Encore Café: An Innovative and Effective Congregate Nutrition Program

Effective community food and nutrition programs are imperative for supporting older adults health and well-being. This three-part study examined to what extent the innovative congregate nutrition program (CNP), Encore Café, and targeted marketing campaign influenced CNP utilization, CNP program satisfaction, and overall CNP impact (e.g., nutritional risk, dietary practices, and loneliness). The Encore Café resulted in increases of 386% in meal distribution and 3,164% in CNP participants during a two-year period compared to a 20.8% reduction at traditional meal sites across the state. Total CNP satisfaction (food and dining) was high for both the Encore Café and Traditional CNP. Encore Café participants maintained their nutritional status and experienced significant reductions in emotional loneliness (p = 0.017) and dietary intake frequencies of processed meat (p = 0.027) compared to non-CNP participants. Utilizing a client-centered approach in marketing and programming for the Encore Café shows promising results for improving the utilization and effectiveness of the CNP.

The relationship of nutritional risk with diet quality and health outcomes in community-dwelling older adults

Objectives

To identify early nutritional risk in older populations, simple screening approaches are needed. This study aimed to compare nutrition risk scores, calculated from a short checklist, with diet quality and health outcomes, both at baseline and prospectively over a 2.5-year follow-up period; the association between baseline scores and risk of mortality over the follow-up period was assessed.

Methods

The study included 86 community-dwelling older adults in Southampton, UK, recruited from outpatient clinics. At both assessments, hand grip strength was measured using a Jamar dynamometer. Diet was assessed using a short validated food frequency questionnaire; derived ‘prudent’ diet scores described diet quality. Body mass index (BMI) was calculated and weight loss was self-reported. Nutrition risk scores were calculated from a checklist adapted from the DETERMINE (range 0–17).

Results

The mean age of participants at baseline (n = 86) was 78 (SD 8) years; half (53%) scored ‘moderate’ or ‘high’ nutritional risk, using the checklist adapted from DETERMINE. In cross-sectional analyses, after adjusting for age, sex and education, higher nutrition risk scores were associated with lower grip strength [difference in grip strength: − 0.09, 95% CI (− 0.17, − 0.02) SD per unit increase in nutrition risk score, p = 0.017] and poorer diet quality [prudent diet score: − 0.12, 95% CI (− 0.21, − 0.02) SD, p = 0.013]. The association with diet quality was robust to further adjustment for number of comorbidities, whereas the association with grip strength was attenuated. Nutrition risk scores were not related to reported weight loss or BMI at baseline. In longitudinal analyses there was an association between baseline nutrition risk score and lower grip strength at follow-up [fully-adjusted model: − 0.12, 95% CI (− 0.23, − 0.02) SD, p = 0.024]. Baseline nutrition risk score was also associated with greater risk of mortality [unadjusted hazard ratio per unit increase in score: 1.29 (1.01, 1.63), p = 0.039]; however, this association was attenuated after adjustment for sex and age.

Conclusions

Cross-sectional associations between higher nutrition risk scores, assessed from a short checklist, and poorer diet quality suggest that this approach may hold promise as a simple way of screening older populations. Further larger prospective studies are needed to explore the predictive ability of this screening approach and its potential to detect nutritional risk in older adults.

Nutrition assessment in long-term care

Assessment of nutrition status is necessary in long-term care settings for both optimal patient care and to meet regulatory standards. Careful nutrition assessment leads to development of an individual plan of care to optimize nutrition status. Although the Minimum Data Set is mandated as the nutrition assessment tool in long-term care settings, published studies show that the use of the Minimum Data Set to assess nutrition status is problematic. Two types of nutrition assessment instruments have been developed. The first type aims to identify those at risk for malnutrition but is not used to diagnose clinical malnutrition, whereas the second type has been designed to diagnose malnutrition. A number of commonly used nutrition assessment tools have not been validated in long-term care populations. This review focuses on the available tools used in the long-term care setting and provides an overview of their characteristics and performance measures.

The ability of the DETERMINE checklist to predict continued community-dwelling in rural, white women

This study evaluated the ability of the DETERMINE checklist to predict continued community-dwelling in rural elderly women. Using a stratified random sample (N = 249) of white women aged 65-94, in-home interviews were completed at baseline and a telephone interview at 3 years. Overall higher total DETERMINE checklist scores negatively predicted continued community-dwelling (p = 0.0005). Lower risk scores indicated continued community-dwelling, while mid-range scores were inconclusive. Regression analysis for each age bracket showed that total DETERMINE checklist scores was most predictive of those aged 75-84 (p = 0.0037). The DETERMINE checklist may be a useful tool to identify those with increased risk of losing independence.

Nutritional screening and assessment tools for older adults: literature review

AIM

This paper reports a literature review to examine the range of published tools available for use by nurses to screen or assess nutritional status of older adults, and the extent to which validity, reliability, sensitivity, specificity and acceptability of the tools has been addressed.

BACKGROUND

The incidence of malnutrition in older adults is high. One method by which malnutrition or risk of malnutrition can be detected is by the use of nutritional screening or assessment tools.

METHODS

A comprehensive literature review methodology was employed. A variety of electronic databases were searched for the period 1982-2002. Search terms incorporating nutrition, screening, validity, reliability and sensitivity and specificity were combined to retrieve relevant literature. In addition, manual searches were conducted and articles retrieved from those listed in key papers. In this paper, nutritional screening or assessment tools are described as tools which use a questionnaire-type format containing more than one risk factor for malnutrition, and give a quantitative or categorical assessment of risk.

RESULTS

Seventy-one nutritional tools were located, 21 of which were identified as designated for use with an older population. A wide variety of risk factors for malnutrition are used with the tools, ranging from objective measurements to subjective assessment. Some tools identify an action plan based on the score obtained. Many tools appear not to have been subjected to validity and/or reliability testing but are used clinically.

CONCLUSIONS

As malnutrition is present in the older adult population, nutritional assessment and screening tools can be useful to highlight those in need of a nutritional care plan. However, many have not been subjected to evaluation and consequently may not demonstrate sensitivity and/or specificity in clinical use. The decision to use a particular tool should therefore be considered carefully.

The interrelationship of nutritional risk factors, indicators of nutritional risk, and severity of disability among home-delivered meal participants

PURPOSE

This study examines the direct and indirect relationships between individual components of nutritional risk and increased severity of disability among a large and diverse sample of homebound older adults.

DESIGN AND METHODS

Using routinely collected nutrition and function data, structural equation modeling of recursive and nonrecursive models examined the interrelationships of nutritional risk factors, indicators of nutritional risk, and disability severity among 1,010 home-delivered meals program participants in Wake County, NC.

RESULTS

The equally good fit for both the recursive and nonrecursive structural models revealed that specific nutritional risk factors were directly and indirectly associated with indicators of nutritional risk and increased severity of disability. The nonrecursive model also revealed significant reciprocal associations of increased disability with unintended weight change and medication use.

IMPLICATIONS

The findings from this study acknowledge aspects of the complex direct and indirect relationships between nutrition and function among homebound older persons. This knowledge will help service providers with the development of effective elderly nutrition programs with nutritional and functional status outcomes.

Dementia, nutrition, and self-feeding: a systematic review of the literature

SUMMARY The outcomes of feeding training are typically evaluated in terms of feeding skills and swallowing abilities rather than the ultimate goal of feeding, namely, adequate nutritional status. To increase occupational therapy practitioners' awareness of nutritional status as an outcome of feeding training, a systematic review of the research literature was conducted to examine the relationship between nutritional status and self-feeding skills in people with dementia. Studies were evaluated by the strength of their evidence and analyzed to determine the relationships among dementia, nutritional status, and the ability to feed one's self. Results revealed that although nutritional status in people with dementia is variable, there is a tendency for lower body weight, lower measures of body composition, and lower body mass indexes in persons with dementia compared to those with no cognitive impairment. Individuals who feed themselves tend to weigh more compared to those who need assistance for feeding. There is also evidence to support that as feeding status improves or declines, body weight similarly increases or decreases.