Focus on Feeding! Evaluation of a framework for maximizing mealtime in aged care facilities

Unintentional weight loss is a health risk for residents of aged care facilities, a concern for families and places demands on nursing staff. An existing weight loss framework to assess and manage residents' weight developed by a multidisciplinary team was implemented and evaluated with nurses and residents in aged care facilities within an area health service of Sydney, Australia. Thematic analysis generated seven binary concepts relating to relational, procedural, behavioural, physical, psychological, environmental and temporal aspects of feeding assistance provided by nurses to residents. Theoretical sampling was applied to the literature confirming those concepts which were organized as a model of feeding assistance labelled the Focus on Feeding! Decision Model. Nurses can play a pivotal role in the assessment of feeding difficulty and implementation of innovative mealtime programs. The Model aims to promote nurses' critical thinking and decision-making to improve nutritional intake of residents and avoid preventable weight loss.

Validity and user-friendliness of the minimal eating observation and nutrition form - version II (MEONF - II) for undernutrition risk screening

OBJECTIVE

To analyze the criterion-related validity and user-friendliness of the Minimal Eating Observation and Nutrition Form - Version II (MEONF - II) and Malnutrition Universal Screening Tool (MUST) in relation to the Mini Nutritional Assessment (MNA). In addition, the effect of substituting body mass index (BMI) with calf circumference (CC) was explored for the MEONF-II.

METHODS

The study included 100 patients who were assessed for nutritional status with the MNA (full version), considered here to be the gold standard, and screened with the MUST and the MEONF-II. The MEONF-II includes assessments of involuntary weight loss, BMI (or calf circumference), eating difficulties, and presence of clinical signs of undernutrition.

RESULTS

The MEONF-II sensitivity (0.73) and specificity (0.88) were acceptable. Sensitivity and specificity for the MUST were 0.57 and 0.93, respectively. Replacing the BMI with CC in the MEONF-II gave similar results (sensitivity 0.68, specificity 0.90). Assessors considered MEONF-II instructions and items to be relevant, easy to understand and complete (100%), and the questions to be relevant (98%). MEONF-II and MUST took 8.8 and 4.7 minutes to complete, respectively, and both were considered relevant and easy to finish. In addition, MEONF-II was thought to reveal problems that allows for nursing interventions.

CONCLUSIONS

The MEONF-II is an easy to use, relatively quick, and sensitive screening tool to assess risk of undernutrition among hospital inpatients, which allows for substituting BMI with CC in situations where measures of patient height and weight cannot be easily obtained. High sensitivity is of primary concern in nutritional screening and the MEONF-II outperforms the MUST in this regard.

Management of malnutrition in older people within the hospital setting

Malnutrition is a major problem among older people in the UK, and one that frequently goes unrecognized and untreated. It impacts on the individual's quality of life and increases both length of stay in hospital and the risk of unsuccessful outcomes to treatment. This article discusses the prevalence of malnutrition, the role of screening and practical steps that can be taken to improve the nutritional management of older people within the hospital environment.

Percutaneous endoscopic gastrostomy feeding: indications and management

Percutaneous endoscopic gastrostomy (PEG) has become one of the most useful and established enteral nutrition techniques available to patients requiring nutritional support worldwide. Good nutrition and the receiving of essential nutrients and electrolytes are vital for growth, healing, repair and delivery of essential energy to carry out daily tasks. The article looks specifically at PEG as a form of enteral nutrition delivery, how it is undertaken, and the care needs of the patient post-insertion of a PEG tube.

Nutrition through the life span. Part 3: adults aged 65 years and over

The UK has an ageing population, but this is not being matched by a similar increase in healthy life expectancy. The greatest challenge in the 21st century will be to improve the quality of life as ageing occurs. Health is the most important prerequisite for people to enjoy life in their older years (Brundtland, 1988). Diet is one factor that is believed to play a key role in the prevention and treatment of chronic diseases associated with ageing. The third and final part of this series addressing the concept of nutrition through the lifespan seeks to educate health-care professionals as to what constitutes a healthy diet for the elderly population, and gives practical guidance as to how to try and prevent the ever-growing problem of malnutrition within this age group. It is suggested that when the older adult is hospitalized their risk of malnutrition increases. Therefore, some guidance for the use of oral nutritional supplements in this population is given. Good nutrition and physical exercise are essential for healthy ageing from both a physical and psychological perspective (NICE, 2008). Therefore a multidisciplinary life course approach to ageing is vital to minimizing its complications for quality of life and subsequent public health (Denny, 2008).