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AlFehaidi AAAHZ, Khan SHU, Abdelrahman RA, Ahel NT, Shine P, De Ramos MD, Skairjeh NM, Khan SA, Al-Saadi RK. Predictors of malnutrition among older residents in Qatari long-term care facilities: a retrospective study. BMC Nutr 2024; 10:23. [PMID: 38303045 PMCID: PMC10835922 DOI: 10.1186/s40795-024-00827-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 01/16/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Malnutrition is a prevalent issue among older adults in long-term care facilities and is associated with adverse health outcomes and increased healthcare costs. Identifying the predictors of malnutrition in this population is crucial for developing effective intervention strategies. This study aimed to explore the factors contributing to malnourishment among older individuals living in long-term care facilities in Qatar. METHODS This cross-sectional study included 75 older adults from two long-term care facilities (Rumailah Hospital and Enaya Specialized Care Center) in Qatar. Baseline characteristics, including age, sex, length of stay, mortality, weight, body mass index, co-morbidities, and laboratory parameters, were assessed. Data were analyzed using the most recent version of the SPSS software, version 29. Predictors of malnutrition and mortality were identified using logistic regression analysis. RESULTS Of the 75 older individuals included in the study, 85% (64) were malnourished. The average age of the participants was 74.89 years, with a standard deviation of 10.21. Of all participants, approximately 61% (46) were males, and 39% (29) were females. Most malnourished older adults were classified as either at "moderate (29.69%)" or "severe risk (37.50%)," according to the Geriatric Nutritional Risk Index. Malnourished participants experienced a significant percentage of weight change within 3 months (14.01 ± 7.89); the only statistically significant predictor of malnutrition was the percentage of weight change within 3 months with an odds ratio (OR) of 4.8 (confidence interval [CI] 1.56-14.75) and p-value of 0.006. Statistically significant predictors of mortality were malnutrition (OR 24.84, CI 1.09-564) and age (OR 1.07, CI 1.00-1.14). CONCLUSIONS A significant predictor of malnutrition in older adults identified in this study was the sudden and recent change in weight, which can be employed to detect individuals at risk early and guide tailored interventions. Malnutrition is a significant predictor of mortality. Employing a multidimensional strategy to tackle malnutrition can improve outcomes for the older individuals.
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Affiliation(s)
- Al Anoud Ali H Z AlFehaidi
- Department of Dietetics & Nutrition, Rumailah Hospital, Hamad Medical Corporation, Al Khaleej Street, Doha, P.O. Box: 3050, Qatar.
| | - Shafi Hashmath Ulla Khan
- Department of Geriatrics & Long-Term Care, Rumailah Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Rana Albdeljubbar Abdelrahman
- Department of Dietetics & Nutrition, Rumailah Hospital, Hamad Medical Corporation, Al Khaleej Street, Doha, P.O. Box: 3050, Qatar
| | - Nesreen Talal Ahel
- Department of Dietetics & Nutrition, Rumailah Hospital, Hamad Medical Corporation, Al Khaleej Street, Doha, P.O. Box: 3050, Qatar
| | - Pavithra Shine
- Department of Dietetics & Nutrition, Rumailah Hospital, Hamad Medical Corporation, Al Khaleej Street, Doha, P.O. Box: 3050, Qatar
| | - Monica Doroja De Ramos
- Department of Dietetics & Nutrition, Rumailah Hospital, Hamad Medical Corporation, Al Khaleej Street, Doha, P.O. Box: 3050, Qatar
| | - Nisreen Mazin Skairjeh
- Department of Dietetics & Nutrition, Rumailah Hospital, Hamad Medical Corporation, Al Khaleej Street, Doha, P.O. Box: 3050, Qatar
| | - Shakeel Ahmad Khan
- Department of Dietetics & Nutrition, Rumailah Hospital, Hamad Medical Corporation, Al Khaleej Street, Doha, P.O. Box: 3050, Qatar
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Perry E, Walton K, Lambert K. Prevalence of Malnutrition in People with Dementia in Long-Term Care: A Systematic Review and Meta-Analysis. Nutrients 2023; 15:2927. [PMID: 37447253 DOI: 10.3390/nu15132927] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 06/25/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
Dementia is a common syndrome in older people. Dementia alters eating behaviors, hunger and thirst cues, swallow function, ability to self-feed, and recognition and interest in food. There is significant variation in the reported prevalence of malnutrition among older people who live in long-term care. The aim was to conduct a systematic literature review and meta-analysis of the prevalence of malnutrition in those with dementia living in long-term care using a validated nutrition assessment tool. Scopus, Web of Science, CINAHL, and Medline were searched. A random effects model was used to determine the prevalence and risk of malnutrition. Data were retrieved from 24 studies. Most of the studies were from Europe or South Asia. The prevalence of malnutrition ranged from 6.8 to 75.6%, and the risk of malnutrition was 36.5-90.4%. The pooled prevalence of malnutrition in those with dementia in long-term care was 26.98% (95% CI 22.0-32.26, p < 0.0001, I2 = 94.12%). The pooled prevalence of the risk of malnutrition in those with dementia was 57.43% (95% CI 49.39-65.28, p < 0.0001, I2 = 97.38%). Malnutrition is widespread in those with dementia living in long-term care. Further research exploring malnutrition in other industrialized countries using validated assessment tools is required.
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Affiliation(s)
- Emma Perry
- School of Medical, Indigenous and Health Sciences, University of Wollongong, Wollongong, NSW 2522, Australia
| | - Karen Walton
- School of Medical, Indigenous and Health Sciences, University of Wollongong, Wollongong, NSW 2522, Australia
| | - Kelly Lambert
- School of Medical, Indigenous and Health Sciences, University of Wollongong, Wollongong, NSW 2522, Australia
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Pradelli L, Zaniolo O, Sanfilippo A, Lezo A, Riso S, Zanetti M. Prevalence and economic cost of malnutrition in Italy: A systematic review and metanalysis from the Italian Society of Artificial Nutrition and Metabolism (SINPE). Nutrition 2023; 108:111943. [PMID: 36669368 DOI: 10.1016/j.nut.2022.111943] [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: 05/25/2022] [Revised: 11/14/2022] [Accepted: 12/08/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Disease-related malnutrition (DRM) is a major public health issue with dramatic consequences on outcomes. However, in Italy a comprehensive and updated overview on national prevalence, in both the adult and pediatric populations, and its burden on the health care environment, is missing. The aim of this systematic literature review and meta-analysis was to identify and summarize the available evidence regarding the prevalence of DRM in Italy from pediatric to adult and older ages, and to project its global costs on the health care system. METHODS We performed a systematic literature search for articles on epidemiology of DRM in Italy published up to June 2021. Studies reporting data on the prevalence of DRM in community-dwelling individuals with chronic diseases, nursing home patients, and hospitalized patients (medical, surgery, and oncology patients), were selected for inclusion. Methodological quality of the studies was assessed by two independent reviewers using published criteria. An epidemiologic meta-analysis to obtain an aggregate estimate of prevalence of DRM was performed and a model for estimating the cost of illness, based on the application of epidemiologic results to official national hospitalization data, and attribution of relevant unit costs in the national context was constructed. RESULTS Sixty-seven studies reporting on the prevalence of DRM in Italian populations were included in the final selection; meta-analytical pooling yields mean prevalence estimates of about 50% and 30% in adult and pediatric hospitalized populations, respectively, with even higher findings for residents of long-term care facilities. Modeled projections of DRM-attributable yearly economic effects on the Italian health care system exceed 10 billion € in base case analysis, with the most optimistic estimate still exceeding 2.5 billion €. CONCLUSION Although comparable in magnitude to data from previous studies in analogous international settings, the diffusion and effects of DRM in the Italian setting is impressive. Increased awareness of these data and proactive fostering of clinical nutrition services are warranted, as prompt identification and treatment of malnutrition have been shown to effectively improve clinical and economic results.
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Affiliation(s)
| | | | | | - Antonella Lezo
- Clinical Nutrition Unit, Children's Hospital "Regina Margherita," AOU Città della Salute e della Scienza, Turin, Italy
| | - Sergio Riso
- Clinical Nutrition and Dietetic Unit - "Maggiore della Carità" University Hospital, Novara, Italy
| | - Michela Zanetti
- Department of Medical, Surgical and Health Sciences, University of Trieste, Italy
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Fielding RA, Landi F, Smoyer KE, Tarasenko L, Groarke J. Association of anorexia/appetite loss with malnutrition and mortality in older populations: A systematic literature review. J Cachexia Sarcopenia Muscle 2023; 14:706-729. [PMID: 36807868 PMCID: PMC10067499 DOI: 10.1002/jcsm.13186] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 01/03/2023] [Accepted: 01/16/2023] [Indexed: 02/22/2023] Open
Abstract
Anorexia/appetite loss in older subjects is frequently underrecognized in clinical practice, which may reflect deficient understanding of clinical sequelae. Therefore, we performed a systematic literature review to assess the morbidity and mortality burden of anorexia/appetite loss in older populations. Following PRISMA guidelines, searches were run (1 January 2011 to 31 July 2021) in PubMed, Embase® and Cochrane databases to identify English language studies of adults aged ≥ 65 years with anorexia/appetite loss. Two independent reviewers screened titles, abstracts and full text of identified records against pre-defined inclusion/exclusion criteria. Population demographics were extracted alongside risk of malnutrition, mortality and other outcomes of interest. Of 146 studies that underwent full-text review, 58 met eligibility criteria. Most studies were from Europe (n = 34; 58.6%) or Asia (n = 16; 27.6%), with few (n = 3; 5.2%) from the United States. Most were conducted in a community setting (n = 35; 60.3%), 12 (20.7%) were inpatient based (hospital/rehabilitation ward), 5 (8.6%) were in institutional care (nursing/care homes) and 7 (12.1%) were in other (mixed or outpatient) settings. One study reported results separately for community and institutional settings and is counted in both settings. Simplified Nutritional Appetite Questionnaire (SNAQ Simplified, n = 14) and subject-reported appetite questions (n = 11) were the most common methods used to assess anorexia/appetite loss, but substantial variability in assessment tools was observed across studies. The most commonly reported outcomes were malnutrition and mortality. Malnutrition was assessed in 15 studies, with all reporting a significantly higher risk of malnutrition in older individuals with anorexia/appetite loss (vs. without) regardless of country or healthcare setting (community n = 9, inpatient n = 2, institutional n = 3, other n = 2). Of 18 longitudinal studies that assessed mortality risk, 17 (94%) reported a significant association between anorexia/appetite loss and mortality regardless of either healthcare setting (community n = 9, inpatient n = 6, institutional n = 2) or method used to assess anorexia/appetite loss. This association between anorexia/appetite loss and mortality was observed in cohorts with cancer (as expected) but was also observed in older populations with a range of comorbid conditions other than cancer. Overall, our findings demonstrate that, among individuals aged ≥ 65 years, anorexia/appetite loss is associated with increased risk of malnutrition, mortality and other negative outcomes across community, care home and hospital settings. Such associations warrant efforts to improve and standardize screening, detection, assessment and management of anorexia/appetite loss in older adults.
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Affiliation(s)
- Roger A Fielding
- Nutrition, Exercise Physiology and Sarcopenia Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, 711 Washington Street, Boston, MA, USA
| | - Francesco Landi
- Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Rome, Italy
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Mavragani A, Shafiee SI, Nor'hisham SH, Ibrahim Z, Jamaluddin R, Rahamat S, Mohd Yusof BN, Minhat HS, Sallehuddin H, Mazlan NS. A Logical Framework (MYGERYFS) for Hospital Foodservice to Prevent Malnutrition Among Geriatric Patients in Hospitals, Malaysia: Protocol for a Feasibility Study. JMIR Res Protoc 2023; 12:e42496. [PMID: 36719732 PMCID: PMC9929728 DOI: 10.2196/42496] [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: 09/06/2022] [Revised: 12/25/2022] [Accepted: 12/27/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Geriatric malnutrition in hospitals is common and can be affected by many things, including poor satisfaction toward hospital foodservice. Hospital foodservice plays an important role in a patient's recovery process by providing adequate nutrients. On top of that, patients' foodservice satisfaction can easily be afflicted by the quality of food served and the overall foodservice experience. Furthermore, malnutrition can occur from poor foodservice quality, especially among geriatric patients. OBJECTIVE This study aims to assess the effectiveness of the Malaysian Geriatric Patients' Hospital Foodservice Protocol (MYGERYFS). METHODS The protocol comprises 3 phases. Phase One is a cross-sectional study that took place at public hospitals with geriatric wards in the Klang Valley. Univariate data from Phase One were analyzed descriptively. Pearson correlation and chi-square were conducted to find factors associated with foodservice satisfaction. Phase Two involves the collaboration of health care professionals in the geriatric field. In Phase Three, a feasibility study will be conducted to determine the feasibility of the MYGERYFS protocol in a hospital among 60 geriatric patients. These patients will be randomized into control and intervention groups, respectively. Intervention care will be done to ensure the safety of the protocol. RESULTS Data collection for Phase One of the study has been completed. A total of 233 geriatric respondents with the mean age of 71.39 (SD 7.99) years were gathered. Approximately 51.5% (n=120) of the respondents were female, while 48.5% (n=113) were male, with a mean BMI of 24.84 (SD 6.05) kg/m2. Their mean energy and protein intakes were 1006.20 kcal (SD 462.03 kcal) and 42.60 (SD 22.20) grams, respectively. Based on the Mini Nutritional Assessment, older patients who scored 12-14 (normal) were 27.9% (n=65), those who scored 8-11 (at risk) were 54.9% (n=128), and those who scored 0-7, which is the lowest (malnutrition), were 17.2% (n=40) of the study population. Hence, most patients were at risk of malnutrition. Although a majority of the patients claimed to have good foodservice satisfaction 26.2% (n=61), they also experienced at least 3 barriers during mealtimes. It was found that dietary intake and mealtime barriers were significantly associated with the respondent's foodservice satisfaction. Data for Phase Two and Phase Three are yet to be collected and analyzed. CONCLUSIONS This study protocol could potentially benefit the hospital foodservice system and aid in improving geriatric nutritional status. TRIAL REGISTRATION ClinicalTrials.gov NCT04858165; https://clinicaltrials.gov/ct2/show/NCT04858165. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR1-10.2196/42496.
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Affiliation(s)
| | - Shazli Illyani Shafiee
- Department of Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
| | - Siti Hazimah Nor'hisham
- Department of Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
| | - Zuriati Ibrahim
- Department of Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
| | - Rosita Jamaluddin
- Department of Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
| | - Syafiqah Rahamat
- Department of Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
| | - Barakatun Nisak Mohd Yusof
- Department of Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
| | - Halimatus Sakdiah Minhat
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Hakimah Sallehuddin
- Malaysian Research Institute on Ageing (MyAgeing™), Universiti Putra Malaysia, Selangor, Malaysia.,Geriatric Unit, Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Nur Syazwani Mazlan
- Department of Economics, School of Business and Economics, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
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Castaldo A, Zanetti ES, Nobili A, Marano G, Zani M, Magri M, Verardi AA, Ianes A, Ardoino G, Gugiari MC, Lusignani M, Bonetti L. Food intake and prevalence of malnutrition in nursing homes. A multicenter observational study. JOURNAL OF GERONTOLOGY AND GERIATRICS 2022. [DOI: 10.36150/2499-6564-n497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Pankhurst M, Yaxley A, Miller M. Identification and Critical Appraisal of Food Service Satisfaction Questionnaires for Use in Nursing Homes: A Systematic Review. J Acad Nutr Diet 2021; 121:1793-1812.e1. [PMID: 34219048 DOI: 10.1016/j.jand.2021.05.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 04/30/2021] [Accepted: 05/12/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Food service provision in nursing homes is a complex, adaptive system through which multiple stakeholders interface. Organizational stakeholders include staff involved in preparing and delivering meals. Consumer stakeholders are the end users including residents and family. Questionnaires can be an economical and efficient method of measuring food service satisfaction in nursing homes and a powerful quality improvement tool. OBJECTIVE (1) To identify questionnaires that measure food service satisfaction of various stakeholders in a nursing homes and (2) to critically appraise the psychometric properties of identified questionnaires. METHODS Five electronic databases were searched (Cumulative Index to Nursing and Allied Health Literature, Medline, ProQuest, Scopus, and Cochrane) in April 2020. Data from the eligible studies were extracted, and the psychometric properties were critically appraised using the Consensus-Based Standards for the Selection of Health Measurement Instruments. RESULTS This review identified 129 studies that used a questionnaire to measure food service satisfaction in nursing homes. Of those, 107 studies representing 75 unique general nursing home satisfaction questionnaires were excluded for failing to adequately explore aspects related to food service. From the remaining 22 studies, 7 food service satisfaction questionnaires were identified; 5 intended for consumers (residents) and 2 intended for organizational stakeholders (staff). Using the Consensus-Based Standards for the Selection of Health Measurement Instruments quality criteria, most questionnaires had flaws in content validity and construct validity, primarily due to small sample sizes. No questionnaires explored food service satisfaction from the family perspective. CONCLUSIONS Nursing homes collect satisfaction information for accreditation, marketing, benchmarking, and quality improvement. Although questionnaires are easy to administer, the quality of the data they collect is impacted by the validity and reliability of the questionnaires used. Using unreliable satisfaction data may mean that nursing homes are not accurately able to understand the impact of changes in the system on stakeholder satisfaction.
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Caçador C, Teixeira-Lemos E, Oliveira J, Pinheiro J, Mascarenhas-Melo F, Ramos F. The Relationship between Nutritional Status and Functional Capacity: A Contribution Study in Institutionalised Portuguese Older Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073789. [PMID: 33916422 PMCID: PMC8038576 DOI: 10.3390/ijerph18073789] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 03/30/2021] [Accepted: 04/01/2021] [Indexed: 12/02/2022]
Abstract
Demographic aging of the population allied with the new family structures and societal dynamics is generating an increasing demand for institutions for older adults. Nutritional status is a key health determinant that impacts the quality of life among older adults. Hence, the aim of the present study was to evaluate the relationship between nutritional status and nutritional risk, functional capacity, and cognition in institutionalised Portuguese older adults by a cross-sectional study in 15 institutions. Nutritional status (body mass index (BMI), waist circumference (WC), nutritional risk (mini nutritional assessment (MNA)), degree of functional independence (Barthel index (BI)), and cognitive ability (mini mental state examination (MMSE)) were assessed. Of the 214 older adults evaluated, 28.0% were at risk of malnutrition, 69.6% were mildly functional dependent, and 39.3% presented minor cognitive impairment. The risk of malnutrition increased functional dependence and cognitive impairment. The MNA score, but not the BMI or WC, was related to disability and deficits in cognition. A differential interdependence was found between nutritional, cognitive, and functional status. Strategies to improve self-care and well-being in nursing homes should consider a correct diet and a closer evaluation of nutritional risk to preserve cognition, independence, and autonomy.
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Affiliation(s)
- Catarina Caçador
- Faculty of Pharmacy, University of Coimbra, 3000-548 Coimbra, Portugal;
| | - Edite Teixeira-Lemos
- Agrarian Scholl-IPV and CERNAS-IPV Research Centre, Polytechnic Institute of Viseu, 3504-510 Viseu, Portugal; (E.T.-L.); (J.O.)
| | - Jorge Oliveira
- Agrarian Scholl-IPV and CERNAS-IPV Research Centre, Polytechnic Institute of Viseu, 3504-510 Viseu, Portugal; (E.T.-L.); (J.O.)
| | - João Pinheiro
- Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal;
| | - Filipa Mascarenhas-Melo
- Department of Pharmaceutical Technology, Faculty of Pharmacy, University of Coimbra, 3000-548 Coimbra, Portugal;
| | - Fernando Ramos
- Faculty of Pharmacy, University of Coimbra, 3000-548 Coimbra, Portugal;
- REQUIMTE/LAQV, R. D. Manuel II, Apartado 55142, 4051-401 Porto, Portugal
- Correspondence:
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Fashho E, Ahmed T, Garden G, Readman D, Storey L, Wilkinson L, Wilson G, Slee A. Investigating the prevalence of malnutrition, frailty and physical disability and the association between them amongst older care home residents. Clin Nutr ESPEN 2020; 40:231-236. [PMID: 33183542 DOI: 10.1016/j.clnesp.2020.09.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 07/22/2020] [Accepted: 09/11/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Malnutrition, frailty and physical disability are inter-related, more prevalent in the older population and increase the risk of adverse health outcomes. Thus, screening is essential, especially in the understudied care home setting where the population is vulnerable and at higher risk of malnutrition. Furthermore, prevalence may vary depending upon screening tools used. The aims of this study were to: 1) investigate the prevalence of 1) malnutrition risk using Mini Nutritional Assessment - Short Form (MNA-SF) and Malnutrition Universal Screening Tool (MUST), 2) frailty using the Edmonton Frailty Scale (EFS), 3) physical disability using the Barthel Index (BI) and (4) examine the association between variables and coexistence of states. METHODS Screening for malnutrition (MNA-SF and MUST) and frailty (EFS) was performed as part of a comprehensive geriatric assessment (CGA) in 527 residents from 17 care homes in Lincoln, UK. Mean age of the group was 85.6 ± 7.6 years and body mass index, BMI 23.0 ± 5.1 kg/m2. RESULTS A high prevalence of malnutrition risk was detected: 41.4% by MNA-SF and 25.5% by MUST (high risk/malnourished). Furthermore, there was a clear discordance between MNA-SF and MUST scoring of malnutrition; for example, the percentage of those identified as being at low risk was 18.8% using the MNA-SF and 57.0% using the MUST. In addition, there was a high prevalence of severe frailty by EFS (69.6%) and functional impairment by BI (62.0%). There was good association between some variables (P < 0.001) and 33.4% of residents had coexistence of all three states of malnutrition, frailty and physical disability. CONCLUSIONS Malnutrition risk, frailty and physical disability are highly prevalent in care home residents and interrelated. However, prevalence varies depending on the screening tool used. More research should be conducted in the care home setting to improve daily clinical practice as screening may impact upon subsequent treatment and care modalities and clinical outcomes.
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Affiliation(s)
- Evate Fashho
- Division of Medicine, University College London, London, UK
| | - Tanweer Ahmed
- Research and Development Department, Lincoln County Hospital, Lincoln, UK
| | - Gill Garden
- Lincoln Medical School, University of Lincoln, Lincoln, UK
| | | | | | | | | | - Adrian Slee
- Division of Medicine, University College London, London, UK.
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What Are the Risk Factors for Malnutrition in Older-Aged Institutionalized Adults? Nutrients 2020; 12:nu12092857. [PMID: 32961917 PMCID: PMC7551464 DOI: 10.3390/nu12092857] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 08/28/2020] [Accepted: 09/15/2020] [Indexed: 01/05/2023] Open
Abstract
Malnutrition is common in older adults and is associated with functional impairment, reduced quality of life, and increased morbidity and mortality. The aim of this study was to explore the association between health (including depression), physical functioning, disability and cognitive decline, and risk of malnutrition. Participants were recruited from nursing homes in Italy and completed a detailed multidimensional geriatric evaluation. All the data analyses were completed using Stata Version 15.1. The study included 246 participants with an age range of 50 to 102 (80.4 ± 10.5). The sample was characterised by a high degree of cognitive and functional impairment, disability, and poor health and nutritional status (according to Mini Nutritional Assessment (MNA), 38.2% were at risk for malnutrition and 19.5% were malnourished). Using a stepwise linear regression model, age (B = −0.043, SE = 0.016, p = 0.010), depression (B = −0.133, SE = 0.052, p = 0.011), disability (B = 0.517, SE = 0.068, p < 0.001), and physical performance (B = −0.191, SE = 0.095, p = 0.045) remained significantly associated with the malnutrition risk in the final model (adjusted R-squared = 0.298). The logistic regression model incorporating age, depression, disability, and physical performance was found to have high discriminative accuracy (AUC = 0.747; 95%CI: 0.686 to 0.808) for predicting the risk of malnutrition. The results of the study confirm the need to assess nutritional status and to investigate the presence of risk factors associated with malnutrition in order to achieve effective prevention and plan a better intervention strategy.
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Velázquez-Alva MC, Irigoyen-Camacho ME, Cabrer-Rosales MF, Lazarevich I, Arrieta-Cruz I, Gutiérrez-Juárez R, Zepeda-Zepeda MA. Prevalence of Malnutrition and Depression in Older Adults Living in Nursing Homes in Mexico City. Nutrients 2020; 12:E2429. [PMID: 32823579 PMCID: PMC7468927 DOI: 10.3390/nu12082429] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 08/08/2020] [Accepted: 08/11/2020] [Indexed: 01/12/2023] Open
Abstract
This study evaluated the association between nutritional status, depressive symptoms, and the number of prescription drugs taken by older adults living in nursing homes in Mexico City. In a cross-sectional study, 262 participants were subjected to anthropometric and nutritional (Mini Nutritional Assessment (MNA)) evaluations; additionally, their depression (Geriatric Depression Scale (GDS)) and functional status were assessed. Multiple logistic regression was used for identifying factors associated with the risk of malnutrition/malnourishment. The mean age of participants was 83.1 ± 8.6 years. A total of 59.9% and 21.1% were at risk of malnutrition and malnourished, respectively. With respect to depression, 27.9% of the participants had mild depression, while 11.4% showed severe depression. An inverse correlation between MNA evaluations and depression scores was found (Spearman's ρ = -0.4624, p < 0.001); residents with a better nutritional status had lower depression scores. Individuals with depressive symptoms were approximately five times more likely to be at risk of malnutrition or malnourished (OR = 5.82, 95% CI = 2.27-14.89) than individuals without depression. Residents taking three or more prescription drugs daily (OR = 1.83, 95% CI = 1.27-2.63, p < 0.001) were more likely to be at risk of malnutrition or malnourished. In summary, poor nutritional status was associated with depression, while the intake of numerous prescription drugs was associated with being at risk of malnutrition or malnourished.
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Affiliation(s)
- María Consuelo Velázquez-Alva
- Health Care Department, Metropolitan Autonomous University, Unit Xochimilco, Mexico City 04960, Mexico; (M.C.V.-A.); (M.F.C.-R.); (I.L.); (M.A.Z.-Z.)
| | - María Esther Irigoyen-Camacho
- Health Care Department, Metropolitan Autonomous University, Unit Xochimilco, Mexico City 04960, Mexico; (M.C.V.-A.); (M.F.C.-R.); (I.L.); (M.A.Z.-Z.)
| | - María Fernanda Cabrer-Rosales
- Health Care Department, Metropolitan Autonomous University, Unit Xochimilco, Mexico City 04960, Mexico; (M.C.V.-A.); (M.F.C.-R.); (I.L.); (M.A.Z.-Z.)
| | - Irina Lazarevich
- Health Care Department, Metropolitan Autonomous University, Unit Xochimilco, Mexico City 04960, Mexico; (M.C.V.-A.); (M.F.C.-R.); (I.L.); (M.A.Z.-Z.)
| | - Isabel Arrieta-Cruz
- Department of Basic Research, National Institute of Geriatrics, Ministry of Health, Mexico City 10200, Mexico;
| | - Roger Gutiérrez-Juárez
- Department of Biomedical Sciences, School of Medicine, Faculty of High Studies Zaragoza, National Autonomous University of Mexico, Mexico City 09230, Mexico;
| | - Marco Antonio Zepeda-Zepeda
- Health Care Department, Metropolitan Autonomous University, Unit Xochimilco, Mexico City 04960, Mexico; (M.C.V.-A.); (M.F.C.-R.); (I.L.); (M.A.Z.-Z.)
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Valmorbida E, Trevisan C, Imoscopi A, Mazzochin M, Manzato E, Sergi G. Malnutrition is associated with increased risk of hospital admission and death in the first 18 months of institutionalization. Clin Nutr 2020; 39:3687-3694. [PMID: 32291111 DOI: 10.1016/j.clnu.2020.03.029] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 02/18/2020] [Accepted: 03/27/2020] [Indexed: 01/04/2023]
Abstract
OBJECTIVES This study aimed to investigate the association between different nutritional and anthropometric parameters with the risk of hospitalizations and death within 18 months from nursing home admission. Our hypothesis was that measures of malnutrition could be more strongly associated with worse clinical outcomes than measures of overweight/obesity. METHODS This prospective study involved 144 older adults newly admitted in nursing home and followed up over 18 months. A multidimensional assessment focusing on clinical, functional and cognitive status was performed at baseline. Assessment also included body mass index (BMI), waist circumference, calf circumference, MNA Short-Form (MNA-SF), and serum albumin and lymphocytes levels. Anthropometric measurements were repeated at 6 months. Data on hospitalizations and mortality over the study period, with their respective causes, were obtained from administrative data. The associations between baseline nutritional parameters and the risk of hospitalizations or death were analyzed through multinomial logistic regressions and Cox regressions, respectively. RESULTS During the follow-up, 64 individuals (44.4%) were hospitalized, and 52 (36.1%) died. Residents who reported low MNA-SF and calf circumference at nursing home admission had more than threefold-increased odds of hospitalizations compared with their healthier counterparts. Adults with low calf circumference also had the highest mortality (HR = 3.39, 95%CI:1.80-6.39), while more attenuated results were observed for low serum albumin, MNA-SF, and BMI (either when considering cut-offs of excess weight or malnutrition). When assessing the associations between 0 and 6 month changes in calf circumference and mortality in the following 12 months, we found that each 1 cm decrease in calf circumference increased the one-year mortality by 29% (95%CI 1.04-1.60). CONCLUSIONS Malnutrition, but not overweight/obesity, seems associated with a higher risk of hospitalization and mortality after nursing home admission. Monitoring calf circumference, in particular, may help in the early detection of individuals who are potentially vulnerable to adverse health-related outcomes after institutionalization.
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Affiliation(s)
- Elena Valmorbida
- Department of Medicine (DIMED), Geriatrics Division, University of Padova, Padova, Italy
| | - Caterina Trevisan
- Department of Medicine (DIMED), Geriatrics Division, University of Padova, Padova, Italy.
| | | | - Mattia Mazzochin
- Department of Medicine (DIMED), Geriatrics Division, University of Padova, Padova, Italy
| | - Enzo Manzato
- Department of Medicine (DIMED), Geriatrics Division, University of Padova, Padova, Italy; National Research Council, Neuroscience Institute, Padova, Italy
| | - Giuseppe Sergi
- Department of Medicine (DIMED), Geriatrics Division, University of Padova, Padova, Italy
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Ge L, Yap CW, Heng BH. Association of Nutritional Status with Physical Function and Disability in Community-Dwelling Older Adults: A Longitudinal Data Analysis. J Nutr Gerontol Geriatr 2020; 39:131-142. [PMID: 32048552 DOI: 10.1080/21551197.2020.1725711] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Objective: To investigate how change in nutritional status is associated with physical function and disability among community-dwelling older adults. Methods: Baseline and 1-year follow-up data of 593 community-dwelling older adults were obtained from the Population Health Index survey in Singapore. The Mini Nutritional Assessment was used to assess nutritional status; the Late-Life Function and Disability Instrument was used to measure physical function and disability. Multivariate linear regression was applied to examine the association of change in nutritional status with physical function and disability. Results: Compared to older adults with normal nutritional status at both baseline and 1-year follow-up, those who became undernourished or remained undernourished reported poorer physical function (B = -6.36 and -5.96, respectively; both P < 0.01), and had less frequent involvement (B = -3.95 and -2.84, respectively; both P < 0.01) and more limitation in performing life tasks (B = -13.24 and -16.02, respectively; both P < 0.01) at 1-year follow-up. However, older adults with improved nutritional status did not differ in physical function and frequency of involvement in life tasks compared to those with normal nutrition. Conclusion: Undernutrition is associated with poorer physical function and disability in community-dwelling older adults regardless of whether it developed or was persistent over one year. Improving nutritional status could be an effective strategy to improve physical function in older adults.
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Affiliation(s)
- Lixia Ge
- Health Services and Outcomes Research, National Healthcare Group, Singapore, Singapore
| | - Chun Wei Yap
- Health Services and Outcomes Research, National Healthcare Group, Singapore, Singapore
| | - Bee Hoon Heng
- Health Services and Outcomes Research, National Healthcare Group, Singapore, Singapore
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Shin JH, Shin IS. The effect of registered nurses on nursing home residents’ outcomes, controlling for organizational and health care market factors. Geriatr Nurs 2019; 40:296-301. [DOI: 10.1016/j.gerinurse.2018.11.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 11/21/2018] [Accepted: 11/26/2018] [Indexed: 10/27/2022]
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Slavíková M, Procházka B, Dlouhý P, Anděl M, Rambousková J. Prevalence of malnutrition risk among institutionalized elderly from North Bohemia is higher than among those in the Capital City of Prague, Czech Republic. Cent Eur J Public Health 2018; 26:111-117. [DOI: 10.21101/cejph.a4944] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 05/13/2018] [Indexed: 11/15/2022]
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Iuglio S, Keller H, Chaudhury H, Slaughter SE, Lengyel C, Morrison J, Boscart V, Carrier N. Construct Validity of the Mealtime Scan: A Secondary Data Analysis of the Making Most of Mealtimes (M3) Study. J Nutr Gerontol Geriatr 2018; 37:82-104. [PMID: 29781782 DOI: 10.1080/21551197.2018.1461166] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Long-term care (LTC) physical and psychosocial mealtime environments have been inconsistently assessed due to the lack of a standardized measure. The purpose of this study was to examine the construct validity of a new standardized observational measure, the Mealtime Scan (MTS), using the Making Most of Mealtimes data collected on 639 residents in 82 dining rooms in 32 LTC homes. The MTS includes physical, social, and person-centered care summary scales scored from 1 to 8. Mean ratings on these summary scales were moderate for physical (5.6 SD 0.9), social (5.0 SD 0.9), and person-centered care (PCC; 5.5 SD 0.8). Regression analyses determined which items within the MTS were associated with these summary scales: physical - music (B = 0.27, p = 0.04), number of staff passing food (B = -0.11, p = 0.03), number of residents (B = -0.03, p = 0.01); social - social sound (B = 0.31 p < 0.0001), number of residents requiring eating assistance (B = 0.11, p = 0.02); PCC - lighting (B = 0.01 p = 0.04), and total excess noise (B = 0.05, p < 0.0001). The Mealtime Relational Care Checklist (M-RCC) was associated positively with ratings on all three summary scales. Correlations revealed that the MTS summary scales were associated with other constructs: Dining Environment Audit Protocol functionality scale, resident and dining room level M-RCC, Mini Nutritional Assessment- Short Form, and resident Cognitive Performance Scale. These results demonstrate that the MTS summary scales exhibit construct validity, as the ratings were associated with expected observed mealtime characteristics and correlated with dining room and resident level constructs in anticipated directions.
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Affiliation(s)
| | - Heather Keller
- b University of Waterloo ; Schlegel-UW Research Institute for Aging , Waterloo , Canada
| | | | | | | | | | - Veronique Boscart
- f Conestoga College ; Schlegel-UW Research Institute for Aging , Kitchener , Canada
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Orlandoni P, Venturini C, Jukic Peladic N, Costantini A, Di Rosa M, Cola C, Giorgini N, Basile R, Fagnani D, Sparvoli D, David S. Malnutrition upon Hospital Admission in Geriatric Patients: Why Assess It? Front Nutr 2017; 4:50. [PMID: 29164125 PMCID: PMC5670098 DOI: 10.3389/fnut.2017.00050] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 10/05/2017] [Indexed: 01/04/2023] Open
Abstract
Objective To assess the prevalence of malnutrition according to the new ESPEN definition in a population of geriatric hospital patients and to determine how malnutrition affects the length of hospital stay (LOS) and hospital mortality. Design A retrospective analysis of data gathered during nutritional screening surveys carried out three consecutive years, from 2012 to 2014, in an Italian geriatric research hospital (INRCA, Ancona) was performed. On the day of the study, demographic data, data on clinical conditions and the nutritional status of newly admitted patients were collected. Patients were screened for malnutrition risk using the Malnutrition Universal Screening Tool (MUST). Subsequently, malnutrition was diagnosed, for subjects at high risk, following the criteria suggested by the European Association for Clinical Nutrition and Metabolism [body mass index (BMI) < 18.5 kg/m2 or different combinations of unintentional weight loss over time and BMI values]. Sensitivity, specificity, positive and negative predictive value of MUST compared to ESPEN criteria were assessed. The characteristics of patients with a diagnosis of malnutrition were compared to those of non-malnourished patients. The impact of malnutrition on LOS and hospital mortality was investigated through logistic and linear regression models. Setting The study was performed in an Italian geriatric research hospital (INRCA, Ancona). Subjects Two hundred eighty-four newly hospitalized geriatric patients from acute care wards (mean age 82.8 ± 8.7 years), who gave their written consent to participate in the study, were enrolled. Results According to the MUST, high risk of malnutrition at hospitalization was found in 28.2% of patients. Malnutrition was diagnosed in 24.6% of subjects. The malnutrition was an independent predictor of both the LOS and hospital mortality. The multivariate analyses—linear and logistic regression—were performed considering different potential confounders contemporarily. The results showed that the malnutrition is an independent predictor of LOS and hospital mortality. Malnourished subjects were hospitalized almost 3 days longer compared to non-malnourished patients (p = 0.047; CI 0.04–5.80). The risk of death during hospitalization was 55% higher for malnourished patients (p = 0.037; CI 0.21–0.95). Conclusion A new ESPEN consensus of malnutrition was easily applicable in a population of geriatric hospital patients. Given that the nutritional status of geriatric patients was strongly correlated with the LOS and hospital mortality, the use of this simple and non-time consuming tool is highly recommended in clinical practice.
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Affiliation(s)
- Paolo Orlandoni
- Clinical Nutrition, Istituto Nazionale di Riposo e Cura per Anziani (IRCCS), Ancona, Italy
| | - Claudia Venturini
- Clinical Nutrition, Istituto Nazionale di Riposo e Cura per Anziani (IRCCS), Ancona, Italy
| | - Nikolina Jukic Peladic
- Clinical Nutrition, Istituto Nazionale di Riposo e Cura per Anziani (IRCCS), Ancona, Italy
| | - Annarita Costantini
- Clinical Nutrition, Istituto Nazionale di Riposo e Cura per Anziani (IRCCS), Ancona, Italy
| | - Mirko Di Rosa
- Clinical Nutrition, Istituto Nazionale di Riposo e Cura per Anziani (IRCCS), Ancona, Italy
| | - Claudia Cola
- Clinical Nutrition, Istituto Nazionale di Riposo e Cura per Anziani (IRCCS), Ancona, Italy
| | - Natascia Giorgini
- Clinical Nutrition, Istituto Nazionale di Riposo e Cura per Anziani (IRCCS), Ancona, Italy
| | - Redenta Basile
- Clinical Nutrition, Istituto Nazionale di Riposo e Cura per Anziani (IRCCS), Ancona, Italy
| | - Donata Fagnani
- Clinical Nutrition, Istituto Nazionale di Riposo e Cura per Anziani (IRCCS), Ancona, Italy
| | - Debora Sparvoli
- Clinical Nutrition, Istituto Nazionale di Riposo e Cura per Anziani (IRCCS), Ancona, Italy
| | - Serenella David
- Clinical Nutrition, Istituto Nazionale di Riposo e Cura per Anziani (IRCCS), Ancona, Italy
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Paino Pardal L, Poblet I Montells L, Ríos Álvarez L. [The elderly living alone and malnutrition. SOLGER Study]. Aten Primaria 2017; 49:450-458. [PMID: 28153387 PMCID: PMC6875975 DOI: 10.1016/j.aprim.2016.10.007] [Citation(s) in RCA: 9] [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: 02/25/2016] [Revised: 09/10/2016] [Accepted: 10/02/2016] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE This study aims to determine if there are any connections between living alone and suffering from malnutrition or having a risk of being malnourished, in people over 79years old in a Mediterranean population. DESIGN A questionnaire was used in a cross-sectional and multicentre study conducted between June and December 2014 in three Primary Care Centres (PCC). PARTICIPANTS A quota was chosen for each centre, including all patients over 79years, with a total of 167 people. STATISTICAL ANALYSIS Was performed using SPSS. A first descriptive part was performed by calculating Chi squared and Student-t tests, and a second part in which logistic regression was used to determine if living was only related to the Mini Nutritional Assessment (MNA) adjusted to age. RESULTS The scores of the nutritional study by MNA showed no differences between the groups according to the family unit as a differentiating factor. On the other hand, age does seem to be a determining factor. CONCLUSION Patients over 79years old and who live alone are nearly always independent for daily life activities, and often have a better state of physical and mental health. These factors could explain their better nutritional status, as living alone is not associated with states of malnutrition or having the risk of suffer from it.
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Urh N, Babnik K, Rebec D, Poklar Vatovec T. Ocena prehranskega stanja starejših v socialnovarstvenem zavodu. OBZORNIK ZDRAVSTVENE NEGE 2017. [DOI: 10.14528/snr.2017.51.3.167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Uvod: Eden od dejavnikov kakovosti življenja starejših v socialnovarstvenem zavodu je prehrana. Namen raziskave je bil proučiti prehransko stanje in ponuditi predloge za izboljšanje prehrane starejših v socialnovarstvenem zavodu.
Metode: V raziskavi je bila uporabljena kvantitativna opisna metoda raziskovanja. Analizirani so bili dnevni jedilniki v socialnovarstvenem zavodu in na vzorcu starejših (n = 48) izvedena analizo dejanskega vnosa hranil in prehranskega statusa. Prehransko stanje je bilo ugotovljeno na podlagi indeksa telesne mase in vprašalnika Mini prehranski pregled. Vključeni v raziskavo so imeli prehrano, pri kateri dietne prilagoditve niso bile potrebne.
Rezultati: Povprečna energijska vrednost ponujenih jedilnikov je znašala 8457 kJ (2021 kcal) na dan, 17 hranil je odstopalo od priporočil. Moški (M) in ženske (Ž) se statistično pomembno razlikujejo v deležu ostanka maščob (μM = 16 %, μŽ = 24 %; p = 0,036), holesterola (μM = 15 %, μŽ = 26 %; p = 0,035), vitamina D (μM = 15 %, μŽ = 27 %; p = 0,017) in vitamina B12 (μM = 17 %, μŽ = 25 %; p = 0,016). Indeks telesne mase je pokazal, da nihče od starejših, ki so bili vključeni v raziskavo, ni bil podhranjen ali v kategoriji debelost III. stopnje.
Diskusija in zaključek: Raziskava je potrdila potrebo po sistematičnem spremljanju kakovosti prehrane starejših v socialnovarstvenih zavodih. Da bi starejšim zagotovili ustrezno prehransko oskrbo, je potrebno sodelovanje medpoklicnega tima s starejšimi in njihovimi družinskimi člani.
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Lardiés-Sánchez B, Sanz-París A, Pérez-Nogueras J, Serrano-Oliver A, Torres-Anoro ME, Cruz-Jentoft AJ. Influence of nutritional status in the diagnosis of sarcopenia in nursing home residents. Nutrition 2017; 41:51-57. [DOI: 10.1016/j.nut.2017.03.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 02/19/2017] [Accepted: 03/06/2017] [Indexed: 01/04/2023]
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Zhang Z, Pereira SL, Luo M, Matheson EM. Evaluation of Blood Biomarkers Associated with Risk of Malnutrition in Older Adults: A Systematic Review and Meta-Analysis. Nutrients 2017; 9:E829. [PMID: 28771192 PMCID: PMC5579622 DOI: 10.3390/nu9080829] [Citation(s) in RCA: 279] [Impact Index Per Article: 39.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 07/22/2017] [Accepted: 07/31/2017] [Indexed: 01/04/2023] Open
Abstract
Malnutrition is a common yet under-recognized problem in hospitalized patients. The aim of this paper was to systematically review and evaluate malnutrition biomarkers among order adults. Eligible studies were identified through Cochrane, PubMed and the ProQuest Dialog. A meta-regression was performed on concentrations of biomarkers according to malnutrition risks classified by validated nutrition assessment tools. A total of 111 studies were included, representing 52,911 participants (55% female, 72 ± 17 years old) from various clinical settings (hospital, community, care homes). The estimated BMI (p < 0.001) and concentrations of albumin (p < 0.001), hemoglobin (p < 0.001), total cholesterol (p < 0.001), prealbumin (p < 0.001) and total protein (p < 0.05) among subjects at high malnutrition risk by MNA were significantly lower than those without a risk. Similar results were observed for malnutrition identified by SGA and NRS-2002. A sensitivity analysis by including patients with acute illness showed that albumin and prealbumin concentrations were dramatically reduced, indicating that they must be carefully interpreted in acute care settings. This review showed that BMI, hemoglobin, and total cholesterol are useful biomarkers of malnutrition in older adults. The reference ranges and cut-offs may need to be updated to avoid underdiagnosis of malnutrition.
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Affiliation(s)
- Zhiying Zhang
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL 61820, USA.
- Abbott Nutrition Research and Development Asia-Pacific Center, 138668 Singapore, Singapore.
| | | | - Menghua Luo
- Abbott Nutrition Research and Development, Columbus, OH 43219, USA.
| | - Eric M Matheson
- Department of Family Medicine, Medical University of South Carolina, Charleston, SC 29412, USA.
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Kim E, Kang H, Kim N. Effects of Nutritional Intervention in Long-Term Care in Korea. J Gerontol Nurs 2017; 43:55-64. [DOI: 10.3928/00989134-20161109-06] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 09/12/2016] [Indexed: 11/20/2022]
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Donini LM, Poggiogalle E, Molfino A, Rosano A, Lenzi A, Rossi Fanelli F, Muscaritoli M. Mini-Nutritional Assessment, Malnutrition Universal Screening Tool, and Nutrition Risk Screening Tool for the Nutritional Evaluation of Older Nursing Home Residents. J Am Med Dir Assoc 2016; 17:959.e11-8. [DOI: 10.1016/j.jamda.2016.06.028] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 06/27/2016] [Accepted: 06/28/2016] [Indexed: 12/15/2022]
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Abstract
PURPOSE OF REVIEW Malnutrition in the nursing home is increasingly recognized as a major international research priority, given the expanding geriatric populations, serious consequences, and challenges conducting research in nursing homes. This review examines the recent literature and suggests implications for research and practice. RECENT FINDINGS Across the recent studies, approximately 20% of nursing home residents had some form of malnutrition. However, malnutrition definitions were variable and prevalence ranged from 1.5 to 66.5%. Depression, cognitive impairment, functional impairment, and swallowing difficulty were consistently associated with malnutrition. Mortality was the major consequence of malnutrition among nursing home residents, whereas higher BMIs had lower risks of mortality. Beneficial interventions to reduce malnutrition in the nursing home included dietary supplements, greater resident role in food choice, and staff training programs. SUMMARY To truly tackle the issue of malnutrition in the nursing home setting, a consistent definition is needed. We strongly recommend that an expert consensus panel identify a standard set of measures to more accurately compare the prevalence across countries. Given the mortality consequences of malnutrition and the paucity of intervention studies, research on interventions for malnutrition in the nursing home needs to be a higher priority for facilities, researchers, and funding agencies.
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Affiliation(s)
- Christina L Bell
- aDepartment of Geriatric Medicine, Pacific Islands Geriatric Education Center, University of Hawaii John A. Burns School of Medicine bHealth Sciences Library, University of Hawaii John A. Burns School of Medicine, Honolulu, Hawaii, USA
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Zhu Y, Hsu WH, Hollis JH. Increased number of chews during a fixed-amount meal suppresses postprandial appetite and modulates glycemic response in older males. Physiol Behav 2014; 133:136-40. [PMID: 24857719 DOI: 10.1016/j.physbeh.2014.05.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 02/20/2014] [Accepted: 05/15/2014] [Indexed: 12/25/2022]
Abstract
Aging is associated with a reduction in appetite. Older adults require a higher number of chews to form a bolus before swallowing. However, whether this ingestive behavior contributes to the reduced appetite in this population is unknown. Fifteen males aged 65 years or older participated in this randomized cross-over trial and attended two test sessions. After an overnight fast, they consumed a fixed-amount meal (2050 kJ) by chewing each portion of food 15 or 40 times before swallowing. Subjective appetite was measured using visual analogue scales at regular intervals for 3 h after completion of the meal. Blood samples were collected at the same time for measurement of glucose, insulin, and glucose-dependent insulinotropic peptide (GIP). Participants were provided an ad libitum meal 3 h later. Compared with 15 chews, chewing food 40 times before swallowing resulted in significantly lower postprandial hunger (P=0.003), preoccupation with food (P<0.001), and desire to eat (P<0.001). Plasma concentrations of glucose, insulin, and GIP were significantly higher at meal completion when 40 chews were made (all P<0.01), and became significantly lower during the late postprandial period (all P<0.05). Food intake at the subsequent ad libitum meal did not differ significantly between test sessions. Our findings suggested that increased number of chews reduced postprandial hunger and desire to eat, and modulated glucose metabolism in older males. The number of chews made during a fixed-amount meal may influence short-term appetite; how this ingestive behavior contributes to energy balance in the long term warrants further investigation.
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Affiliation(s)
- Yong Zhu
- Department of Food Science and Human Nutrition, Iowa State University, United States
| | - Walter H Hsu
- Department of Biomedical Sciences, Iowa State University, United States
| | - James H Hollis
- Department of Food Science and Human Nutrition, Iowa State University, United States.
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Pileggi C, Manuti B, Costantino R, Bianco A, Nobile CGA, Pavia M. Quality of care in one Italian nursing home measured by ACOVE process indicators. PLoS One 2014; 9:e93064. [PMID: 24675745 PMCID: PMC3968054 DOI: 10.1371/journal.pone.0093064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Accepted: 03/01/2014] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To adapt the Assessing Care of Vulnerable Elders Quality Indicators (ACOVE QIs) for use in Italy, to assess the adherence to these indicators as reported in the medical records of residents in a nursing home (NH), to compare this adherence for general medical and geriatric conditions, and eventually, to identify the relationships between patients' characteristics and reported processes of care. METHODS Two physicians collected the data by reviewing medical records of all NH residents in the previous 5 years, for a period of one year. Patients aged <65 years were excluded. A total of 245 patients were reviewed during the study period. The ACOVE QIs set, developed for NH processes of care, was used to assess the quality of care. Multivariate analysis was performed to identify and to assess the role of patients' characteristics on quality of processes of care by several domains of care in general medical and geriatric conditions. RESULTS With the exception of diabetes management, quality of processes of care for general medical conditions approached adequate adherence. Care falls substantially short of acceptable levels for geriatric conditions (pressure ulcers, falls, dementia). On the contrary, the recommended interventions for urinary incontinence were commonly performed. Adherence to indicators varied for the different domains of care and was proven worse for the screening and prevention indicators both for geriatric and general medical conditions. Statistical analysis showed disparities in provision of appropriate processes of care associated with gender, age, co-morbidities, level of function and mobility, length of stay and modality of discharge by NHs. CONCLUSIONS Adherence to recommended processes of care delivered in NH is inadequate. Substantial work lies ahead for the improvement of care. Efforts should focus particularly on management of geriatric conditions and on preventive healthcare.
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Affiliation(s)
- Claudia Pileggi
- Department of Health Sciences, University of Catanzaro “Magna Græcia”, Catanzaro, Italy
| | - Benedetto Manuti
- Department of Health Sciences, University of Catanzaro “Magna Græcia”, Catanzaro, Italy
| | - Rosa Costantino
- Department of Health Sciences, University of Catanzaro “Magna Græcia”, Catanzaro, Italy
| | - Aida Bianco
- Department of Health Sciences, University of Catanzaro “Magna Græcia”, Catanzaro, Italy
| | - Carmelo G. A. Nobile
- Department of Health Sciences, University of Catanzaro “Magna Græcia”, Catanzaro, Italy
| | - Maria Pavia
- Department of Health Sciences, University of Catanzaro “Magna Græcia”, Catanzaro, Italy
- * E-mail:
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Malara A, Sgrò G, Caruso C, Ceravolo F, Curinga G, Renda GF, Spadea F, Garo M, Rispoli V. Relationship between cognitive impairment and nutritional assessment on functional status in Calabrian long-term-care. Clin Interv Aging 2014; 9:105-10. [PMID: 24453481 PMCID: PMC3892960 DOI: 10.2147/cia.s54611] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective The interaction between dementia and nutritional state is very complex and not yet fully understood. The aim of the present study was to assess the interaction between cognitive impairment and nutritional state in a cohort of residential elderly in relationship with functional condition of patients and their load of assistance in long-term-care facilities of the National Association of Third Age Structures (ANASTE) Calabria. Methods One hundred seventy-four subjects (122 female and 52 male) were admitted to the long-term-care ANASTE Calabria study. All patients underwent multidimensional geriatric assessment. Nutritional state was assessed with the Mini Nutritional Assessment (MNA), whereas cognitive performance was evaluated by the Mini-Mental State Examination (MMSE). The functional state was assessed by Barthel Index (BI) and Activity Daily Living (ADL). The following nutritional biochemical parameters were also evaluated: albumin, cholesterol, iron, and hemoglobin. All patients were reassessed 180 days later. Results A severe cognitive impairment in MMSE performance was displayed in 49.7% patients, while 39.8% showed a moderate deficit; 6.9% had a slight deficit; and 3.4% evidenced no cognitive impairment. In MNA, 30% of patients exhibited an impairment of nutritional state; 56% were at risk of malnutrition; and 14% showed no nutritional problems. Malnutrition was present in 42% of patients with severe cognitive impairment, but only 4% of malnourished patients showed moderate cognitive deficit. The statistical analysis displayed a significant correlation between MNA and MMSE (P<0.001), as did MMSE correlated with Activity Daily Living (P<0.001) and BI (P<0.05). MNA correlated with BI (P<0.001) and albumin (P<0.001). The follow-up showed a strong correlation between cognitive deterioration and worsening of nutritional state (P<0.005) as well as with the functional state (P<0.05) and mortality (P<0.01). Conclusion The present study clearly shows that malnutrition may play an important role in the progression of cognitive loss.
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Affiliation(s)
- Alba Malara
- Scientific Committee of the National Association of Third Age Structures (ANASTE) Calabria, Italy
| | - Giovanni Sgrò
- Scientific Committee of the National Association of Third Age Structures (ANASTE) Calabria, Italy
| | - Chiara Caruso
- Scientific Committee of the National Association of Third Age Structures (ANASTE) Calabria, Italy
| | - Francesco Ceravolo
- Scientific Committee of the National Association of Third Age Structures (ANASTE) Calabria, Italy
| | - Giuseppe Curinga
- Scientific Committee of the National Association of Third Age Structures (ANASTE) Calabria, Italy
| | - Grazia Francesca Renda
- Scientific Committee of the National Association of Third Age Structures (ANASTE) Calabria, Italy
| | - Fausto Spadea
- Scientific Committee of the National Association of Third Age Structures (ANASTE) Calabria, Italy
| | - Michele Garo
- Scientific Committee of the National Association of Third Age Structures (ANASTE) Calabria, Italy
| | - Vincenzo Rispoli
- Scientific Committee of the National Association of Third Age Structures (ANASTE) Calabria, Italy
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Papparotto C, Bidoli E, Palese A. Risk factors associated with malnutrition in older adults living in Italian nursing homes: a cross-sectional study. Res Gerontol Nurs 2013; 6:187-97. [PMID: 23739882 DOI: 10.3928/19404921-20130528-01] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Accepted: 05/13/2013] [Indexed: 01/08/2023]
Abstract
Malnutrition is a significant problem among older adults living in nursing homes: Malnourished residents are at increased risk of hospitalization and mortality. Multiple factors determine malnutrition, and the extant literature has focused attention on individual factors such as aging, sex, and dependence in activities of daily living. However, little evidence is available on factors influenced by nursing care. Exploring the relationship between the nutritional status of nursing home residents and certain individual factors, including those potentially influenced by nursing care, was the aim of this cross-sectional study. A total of 186 nursing home residents was enrolled in the study; in addition, 18 nurses were involved in the data collection process. Twenty-one percent of the residents had an adequate nutritional status, 43% were at risk of malnutrition, and 36% were malnourished. Multivariate analysis revealed that those independent factors associated with malnutrition, once adjusted for age, sex, and dependence in activities of daily living, were: having had a stroke, being dependent in activities of daily living, eating half or less of food provided at mealtimes, and having their weight checked only every 3 months or longer. Nursing care projects may be effective in reducing the risk of malnutrition among nursing home residents. However, further research is needed to develop knowledge of the factors associated with malnutrition and those influenced by care delivered in nursing homes.
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