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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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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: 76] [Impact Index Per Article: 76.0] [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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Ten Cate D, Dikken J, Ettema RGA, Schoonhoven L, Schuurmans MJ. Development of a microlearning intervention regarding nursing nutritional care for older adults: A multi-methods study. NURSE EDUCATION TODAY 2023; 120:105623. [PMID: 36459951 DOI: 10.1016/j.nedt.2022.105623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 09/18/2022] [Accepted: 11/03/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Nutritional care for older adults provided by hospital and home care nurses and nursing assistants is suboptimal. This is due to several factors including professionals' lack of knowledge and low prioritisation. Affecting these factors may promote nurses' and nursing assistants' behavioral change and eventually improve nutritional care. To increase the likelihood of successfully targeting these factors, an evidence-based educational intervention is needed. OBJECTIVES To develop an educational intervention for hospital and home care nurses and nursing assistants to promote behaviour change by affecting factors that influence current behaviour in nutritional care for older adults. In this paper, we describe the intervention development process. DESIGN A multi-methods approach using literature and expert input. SETTINGS Hospital and home care. PARTICIPANTS Older adults, nurses, nursing assistants, experts, and other professionals involved in nutritional care. METHODS The educational intervention was based on five principles: 1) interaction between intervention and users, 2) targeting users on both individual and team level, 3) supporting direct and easy transfer to the workplace, and continuous learning, 4) facilitating learning within an appropriate period, and 5) fitting with the context. Consistent with these principles, the research team focussed on developing a microlearning intervention and they established consensus on seven features of the intervention: content, provider, mode of delivery, setting, recipient, intensity, and duration. RESULTS The intervention consisted of 30 statements about nursing nutritional care for older adults, which nurses and nursing assistants were asked to confirm or reject, followed by corresponding explanations. These can be presented in a snack-sized way, this means one statement per day, five times a week over a period of six weeks through an online platform. CONCLUSIONS Based on a well-founded and comprehensive procedure, the microlearning intervention was developed. This intervention has the potential to contribute to nursing nutritional care for older adults.
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Affiliation(s)
- Debbie Ten Cate
- Research Group Proactive Care for Older People, Utrecht University of Applied Sciences, Heidelberglaan 7, 3584 CS Utrecht, the Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands.
| | - Jeroen Dikken
- Faculty of Health, Nutrition and Sport, The Hague University of Applied Sciences, Johanna Westerdijkplein 75, 2521 EN The Hague, the Netherlands.
| | - Roelof G A Ettema
- Research Group Personalized Integrated Care, Institute for Nursing Studies, Utrecht University of Applied Sciences, Heidelberglaan 7, 3584 CS Utrecht, the Netherlands.
| | - Lisette Schoonhoven
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands; School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, University Road, Southampton SO17 1BJ, United Kingdom.
| | - Marieke J Schuurmans
- Education Center, UMC Utrecht Academy, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands.
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Trabulo C, Lopes J, da Silva Dias D, Gramaça J, Fernandes I, Gameiro R, Pina I, Mäkitie A, Ottery F, Ravasco P. Assessment of nutritional status of oncology patients at hospital admission: A Portuguese real-world study. Front Nutr 2022; 9:972525. [PMID: 36159492 PMCID: PMC9500582 DOI: 10.3389/fnut.2022.972525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 08/19/2022] [Indexed: 11/13/2022] Open
Abstract
Background Nutritional status in patients with cancer has a determining role in the evolution of the disease and tolerance to treatments. Severity of undernutrition impacts morbidity and mortality in cancer patients and can limit patient response to the optimal therapies if nutritional issues are not appropriately addressed and managed. Despite the importance of malnutrition for the clinical evolution of oncology patients, there is not yet a universally accepted standard method for evaluating malnutrition in such patients. The aim of this study was to stratify the nutritional status of inpatients at an Oncology Department. Methods This is an observational study with 561 cancer patients, assessed at admission to a Medical Oncology Department from November 2016 to February 2020. All patients were considered eligible. Non-compliant and/or comatose patients were excluded. Nutritional status was assessed using the PG-SGA, BMI classified with the WHO criteria, and calculation of the percentage of weight loss in the previous 3–6 months. Results A total of 561 patients (303 F: 258 M; mean age 65 ± 13 years) were included. One-third of the patients, n=191/561 (34%), lost 6% of their weight in the month prior to admission and 297/561 (53%) patients lost 10.2% of weight in the previous 6 months. Mean BMI was 24.1 ± 5.8 kg/m2; N = 280/561 (50%) patients had regular BMI according to the WHO criteria. N = 331/561 (59%) patients reported eating less in the month prior to admission. N = 303/561 (54%) had moderate/severe deficits of muscle and adipose compartments. The PG-SGA identified 499/561 (89%) patients as moderately/severely malnourished, of which 466/561 (83%) patients scored ≥9 points, meeting criteria for a critical need for nutritional support. Fifteen percent of patients scored >4 points, indicating a need for directed therapy for symptom control and only 1% scored <2 points (maintenance nutritional counseling). Conclusion In this oncological setting, a higher proportion of patients were nutritionally-at-risk or with moderate/severe malnutrition. The large majority of patients in this study presented with a critical need for nutritional intervention. These findings highlight the need for an integrated assessment of nutritional status at patient referral. This will allow early and timely nutrition care, which is recommended to prevent or reverse further deterioration of the condition and to optimize treatment administration.
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Affiliation(s)
- Carolina Trabulo
- Centro Hospitalar do Barreiro Montijo, Barreiro, Portugal
- Centre for Interdisciplinary Research in Health (CIIS), Universidade Católica Portuguesa, Lisbon, Portugal
- *Correspondence: Carolina Trabulo
| | - Joana Lopes
- Centro Hospitalar do Barreiro Montijo, Barreiro, Portugal
| | - David da Silva Dias
- Centre for Interdisciplinary Research in Health (CIIS), Universidade Católica Portuguesa, Lisbon, Portugal
- Hospital Universitário Algarve, Faro, Portugal
| | - João Gramaça
- Centro Hospitalar do Barreiro Montijo, Barreiro, Portugal
| | | | - Rita Gameiro
- Centro Hospitalar do Barreiro Montijo, Barreiro, Portugal
| | - Idília Pina
- Centro Hospitalar do Barreiro Montijo, Barreiro, Portugal
| | - Antti Mäkitie
- Centre for Interdisciplinary Research in Health (CIIS), Universidade Católica Portuguesa, Lisbon, Portugal
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
- Department of Otorhinolaryngology-Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Faith Ottery
- Department of Otorhinolaryngology-Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Paula Ravasco
- Centre for Interdisciplinary Research in Health (CIIS), Universidade Católica Portuguesa, Lisbon, Portugal
- Católica Medical School, Universidade Católica Portuguesa, Lisbon, Portugal
- Clinical Research Unit, Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz, Cooperativa de Ensino Superior, CRL, Almada, Portugal
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Verwijs MH, Haveman-Nies A, Borkent JW, Linschooten JO, Roodenburg AJC, de Groot LCPGM, de van der Schueren MAE. Protein Intake among Community-Dwelling Older Adults: The Influence of (Pre-) Motivational Determinants. Nutrients 2022; 14:nu14020293. [PMID: 35057473 PMCID: PMC8778399 DOI: 10.3390/nu14020293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/04/2022] [Accepted: 01/08/2022] [Indexed: 11/18/2022] Open
Abstract
An adequate protein intake is important for healthy ageing, yet nearly 50% of Dutch community-dwelling older adults do not meet protein recommendations. This study explores protein intake in relation to eight behavioral determinants (I-Change model) among Dutch community-dwelling older adults. Data were collected through an online questionnaire from October 2019–October 2020. Protein intake was assessed by the Protein Screener 55+, indicating a high/low chance of a low protein intake (<1.0 g/kg body weight/day). The behavioral determinants of cognizance, knowledge, risk perception, perceived cues, attitude, social support, self-efficacy and intention were assessed by evaluating statements on a 7-point Likert scale. A total of 824 Dutch community-dwelling older adults were included, recruited via online newsletters, newspapers and by personal approach. Poisson regression was performed to calculate quartile-based prevalence ratios (PRs). Almost 40% of 824 respondents had a high chance of a low protein intake. Univariate analyses indicated that lower scores for all different behavioral determinants were associated with a higher chance of a low protein intake. Independent associations were observed for knowledge (Q4 OR = 0.71) and social support (Q4 OR = 0.71). Results of this study can be used in future interventions aiming to increase protein intake in which focus should lie on increasing knowledge and social support.
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Affiliation(s)
- Marije H. Verwijs
- Department of Nutrition, Dietetics and Lifestyle, School of Allied Health, HAN University of Applied Sciences, Kapittelweg 33, 6525 EN Nijmegen, The Netherlands; (M.H.V.); (J.W.B.)
- Division of Human Nutrition and Health, Wageningen University & Research, Stippeneng 4, 6708 WE Wageningen, The Netherlands;
| | - Annemien Haveman-Nies
- Department of Social Sciences, Consumption and Healthy Lifestyles, Wageningen University & Research, Hollandseweg 1, 6706 KN Wageningen, The Netherlands;
| | - Jos W. Borkent
- Department of Nutrition, Dietetics and Lifestyle, School of Allied Health, HAN University of Applied Sciences, Kapittelweg 33, 6525 EN Nijmegen, The Netherlands; (M.H.V.); (J.W.B.)
- Division of Human Nutrition and Health, Wageningen University & Research, Stippeneng 4, 6708 WE Wageningen, The Netherlands;
| | - Joost O. Linschooten
- Department of Food Science & Technology, HAS University of Applied Sciences, P.O. Box 90108, 5200 MA Den Bosch, The Netherlands; (J.O.L.); (A.J.C.R.)
| | - Annet J. C. Roodenburg
- Department of Food Science & Technology, HAS University of Applied Sciences, P.O. Box 90108, 5200 MA Den Bosch, The Netherlands; (J.O.L.); (A.J.C.R.)
| | - Lisette C. P. G. M. de Groot
- Division of Human Nutrition and Health, Wageningen University & Research, Stippeneng 4, 6708 WE Wageningen, The Netherlands;
| | - Marian A. E. de van der Schueren
- Department of Nutrition, Dietetics and Lifestyle, School of Allied Health, HAN University of Applied Sciences, Kapittelweg 33, 6525 EN Nijmegen, The Netherlands; (M.H.V.); (J.W.B.)
- Division of Human Nutrition and Health, Wageningen University & Research, Stippeneng 4, 6708 WE Wageningen, The Netherlands;
- Correspondence: ; Tel.: +31-6-44296477
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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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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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Verwijs MH, Puijk-Hekman S, van der Heijden E, Vasse E, de Groot LCPGM, de van der Schueren MAE. Interdisciplinary communication and collaboration as key to improved nutritional care of malnourished older adults across health-care settings - A qualitative study. Health Expect 2020; 23:1096-1107. [PMID: 32525265 PMCID: PMC7696200 DOI: 10.1111/hex.13075] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/24/2020] [Accepted: 05/03/2020] [Indexed: 01/25/2023] Open
Abstract
Background Malnutrition is a risk factor for impaired functionality and independence. For optimal treatment of malnourished older adults (OA), close collaboration and communication between all stakeholders involved (OA, their caregivers and health‐care and welfare professionals) is important. This qualitative study assesses current collaboration and communication in nutritional care over the continuum of health‐care settings and provides recommendations for improvement. Methods Eleven structured focus group interviews and five individual interviews took place in three regions across the Netherlands from November 2017 until February 2018, including OA, caregivers and health‐care and welfare professionals. Various aspects of collaboration and communication between all stakeholders were discussed. Interviews were transcribed and analysed using a thematic approach. Results Six main themes emerged: causes of malnutrition, knowledge and awareness, recognition and diagnosis of malnutrition, communication, accountability and food preparation and supply. Physical and social aspects were recognized as important risk factors for malnutrition. Knowledge and awareness regarding malnutrition were acknowledged as being insufficient among all involved. This may impair timely recognition and diagnosis. Responsibility for nutritional care and its communication to other disciplines are low. Food preparation and supply in hospitals, rehabilitation centres and home care are below expected standards. Conclusion Many stakeholders are involved in nutritional care of OA, and lack of communication and collaboration hinders continuity of nutritional care over health‐care settings. Lack of knowledge is an important risk factor. Establishing one coordinator of nutritional care is suggested to improve collaboration and communication across health‐care settings.
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Affiliation(s)
- Marije H Verwijs
- Department of Nutrition and Health, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | | | | | - Emmelyne Vasse
- Dutch Malnutrition Steering Group, Amsterdam, The Netherlands
| | | | - Marian A E de van der Schueren
- Department of Nutrition and Health, HAN University of Applied Sciences, Nijmegen, The Netherlands.,Dutch Malnutrition Steering Group, Amsterdam, The Netherlands
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9
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A systematic scoping review of interventions to improve appropriate prescribing of oral nutritional supplements in primary care. Clin Nutr 2020; 39:654-663. [DOI: 10.1016/j.clnu.2019.03.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 02/07/2019] [Accepted: 03/05/2019] [Indexed: 02/03/2023]
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Fleurke M, Voskuil DW, Beneken Genaamd Kolmer DM. The role of the dietitian in the management of malnutrition in the elderly: A systematic review of current practices. Nutr Diet 2019; 77:60-75. [PMID: 31157519 DOI: 10.1111/1747-0080.12546] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 04/03/2019] [Accepted: 04/07/2019] [Indexed: 01/19/2023]
Abstract
AIM The prevalence of age-related malnutrition is increasing in almost all Western countries. Because of their expertise, dietitians should have a central role in the management of malnutrition. This review aimed to synthesise the literature on the role of the dietitian in the management of malnutrition in the elderly in comparison with other health professionals. METHODS In November 2018, a search of Embase, Medline Ovid, Cinahl Ebscohost, Cochrane Central, Web of Science and Google Scholar was undertaken using 'dietitian', 'elderly' and 'malnutrition' as the main search terms. Qualitative and quantitative empirical research studies that focussed on the role of dietitians as the (main) subject of the study were included. Data extraction and data synthesis were performed by the three authors using a thematic synthesis approach. RESULTS Three themes emerged from the coding and synthesis of the 21 included studies. The first theme demonstrates that other health professionals' time for, and knowledge of, screening policies negatively affects the role of the dietitian. The second theme demonstrates that the importance of nutritional care is acknowledged. However, this does not always imply familiarity with dietetics nor does it always mean that other health professionals think involving dietitians is worth the effort. The third theme demonstrates that issues of workload appeared to be especially important in crossing or guarding role boundaries. CONCLUSIONS The role of dietitians in managing age-related malnutrition is not always clear and coherent. Therefore, how dietitians shape their role to provide optimal management of malnutrition in the elderly is open to debate.
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Affiliation(s)
- Matthijs Fleurke
- Research Group Informal Care and Department of Nutrition and Dietetics, The Hague University of Applied Sciences, The Hague, Netherlands
| | - Dorien W Voskuil
- Research Group Informal Care and Department of Nutrition and Dietetics, The Hague University of Applied Sciences, The Hague, Netherlands
| | - Deirdre M Beneken Genaamd Kolmer
- Research Group Informal Care and Department of Nutrition and Dietetics, The Hague University of Applied Sciences, The Hague, Netherlands
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Borkent JW, Naumann E, Vasse E, van der Heijden E, de van der Schueren MAE. Prevalence and Determinants of Undernutrition in A Sample of Dutch Community-Dwelling Older Adults: Results from Two Online Screening Tools. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16091562. [PMID: 31060212 PMCID: PMC6539798 DOI: 10.3390/ijerph16091562] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 04/18/2019] [Accepted: 05/01/2019] [Indexed: 12/20/2022]
Abstract
To stimulate undernutrition screening among Dutch community-dwelling adults, a website was developed with general information on healthy eating for healthy aging and self-tests. Based on cross-sectional data obtained from the self-tests, we studied nutritional risk factors (early determinants) as well as risk of undernutrition (late symptoms). SCREEN II (n = 2470) was used to asses nutritional risk factors. This tool consists of 16 items regarding nutritional intake, perception of body weight, appetite, oral health and meal preparation. An adjusted SNAQ65+ (n = 687) was used to assess risk of undernutrition. This four-item tool contains questions on weight loss, appetite, walking stairs and body mass index. Differences between age-groups (65-74, 75-84, ≥85) were tested by logistic regression. Overall prevalence of nutritional risk factors was 84.1%, and increased risk of undernutrition was 56.8%. Participants aged ≥85 scored worst on almost all items of the SCREEN II and the SNAQ65+. In conclusion: A large proportion of older adults reported early determinants for increased nutrition risk, while a smaller, yet remarkable proportion scored positive on undernutrition risk. Internet screening may be a useful, contemporary, and easy, accessible way to reach older adults who are at nutritional risk and may thus contribute to early identification and prevention of undernutrition.
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Affiliation(s)
- Jos W Borkent
- Dutch Malnutrition Steering Group, Nicolaas Witsenkade 13hs, 1017 ZR Amsterdam, The Netherlands.
- Faculty of Health and Social Studies, Department of Nutrition and Health, HAN University of Applied Sciences, Kapittelweg 33, 6525 EN Nijmegen, The Netherlands.
| | - Elke Naumann
- Dutch Malnutrition Steering Group, Nicolaas Witsenkade 13hs, 1017 ZR Amsterdam, The Netherlands.
- Faculty of Health and Social Studies, Department of Nutrition and Health, HAN University of Applied Sciences, Kapittelweg 33, 6525 EN Nijmegen, The Netherlands.
| | - Emmelyne Vasse
- Dutch Malnutrition Steering Group, Nicolaas Witsenkade 13hs, 1017 ZR Amsterdam, The Netherlands.
- Department of Dietetics, Hospital Gelderse Vallei, Willy Brandtlaan 10, 6716 RP Ede, The Netherlands.
| | - Ellen van der Heijden
- Dutch Malnutrition Steering Group, Nicolaas Witsenkade 13hs, 1017 ZR Amsterdam, The Netherlands.
| | - Marian A E de van der Schueren
- Dutch Malnutrition Steering Group, Nicolaas Witsenkade 13hs, 1017 ZR Amsterdam, The Netherlands.
- Faculty of Health and Social Studies, Department of Nutrition and Health, HAN University of Applied Sciences, Kapittelweg 33, 6525 EN Nijmegen, The Netherlands.
- Department of Nutrition and Dietetics, Amsterdam UMC, Vrije Universiteit, De Boelelaan 1117; 1081 HV Amsterdam, The Netherlands.
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van Doorn-van Atten MN, Haveman-Nies A, Pilichowski P, Roca R, de Vries JHM, de Groot CPGM. Telemonitoring to improve nutritional status in community-dwelling elderly: design and methods for process and effect evaluation of a non-randomized controlled trial. BMC Geriatr 2018; 18:284. [PMID: 30445922 PMCID: PMC6240290 DOI: 10.1186/s12877-018-0973-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 11/02/2018] [Indexed: 01/29/2023] Open
Abstract
Background A good nutritional status is key for maintaining health and quality of life in older adults. In the Netherlands, 11 to 35% of the community-dwelling elderly are undernourished. Undernutrition or the risk of it should be signalled as soon as possible to be able to intervene at an early stage. However, in the context of an ageing population health care resources are scarce, evoking interest in health enabling technologies such as telemonitoring. This article describes the design of an intervention study focussing at telemonitoring and improving nutritional status of community-dwelling elderly. Methods The PhysioDom Home Dietary Intake Monitoring intervention was evaluated using a parallel arm pre-test post-test design including 215 Dutch community-dwelling elderly aged > 65 years. The six-month intervention included nutritional telemonitoring, television messages, and dietary advice by a nurse or a dietician. The control group received usual care. Measurements were performed at baseline, after 4.5 months, and at the end of the study, and included the primary outcome nutritional status and secondary outcomes behavioural determinants, diet quality, appetite, body weight, physical activity, physical functioning, and quality of life. Furthermore, a process evaluation was conducted to provide insight into intervention delivery, feasibility, and acceptability. Discussion This study will improve insight into feasibility and effectiveness of telemonitoring of nutritional parameters in community-dwelling elderly. This will provide relevant insights for health care professionals, researchers, and policy makers. Trial registration The study was retrospectively registered at Clinical-Trials.gov (identifier NCT03240094) since August 3, 2017. Electronic supplementary material The online version of this article (10.1186/s12877-018-0973-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - A Haveman-Nies
- Wageningen University & Research, P.O. Box 17, 6700 AA, Wageningen, The Netherlands
| | - P Pilichowski
- Habitat&Santé, 373 Chemin Plate-Rousset, F 38330, Biviers, France
| | - R Roca
- Consorci Sanitari de Terrassa, Ctra Torrebonica s/n, E-08227, Terrassa, Spain
| | - J H M de Vries
- Wageningen University & Research, P.O. Box 17, 6700 AA, Wageningen, The Netherlands
| | - C P G M de Groot
- Wageningen University & Research, P.O. Box 17, 6700 AA, Wageningen, The Netherlands
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13
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van Doorn-van Atten MN, de Groot LCPGM, de Vries JHM, Haveman-Nies A. Determinants of Behaviour Change in a Multi-Component Telemonitoring Intervention for Community-Dwelling Older Adults. Nutrients 2018; 10:E1062. [PMID: 30103399 PMCID: PMC6115846 DOI: 10.3390/nu10081062] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 08/06/2018] [Accepted: 08/09/2018] [Indexed: 01/09/2023] Open
Abstract
Optimal diet quality and physical activity levels are essential for healthy ageing. This study evaluated the effects of a multi-component telemonitoring intervention on behavioural determinants of diet quality and physical activity in older adults, and assessed the mediating role of these determinants and two behaviour change techniques in the intervention's effects. A non-randomised controlled design was used including 214 participants (average age 80 years) who were allocated to the intervention or control group based on municipality. The six-month intervention consisted of self-measurements of nutritional outcomes and physical activity, education, and follow-up by a nurse. The control group received regular care. Measurements took place at baseline, after 4.5 months and at the end of the study. The intervention increased self-monitoring and improved knowledge and perceived behavioural control for physical activity. Increased self-monitoring mediated the intervention's effect on diet quality, fruit intake, and saturated fatty acids intake. Improved knowledge mediated the effect on protein intake. Concluding, this intervention led to improvements in behavioural determinants of diet quality and physical activity. The role of the hypothesised mediators was limited. Insight into these mechanisms of impact provides directions for future development of nutritional eHealth interventions for older adults, in which self-monitoring may be a promising behaviour change technique. More research is necessary into how behaviour change is established in telemonitoring interventions for older adults.
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Affiliation(s)
- Marije N van Doorn-van Atten
- Division of Human Nutrition and Health, Wageningen University and Research, P.O. Box 17, 6700 AA Wageningen, The Netherlands.
| | - Lisette C P G M de Groot
- Division of Human Nutrition and Health, Wageningen University and Research, P.O. Box 17, 6700 AA Wageningen, The Netherlands.
| | - Jeanne H M de Vries
- Division of Human Nutrition and Health, Wageningen University and Research, P.O. Box 17, 6700 AA Wageningen, The Netherlands.
| | - Annemien Haveman-Nies
- Strategic Communication Chair, Wageningen University and Research, P.O. Box 17, 6700 AA Wageningen, The Netherlands.
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van Doorn-van Atten MN, Haveman-Nies A, Heery D, de Vries JHM, de Groot LCPGM. Feasibility and Effectiveness of Nutritional Telemonitoring for Home Care Clients: A Pilot Study. THE GERONTOLOGIST 2018; 59:158-166. [DOI: 10.1093/geront/gny059] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Indexed: 01/05/2023] Open
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Effects of a multi-component nutritional telemonitoring intervention on nutritional status, diet quality, physical functioning and quality of life of community-dwelling older adults. Br J Nutr 2018; 119:1185-1194. [DOI: 10.1017/s0007114518000843] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
AbstractThis study aimed to evaluate the effects of an intervention including nutritional telemonitoring, nutrition education, and follow-up by a nurse on nutritional status, diet quality, appetite, physical functioning and quality of life of Dutch community-dwelling elderly. We used a parallel arm pre-test post-test design with 214 older adults (average age 80 years) who were allocated to the intervention group (n97) or control group (n107), based on the municipality. The intervention group received a 6-month intervention including telemonitoring measurements, nutrition education and follow-up by a nurse. Effect measurements took place at baseline, after 4·5 months, and at the end of the study. The intervention improved nutritional status of participants at risk of undernutrition (β(T1)=2·55; 95 % CI 1·41, 3·68;β(T2)=1·77; 95 % CI 0·60, 2·94) and scores for compliance with Dutch guidelines for the intake of vegetables (β=1·27; 95 % CI 0·49, 2·05), fruit (β=1·24; 95 % CI 0·60, 1·88), dietary fibre (β=1·13; 95 % CI 0·70, 1·57), protein (β=1·20; 95 % CI 0·15, 2·24) and physical activity (β=2·13; 95 % CI 0·98, 3·29). The intervention did not have an effect on body weight, appetite, physical functioning and quality of life. In conclusion, this intervention leads to improved nutritional status in older adults at risk of undernutrition, and to improved diet quality and physical activity levels of community-dwelling elderly. Future studies with a longer duration should focus on older adults at higher risk of undernutrition than this study population to investigate whether the impact of the intervention on nutritional and functional outcomes can be improved.
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Visser M, Volkert D, Corish C, Geisler C, de Groot LC, Cruz-Jentoft AJ, Lohrmann C, O'Connor EM, Schindler K, de van der Schueren MA. Tackling the increasing problem of malnutrition in older persons: The Malnutrition in the Elderly (MaNuEL) Knowledge Hub. NUTR BULL 2017. [DOI: 10.1111/nbu.12268] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- M. Visser
- VU University Medical Center; Amsterdam The Netherlands
- Vrije Universiteit Amsterdam; Amsterdam The Netherlands
| | - D. Volkert
- Friedrich-Alexander-Universität Erlangen-Nürnberg; Erlangen-Nürnberg Germany
| | - C. Corish
- University College Dublin; Dublin Ireland
| | - C. Geisler
- Christian-Albrechts-Universität; Kiel Germany
| | | | | | | | | | | | - M. A. de van der Schueren
- VU University Medical Center; Amsterdam The Netherlands
- HAN University of Applied Sciences; Nijmegen The Netherlands
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Beelen J, Vasse E, Ziylan C, Janssen N, de Roos NM, de Groot LCPGM. Undernutrition: who cares? Perspectives of dietitians and older adults on undernutrition. BMC Nutr 2017; 3:24. [PMID: 32153806 PMCID: PMC7050937 DOI: 10.1186/s40795-017-0144-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 03/04/2017] [Indexed: 01/02/2023] Open
Abstract
Background Many older adults are at risk of undernutrition. Dietitians play a key role in the management and treatment of undernutrition, but older adults have difficulties to comply with dietetic recommendations. This qualitative study investigated which barriers older adults experience in adhering to treatment for undernutrition. Current dietetic practices and older adults’ experiences were studied, and the potential to use protein-enriched regular products in undernutrition treatment was investigated. Methods We interviewed 18 older adults who were under treatment for undernutrition, and 13 dietitians. Semi-structured interview guides were used, and all interviews were audiotaped and transcribed verbatim. The interviews were coded with qualitative analysis software NVivo9, followed by content analysis to formulate main themes. Results The interviews resulted in seven themes, which related to three main topics: barriers for treating undernutrition in older adults, current dietetic treatment, and new strategies to complement current treatment. Low awareness and a lack of knowledge regarding undernutrition, physical limitations, and loss of appetite were found to be major barriers for treating undernutrition in older adults. Dietitians said to focus mostly on increasing energy and protein intake by recommending the use of regular food products that fit the needs and habits of the patient, before prescribing oral nutritional supplements. Dietitians considered enriched regular products to be useful if they fit with the habits of older adults, the portion sizes were kept small, if products were easy to open and prepare, had good palatability, and were offered in a variety of taste and textures. Conclusions Results from the interviews suggest that undernutrition awareness is low among older adults and they lack knowledge on how to manage undernutrition despite efforts taken by dietitians. Enriched regular products could enable older adults to better adhere to undernutrition treatment, provided that these products meet the needs and eating habits of older adults. If protein-enriched food products can replace regular, low-protein variants, older adults do not need to consume more, but can adhere to their usual pattern while consuming more protein.
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Affiliation(s)
- Janne Beelen
- 1Division of Human Nutrition, Wageningen University, PO Box 17, 6700AA Wageningen, The Netherlands
| | - Emmelyne Vasse
- 2Department of Dietetics, Hospital Gelderse Vallei, PO Box 9025, 6710HN Ede, The Netherlands
| | - Canan Ziylan
- 1Division of Human Nutrition, Wageningen University, PO Box 17, 6700AA Wageningen, The Netherlands.,Consumer Science and Health, Wageningen UR Food and Biobased Research, PO Box 17, 6700AA Wageningen, The Netherlands
| | - Nancy Janssen
- 2Department of Dietetics, Hospital Gelderse Vallei, PO Box 9025, 6710HN Ede, The Netherlands
| | - Nicole M de Roos
- 1Division of Human Nutrition, Wageningen University, PO Box 17, 6700AA Wageningen, The Netherlands
| | - Lisette C P G M de Groot
- 1Division of Human Nutrition, Wageningen University, PO Box 17, 6700AA Wageningen, The Netherlands
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Ziylan C, Haveman-Nies A, Kremer S, de Groot LCPGM. Protein-Enriched Bread and Readymade Meals Increase Community-Dwelling Older Adults' Protein Intake in a Double-Blind Randomized Controlled Trial. J Am Med Dir Assoc 2016; 18:145-151. [PMID: 27751801 DOI: 10.1016/j.jamda.2016.08.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 08/17/2016] [Accepted: 08/23/2016] [Indexed: 01/04/2023]
Abstract
OBJECTIVES Sufficient protein intake can decrease undernutrition risk among community-dwelling older adults. This study aimed to increase community-dwelling older adults' daily protein intake with acceptable and applicable protein-enriched bread and readymade meals at home. DESIGN Double-blind randomized controlled trial of 2 weeks. SETTING Senior residential center in the Netherlands. PARTICIPANTS Forty-two community-dwelling elderly residents (≥65 years) participated, with a mean age of 74.0 ± 6.9 years and mean body mass index of 28.5 ± 3.45 kg/m2. INTERVENTION The intervention group (n = 22) received 5 protein-enriched readymade meals and plentiful protein-enriched bread during 2 weeks, whereas the control group (n = 20) received the regular equivalents during these 2 weeks. MEASUREMENTS Food intake was assessed by using dietary food record-assisted 24-hour recalls and by weighing meal leftovers. Acceptability of the enriched products was assessed with product evaluation questionnaires and in-depth interviews. RESULTS Mean intake of food products (g) and energy (kJ) did not differ significantly between the control and the intervention groups. Total daily protein intake in the intervention group was 14.6 g higher than in the control group (87.7 vs 73.1 g/d, P = .004). Expressed in g/kg body weight per day, protein intake was significantly higher in the intervention group than in the control group (1.25 vs 0.99 g/kg/d, P = .003). The enriched products were equally liked, scoring 7.7 of 10.0. The in-depth interviews with participants indicated high acceptability of the enriched products. CONCLUSION This study showed that community-dwelling older adults' protein intake can be increased to recommended levels with highly acceptable and applicable protein-enriched products that fit into the normal eating pattern. Future studies should investigate whether this effect is maintained in the long-term among a frailer population.
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Affiliation(s)
- Canan Ziylan
- Consumer Science and Health, Wageningen Food & Biobased Research, Wageningen, The Netherlands; Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands.
| | | | - Stefanie Kremer
- Consumer Science and Health, Wageningen Food & Biobased Research, Wageningen, The Netherlands
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