Promoting nutrition in older people in nursing and residential homes

I-Hydrate training intervention for staff working in a care home setting: An observational study

BACKGROUND

Dehydration is a complex and well-recognised problem for older people residing in care homes. Within the social care sector support staff provide the majority of direct care for residents, and yet receive minimal training.

OBJECTIVES

To design, deliver and evaluate a hydration specific training session for care home staff to develop their knowledge and skills in supporting the hydration of care home residents.

DESIGN

An observational study comprising a pre-test post-test survey of staff knowledge following a training intervention.

PARTICIPANTS AND SETTINGS

Training of care home staff took place in two care homes in North West London.

METHODS

An interactive training session was developed and delivered, with content informed by observations of hydration care within the two homes and evaluated using CIRO model. Participant self-evaluation forms were used to collect data after the session regarding satisfaction and usefulness of the session, and pre and post levels of self-reported knowledge across six facets of hydration care. Training facilitators captured qualitative data in the form of field notes. Observations of hydration care explored the impact of training on practice.

RESULTS

Eighteen training sessions were delivered. A total of 161 participant evaluation forms were returned. There was a significant increase in self-reported knowledge across all six facets of hydration care (p = 0.000). The majority of participants found the training enjoyable and useful, and expressed an expected change in their practice. Participants enjoyed the interactive components of the training. A lack of reflective practice skills meant participants were unable to reflect realistically about the hydration care provided in the home.

CONCLUSION

Focused training on hydration in the care home environment benefits from being interactive and experiential. Although such training can be effective in increasing staff knowledge, inclusion of skills in reflective practice is required if this knowledge is to be translated into practice.

Nutritional care of elderly patients in acute care settings: A qualitative study

AIM

Poor nutritional status is common in older adult patients. The present study aimed to explore barriers and facilitators to nutritional care of elderly patients in acute care settings.

METHODS

Data were collected through individual face-to-face interviews with 12 registered nurses, and analyzed using interpretive description methodology.

RESULTS

Two core themes emerged from the analysis of data: (i) neglected care, with three subthemes of "support but also independence," "unsupportive environment" and "responsibility of the family;" and (ii) a humanitarian ethic, with two subthemes of "respect and dignity" and "humanitarian care."

CONCLUSIONS

As an integral part of holistic care, elderly patient nutrition should be emphasised in health professional education, and promoted through managerial support, multidisciplinary collaborations, and implementation of appropriate monitoring and evaluation systems.

Nutritional status of nursing home residents in Taiwan

The purpose of this study was to explore the nutritional status of nursing home residents. A convenience sample of 111 residents from four nursing homes in Kaohsiung, Taiwan, was recruited. The residents' nutritional status was assessed on the basis of body mass index (BMI) and serum albumin level. Data on demographic characteristics, cognitive function, activities of daily living, and mode of feeding were collected and examined for association with nutritional status. Among the subjects, 41.1% had a BMI of less than 18.5 kg/m² and 18.9% had a serum albumin level of less than 3.5 g/dl. Mode of feeding was a significant predictor of malnutrition. When compared with residents on oral feedings, those on nasogastric (NG) feedings had four times the risk of a low BMI and about eight times the risk of a low albumin level. In conclusion, it is important to regularly assess the physical function and nutritional status of nursing home residents and adjust their dietary intake accordingly.

A modified mini nutritional assessment without BMI predicts nutritional status of community-living elderly in Taiwan

OBJECTIVE

The study was to determine whether a modified MNA (Mini Nutritional Assessment) which adopted population-specific anthropometric cut-points but without BMI could maintain its predicting ability in community-living elderly in Taiwan.

DESIGN

Purposive sampling.

SETTING

Community-living elderly.

PARTICIPANTS

Three hundred and one (138 male and 163 female) > 65-year-old outpatients seeking free annual health examination at an area hospital in central Taiwan.

MEASUREMENTS

A structured questionnaire elicited personal data, lifestyle information and answers to the MNA. Laboratory results from health checkup provided the needed biochemical data. Each subject's nutritional status was assessed with the MNA in three versions: the original, the MNA-TI (with population-specific cut-points), and the MNA-TII (further eliminated the BMI question and redistributed its score to the MAC and CC questions).

RESULTS

All three versions identified the same 0.7% elderly malnourished. The proportions predicted at risk of malnutrition were 16.6, 12.0 and 10% according to the original, MNA-TI and MNA-TII, respectively. Friedman Test and post hoc analysis indicated that the pattern predicted by the original MNA was different from that predicted by the two modified versions whereas the patterns predicted by the two modified versions were not different from each other.

CONCLUSION

Adoption of population-specific anthropometric cut-points improves the predicting ability of the MNA in Taiwanese elderly, and the improved functionality is maintained in a version without BMI (but with adjusted MAC and CC scores). A MNA without BMI has greater applicability and can enhance professional efficiency of healthcare workers.

Maintaining nutrition in aged care residents with a train-the-trainer intervention and Nutrition Coordinator

OBJECTIVE

To investigate the impact of a train-the-trainer program on the nutritional status of older people in residential care.

DESIGN

Prospective, randomized controlled study.

SETTING

Eight nursing homes in Southeast Queensland, Australia.

PARTICIPANTS

A total of 352 residents participated - 245 were female (69.6%). The mean age was 84.2 years and the majority (79.4%) were classified as high dependency.

INTERVENTION

Residents from four nursing homes were randomly selected for a nutrition education program coordinated by Nutrition Coordinators. Residents from the other four nursing homes (control) received usual care.

MEASUREMENTS

The Subjective Global Assessment was used to determine prevalence of malnutrition at baseline and six months post intervention. The Resident Classification Scale measured functional dependency. Prescribed diet, fluids, oral hygiene status and allied health referrals were obtained by chart audit.

RESULTS

Approximately half the residents were well nourished with 49.4% moderately or severely malnourished. Residents in the intervention group were more likely to maintain or improve their nutritional status compared with the control group who were more likely to experience a deterioration (P=0.027). The odds of the control group being malnourished post test was 1.6 times more likely compared with the intervention group but this did not reach statistical significance (P=0.1).

CONCLUSION

The results of the study encourage the implementation of a Nutrition Coordinator program to maintain nutritional status of aged care residents. Nevertheless, malnutrition rates continue to be unacceptably high. In a rapidly aging society, the aged care sector needs to confront malnutrition and provide better resources for staff to take measures against this problem.

[Multi-level analysis of factors related to quality of service in long-term care hospitals]

PURPOSE

In this research multi-level analysis was done to identify factors related to quality of services. Patient characteristics and organizational factors were considered.

METHODS

The data were collected from the Health Insurance Review and Assessment Service (HIRA) data base. The sample was selected from 17,234 patients who had been admitted between January 2007 and May 2008 to one of 253 long-term care hospitals located in Seoul, six other metropolitan cities or nine provinces The data were analyzed with SAS 9.1 using multi-level analysis.

RESULTS

The results indicated that individual level variables related to quality of service were age, cognitive ability, patient classification, and initial quality scores. The organizational level variables related to quality of service were ownership, number of beds, and turnover rate. The explanatory power of variables related to organizational level variances in quality of service was 23.72%.

CONCLUSION

The results of this study indicate that differences in the quality of services were related to organizational factors. It is necessary to consider not only individual factors but also higher-level organizational factors such as nurse' welfare and facility standards if quality of service in long term care hospitals is to be improved.

Nutritional status of older people in long term care settings: current status and future directions

Despite being preventable and treatable, in the 21st Century, malnutrition remains a problem in the developed world and the nutritional needs of many older people in long-term care settings are not met. The UK government has pledged to provide high-quality care for this sector of the population, including minimum standards to ensure adequate nutrition. However, research is still needed into the detection, prevalence, cause and effects of malnutrition and maintenance of optimum nutrition; and to address the lack of training and education among those caring for older peoples. In the interim, simple measures such as monitoring older people's weight regularly need to be implemented as a surveillance measure of nutritional status.

The assessment and management of pain among older people in care homes: current status and future directions

Pain is highlighted as a significant, yet neglected problem among older people, particularly in long-term care settings. The effects of inadequate assessment and treatment of pain among older people may lead to multiple problems. Problems arise due to cognitive impairment of clients and inadequate assessment by healthcare professionals. Analgesics are under-used and there is a need for improved education of both healthcare professionals and older people regarding attitudes to pain and ageing. Research is needed into the prevalence of pain among older people in United Kingdom (UK) care homes, how best to further educate healthcare professionals regarding pain management and how to enable older people to be facilitative partners in this process.

Medicines management in care homes for older people: the nurse's role

Increasing attention is being paid to the inappropriate use of medicines in UK care homes for older people. While polypharmacy may sometimes be necessary, older people can be particularly sensitive to the effects of medicines due to physiological chances, while the effect of a mixture of medicines is often unknown. The harmful consequences of inappropriate prescribing for older people unnecessarily add to overall health-care expenditure and the workload of staff. Community nurses can play an important role in attenuating some of these problems while enhancing the quality of life of older people in care homes. The growing population of older people and burgeoning health-care expenditure on medicines demands that greater attention is given to medicine management among older people so that the efficacy of therapeutic regimes are maximized.