University of Medical Sciences, 61-245 Poznan, Poland; (E.D.-Ś.); (A.K.-S.); (B.K.); (K.W.-T.)
| | - Hanna Kujawska-Danecka
- Clinic of Internal Medicine, Connective Tissue Diseases and Geriatrics, Medical University of Gdansk, 80-210 Gdansk, Poland;
| | - Alicja Klich-Rączka
- Department of Internal Medicine and Gerontology, Collegium Medicum of Jagiellonian University, 31-008 Krakow, Poland;
| | | | - Sylwia Małgorzewicz
- Department of Clinical Nutrition, Medical University of Gdansk, 80-210 Gdansk, Poland;
| | | | - Tomasz Kostka
- Healthy Ageing Research Centre (HARC), Department of Geriatrics, Medical University of Lodz, 90-647 Lodz, Poland;
| | - Jerzy Chudek
- Department of Internal Medicine and Oncological Chemotherapy, Medical University of Silesia, 40-055 Katowice, Poland;
| | - Katarzyna Wieczorowska-Tobis
- Department of Palliative Medicine, Poznan University of Medical Sciences, 61-245 Poznan, Poland; (E.D.-Ś.); (A.K.-S.); (B.K.); (K.W.-T.)
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22
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Payne L, Ghio D, Grey E, Slodkowska-Barabasz J, Harris P, Sutcliffe M, Green S, Roberts HC, Childs C, Robinson S, Gudgin B, Holloway P, Kelly J, Wallis K, Dean O, Aveyard P, Gill P, Stroud M, Little P, Yardley L, Morrison L. Optimising an intervention to support home-living older adults at risk of malnutrition: a qualitative study. BMC FAMILY PRACTICE 2021; 22:219. [PMID: 34758733 PMCID: PMC8580738 DOI: 10.1186/s12875-021-01572-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 10/22/2021] [Indexed: 11/17/2022]
Abstract
Background In the UK, about 14% of community-dwelling adults aged 65 and over are estimated to be at risk of malnutrition. Screening older adults in primary care and treating those at risk may help to reduce malnutrition risk, reduce the resulting need for healthcare use and improve quality of life. Interventions are needed to raise older adults’ risk awareness, offer relevant and meaningful strategies to address risk and support general practices to deliver treatment and support. Methods Using the Person-based Approach and input from Patient and Public Involvement representatives, we developed the ‘Eat well, feel well, stay well’ intervention. The intervention was optimised using qualitative data from think aloud and semi-structured process evaluation interviews with 23 and 18 older adults respectively. Positive and negative comments were extracted to inform rapid iterative modifications to support engagement with the intervention. Data were then analysed thematically and final adjustments made, to optimise the meaningfulness of the intervention for the target population. Results Participants’ comments were generally positive. This paper focuses predominantly on participants’ negative reactions, to illustrate the changes needed to ensure that intervention materials were optimally relevant and meaningful to older adults. Key factors that undermined engagement included: resistance to the recommended nutritional intake among those with reduced appetite or eating difficulties, particularly frequent eating and high energy options; reluctance to gain weight; and a perception that advice did not align with participants’ specific personal preferences and eating difficulties. We addressed these issues by adjusting the communication of eating goals to be more closely aligned with older adults’ beliefs about good nutrition, and acceptable and feasible eating patterns. We also adjusted the suggested tips and strategies to fit better with older adults’ everyday activities, values and beliefs. Conclusions Using iterative qualitative methods facilitated the identification of key behavioural and contextual elements that supported engagement, and issues that undermined older adults’ engagement with intervention content. This informed crucial revisions to the intervention content that enabled us to maximise the meaningfulness, relevance and feasibility of the key messages and suggested strategies to address malnutrition risk, and therefore optimise engagement with the intervention and the behavioural advice it provided. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-021-01572-z.
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Affiliation(s)
- Liz Payne
- School of Psychology, University of Southampton, Southampton, UK.
| | - Daniela Ghio
- Primary Care Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | | | | | - Philine Harris
- School of Psychology, University of Southampton, Southampton, UK
| | - Michelle Sutcliffe
- Dietetics Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Sue Green
- Department for Nursing Science, Bournemouth University, Poole, UK
| | - Helen C Roberts
- Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Caroline Childs
- Human Development and Health, University of Southampton, Southampton, UK
| | - Sian Robinson
- AGE Research Group, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.,NIHR Newcastle Biomedical Research Centre, Newcastle University and Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Bernard Gudgin
- Public and Patient Involvement, University of Southampton, Southampton, UK
| | - Pam Holloway
- Public and Patient Involvement, University of Southampton, Southampton, UK
| | - Jo Kelly
- Primary Care Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Kathy Wallis
- Wessex Academic Health Science Network, Southampton, UK
| | - Oliver Dean
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Paramjit Gill
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Mike Stroud
- Clinical Nutrition, University of Southampton, Southampton, UK
| | - Paul Little
- Primary Care Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Lucy Yardley
- School of Psychology, University of Southampton, Southampton, UK.,School of Psychological Science, University of Bristol, Bristol, UK
| | - Leanne Morrison
- School of Psychology, University of Southampton, Southampton, UK.,Primary Care Population Sciences and Medical Education, University of Southampton, Southampton, UK
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Reynolds CME, Dominguez Castro P, Geraghty AA, Browne S, Bardon LA, Corish CA. 'It takes a village': a qualitative study on malnutrition and oral nutritional supplements with older adults in Ireland. Eur J Public Health 2021; 31:1284-1290. [PMID: 34219166 DOI: 10.1093/eurpub/ckab099] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Malnutrition affects approximately 20% of older adult populations in Europe, yet their views on the condition are rarely explored. This qualitative study aimed to explore the experiences of older adults living with malnutrition and prescribed oral nutritional supplements in the community setting. METHODS Semi-structured individual interviews were used to collect data from 13 community-dwelling individuals aged ≥60 years with a current or previous prescription for oral nutritional supplements. Self-perceived health status was measured using the EuroQol EQ-5D-5L, a short questionnaire and visual analogue scale. Interviews were audio-recorded and transcribed verbatim. Interview data were organized using NVivo 12 and analyzed using inductive thematic analysis. RESULTS Median age was 80.0 (interquartile range 19.5) years, seven were male and six were female. Median health score was 60.0 (interquartile range 35.0) out of 100. Almost one-third reported severe or extreme problems with usual activities, and pain or discomfort. One main theme was identified from the interviews: 'It takes a village', with four subthemes (i) 'I get by with a little help from my friends', (ii) 'The obvious diagnosis', (iii) 'The missing T in MDT' and (iv) 'Confusion'. Participants with malnutrition reported relying on friends, family and carers with poor multidisciplinary team communication and lack of dietetic support. CONCLUSIONS Participants in this study experienced poor management of malnutrition with missing links between the hospital and community healthcare settings, and lack of dietetic services. Patient views should be used to inform public health guidelines and guide future interventions in the community to improve the health status of older adults with malnutrition.
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Affiliation(s)
- Ciara M E Reynolds
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Republic of Ireland.,UCD Institute of Food and Health, University College Dublin, Dublin, Republic of Ireland
| | - Patricia Dominguez Castro
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Republic of Ireland.,UCD Institute of Food and Health, University College Dublin, Dublin, Republic of Ireland
| | - Aisling A Geraghty
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Republic of Ireland.,UCD Institute of Food and Health, University College Dublin, Dublin, Republic of Ireland
| | - Sarah Browne
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Republic of Ireland.,UCD Institute of Food and Health, University College Dublin, Dublin, Republic of Ireland
| | - Laura A Bardon
- UCD Institute of Food and Health, University College Dublin, Dublin, Republic of Ireland.,School of Agriculture and Food Science, University College Dublin, Dublin, Republic of Ireland
| | - Clare A Corish
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Republic of Ireland.,UCD Institute of Food and Health, University College Dublin, Dublin, Republic of Ireland
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24
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Malnutrition: A Misunderstood Diagnosis by Primary Care Health Care Professionals and Community-Dwelling Older Adults in Ireland. J Acad Nutr Diet 2021; 121:2443-2453. [PMID: 34219047 DOI: 10.1016/j.jand.2021.05.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 05/17/2021] [Accepted: 05/18/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND Language and communication have an impact on how a clinical condition is treated and experienced, from both the health care professional (HCP) and patient perspective. Malnutrition is prevalent among community-dwelling older adults, yet perceptions of patient understanding of the term malnutrition to date remain underexplored. OBJECTIVE This qualitative study explored the use and perceptions of the term malnutrition among HCPs and older adults at risk of malnutrition. DESIGN Semi-structured interviews and focus groups were conducted with HCPs and older adults with a prescription for oral nutritional supplements (ONS) in the community, to explore perspectives. PARTICIPANTS AND SETTING HCPs with experience of working with older adults were recruited in primary care centers, general practitioner practices, community health organizations, and community pharmacies in County Dublin, Ireland, between 2018 and 2019. Older adults, aged ≥60 years, with a current or previous prescription for ONS were recruited from daycare centers. One-to-one interviews were conducted with general practitioners (n = 16) and patients (n = 13), and focus groups were conducted with other HCPs, including dietitians (n = 22), nurses (n = 22), pharmacists (n = 9), physiotherapists (n = 12), occupational therapists (n = 6), and speech and language therapists (n = 4). DATA ANALYSIS Data from interviews and focus groups were transcribed verbatim and analyzed using thematic analysis. RESULTS There was mutual agreement between HCPs and patients on the main theme, "malnutrition is a term to be avoided." There were three subthemes with varying input from the different HCP groups and patients: "Malnutrition is a term a patient doesn't want to hear"-malnutrition has negative connotations that imply neglect and stigma; "malnutrition is a clinical term which patients don't understand"-with perceptions that it is better to substitute the term with simpler motivating messages; and "lack of confidence identifying malnutrition"-expressed by non-dietetics HCPs who believed they had insufficient expertise on malnutrition to communicate effectively with patients. CONCLUSIONS HCPs and patients perceived negative connotations with the term malnutrition, and HCPs used alternatives in practice. Additional consultation with HCPs and patients is recommended to explore appropriate language for conveying health risks associated with malnutrition. Future research should also address how current communication challenges can be addressed as part of strategic management programs or interventions to prevent and treat malnutrition.
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25
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Edwards S, Farrer K, Rose E, Haynes D, McLaughlin J. Brief intervention using the PaperWeight Armband to identify older people at risk of undernutrition in the community: a preliminary evaluation. J Epidemiol Community Health 2021; 76:32-37. [PMID: 34158407 DOI: 10.1136/jech-2020-216277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 05/27/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND The risk of undernutrition in older adults in the community is high, with clear negative impacts on health and well-being. Nutritional screening is not routine and undernutrition often goes unrecognised. A community-level population public health intervention has the potential to target environments where the risk of undernutrition is highest. A programme has been established locally using the PaperWeight Armband as a simple nutritional screening tool in residents over 65 years, followed by supporting advice and community interventions. We undertook a nested pilot cohort evaluation within the wider programme to assess whether this could impact positively. METHODS Participants found to be at risk of undernutrition in the programme were recruited consecutively. Baseline weight and other descriptors including accommodation and frailty were recorded, and then again at 12 weeks. RESULTS 83 participants were recruited from a wide variety of community settings, age range 65-99 years; 75% were women. Sixty-seven recruits were followed up for 12-week review. Of these, 54 (81%) had a positive outcome, recording either weight gain (66%) or no weight loss (15%) at 12 weeks. Benefit was seen in all living circumstances but was least evident in the frailest participants. CONCLUSION The intervention is associated with positive outcomes, with reduction or stabilisation of nutritional risk in the majority of participants studied. The intervention can be delivered in a wide range of settings and does not require healthcare professions for the screening. Longer and larger studies are now required to study the health, well-being and socioeconomic impacts of the intervention in depth.
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Affiliation(s)
- Steven Edwards
- School of Medical Sciences, Faculty of Biology, Medicine and Heath, Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK
| | - Kirstine Farrer
- Nutrition and Dietetics Department, Salford Royal Hospitals NHS Trust, Salford, UK
| | | | | | - John McLaughlin
- School of Medical Sciences, Faculty of Biology, Medicine and Heath, Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK
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26
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Bullock AF, Greenley SL, Patterson MJ, McKenzie GAG, Johnson MJ. Patient, family and carer experiences of nutritional screening: a systematic review. J Hum Nutr Diet 2021; 34:595-603. [PMID: 33316101 PMCID: PMC8246934 DOI: 10.1111/jhn.12849] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 11/04/2020] [Accepted: 11/13/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Despite recommendations for nutritional risk screening of all inpatients, outpatients and care home residents, as well as work to assess clinician's experiences and the validity of tools, little attention has been paid to the experiences of patients undergoing nutritional screening. This review aims to synthesise systematically the current evidence regarding nutritional risk screening with respect to the experiences and views of patients, their families and carers. METHODS A systematic search was performed in MEDLINE, Embase, PsychINFO, CINAHL, Web of Science and British Nursing Database (inception - July 2019); with screening terms related to malnutrition, screening tools and experience. Titles, abstracts and full-text papers were independently reviewed by two reviewers and then quality-appraised. Qualitative papers and quantitative surveys were included. A narrative review of surveys and a thematic framework synthesis of interviews were used to identify themes. RESULTS Nine studies, including five qualitative interview papers, were included. Qualitative and quantitative study results were combined using a matrix chart to allow comparison. Surveyed participants reported processes of nutritional screening as acceptable. Three key themes emerged from qualitative data: (i) experience of nutritional screening; (ii) misunderstanding of malnutrition: of causes, role of screening and poor self-perception of risk; and (iii) barriers to and opportunities for change. CONCLUSIONS Although the screening process is acceptable, patients' misunderstanding and poor knowledge regarding causes and consequences of malnutrition result in reduced risk perception and disbelief or disregard of nutritional screening results. Findings should inform policy and clinical practice, as well as highlight the known paucity of data regarding the effectiveness of screening on clinical outcomes.
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Affiliation(s)
- A. F. Bullock
- Wolfson Palliative Care Research CentreHull York Medical SchoolUniversity of HullHullUK
| | - S. L. Greenley
- Academy of Primary CareHull York Medical SchoolUniversity of HullHullUK
| | - M. J. Patterson
- Wolfson Palliative Care Research CentreHull York Medical SchoolUniversity of HullHullUK
| | - G. A. G. McKenzie
- Wolfson Palliative Care Research CentreHull York Medical SchoolUniversity of HullHullUK
| | - M. J. Johnson
- Wolfson Palliative Care Research CentreHull York Medical SchoolUniversity of HullHullUK
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27
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Browne S, Kelly L, Geraghty AA, Reynolds CM, McBean L, McCallum K, Clyne B, Bury G, Perrotta C, Kennelly S, Bradley C, McCullagh L, Finnigan K, Clarke S, Bardon LA, Murrin C, Gibney ER, Dominguez Castro P, Corish CA. Healthcare professionals' perceptions of malnutrition management and oral nutritional supplement prescribing in the community: A qualitative study. Clin Nutr ESPEN 2021; 44:415-423. [PMID: 34330499 DOI: 10.1016/j.clnesp.2021.04.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 04/21/2021] [Accepted: 04/25/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND & AIM Protein-energy malnutrition is under-recognised in the community despite being common in older adults due to physiological and social changes which are often compounded by chronic disease. This qualitative study aimed to explore the opinions of healthcare professionals (HCPs) working in the primary care and community settings about the management of malnutrition and the prescription of oral nutritional supplements (ONS), often included in the treatment of malnutrition. METHODS Twelve healthcare professional (HCP) focus groups with 75 participants were conducted: community dietitians (n = 17), registered dietitians working in industry (n = 5), community and residential care nurses (n = 22), physiotherapists (n = 12), pharmacists (n = 9), occupational therapists (n = 6) and speech and language therapists (n = 4). Focus group discussions were audio-recorded and transcribed verbatim. The data were coded and analysed using thematic analysis and key themes with illustrative quotes extracted are presented. RESULTS Similar views on malnutrition management existed across professions. 'Gaps in Primary Care Management' was the first key theme wherein HCPs identified limitations in malnutrition management in the community. Barriers included limited or no dietetic services available in primary care and poor communication between general practitioners and wider primary care team members which resulted in inappropriate or delayed treatment. The second key theme, 'Challenges with ONS use in the Community', encapsulated several issues HCPs experienced with ONS usage including inappropriate prescribing and lack of monitoring of treatment goals. Conflicts of interest regarding dietitians working in industry assessing and treating older adults in residential care settings was highlighted by participants. CONCLUSIONS This study highlights that more emphasis is needed to identify patients when they are at risk of malnutrition to avoid advanced or severe malnutrition presentations currently seen. Community dietitians for older people are required to address many of the issues raised including the need for awareness, education and training, resources, and malnutrition care pathway structures.
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Affiliation(s)
- Sarah Browne
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Republic of Ireland; UCD Institute of Food and Health, University College Dublin, Dublin, Republic of Ireland
| | - Lucy Kelly
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Republic of Ireland
| | - Aisling A Geraghty
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Republic of Ireland; UCD Institute of Food and Health, University College Dublin, Dublin, Republic of Ireland
| | - Ciara Me Reynolds
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Republic of Ireland; UCD Institute of Food and Health, University College Dublin, Dublin, Republic of Ireland
| | - Laura McBean
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Republic of Ireland; UCD Institute of Food and Health, University College Dublin, Dublin, Republic of Ireland
| | - Kimberley McCallum
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Republic of Ireland
| | - Barbara Clyne
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Republic of Ireland
| | - Gerard Bury
- School of Medicine, University College Dublin, Belfield, Dublin 4, Republic of Ireland
| | - Carla Perrotta
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Republic of Ireland
| | - Sharon Kennelly
- National Primary Care Division, Community Funded Schemes Service Improvement, Mountmellick Primary Care Building, Co. Laois, Republic of Ireland
| | - Catriona Bradley
- Royal College of Surgeons in Ireland, Dublin, Republic of Ireland
| | - Laura McCullagh
- Department of Pharmacology and Therapeutics, Trinity Centre for Health Sciences, St James's Hospital, Dublin 8, Republic of Ireland
| | - Karen Finnigan
- HSE Medicines Management Programme, Health Service Executive, St James's Hospital, Dublin 8, Republic of Ireland
| | - Sarah Clarke
- HSE Medicines Management Programme, Health Service Executive, St James's Hospital, Dublin 8, Republic of Ireland
| | - Laura A Bardon
- UCD Institute of Food and Health, University College Dublin, Dublin, Republic of Ireland; School of Agriculture and Food Science, University College Dublin, Dublin, Republic of Ireland
| | - Celine Murrin
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Republic of Ireland; UCD Institute of Food and Health, University College Dublin, Dublin, Republic of Ireland
| | - Eileen R Gibney
- UCD Institute of Food and Health, University College Dublin, Dublin, Republic of Ireland; School of Agriculture and Food Science, University College Dublin, Dublin, Republic of Ireland
| | - Patricia Dominguez Castro
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Republic of Ireland; UCD Institute of Food and Health, University College Dublin, Dublin, Republic of Ireland
| | - Clare A Corish
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Republic of Ireland; UCD Institute of Food and Health, University College Dublin, Dublin, Republic of Ireland.
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28
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Characteristics and determinants of high volume dispensing in long-term oral nutritional supplement users in primary care: a secondary analysis. BJGP Open 2021; 5:BJGPO.2020.0131. [PMID: 33495164 PMCID: PMC8170613 DOI: 10.3399/bjgpo.2020.0131] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 09/24/2020] [Indexed: 01/04/2023] Open
Abstract
Background Oral nutritional supplements (ONS) are recommended for patients who are malnourished or at risk of malnutrition. Appropriate ONS prescribing requires regular monitoring to assess its continued requirement. Previous research identified long-term ONS prescriptions (>6 months) without review, with 70% of these influenced by social factors. Aim To investigate the characteristics of long-term ONS users in Ireland and the determinants of larger volumes of ONS dispensing. Design & setting Secondary analysis of anonymous dispensed pharmacy claims data of patients dispensed standard ONS for 12 consecutive months in 2018 (n = 912). Method Factors showing significant (P<0.05) univariate associations with above the median consumption of ONS units were entered into a multivariable model. Results Median age was 76 (range 18 to 101) years, with 66.9% of the sample being ≥65 years. Almost 70% of the samples were on polypharmacy (45.6%; ≥5 medications) or excessive polypharmacy (21.5%; ≥10 medications). Younger age and being on polypharmacy for drugs having an effect on the central nervous system (CNS) were significantly associated with being dispensed more ONS units in univariate and multivariate analysis. Those patients in the age range 18 to 44 were 2.5 fold more likely to be prescribed more ONS units (odds ratio [OR] 2.5; 95% confidence interval [CI] 1.5 to 4.3; P<0.001). Patients using CNS drugs or on CNS polypharmacy were more likely to be prescribed more ONS units (ORs 1.2 and 2.4; 95% CI 0.9 to 1.4 and 1.3 to 4.4 respectively; P = 0.029). Conclusion Older age and polypharmacy characterise long-term ONS users in this study. Younger age and CNS medication polypharmacy are predictors of more ONS units prescribed over a year.
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29
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Liljeberg E, Nydahl M, Lövestam E, Andersson A. A qualitative exploration of dietitians' experiences of prescribing oral nutritional supplements to patients with malnutrition: A focus on shared tailoring and behaviour change support. J Hum Nutr Diet 2021; 34:858-867. [PMID: 33586831 DOI: 10.1111/jhn.12867] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 12/04/2020] [Accepted: 01/14/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Oral nutritional supplements (ONS) are commonly prescribed to patients with malnutrition. Dietitians have been suggested as preferred prescribers but generally lack ONS prescribing rights. How dietitians with prescribing rights experience their professional practice of prescribing ONS remains understudied. Thus, by exploring dietitians' experiences of prescribing ONS, the present study aimed to obtain a deeper understanding of specific aspects that are of importance for dietitians when providing a nutrition therapy including ONS. METHODS Qualitative individual interviews were conducted with 13 dietitians prescribing ONS to free-living adult outpatients with malnutrition or at nutritional risk in the hospital or primary care setting. Systematic text condensation was used for data analysis. RESULTS Two main categories signifying important aspects were identified and labelled: 'Shared tailoring of the ONS prescription' and 'Supporting and facilitating ONS use'. First, the dietitians described tailoring the ONS prescription together with the patient, having their acceptance as a prerequisite, and being flexible regarding products and amounts prescribed. Second, they described performing different communication strategies and organising of practical issues (e.g., ONS delivery and support from others) to support and facilitate patients' ONS usage. CONCLUSIONS The present study identifies patient involvement and the role of dietitians as behaviour change facilitators as two important aspects when dietitians prescribe ONS. These findings allow for dietitians' ideals and strategies on how to prescribe ONS to be made more visible, which can inform both clinical practice and clinical trials for future improvements in nutrition therapy to address malnutrition.
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Affiliation(s)
- Evelina Liljeberg
- Department of Food Studies, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden.,Function Area Clinical Nutrition, Karolinska University Hospital, Stockholm, Sweden
| | - Margaretha Nydahl
- Department of Food Studies, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden
| | - Elin Lövestam
- Department of Food Studies, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden
| | - Agneta Andersson
- Department of Food Studies, Nutrition and Dietetics, Uppsala University, Uppsala, Sweden
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30
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Bergeron CD, John JM, Sribhashyam M, Odonkor G, Oloruntoba O, Merianos AL, Horel S, Smith ML. County-Level Characteristics Driving Malnutrition Death Rates among Older Adults in Texas. J Nutr Health Aging 2021; 25:862-868. [PMID: 34409963 PMCID: PMC8013203 DOI: 10.1007/s12603-021-1626-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 03/09/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study aims to identify older adult malnutrition in Texas, examine county-level characteristics associated with crude malnutrition death rates, and describe assets and opportunities available to address and improve malnutrition among the older population. DESIGN Secondary data analysis using the Centers for Disease Control and Prevention's WONDER online database, the U.S. Census 2014-2018 American Community Survey, and the U.S. Department of Agriculture's Food Access Research Atlas data. SETTING All 254 counties in the state of Texas. PARTICIPANTS Individuals aged 65 years and older. MEASUREMENT The dependent variable was the proportion of county-level malnutrition crude death rates. Independent variables included Health Provider Shortage Area designations, rurality, poverty status, food access, age, race, ethnicity, and education. RESULTS The overall malnutrition crude death rate in Texas was 65.6 deaths per 100,000 older Texans, ranging from 0 to 414.46 deaths per 100,000 depending on the county. Higher malnutrition crude death rates were associated with non-metropolitan counties (P=0.018), lower education (P=0.047), greater household poverty (P=0.010), and low food access (P<0.001). CONCLUSION Socioeconomic disadvantages at the county-level appear to be one of the root causes of malnutrition crude death rates in Texas.
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Affiliation(s)
- C D Bergeron
- Matthew Lee Smith, Department of Environmental and Occupational Health, School of Public Health, Texas A and M University, College Station, TX, USA,
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31
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Castro PD, Reynolds CM, Kennelly S, Geraghty AA, Finnigan K, McCullagh L, Gibney ER, Perrotta C, Corish CA. An investigation of community-dwelling older adults' opinions about their nutritional needs and risk of malnutrition; a scoping review. Clin Nutr 2020; 40:2936-2945. [PMID: 33422348 DOI: 10.1016/j.clnu.2020.12.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 11/10/2020] [Accepted: 12/15/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Understanding how older adults perceive their nutritional needs and malnutrition risk is important to inform strategies to improve prevention and management of the condition. This scoping review aimed to identify, characterize and summarize the findings from studies analysing community-dwelling older adults' opinions and perceptions towards their nutritional needs and malnutrition risk. METHODS An electronic literature search was carried out using three databases, Pubmed, Embase, and CINAHL up to January 2020. Articles were reviewed following PRISMA guidelines. RESULTS A total of 16,190 records were identified and reviewed with 15 studies being included, all of which were conducted in high income countries. Common conceptual categories that were identified included; older community-dwelling adults consider that a healthy diet for them is the same as that recommended for the general population, consisting of fruits, vegetables, reduced fat and reduced sugar. Weight loss was seen as a positive outcome and a normal component of the ageing process. Lack of appetite was identified by participants in the majority of studies as a barrier to food intake. CONCLUSIONS This review shows how older community-dwelling adults, with a high risk of malnutrition, follow dietary public health recommendations for the general population and have a greater awareness of the risks of overweight. The implementation of nutritional guidelines that consider the nutritional needs of all older adults and education of non-dietetic community healthcare professionals on providing appropriate nutritional advice to this population are warranted.
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Affiliation(s)
- Patricia Dominguez Castro
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin 4, Republic of Ireland; UCD Institute of Food and Health, University College Dublin, Dublin 4, Republic of Ireland
| | - Ciara Me Reynolds
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin 4, Republic of Ireland; UCD Institute of Food and Health, University College Dublin, Dublin 4, Republic of Ireland
| | - Sharon Kennelly
- National Primary Care Division, Community Funded Schemes Service Improvement, Mountmellick Primary Care Building, Co. Laois, Republic of Ireland
| | - Aisling A Geraghty
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin 4, Republic of Ireland; UCD Institute of Food and Health, University College Dublin, Dublin 4, Republic of Ireland
| | - Karen Finnigan
- Department of Pharmacology and Therapeutics, Trinity Centre for Health Sciences, St James's Hospital, Dublin 8, Republic of Ireland
| | - Laura McCullagh
- Department of Pharmacology and Therapeutics, Trinity Centre for Health Sciences, St James's Hospital, Dublin 8, Republic of Ireland
| | - Eileen R Gibney
- UCD Institute of Food and Health, University College Dublin, Dublin 4, Republic of Ireland; School of Agriculture and Food Science, University College Dublin, Dublin 4, Republic of Ireland
| | - Carla Perrotta
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin 4, Republic of Ireland
| | - Clare A Corish
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin 4, Republic of Ireland; UCD Institute of Food and Health, University College Dublin, Dublin 4, Republic of Ireland.
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32
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Abstract
An increased lifespan does not necessarily equate to a high quality of life. This article discusses strategies to help older adult patients cope with loneliness, social isolation, and chronic illness to improve their health and quality of life.
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Affiliation(s)
- Lori Hammond
- At Texas Tech University Health Sciences Center School in Lubbock, Tex., Lori Hammond is an associate professor and Richard L. Pullen, Jr., is a professor
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33
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Payne L, Harris P, Ghio D, Slodkowska-Barabasz J, Sutcliffe M, Kelly J, Stroud M, Little P, Yardley L, Morrison L. Beliefs about inevitable decline among home-living older adults at risk of malnutrition: a qualitative study. J Hum Nutr Diet 2020; 33:841-851. [PMID: 32840942 DOI: 10.1111/jhn.12807] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 07/20/2020] [Accepted: 07/23/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Approximately 14% of free-living adults aged ≥65 years are at risk of malnutrition. Malnutrition screen and treat interventions in primary care are few, show mixed results, and the advice given is not always accepted and followed. We need to better understand the experiences and contexts of older adults when aiming to develop interventions that are engaging, optimally persuasive and relevant. METHODS Using the Person-based Approach, we carried out 23 semi-structured interviews with purposively selected adults ≥65 years with chronic health or social conditions associated with malnutrition risk. Thematic analysis informed the development of key principles to guide planned intervention development. RESULTS We found that individuals' beliefs about an inevitable decline in appetite and eating in older age compound the many and varied physical and physiological barriers that they experience. Also, we found that expectations of decline in appetite and physical ability may encourage resignation, reduce self-efficacy to overcome barriers, and reduce motivation to address weight loss and/or recognise it as an issue that needs to be addressed. Fear of loss of independence may also reduce the likelihood of asking general practitioners for advice. CONCLUSIONS The key findings identified include a sense of resignation, multiple different barriers to eating and a need for independence, each underpinned by the expectation of a decline in older adulthood. Interventions need to address misperceptions about the inevitability of decline, highlight how and why diet recommendations are somewhat different from recommendations for the general population, and suggest easy ways to increase food intake that address common barriers.
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Affiliation(s)
- L Payne
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK
| | - P Harris
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK
| | - D Ghio
- School of Primary Care, Population Sciences and Medical Education, Aldermoor Health Centre, University of Southampton, Southampton, UK
| | - J Slodkowska-Barabasz
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK
| | - M Sutcliffe
- Dietetics Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - J Kelly
- School of Primary Care, Population Sciences and Medical Education, Aldermoor Health Centre, University of Southampton, Southampton, UK
| | - M Stroud
- Department of Gastroenterology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - P Little
- School of Primary Care, Population Sciences and Medical Education, Aldermoor Health Centre, University of Southampton, Southampton, UK
| | - L Yardley
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK.,School of Psychological Science, University of Bristol, Bristol, UK
| | - L Morrison
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK.,School of Primary Care, Population Sciences and Medical Education, Aldermoor Health Centre, University of Southampton, Southampton, UK
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General practitioners' views on malnutrition management and oral nutritional supplementation prescription in the community: A qualitative study. Clin Nutr ESPEN 2020; 36:116-127. [PMID: 32220354 DOI: 10.1016/j.clnesp.2020.01.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 12/04/2019] [Accepted: 01/10/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND & AIMS Malnutrition or undernutrition, arising from a deficiency of energy and protein intake, occurs commonly among community-dwelling individuals in developed countries. Once identified, malnutrition can be effectively treated in the majority of cases with dietary advice and the prescription of oral nutritional supplements (ONS) for patients who can eat and drink orally. However, previous research has reported inadequate screening and treatment of malnutrition in the community. The aim of this qualitative study was to explore general practitioners' (GPs) experiences and opinions on the management of malnutrition and the prescription of ONS in the primary care/community setting in Ireland. METHODS Sixteen semi-structured interviews including chart stimulated recalls (CSR) were conducted with GPs. The interviews and CSRs explored, among others, the following domains; barriers and facilitators in the management of malnutrition, ONS prescribing in the primary care/community setting, and future directions in the management of malnutrition and ONS prescribing. Recorded interviews were transcribed and analysed following a generic qualitative approach with inductive thematic analysis using NVIVO 12 to facilitate data management. RESULTS Three main themes were identified. Theme 1: 'Malnutrition is a secondary concern', encapsulating the idea that the identification of malnutrition is usually secondary to other clinical issues or disease rather than an independent clinical outcome. This theme also includes the idea that obesity is viewed as a dominant nutritional issue for GPs. Theme 2: 'Responsibility for malnutrition and ONS management in the community', highlighting that GPs feel they do not know who is responsible for the management of malnutrition in the community setting and expressed their need for more support from other healthcare professionals (HCPs) to effectively monitor and treat malnutrition. Theme 3: 'Reluctance to prescribe ONS', emerging from the GPs reported lack of knowledge to prescribe the appropriate ONS, their concern that ONS will replace the patient's meals and the costs associated with the prescription of ONS. CONCLUSIONS GPs in Ireland do not routinely screen for malnutrition in their clinics as they feel unsupported in treating and managing malnutrition in the community due to limited or no dietetic service availability and time constraints. GPs also view malnutrition as a secondary concern to disease management and prioritise referral to dietetic services for patients with overweight and obesity. GPs reported that they have insufficient knowledge to change or discontinue ONS prescriptions. This study demonstrates that there is a clear need for primary care training in malnutrition identification, treatment and management and more community dietetic services are needed in order to support GPs and deliver high quality care to patients.
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Allmark G, Calder PC, Marino LV. Research identified variation in nutrition practice by community prescribing dietitians with regards to the identification and management of malnutrition amongst community dwelling adults. Nutr Res 2019; 76:94-105. [PMID: 31837829 DOI: 10.1016/j.nutres.2019.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 09/30/2019] [Accepted: 10/15/2019] [Indexed: 01/29/2023]
Abstract
To improve nutritional outcomes of community dwelling adults with malnutrition we identified three related hypotheses to be tested: i) Southampton Community Prescribing Support Service dietitians achieve 100% compliance with selected standards of the National Institute for Health and Clinical Excellence Clinical Guideline (CG) 32, ii) patient service satisfaction amongst community dwelling adults accessing the prescribing support service is high (90%), and iii) nationally, dietitians use weight gain goal >10% and BMI >18.5 kg/m2 as outcome measures from the service phases of prescribing support. A retrospective audit of records of 100 community-dwelling adults accessing local services considered CG32 "Indications for nutrition support in hospital and community standard 1.3.1" and CG32 "Monitoring of nutrition support in hospital and community standard 1.5.6". A questionnaire was distributed to community-dwelling adults (n = 52) accessing the service, in addition to a national survey of dietetic practice. Compliance with standard 1.3.1 was 46% and with standard 1.5.6 it was 82%. The majority of patients (86%; n = 13) reported satisfaction with the support service. Nationally, 89% (n = 51) of dietitians use weight and 87% (n = 50) use BMI as an outcome measure for success of nutritional intervention. All research hypotheses were rejected. These results suggest there is considerable variation in the identification and management of malnutrition amongst community dwelling adults, which may impact on clinical and nutritional outcomes. Future work should consider quality improvement projects to address potential barriers to achieving best practice by community prescribing dietitians through the use of nutrition pathways to support older adults with malnutrition.
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Affiliation(s)
- Grace Allmark
- Department of Dietetics/Speech and Language Therapy, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.
| | - Philip C Calder
- Faculty of Medicine, University of Southampton, Southampton, United Kingdom; NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, United Kingdom
| | - Luise V Marino
- Department of Dietetics/Speech and Language Therapy, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom; NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, United Kingdom; Faculty of Health Sciences, University of Southampton, Southampton, United Kingdom
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