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Kim E, Seol EM, Lee HJ. The Association of Body Mass Index on Falls Risk and Mortality in Hospitalized Patients of Different Old-Age Categories Requiring Nutritional Support. Clin Nutr Res 2024; 13:96-107. [PMID: 38784849 PMCID: PMC11109932 DOI: 10.7762/cnr.2024.13.2.96] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 04/04/2024] [Accepted: 04/12/2024] [Indexed: 05/25/2024] Open
Abstract
Malnutrition affect clinical outcomes in hospitalized old age patients, but the data on the related outcomes on the basis of different age categories are still limited. We aimed to investigate the interplay of associations among body mass index (BMI), falls risk, and mortality rate in different older adult patient age categories. This retrospective study included hospitalized patients aged ≥ 65 years who received artificial nutrition. Demographic, biochemical, and survival data were collected. BMI was evaluated using the World Health Organization BMI cutoffs for Asians, and patients were classified into high (≥ 23.0 kg/m2), normal (18.5-22.9 kg/m2), and low (< 18.5 kg/m2) BMI groups. The Morse Fall Scale was used to assess falls risk. By age categories, all patients (n = 4,642) were divided into the 65-74 (n = 2,649) and ≥ 75 (n = 1,993) years age groups. We found that the proportion of low-BMI and high risk of falls increased with age. Further, low-BMI was associated with increased falls risk in both age groups. Overall survival rate tended to be lower in the low-BMI and ≥ 75 years group than that in other patient groups, but did not differ significantly compared with the low-BMI and 65-74 years group. Low-BMI was associated with increased falls risk and mortality; however, the association depended on specific patient age groups.
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Affiliation(s)
- Eunjung Kim
- Department of Nutritional Support Team, Seoul National University Hospital, Seoul 03080, Korea
- Department of Nursing, Seoul National University Hospital, Seoul 03080, Korea
| | - Eun-Mi Seol
- Department of Nutritional Support Team, Seoul National University Hospital, Seoul 03080, Korea
- Department of Nursing, Seoul National University Hospital, Seoul 03080, Korea
| | - Hyuk-Joon Lee
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul 03080, Korea
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2
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van Zwienen-Pot JI, Reinders I, de Groot LCPGM, Beck AM, Feldblum I, Jobse I, Neelemaat F, de van der Schueren MAE, Shahar DR, Smeets ETHC, Tieland M, Wijnhoven HAH, Volkert D, Visser M. Effects of Nutritional Interventions in Older Adults with Malnutrition or at Risk of Malnutrition on Muscle Strength and Mortality: Results of Pooled Analyses of Individual Participant Data from Nine RCTs. Nutrients 2023; 15:2025. [PMID: 37432139 DOI: 10.3390/nu15092025] [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: 03/20/2023] [Revised: 04/17/2023] [Accepted: 04/20/2023] [Indexed: 07/12/2023] Open
Abstract
Nutritional intervention studies in older adults with malnutrition aim to improve nutritional status. Although these studies show a significant gain in body weight, there is inconsistent evidence of clinical effectiveness on muscle strength and mortality. This study aimed to examine the effects of nutritional interventions on muscle strength and risk of mortality in older adults (malnourished or at risk) and explore whether these effects are influenced by participant characteristics. Individual participant data were used from nine RCTs (community setting, hospital and long-term care; duration 12-24 weeks and included oral nutritional supplements, dietary counseling, or both). Handgrip strength (HGS) was measured in seven RCTs and six RCTs obtained mortality data. A ≥3 kg increase in HGS was considered clinically relevant. Logistic generalized estimating equations analyses (GEE) were used to test intervention effectiveness. GEE showed no overall treatment effect (OR 1.11, 95% CI 0.78-1.59) on HGS. A greater, but not statistically significant, effect on HGS was observed for older (>80 years) versus younger participants. No significant treatment effect was observed for mortality (OR 0.78, 95% CI 0.42-1.46). The treatment effect on mortality was greater but remained non-significant for women and those with higher baseline energy or protein intake. In conclusion, no effects of nutritional interventions were observed on HGS and mortality in older adults (malnourished or at risk). While the treatment effect was modified by some baseline participant characteristics, the treatment also lacked an effect in most subgroups.
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Affiliation(s)
- Judith I van Zwienen-Pot
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, 3015 EK Rotterdam, The Netherlands
- Department of Nutrition and Dietetics, Amsterdam University Medical Centers, Location VUmc, 1081 HV Amsterdam, The Netherlands
| | - Ilse Reinders
- Department of Health Sciences, Faculty of Science, Amsterdam Public Health Research Institute, Vrije Universiteit, 1081 HV Amsterdam, The Netherlands
| | - Lisette C P G M de Groot
- Division of Human Nutrition and Health, Wageningen University & Research, 6703 HE Wageningen, The Netherlands
| | - Anne Marie Beck
- The Dietitians and Nutritional Research Unit, EATEN, Herlev and Gentofte Hospital, DK-2730 Herlev, Denmark
| | - Ilana Feldblum
- The Daniel Abraham International Center for Health Nutrition, Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba 84105, Israel
| | - Inken Jobse
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, 90408 Nuremberg, Germany
| | - Floor Neelemaat
- Department of Nutrition and Dietetics, Amsterdam University Medical Centers, Location VUmc, 1081 HV Amsterdam, The Netherlands
| | - Marian A E de van der Schueren
- Division of Human Nutrition and Health, Wageningen University & Research, 6703 HE Wageningen, The Netherlands
- Department of Nutrition, Dietetics and Lifestyle, HAN University of Applied Sciences, 6525 EN Nijmegen, The Netherlands
| | - Danit R Shahar
- The Daniel Abraham International Center for Health Nutrition, Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba 84105, Israel
| | - Ellen T H C Smeets
- Division of Human Nutrition and Health, Wageningen University & Research, 6703 HE Wageningen, The Netherlands
| | - Michael Tieland
- Center of Expertise Urban Vitality, Amsterdam University of Applied Science, 1067 SM Amsterdam, The Netherlands
| | - Hanneke A H Wijnhoven
- Department of Health Sciences, Faculty of Science, Amsterdam Public Health Research Institute, Vrije Universiteit, 1081 HV Amsterdam, The Netherlands
| | - Dorothee Volkert
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, 90408 Nuremberg, Germany
| | - Marjolein Visser
- Department of Health Sciences, Faculty of Science, Amsterdam Public Health Research Institute, Vrije Universiteit, 1081 HV Amsterdam, The Netherlands
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Mills CM, Keller HH, DePaul VG, Donnelly C. Social Network Factors Affect Nutrition Risk in Middle-Aged and Older Adults: Results from the Canadian Longitudinal Study on Aging. J Nutr Health Aging 2023; 27:46-58. [PMID: 36651486 DOI: 10.1007/s12603-022-1877-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To determine which social network, demographic, and health-indicator variables are associated with SCREEN-8 (nutrition risk) scores at two time points, three years apart, using data from the Canadian Longitudinal Study on Aging. DESIGN A retrospective cross-sectional study. SETTING AND PARTICIPANTS 17051 Canadians aged 45 years and older with data from baseline and first follow-up of the Canadian Longitudinal Study on Aging. MEASUREMENTS Nutrition risk was measured using SCREEN-8. Social network factors included social network size, frequency of contact with social network members, social participation, social support, self-rated social standing, and household income. Demographic variables included age, sex assigned at birth, marital status, educational attainment, and living situation (alone or with others). Health-indicator variables included depression, disability, and self-rated general health, mental health, healthy aging, and oral health. Multivariable linear regression was used to analyze the relationship between the social network, demographic, and health-indicator variables and SCREEN-8 scores at two time points, three years apart. RESULTS Among the social network variables, individuals with higher social participation, self-rated social standing, and social support had higher SCREEN-8 scores at baseline and follow-up. Among the demographic variables, individuals who were single or widowed, compared to married or partnered, had lower SCREEN-8 scores at both time points. For the health-indicator variables, individuals who screened negative for depression, and those with higher self-rated general health, healthy aging, and oral health had higher SCREEN-8 scores at both time points. At baseline, as age increased, SCREEN-8 scores also increased. CONCLUSION Individuals with low social participation, low social standing, and low social support may be at increased nutrition risk and should be proactively screened by healthcare professionals. Interventions and community programs designed to increase levels of social participation and foster social support may help to reduce the prevalence of nutrition risk.
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Affiliation(s)
- C M Mills
- Christine Maire Mills, Queen's University, Faculty of Health Sciences, School of Rehabilitation Therapy, Kingston, ON, Canada, https://orcid.org/0000-0002-6662-8613
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Coker MS, Barati Z, Murphy CJ, Bateman T, Newcomer BR, Wolfe RR, Coker RH. Essential amino acid enriched meal replacement improves body composition and physical function in obese older adults: A randomized controlled trial. Clin Nutr ESPEN 2022; 51:104-111. [PMID: 36184194 PMCID: PMC10162659 DOI: 10.1016/j.clnesp.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 07/14/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Older adults are threatened by the risk of muscle atrophy and excess accumulation of adipose tissue. The objective of this study was to determine whether an essential amino acid enriched meal replacement would reduce excess fat and foster skeletal muscle retention, potentially improving physical function in this cohort. METHODS Using a double blind, randomized controlled trial, we compared the influence of an experimental meal replacement enriched with essential amino acids (EMR) to a commercially available, widely used meal replacement (Optifast®) provided once/day (q.d.) for four weeks on body composition, skeletal muscle and physical function in obese older participants. Twenty-eight individuals completed either EMR (n = 13) or Optifast® (n = 15) supplementation protocols. Measurements of body composition, thigh skeletal muscle cross-sectional area (CSA), blood panels, intrahepatic lipid, and physical function were completed pre- and post-supplementation. RESULTS Body fat mass, visceral fat mass and volume, and intrahepatic lipid were reduced with EMR but not with Optifast®. Thigh muscle CSA increased (Δ 2.4 ± 3.0 cm2) with EMR but not Optifast® (Δ -1.8 ± 6.0 cm2). There was a significant increase in the distance covered during the 6-min walk test with EMR (Δ 23 ± 27 m) but no change in Optifast® (Δ 11 ± 37 m). CONCLUSIONS Beneficial alterations in fat and muscle support the use of EMR-based meal replacements in obese older adults. CLINICAL TRIAL REGISTRATION ISRCTN registry under Reference Number ISRCTN15814848.
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Affiliation(s)
- Melynda S Coker
- Montana Center for Work Physiology and Exercise Metabolism, University of Montana, Missoula, MT, USA
| | - Zeinab Barati
- Institute of Arctic Biology, University of Alaska Fairbanks, Fairbanks, AK, USA
| | - Carl J Murphy
- Institute of Arctic Biology, University of Alaska Fairbanks, Fairbanks, AK, USA
| | - Terry Bateman
- Institute of Arctic Biology, University of Alaska Fairbanks, Fairbanks, AK, USA
| | | | - Robert R Wolfe
- Donald W. Reynolds Institute on Aging, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Robert H Coker
- Montana Center for Work Physiology and Exercise Metabolism, University of Montana, Missoula, MT, USA.
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Thomas J, Lawless C, Christie A, Kuhr O, Miller M. In patients admitted to a home rehabilitation service, is remote completion of the PG-SGA physical examination using still images captured by Allied Health Assistants a valid alternative to an in-person physical examination? J Acad Nutr Diet 2022; 122:2320-2329. [PMID: 35589068 DOI: 10.1016/j.jand.2022.05.012] [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: 11/01/2021] [Revised: 05/08/2022] [Accepted: 05/12/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND There is increasing provision of telehealth services, including nutrition services. However remote nutrition assessments are challenging due to difficulties in conducting physical assessments remotely, a crucial component of assessing nutritional status. OBJECTIVE The aim of this study was to evaluate whether remote completion of the PG-SGA physical examination using still images captured by Allied Health Assistants is a valid alternative to an in-person physical examination in patients admitted to a home rehabilitation service. DESIGN This study was Cross-sectional in design. PARTICIPANTS/SETTING This study involved 104 adults admitted to the home-rehabilitation service at Southern Adelaide Local Health Network, Adelaide Australia over two sampling periods in 2019 and 2020 who were receiving home visits by an AHA and were engaged in rehabilitation activities. MAIN OUTCOME MEASURES Validity of the still-image based physical assessment was determined using still-images collected by an AHA and an in-person physical assessment completed by a dietitian from each participant. A dietitian blinded to the in-person results later assessed the de-identified still-images to determine the presence and extent of deficit at each anatomical site and overall physical examination component of the Patient-generated subjective global assessment (PG-SGA). STATISTICAL ANALYSES PERFORMED Percentage agreement, weighted kappa, sensitivity and specificity between the still-image based and in-person physical examinations were determined to assess agreement between the two methods of assessment. RESULTS The still-image based physical examination achieved a percentage agreement of 75% against the in-person examination, with a weighted kappa of 0.662 (0.516, 0.808) and a sensitivity-specificity pair of 76.6% and 89.1%. CONCLUSIONS Physical examination using still-images collected by AHAs achieved percentage agreement, kappa and sensitivity and specificity compared to an in-person physical examination that is consistent with or superior to commonly adopted nutrition screening and assessment tools. There is potential for implementation of this method to facilitate remote nutritional assessments by dietitians however further work is needed to ensure dietitians are able to assess still-images reliably.
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Affiliation(s)
- Jolene Thomas
- College of Nursing & Health Sciences, Flinders University, Bedford Park, SA. 5042
| | | | - Alexandra Christie
- College of Nursing & Health Sciences, Flinders University, Bedford Park, SA. 5042; Southern Adelaide Local Health Network, Bedford Park, SA 5042
| | - Owen Kuhr
- College of Nursing & Health Sciences, Flinders University, Bedford Park, SA. 5042
| | - Michelle Miller
- College of Nursing & Health Sciences, Flinders University, Bedford Park, SA. 5042
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Langley-Evans SC. Nutrition screening tools: Still no consensus 40 years on. J Hum Nutr Diet 2021; 34:923-925. [PMID: 34783403 DOI: 10.1111/jhn.12952] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Roberts S, Collins P, Rattray M. Identifying and Managing Malnutrition, Frailty and Sarcopenia in the Community: A Narrative Review. Nutrients 2021; 13:nu13072316. [PMID: 34371823 PMCID: PMC8308465 DOI: 10.3390/nu13072316] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 06/29/2021] [Accepted: 06/30/2021] [Indexed: 12/29/2022] Open
Abstract
Malnutrition, frailty and sarcopenia are becoming increasingly prevalent among community-dwelling older adults; yet are often unidentified and untreated in community settings. There is an urgent need for community-based healthcare professionals (HCPs) from all disciplines, including medicine, nursing and allied health, to be aware of, and to be able to recognise and appropriately manage these conditions. This paper provides a comprehensive overview of malnutrition, frailty and sarcopenia in the community, including their definitions, prevalence, impacts and causes/risk factors; and guidance on how these conditions may be identified and managed by HCPs in the community. A detailed description of the care process, including screening and referral, assessment and diagnosis, intervention, and monitoring and evaluation, relevant to the community context, is also provided. Further research exploring the barriers/enablers to delivering high-quality nutrition care to older community-dwelling adults who are malnourished, frail or sarcopenic is recommended, to inform the development of specific guidance for HCPs in identifying and managing these conditions in the community.
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Affiliation(s)
- Shelley Roberts
- School of Health Sciences and Social Work, Griffith University, Gold Coast 4222, Australia;
- Menzies Health Institute Queensland, Griffith University, Gold Coast 4222, Australia
- Allied Health Research, Gold Coast Hospital and Health Service, Gold Coast 4219, Australia
- Correspondence: ; Tel.: +61-7-5552-9557
| | - Peter Collins
- Dietetics and Food Services, Mater Health, Brisbane 4101, Australia;
- Mater Research Institute, University of Queensland, Brisbane 4101, Australia
| | - Megan Rattray
- School of Health Sciences and Social Work, Griffith University, Gold Coast 4222, Australia;
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8
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Kramer LL, Mulder BC, van Velsen L, de Vet E. Use and Effect of Web-Based Embodied Conversational Agents for Improving Eating Behavior and Decreasing Loneliness Among Community-Dwelling Older Adults: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2021; 10:e22186. [PMID: 33404513 PMCID: PMC7817356 DOI: 10.2196/22186] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 10/20/2020] [Accepted: 11/17/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND An unhealthy eating pattern and loneliness negatively influence quality of life in older age. Embodied conversational agents (ECAs) are a promising way to address these health behaviors in an engaging manner. OBJECTIVE We aim to (1) identify whether ECAs can persuade community-dwelling older adults to change their dietary behavior and whether ECA use can decrease loneliness, (2) test these pathways to effects, and (3) understand the use of an ECA. METHODS The web-based eHealth app PACO is a fully automated 8-week intervention in which 2 ECAs engage older adults in dialogue to motivate them to change their dietary behavior and decrease their loneliness. PACO was developed via a human-centered and stakeholder-inclusive design approach and incorporates Self-determination Theory and various behavior change techniques. For this study, an unblinded randomized controlled trial will be performed. There will be 2 cohorts, with 30 participants per cohort. Participants in the first cohort will immediately receive the PACO app for 8 weeks, while participants in the second cohort receive the PACO app after a waiting-list condition of 4 weeks. Participants will be recruited via social media, an online panel, flyers, and advertorials. To be eligible, participants must be at least 65 years of age, must not be in paid employment, and must live alone independently at home. Primary outcomes will be self-assessed via online questionnaires at intake, control, after 4 weeks, and after 8 weeks, and will include eating behavior and loneliness. In addition, the primary outcome-use-will be measured via data logs. Secondary outcomes will be measured at the same junctures, via either validated, self-assessed, online questionnaires or an optional interview. RESULTS As of July 2020, we have begun recruiting participants. CONCLUSIONS By unraveling the mechanisms behind the use of a web-based intervention with ECAs, we hope to gain a fine-grained understanding of both the effectiveness and the use of ECAs in the health context. TRIAL REGISTRATION ClinicalTrials.gov NCT04510883; https://clinicaltrials.gov/ct2/show/NCT04510883. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/22186.
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Affiliation(s)
- Lean L Kramer
- Consumption and Healthy Lifestyles, Wageningen University & Research, Wageningen, Netherlands
| | - Bob C Mulder
- Strategic Communication, Wageningen University & Research, Wageningen, Netherlands
| | - Lex van Velsen
- eHealth Cluster, Roessingh Research and Development, Enschede, Netherlands
- Biomedical Signals and Systems Group, University of Twente, Enschede, Netherlands
| | - Emely de Vet
- Consumption and Healthy Lifestyles, Wageningen University & Research, Wageningen, Netherlands
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Type of Care and Living Situation Are Associated with Nutritional Care but Not Nutritional Status of Older Persons Receiving Home Care. Healthcare (Basel) 2020; 8:healthcare8030296. [PMID: 32854303 PMCID: PMC7551165 DOI: 10.3390/healthcare8030296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/17/2020] [Accepted: 08/21/2020] [Indexed: 12/03/2022] Open
Abstract
Nutritional care and nutritional status may differ in older persons receiving informal (IC) or professional (PC) home care and further depend on the living situation, but little is known in this regard. In this analysis of a cross-sectional multicenter study, type of care, living situation, and nutritional care were enquired in 353 older adults (≥65) receiving IC or PC, living either with partner (LP), with others (LO) or alone (LA), and the nutritional status was determined by BMI and MNA®. For IC receivers, food shopping (IC-LP 94%, IC-LO 96%, IC-LA 92%) and warm meals (IC-LP 89%, IC-LO 90%, IC-LA 71%) were mainly provided by relatives, whereas 47% of PC-LA prepared warm meals by themselves and 22% received meals on wheels. Thirteen percent were underweight, 13% malnourished, and 57% at risk of malnutrition without differences between the groups. Adjusted odds ratios (OR) of being malnourished were also not different (IC-LP 2.2 [95% CI 0.5–9.7], IC-LO 1.4 [0.3–6.6], IC-LA 1.4 [0.3–6.6]) compared to PC-LA. In conclusion, provision of nutritional care obviously differed according to the type of care and living situation, whereas nutritional status does not seem to be affected by these aspects. More research is clearly needed in this field.
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Verwijs MH, Puijk-Hekman S, van der Heijden E, Vasse E, de Groot LCPGM, de van der Schueren MAE. Interdisciplinary communication and collaboration as key to improved nutritional care of malnourished older adults across health-care settings - A qualitative study. Health Expect 2020; 23:1096-1107. [PMID: 32525265 PMCID: PMC7696200 DOI: 10.1111/hex.13075] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/24/2020] [Accepted: 05/03/2020] [Indexed: 01/25/2023] Open
Abstract
Background Malnutrition is a risk factor for impaired functionality and independence. For optimal treatment of malnourished older adults (OA), close collaboration and communication between all stakeholders involved (OA, their caregivers and health‐care and welfare professionals) is important. This qualitative study assesses current collaboration and communication in nutritional care over the continuum of health‐care settings and provides recommendations for improvement. Methods Eleven structured focus group interviews and five individual interviews took place in three regions across the Netherlands from November 2017 until February 2018, including OA, caregivers and health‐care and welfare professionals. Various aspects of collaboration and communication between all stakeholders were discussed. Interviews were transcribed and analysed using a thematic approach. Results Six main themes emerged: causes of malnutrition, knowledge and awareness, recognition and diagnosis of malnutrition, communication, accountability and food preparation and supply. Physical and social aspects were recognized as important risk factors for malnutrition. Knowledge and awareness regarding malnutrition were acknowledged as being insufficient among all involved. This may impair timely recognition and diagnosis. Responsibility for nutritional care and its communication to other disciplines are low. Food preparation and supply in hospitals, rehabilitation centres and home care are below expected standards. Conclusion Many stakeholders are involved in nutritional care of OA, and lack of communication and collaboration hinders continuity of nutritional care over health‐care settings. Lack of knowledge is an important risk factor. Establishing one coordinator of nutritional care is suggested to improve collaboration and communication across health‐care settings.
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Affiliation(s)
- Marije H Verwijs
- Department of Nutrition and Health, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | | | | | - Emmelyne Vasse
- Dutch Malnutrition Steering Group, Amsterdam, The Netherlands
| | | | - Marian A E de van der Schueren
- Department of Nutrition and Health, HAN University of Applied Sciences, Nijmegen, The Netherlands.,Dutch Malnutrition Steering Group, Amsterdam, The Netherlands
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11
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Malnutrition as Key Predictor of Physical Frailty among Malaysian Older Adults. Nutrients 2020; 12:nu12061713. [PMID: 32521618 PMCID: PMC7352933 DOI: 10.3390/nu12061713] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 05/08/2020] [Accepted: 05/15/2020] [Indexed: 12/14/2022] Open
Abstract
Studies have been carried out on the association between frailty and malnutrition, but the similarities and divergence of the relationship remain debatable. This study aimed to explore the prevalence of malnutrition risk and frailty as well as the overlapping constructs. The associations that emerged were assessed independently of other risk factors. A total of 301 community-dwelling older adults with a mean age of 66.91 ± 5.59 years old were randomly recruited. Fried Criteria and Mini Nutritional Assessment-Short Form (MNA-SF) were used to assess frailty status and malnutrition, respectively. Other related nutritional assessments were assessed (body mass index (BMI), circumference measures, body fat % and skeletal muscle mass). The prevalence of frailty was 14.6% and prefrail was 59.7%; 29.6% were at risk of malnutrition, and 3.3% were malnourished. Malnutrition risk was significantly associated with a higher number of chronic diseases, BMI, circumference of mid-upper arm (MUAC), and calf, (CC)and skeletal muscle mass (SMM) and frailty, whereas frailty was significantly associated with higher number of chronic diseases, SMM and malnutrition. Frailty syndrome can be predicted with increasing age, body fat, lower skeletal muscle and malnutrition. Those who were frail were found to be five times more likely to be at risk of malnutrition. Results suggested that frailty and malnutrition shared considerable overlap, which emphasised the interrelated but discrete concepts. Therefore, the assessment of malnutrition is imperative and could be used as a practical implication in assessing frailty syndrome.
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12
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Borkent JW, Keller H, Wham C, Wijers F, de van der Schueren MAE. Cross-Country Differences and Similarities in Undernutrition Prevalence and Risk as Measured by SCREEN II in Community-Dwelling Older Adults. Healthcare (Basel) 2020; 8:E151. [PMID: 32498433 PMCID: PMC7349548 DOI: 10.3390/healthcare8020151] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 05/27/2020] [Accepted: 05/29/2020] [Indexed: 11/16/2022] Open
Abstract
Undernutrition is highly prevalent among community-dwelling older adults. Early identification of nutrition risk is important to prevent or treat undernutrition. This study describes the prevalence rates of nutrition risk in community-dwelling older adults (aged ≥ 65) using the same validated tool across different countries and aims to identify differences in nutritional risk factors. Cross-sectional data was obtained from three datasets including participants from the Netherlands (NL), Canada (CA) and New Zealand (NZ). Seniors in the Community Risk Evaluation for Eating and Nutrition II (SCREEN II) was used to assess nutritional risk factors and prevalence of risk. Differences between countries were tested with logistic and linear regression. Sensitivity analyses were conducted to test the influence of sampling strategy. A total of 13,340 participants were included, and 66.3% were found to be at high nutrition risk. After stratifying the data for method of data sampling, prevalence rates showed some differences across countries (NL: 61.5%, NZ: 68.2%, CA: 70.1%). Risk factor items that contributed to nutrition risk also differed among countries: NZ and CA participants scored higher for weight change, skipping meals, problems with meal preparation, use of meal replacements, problems with biting and chewing, low fluid intake and problems with doing groceries, as compared to participants in NL. Low intake of fruits and vegetables and meat were more prevalent in NL. In conclusion: nutrition risk is a worldwide, highly prevalent problem among community-dwelling older adults, but risk factors contributing to nutrition risk differ by country.
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Affiliation(s)
- Jos W. Borkent
- Department of Nutrition and Health, School of Allied Health, HAN University of Applied Sciences, 6525 EN Nijmegen, The Netherlands; (F.W.); (M.A.E.d.v.d.S.)
| | - Heather Keller
- Schlegel-University of Waterloo Research Institute for Aging, Department of Kinesiology, University of Waterloo, Waterloo, ON N2G 0E2, Canada;
| | - Carol Wham
- School of Sport, Exercise and Nutrition, Massey University, Auckland 0632, New Zealand;
| | - Fleur Wijers
- Department of Nutrition and Health, School of Allied Health, HAN University of Applied Sciences, 6525 EN Nijmegen, The Netherlands; (F.W.); (M.A.E.d.v.d.S.)
| | - Marian A. E. de van der Schueren
- Department of Nutrition and Health, School of Allied Health, HAN University of Applied Sciences, 6525 EN Nijmegen, The Netherlands; (F.W.); (M.A.E.d.v.d.S.)
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General practitioners' views on malnutrition management and oral nutritional supplementation prescription in the community: A qualitative study. Clin Nutr ESPEN 2020; 36:116-127. [PMID: 32220354 DOI: 10.1016/j.clnesp.2020.01.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 12/04/2019] [Accepted: 01/10/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND & AIMS Malnutrition or undernutrition, arising from a deficiency of energy and protein intake, occurs commonly among community-dwelling individuals in developed countries. Once identified, malnutrition can be effectively treated in the majority of cases with dietary advice and the prescription of oral nutritional supplements (ONS) for patients who can eat and drink orally. However, previous research has reported inadequate screening and treatment of malnutrition in the community. The aim of this qualitative study was to explore general practitioners' (GPs) experiences and opinions on the management of malnutrition and the prescription of ONS in the primary care/community setting in Ireland. METHODS Sixteen semi-structured interviews including chart stimulated recalls (CSR) were conducted with GPs. The interviews and CSRs explored, among others, the following domains; barriers and facilitators in the management of malnutrition, ONS prescribing in the primary care/community setting, and future directions in the management of malnutrition and ONS prescribing. Recorded interviews were transcribed and analysed following a generic qualitative approach with inductive thematic analysis using NVIVO 12 to facilitate data management. RESULTS Three main themes were identified. Theme 1: 'Malnutrition is a secondary concern', encapsulating the idea that the identification of malnutrition is usually secondary to other clinical issues or disease rather than an independent clinical outcome. This theme also includes the idea that obesity is viewed as a dominant nutritional issue for GPs. Theme 2: 'Responsibility for malnutrition and ONS management in the community', highlighting that GPs feel they do not know who is responsible for the management of malnutrition in the community setting and expressed their need for more support from other healthcare professionals (HCPs) to effectively monitor and treat malnutrition. Theme 3: 'Reluctance to prescribe ONS', emerging from the GPs reported lack of knowledge to prescribe the appropriate ONS, their concern that ONS will replace the patient's meals and the costs associated with the prescription of ONS. CONCLUSIONS GPs in Ireland do not routinely screen for malnutrition in their clinics as they feel unsupported in treating and managing malnutrition in the community due to limited or no dietetic service availability and time constraints. GPs also view malnutrition as a secondary concern to disease management and prioritise referral to dietetic services for patients with overweight and obesity. GPs reported that they have insufficient knowledge to change or discontinue ONS prescriptions. This study demonstrates that there is a clear need for primary care training in malnutrition identification, treatment and management and more community dietetic services are needed in order to support GPs and deliver high quality care to patients.
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