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Galicia Ernst I, Siebentritt H, Tarantino S, Hiesmayr M, Volkert D. Malnutrition in nursing home residents: A nutritionDay analysis of staff judgment of residents' nutritional status and a validated tool. Clin Nutr ESPEN 2025; 68:326-334. [PMID: 40403966 DOI: 10.1016/j.clnesp.2025.05.023] [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: 03/03/2025] [Revised: 04/28/2025] [Accepted: 05/10/2025] [Indexed: 05/24/2025]
Abstract
BACKGROUND & AIMS Malnutrition among nursing home (NH) residents increases the mortality risk, with prevalence differing based on the screening tool utilized. This study aims to analyze the differences between NH staff's judgment of residents' nutritional status (NH staff) and Mini Nutritional Assessment Short-Form® (MNA) and examine the relationship between these methods and various health factors with six-month mortality in NH residents. METHODS The nutritionDay is a one-day cross-sectional audit with outcome evaluation. The analysis included NH residents ≥65 years old from units participating with ≥5 residents. Differences between NH staff and MNA were analyzed using a cross table, and concordance, minor, and major discrepancies were calculated. Mortality rates for residents with malnutrition, according to both methods, are reported. Two unadjusted and five adjusted binomial logistic regression models analyzed differences regarding mortality, MNA, and NH staff. RESULTS The analysis included 7767 residents (mean age of 87 ± 8 years, 74 % female). MNA identified 18.4 % as malnourished and 48.7 % at risk, while NH staff classified 10.2 % as malnourished and 26.2 % at risk. MNA and NH staff categorizations concurred in 52 % of the cases, 44 % were minor, and 4 % major discrepancies. Overall mortality was 13.8 %, with higher rates observed among malnourished residents (27.1 % MNA and 27.0 % NH staff) and at risk (19.1 % MNA, 13.8 % NH staff). The odds ratio (OR) for mortality was higher for malnourished residents and those at risk (MNA OR 4.4 [95 % confidence interval (CI) 3.6-5.5]; at risk MNA 2.2 [1.8-2.6]) and malnutrition NH staff 2.8 [2.3-3.4]; at risk NH staff 1.988 [1.7-2.3]). These associations were consistent across models, with differences in OR and 95 % CI. Factors such as the inability to express oneself, requiring ≥5 drugs/day, >120 min of care/day, and almost all MNA items were linked to increased mortality risk. CONCLUSIONS The prevalence of malnutrition varied depending on the screening method, with the MNA identifying more residents as malnourished or at risk than the NH staff. Both MNA and NH staff were associated with six-month mortality, confirming previous literature. Consistency across models indicates robust predictors for identifying high-risk residents.
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Affiliation(s)
- Isabel Galicia Ernst
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Institute for Biomedicine of Aging, Nuremberg, Bavaria, Germany.
| | - Hanna Siebentritt
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Institute for Biomedicine of Aging, Nuremberg, Bavaria, Germany
| | - Silvia Tarantino
- Medical University of Vienna, Center for Medical Data Science, Institute of Medical Statistics, Vienna, Austria
| | - Michael Hiesmayr
- Medical University of Vienna, Center for Medical Data Science, Institute of Medical Statistics, Vienna, Austria
| | - Dorothee Volkert
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Institute for Biomedicine of Aging, Nuremberg, Bavaria, Germany
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Malgrat-Caballero S, Kannukene A, Orrego C. Instruments and Warning Signs for Identifying and Evaluating the Frequency of Adverse Events in Intermediate and Long-Term Care Centres: A Narrative Systematic Review. J Healthc Qual Res 2024; 39:315-326. [PMID: 39013688 DOI: 10.1016/j.jhqr.2024.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 05/27/2024] [Accepted: 06/21/2024] [Indexed: 07/18/2024]
Abstract
INTRODUCTION There is a lack of data about adverse events (AE) in intermediate and long-term care centers (ILCC). We aimed to synthesize the available scientific evidence on instruments used to identify and characterize AEs. We also aimed to describe the most common adverse events in ILCCs. MATERIAL AND METHODS A narrative systematic review of the literature was conducted according to Prisma recommendations. The PubMed database was searched for articles published between 2000 and 2021. Two reviewers independently screened and reviewed the studies through blind and independent review. We evaluated bias risk with Cochrane's risk of bias tool. Disagreements were resolved by consensus. Discrepancies that were not resolved by discussion were discussed with a third reviewer. Descriptive data was extracted and qualitative content analysis was performed. RESULTS We found 2191 articles. Based on the inclusion and exclusion criteria, 272 papers were screened by title and abstract, and 66 studies were selected for full review. The instruments used to identify AEs were mostly tools to identify specific AEs or risks of AEs (94%), the remaining 6% were multidimensional. The most frequent categories detected medication-related AEs (n=26, 40%); falls (n=7, 11%); psychiatric AEs (6.9%); malnutrition (4.6%), and infections (4.6%). The studies that used multidimensional tools refer to frailty, dependency, or lack of energy as predictors of AEs. However, they do not take into account the importance of detecting AEs. We found 2-11 adverse drug events (ADE) per resident/month. We found a prevalence of falls (12.5%), delirium (9.6-89%), pain (68%), malnutrition (2-83%), and pressure ulcers (3-30%). Urinary tract infections, lower respiratory tract infections, skin and soft tissue infections, and gastroenteritis were the most common infections in this setting. Transitions between different care settings (from hospitals to ILCC and vice versa) expose AE risk. CONCLUSION There are many instruments to detect AEs in ILCC, and most have a specific approach. Adverse events affect a significant proportion of patients in ILCC, the nurse-sensitive outcomes, nosocomial infections, and adverse drug events are among the most common. The systematic review was registered with Prospero, ID: CRD42022348168.
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Affiliation(s)
- S Malgrat-Caballero
- Centre d'Atenció Intermèdia, Parc Sanitari Pere Virgili, Barcelona, Spain; REFiT-BCN (Research Group on Aging, Frailty and Care Transitions in Barcelona), VHIR (Vall d'Hebron Research Institute), Barcelona, Spain; Programa de Doctorat Interuniversitari de Cures Integrals i Serveis de Salut, Universitat de Vic-Universitat Central de Catalunya, Spain.
| | - A Kannukene
- University of Tartu, Junior Researcher and PhD Student L. Puusepa 8, 50406 Tartu, Estonia
| | - C Orrego
- Avedis Donabedian Research Institute (FAD), 08037 Barcelona, Spain; Faculty of Medicine, Universitat Autónoma de Barcelona (UAB), 08025 Barcelona, Spain; Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barcelona, Spain
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Fernández-Garza LE, Coindreau-Frías F, Botello-González L, Ramos-Bacco M, Barrera-Saldaña HA. Factors Associated with Malnutrition Risk in Residents of Long-Term Care Facilities in Mexico. J Nutr Gerontol Geriatr 2023; 42:91-101. [PMID: 37738390 DOI: 10.1080/21551197.2023.2259348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/24/2023]
Abstract
OBJECTIVE To investigate factors associated with the nutritional status in institutionalized Mexican older adults. MATERIAL AND METHODS In this cross-sectional study of residents in three long-term care facilities (LTCFs) in Monterrey, Mexico, a medical history, Mini-Mental State Examination, Barthel index, and geriatric depression scale, and Mini Nutritional Assessment (MNA) were performed. Risk of malnutrition and malnutrition status were defined as MNA 17-23.5 and <17, respectively. RESULTS Residents (n = 280) had a median age of 85 years and 72.1% were female. A total of 116 (41.4%) were at risk of malnutrition and 35 (12.5%) were malnourished. Having malnutrition or being at risk of malnutrition was associated with age (OR = 1.048), functional dependence (OR = 8.376), body mass index (BMI) <22 (OR = 7.518), cognitive impairment (OR = 2.210), urinary incontinence (OR = 2.397), previous stroke (OR = 2.870), Parkinson's disease (OR = 5.193), use of calcium channel blockers (OR = 3.706), and use of atypical antipsychotics (OR = 2.277). Having benign prostatic hyperplasia (OR = 0.067) or the use of angiotensin II receptor blockers (OR = 0.038) were related to being well-nourished. CONCLUSIONS In a population of residents of three LTCFs in Mexico, we found a high prevalence of malnutrition or being at risk of malnutrition. This underscores the need to implement guidelines for the prompt identification of this condition and further explanation of the factors identified as possibly related to malnutrition.
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Affiliation(s)
- Luis E Fernández-Garza
- National Laboratory of Specialized Services of Research, Development, and Innovation for Chemical and Biotechnological Drugs (LANSEIDI), CONACyT at Innbiogem, Monterrey, Nuevo León, Mexico
- Internal Medicine Department, Mexican Institute of Social Security, Monterrey, Nuevo León, Mexico
| | | | | | | | - Hugo A Barrera-Saldaña
- National Laboratory of Specialized Services of Research, Development, and Innovation for Chemical and Biotechnological Drugs (LANSEIDI), CONACyT at Innbiogem, Monterrey, Nuevo León, Mexico
- Schools of Medicine & of Biological Sciences, Universidad Autónoma de Nuevo León, San Nicolás de los Garza, Nuevo León, Mexico
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Alkhalaf M, Zhang Z, Chang HCR, Wei W, Yin M, Deng C, Yu P. Malnutrition and its contributing factors for older people living in residential aged care facilities: Insights from natural language processing of aged care records. Technol Health Care 2023; 31:2267-2278. [PMID: 37302059 DOI: 10.3233/thc-230229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Malnutrition is a serious health risk facing older people living in residential aged care facilities. Aged care staff record observations and concerns about older people in electronic health records (EHR), including free-text progress notes. These insights are yet to be unleashed. OBJECTIVE This study explored the risk factors for malnutrition in structured and unstructured electronic health data. METHODS Data of weight loss and malnutrition were extracted from the de-identified EHR records of a large aged care organization in Australia. A literature review was conducted to identify causative factors for malnutrition. Natural language processing (NLP) techniques were applied to progress notes to extract these causative factors. The NLP performance was evaluated by the parameters of sensitivity, specificity and F1-Score. RESULTS The NLP methods were highly accurate in extracting the key data, values for 46 causative variables, from the free-text client progress notes. Thirty three percent (1,469 out of 4,405) of the clients were malnourished. The structured, tabulated data only recorded 48% of these malnourished clients, far less than that (82%) identified from the progress notes, suggesting the importance of using NLP technology to uncover the information from nursing notes to fully understand the health status of the vulnerable older people in residential aged care. CONCLUSION This study identified 33% of older people suffered from malnutrition, lower than those reported in the similar setting in previous studies. Our study demonstrates that NLP technology is important for uncovering the key information about health risks for older people in residential aged care. Future research can apply NLP to predict other health risks for older people in this setting.
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Affiliation(s)
- Mohammad Alkhalaf
- Centre for Digital Transformation, School of Computing and Information Technology, University of Wollongong, Wollongong, Australia
- School of Computer Science, Qassim University, Buraydah, Saudi Arabia
| | - Zhenyu Zhang
- Centre for Digital Transformation, School of Computing and Information Technology, University of Wollongong, Wollongong, Australia
| | - Hui-Chen Rita Chang
- School of Nursing and Midwifery, Western Sydney University, Penrith, Australia
| | - Wenxi Wei
- School of Nursing, University of Wollongong, Wollongong, Australia
| | | | - Chao Deng
- School of Medical, Indigenous and Health Sciences, University of Wollongong, Wollongong, Australia
| | - Ping Yu
- Centre for Digital Transformation, School of Computing and Information Technology, University of Wollongong, Wollongong, Australia
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Sjögren K, Bergland Å, Kirkevold M, Lindkvist M, Lood Q, Sandman PO, Vassbø TK, Edvardsson D. Effects of a person-centred and thriving-promoting intervention on nursing home residents' experiences of thriving and person-centredness of the environment. Nurs Open 2022; 9:2117-2129. [PMID: 35485234 PMCID: PMC9190681 DOI: 10.1002/nop2.1222] [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: 01/21/2021] [Revised: 02/25/2022] [Accepted: 04/03/2022] [Indexed: 11/09/2022] Open
Abstract
AIM To evaluate the effects of a person-centred and thriving-promoting intervention on nursing home residents´ experiences of thriving and person-centredness of the environment, and to evaluate if the effects varied between female and male residents. DESIGN A multi-centre, non-equivalent controlled group before-after intervention design. METHODS Six nursing homes in Australia, Norway and Sweden were allocated to either intervention or control group. The intervention comprised a staff educational programme. A survey using proxy-ratings by staff was administered before (T0), immediately after (T1) and six months after (T2) the intervention. The sample varied between 205 and 292 residents. Linear regression models were used to explore effects. RESULTS Statistically significant effects were found on experiences of thriving and person-centredness of the environment. These effects were significant for male residents but not for female residents. The results emphasize the importance of individually tailored social and recreational activities.
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Affiliation(s)
- Karin Sjögren
- Department of Nursing, Umeå University, Umeå, Sweden
| | - Ådel Bergland
- Lovisenberg Diaconal University College, Oslo, Norway
| | - Marit Kirkevold
- Department of Nursing Science, Faculty of Medicine, Institute of Health and Society, Oslo University, Oslo, Norway.,Institute of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | - Marie Lindkvist
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Qarin Lood
- Department of Nursing, Umeå University, Umeå, Sweden.,Department of Health and Rehabilitation, Centre for Ageing and Health - AgeCap, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, Australia
| | | | - Tove Karin Vassbø
- Lovisenberg Diaconal University College, Oslo, Norway.,Faculty of Medicine, Institute of Health and Society, Oslo University, Oslo, Norway
| | - David Edvardsson
- Department of Nursing, Umeå University, Umeå, Sweden.,School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, Australia
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Sunbeam Program Reduces Rate of Falls in Long-Term Care Residents With Mild to Moderate Cognitive Impairment or Dementia: Subgroup Analysis of a Cluster Randomized Controlled Trial. J Am Med Dir Assoc 2022; 23:743-749.e1. [DOI: 10.1016/j.jamda.2022.01.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 12/23/2021] [Accepted: 01/18/2022] [Indexed: 11/22/2022]
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Borkent JW, van Hout HPJ, Feskens EJM, Naumann E, de van der Schueren MAE. Behavioral and Cognitive Problems as Determinants of Malnutrition in Long-Term Care Facilities, a Cross-Sectional and Prospective Study. J Nutr Health Aging 2022; 26:749-759. [PMID: 35934819 DOI: 10.1007/s12603-022-1827-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
OBJECTIVES To investigate the cross-sectional and prospective associations between behavior and cognitive problems and malnutrition in long-term care facilities (LTCF). DESIGN Cross-sectional and prospective routine care cohort study. SETTING 6874 Residents in Dutch LTCFs (period 2005-2020). PARTICIPANTS Data were obtained from the InterRAI-LTCF instrument. Cross-sectional analyses on prevalence of malnutrition at admission included 3722 residents. Prospective analyses studied incident malnutrition during stay (total follow-up time 7104 years) and included data of 1826 residents with first measurement on admission ('newly-admitted') and n=3152 with first measurement on average ~1 year after admission ('existing'). MEASUREMENTS InterRAI scales for communication problems (CS), aggressive behavior (ABS), social engagement (RISE), depressive symptoms (DRS), cognitive performance (CPS) and the total number of behavior and cognitive problems were investigated as independent variables and malnutrition (ESPEN 2015 definition) as dependent variable in regression analyses. Results were stratified for gender and group 'newly-admitted' vs. 'existing'. RESULTS On admission, 9.5% of residents was malnourished. In men, low social engagement was associated with prevalence of malnutrition. In women, all behavior and cognitive problems except depression were associated with malnutrition in the unadjusted analyses, but this attenuated in the full model taking all problems into account. The incidence of malnutrition during stay amounted to 8.9%. No significant associations of behavior and cognitive problems with malnutrition incidence were seen in 'newly-admitted' male residents while in 'existing' male residents all determinants were significantly associated. In 'newly-admitted' female residents CS, ABS and CPS, and in 'existing' female residents CS, RISE, ABS and CPS were significantly associated with incident malnutrition. All associations slightly attenuated after adjustment. Malnutrition incidence increased with increasing number of combined behavior and cognitive problems. CONCLUSION Residents with behavior and cognitive problems are at an increased risk of being malnourished at admission, or becoming malnourished during stay in a LTCF, especially residents with multiple behavior and cognitive problems.
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Affiliation(s)
- J W Borkent
- Jos W. Borkent, Wageningen University, Stippeneng 4, 6708 WE Wageningen, The Netherlands,
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Karim KMR, Tasnim T, Shams SD, Zaher MA, Mamun S. Mini Nutritional Assessment and physical function of older people in residential aged care facility, Bangladesh. Nutr Health 2021; 28:443-452. [PMID: 34250851 DOI: 10.1177/02601060211030119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Malnutrition may decrease physical function and exacerbate health conditions and thus have a negative effect on health-related quality of life of older people. AIM The study was aimed at evaluating the extent of malnutrition, physical function and other associated risk factors for the older persons (>65 years) living in the residential aged care facilities in Bangladesh. METHODS A cross-sectional study was performed with a sample of 200 older people in various residential aged care facilities in Dhaka, Bangladesh. Nutritional status was evaluated using the Mini Nutritional Assessment. A structured questionnaire was used to assess the socioeconomic condition, dietary diversity, functional ability and other related risk factors for malnutrition. RESULTS According to the Mini Nutritional Assessment, 33.5% of participants living in residential aged care facilities were malnourished and 52.5% were at risk of malnutrition. Dietary diversity score differs significantly (p<0.001) among malnourished (3.78 ± 0.45), at risk of malnutrition (4.46 ± 0.98) and well-nourished (4.75 ± 1.11) groups. Twenty-five percent of the study participants reported limitations in mobility and 26.5% reported limitations in activities of daily living. Females were more vulnerable in terms of malnutrition and physical function than males. Mini Nutritional Assessment score is significantly correlated (p<0.05) with several risk factors for malnutrition such as body mass index, education level, meal, protein consumption, dietary diversity score, weight loss, reduced food intake, mobility and activities of daily living of the older people. CONCLUSIONS The study reaffirms that a high rate of malnutrition and risk of malnutrition is prevalent among aged care residents, who need special attention and may benefit from individualized nutrition interventions.
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Affiliation(s)
| | - Tasmia Tasnim
- Department of Nutrition and Food Engineering, 130058Daffodil International University, Bangladesh
| | - Sabrin Deeba Shams
- Institute of Nutrition and Food Science, 95324University of Dhaka, Bangladesh
| | | | - Sumaiya Mamun
- Institute of Nutrition and Food Science, 95324University of Dhaka, Bangladesh
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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: 0.8] [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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Pakai A, Havasi-Sántha E, Mák E, Máté O, Pusztai D, Fullér N, Zrínyi M, Oláh A. Influence of cognitive function and nurse support on malnutrition risk in nursing home residents. Nurs Open 2021; 8:1805-1811. [PMID: 33635604 PMCID: PMC8186720 DOI: 10.1002/nop2.824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 12/09/2020] [Accepted: 01/29/2021] [Indexed: 12/19/2022] Open
Abstract
Aim To predict malnutrition risk of older residents by cognitive function, nurse support and self‐care capacity as primary measures of interest. Design Cross‐sectional, correlation design with linear regression analysis. Methods Older residents over 60 years of age were randomly selected from nursing homes. Mini Mental State Exam and the Mini Nutritional Assessment were used were as main measures. Results Lower malnutrition risk was associated with better cognitive functioning. Improved independence of self‐feeding was also linked to reduced nutritional risk. Nurse support was positively related to BMI and cognitive impairment. General self‐care capacity and ‘appetite the week before’ were key predictors of malnutrition risk; 1‐point increase in both variables caused nutritional risk to decrease by 1.73 and 1.38 points, respectively. That is, a 1‐point increase in self‐care capacity and appetite would decrease malnutrition risk by 5.76% and 4.6%. The regression model explained significant amount (65.6%) of variance in malnutrition risk.
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Affiliation(s)
| | | | - Erzsébet Mák
- Department of Dietetics, Faculty of Health, Semmelweis University, Budapest, Hungary
| | - Orsolya Máté
- Faculty of Health, University of Pécs, Pécs, Hungary
| | | | - Noémi Fullér
- Faculty of Health, University of Pécs, Pécs, Hungary
| | - Miklós Zrínyi
- Faculty of Health, University of Pécs, Pécs, Hungary
| | - András Oláh
- Faculty of Health, University of Pécs, Pécs, Hungary
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Donnelly NA, Sexton E, Merriman NA, Bennett KE, Williams DJ, Horgan F, Gillespie P, Hickey A, Wren MA. The Prevalence of Cognitive Impairment on Admission to Nursing Home among Residents with and without Stroke: A Cross-Sectional Survey of Nursing Homes in Ireland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E7203. [PMID: 33019730 PMCID: PMC7579486 DOI: 10.3390/ijerph17197203] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 09/25/2020] [Accepted: 09/28/2020] [Indexed: 12/27/2022]
Abstract
Post-stroke cognitive impairment (PSCI) is a common consequence of stroke. Epidemiological evidence indicates that, with an ageing population, stroke and PSCI are likely to increase in the coming decades. This may have considerable implications for the demand for nursing home placement. As prevalence estimates of both cognitive impairment and dementia on admission to nursing home among residents with and without stroke have not yet been compared, they were estimated and compared in this study. We performed a cross-sectional survey to establish the admission characteristics of 643 residents in 13 randomly selected nursing homes in Ireland. The survey collected data on resident's stroke and cognitive status at the time of nursing home admission. The survey found, among nursing home residents that experienced stroke prior to admission, prevalence estimates for cognitive impairment (83.8%; 95% CI = 76.9-90.6%) and dementia (66.7%; 95% CI = 57.9-75.4%) were significantly higher compared to residents that had not experienced stroke prior to admission (cognitive impairment: 56.6%; 95% CI = 52.4-60.8%; X2 (1) = 28.64; p < 0.001; dementia: 49.8%; 95% CI = 45.6-54.1%; X2 (1) = 10.47; p < 0.01). Since the prevalence of PSCI is likely to increase in the coming decades, the findings highlight an urgent need for health service planning for this increased demand for nursing home care to meet the care needs of these stroke survivors.
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Affiliation(s)
- Nora-Ann Donnelly
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, D02 P796, Ireland; (E.S.); (N.A.M.); (K.E.B.); (A.H.)
- Social Research Division, Economic and Social Research Institute, D02 K138, Ireland;
| | - Eithne Sexton
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, D02 P796, Ireland; (E.S.); (N.A.M.); (K.E.B.); (A.H.)
| | - Niamh A. Merriman
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, D02 P796, Ireland; (E.S.); (N.A.M.); (K.E.B.); (A.H.)
| | - Kathleen E. Bennett
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, D02 P796, Ireland; (E.S.); (N.A.M.); (K.E.B.); (A.H.)
| | - David J Williams
- Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland, D02 P796, Ireland;
| | - Frances Horgan
- Department Physiotherapy, Royal College of Surgeons in Ireland, D02 P796, Ireland;
| | - Paddy Gillespie
- Health Economics & Policy Analysis Centre (HEPAC), Department of Economics, NUI Galway, H91 TK33, Ireland;
| | - Anne Hickey
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, D02 P796, Ireland; (E.S.); (N.A.M.); (K.E.B.); (A.H.)
| | - Maev-Ann Wren
- Social Research Division, Economic and Social Research Institute, D02 K138, Ireland;
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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: 0.6] [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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O'Neill D, Briggs R, Holmerová I, Samuelsson O, Gordon AL, Martin FC. COVID-19 highlights the need for universal adoption of standards of medical care for physicians in nursing homes in Europe. Eur Geriatr Med 2020; 11:645-650. [PMID: 32557250 PMCID: PMC7298916 DOI: 10.1007/s41999-020-00347-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 06/07/2020] [Indexed: 12/17/2022]
Abstract
The nursing home sector has seen a disproportionately high number of deaths as part of the COVID-19 pandemic. This reflects, in part, the frailty and vulnerability of older people living in care homes but has also, in part, been a consequence of the failure to include care homes in the systematic planning of a response to COVID, as well as a measure of neglect of standards and quality improvement in the sector. In response, the EUGMS published a set of medical standards of care developed in consultation with experts across its member national societies in 2015. The standards consisted of seven core principles of medical care for physicians working in nursing homes as a first step in developing a programme of clinical, academic and policy engagement in improving medical care for older people who are living and frequently also dying as residents in nursing homes. The gravity of the concerns arising for nursing home care from the COVID-19 pandemic, as well as emerging insights on care improvement in nursing homes indicate that an update of these medical standards is timely. This was performed by the writing group from the original 2015 guidelines and is intended as an interim measure pending a more formal review incorporating a systematic review of emerging literature and a Delphi process.
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Affiliation(s)
- Desmond O'Neill
- Centre for Ageing, Neuroscience and the Humanities, Trinity College Dublin, Trinity Centre for Health Sciences, Tallaght University Hospital, Dublin, D24 NR0A, Ireland.
| | | | | | | | - Adam L Gordon
- Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Nottingham, UK
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Nutritional Status Plays More Important Role in Determining Functional State in Older People Living in the Community than in Nursing Home Residents. Nutrients 2020; 12:nu12072042. [PMID: 32660012 PMCID: PMC7400166 DOI: 10.3390/nu12072042] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 07/05/2020] [Accepted: 07/06/2020] [Indexed: 12/14/2022] Open
Abstract
The aim of this study was to verify whether the relationship between nutritional and functional status differs between seniors in the community and those in long-term care institutions. One hundred nursing home (NH) residents aged 60 years and above and 100 sex- and age-matched community-dwelling (CD) older adults were examined. Functional status was assessed using the Comprehensive Geriatric Assessment (CGA) and nutritional status using anthropometric measures, the Mini Nutritional Assessment questionnaire (MNA) and bioimpedance analysis (BIA). Significant environmental interactions were observed with resting metabolic rate (RMR), extracellular water (ECW) and intracellular water (ICW) ratio, skeletal muscle mass (SMM), skeletal muscle index (SMI) and impedance (Z) and resistance (R) to the results of the Timed Up and Go (TUG) test. The two groups demonstrated different relationships between Z and R and handgrip strength and between Geriatric Depression Scale (GDS) score and fat free mass (FFM), body density, total body water (TBW) and phase angle (PhA). Nutritional status seems to be more important for functional state in CD older people than in NH residents. Therefore, to ensure the functional independence of seniors living in the community, it is crucial to maintain the correct nutritional parameters. Further studies are necessary to account for the fact that this relationship is less significant among NH residents and to identify other factors that may contribute to these discrepancies between community and institutional environments.
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Ultrasound Muscle Assessment and Nutritional Status in Institutionalized Older Adults: A Pilot Study. Nutrients 2019; 11:nu11061247. [PMID: 31159255 PMCID: PMC6627854 DOI: 10.3390/nu11061247] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 05/26/2019] [Accepted: 05/29/2019] [Indexed: 01/10/2023] Open
Abstract
Muscle thickness, measured by ultrasonography, has been investigated for nutritional assessment in older adults, however the associations between muscle ultrasound parameters in the lower limb and nutritional status have not been studied. The aim of this study was to investigate the relationship between muscle thickness echo intensity (EI), and nutritional status in home care residents. A cross sectional study was conducted involving 19 older adults from a home care in Malaga (Spain). We evaluated lower leg muscles by ultrasound, anthropometric data, physical function (measured by gait speed and the Short Physical Performance Battery), strength (handgrip and knee extensors strength) and nutritional status across the Mini-Nutritional Assessment Short-Form (MNA-SF). We found that muscle thickness assessed by ultrasonography independently predicts nutritional status by MNA-SF and after adjusting for handgrip strength or age and sex. As secondary findings, we found relations between strength, functional capacity and the MNA-SF test. These results suggest that lower leg muscle ultrasound parameters could be used as a low-cost objective method for muscle evaluation in nutritional assessment in older adults.
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Ortiz M, Schnabel K, Binting S, Fischer HF, Teut M, Suhr R, Brinkhaus B. Complementary and Integrative Medicine in Nursing Homes: Results of a Cross-Sectional Study in Residents and Caregivers. Complement Med Res 2019; 26:310-321. [PMID: 31141810 DOI: 10.1159/000500515] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 04/21/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Some nursing homes for the elderly in Germany integrate complex complementary and integrative medicine interventions in the form of hydrotherapy, herbal and mind-body therapies, physical activities, and healthy eating, known as Kneipp therapy (KT), in care. This pilot study explored health- and work-related characteristics and acceptance of KT amongst residents and caregivers. METHODS Within a mixed-methods cross-sectional study in nursing homes who had integrated KT, we assessed work ability, psychosocial burden at work and health-related quality of life of caregivers, as well as a broad selection of health-related data of residents by questionnaires and assessments. Data were analyzed descriptively. RESULTS The data from 29 female caregivers (42.0 ± 11.7 years) and 64 residents (83.2 ± 8.1 years) were analyzed. Both caregivers (96%) and residents (89%) considered KT to be beneficial for health and well-being. Ninety percent of the caregivers indicated an improved relationship to residents since implementing KT. Caregivers showed a good work ability and quality of life. Residents attained remarkable ratings in social relation and affect-related aspects of quality of life. CONCLUSION The results of this cross-sectional study indicate a high acceptance of integrating KT by residents and caregivers. The effectiveness and safety of KT should be explored in further comparative studies.
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Affiliation(s)
- Miriam Ortiz
- Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany,
| | - Katharina Schnabel
- Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sylvia Binting
- Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Herbert Felix Fischer
- Department of Psychosomatic Medicine, Centre for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Michael Teut
- Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Ralf Suhr
- Centre for Quality in Care, Berlin, Germany
| | - Benno Brinkhaus
- Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Psychometric properties of the Persian version of the nutritional form for the elderly (NUFFE) in nursing home residents. Med J Islam Repub Iran 2019; 32:105. [PMID: 30815400 PMCID: PMC6387812 DOI: 10.14196/mjiri.32.105] [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: 10/17/2017] [Indexed: 11/18/2022] Open
Abstract
Background: The Nutritional Form for the Elderly (NUFFE) is a newly developed tool. This study aimed to carry out a psychometric evaluation of the Persian version of NUFFE (NUFFE-P) among nursing home residents.
Methods: Nursing home participant’s aged ≥ 60 years (n=97) were enrolled. The inclusion criteria were residency for at least 6 months in the nursing home, and ability to communicate. Exclusion criteria included cognitive impairment, having depressed mood, severe hearing loss, problems in upper and lower extremities also, history of hospital admission during 6 months before enrollment. Anthropometric measures, laboratory tests, three-day food intake, NUFFE-P version, Mini Nutritional Assessment (MNA), Barthel Index (BI) and Geriatric Depression Scale (GDS-15) were assessed. The relationship between the NUFFE-P and MNA scores was considered as concurrent validity.
Results: The Cronbach’s alpha coefficient of NUFFE-P tool was 0.76. The intraclass correlation coefficient for the total score between two raters obtained 0.98 (CI 0.97-0.99). The correlation coefficient between the NUFFE-P and the MNA scores was -0.75 (p<0.01). Four factors were extracted for the NUFFE-P in an exploratory factor analyses. Sensitivity 69.8% and 100% and specificity 75.7% and 85.6% were achieved to detect elderly at medium risk (cutoff=6), and at high risk of under-nutrition (cutoff=11) respectively.
Conclusion: The NUFFE-P has sufficient psychometric properties in nutritional status screening among the Iranian elderly nursing homes residents.
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Damo CC, Doring M, Alves ALS, Portella MR. Risk of malnutrition and associated factors in institutionalized elderly persons. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2018. [DOI: 10.1590/1981-22562018021.180152] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Abstract Objective : to evaluate the risk of malnutrition and associated factors in institutionalized elderly persons. Method : a cross-sectional study was carried out with elderly persons living in long-term care facilities in the municipal regions of Passo Fundo (Rio Grande do Sul) and Carazinho (Rio Grande do Sul) in 2017. A standardized, pre-codified questionnaire with sociodemographic variables was used, along with anthropometric data and the Mini Nutritional Assessment. Cognitive decline and non-intentional weight loss were also evaluated. The qualitative variables were presented in terms of univariate frequencies and the quantitative variables were described through measures of central tendency and dispersion. In order to verify the association between the categorical variables, the Pearson’s correlation coefficient, Chi-Squared test and the Fisher Exact test were applied, and in the crude and adjusted analysis the Poisson regression was used with robust variance. The level of significance was 5%. Results : a total of 399 elderly people were included, of whom 69.9% were female, 54.5% were aged 80 years or older and 88.4% were white. Of these elderly people, 61.7% lived in non-profit facilities. In the evaluation of nutritional status, 26.6% of the elderly were found to be malnourished, 48.1% were at risk of malnutrition and 25.3% had normal nutritional status. The highest prevalence ratio of at risk of malnutrition/malnutrition was with cognitive decline and unintentional weight loss (p<0.001). Conclusion : through the results, identifying nutritional status and the characteristics associated with the risk of malnutrition contribute to effective evaluation and nutritional monitoring, assisting in the prevention of diseases related to this condition.
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Backlund A, Holmbeck O, Kumlien C, Axelsson M. A registry study of nursing assessments, interventions and evaluations according to nutrition for persons living in municipal residential care homes. Nurs Open 2018; 5:341-350. [PMID: 30062028 PMCID: PMC6056451 DOI: 10.1002/nop2.144] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 02/28/2018] [Indexed: 01/04/2023] Open
Abstract
AIM The aim was to explore planned nursing interventions and evaluations of such interventions, in older people at risk for malnutrition living in municipal residential care homes. DESIGNS A registry study. METHODS The study was conducted using data from the Swedish national quality registry Senior Alert. Data on all persons assessed and registered in Senior Alert living in municipal residential care homes in a mid-sized town between January and December 2014 were subjected to statistical analysis. RESULTS In total, 677 nutritional risk assessments were performed among the participants (N = 587), who were between 65-109 years. A larger proportion of women were estimated as being at risk for malnutrition compared with men. The three most common prescribed nursing interventions were nutritional treatment, dietary support and weight control; however, interventions were not prescribed for all participants at risk for malnutrition. Lesser than 50% of the interventions were evaluated, with dietary support, pharmaceutical review and weight control the three most likely to be evaluated. Further, planned interventions for participants at risk of malnutrition were implemented more often for men than for women.
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Affiliation(s)
- Anja Backlund
- Faculty of Health and SocietyDepartment of Caring ScienceMalmö UniversityMalmöSweden
| | - Olga Holmbeck
- Faculty of Health and SocietyDepartment of Caring ScienceMalmö UniversityMalmöSweden
| | - Christine Kumlien
- Faculty of Health and SocietyDepartment of Caring ScienceMalmö UniversityMalmöSweden
- Department of Cardio‐Thoracic and Vascular SurgerySkane University hospitalMalmöSweden
| | - Malin Axelsson
- Faculty of Health and SocietyDepartment of Caring ScienceMalmö UniversityMalmöSweden
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20
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Harsányiová M, Prokop P. Living condition, weight loss and cognitive decline among people with dementia. Nurs Open 2018; 5:275-284. [PMID: 30062020 PMCID: PMC6056446 DOI: 10.1002/nop2.137] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 01/22/2018] [Indexed: 12/14/2022] Open
Abstract
AIMS The aim of this study was to investigate cognitive performance and BMI of patients with dementia living in their own homes with family members, nursing homes and alone. DESIGN A prospective observational cohort study with a quantitative design. METHOD Mini-mental state examination (MMSE) scores and BMI were examined with a sample of Slovak patients (N = 428). Patients were followed up 12 months later after the first examination. RESULTS Cognitive decline was significantly faster for patients living in nursing homes and for solitary patients. BMI consistently decreased in the follow-up examination and this drop was stronger in patients living alone and in nursing homes. Patients with VaD manifested a stronger BMI decline as compared with AD patients. This study suggests that impoverished conditions such as nursing homes or social isolation of solitary people contribute to stronger progress in dementia. Healthcare professionals need to implement meaningful activities for institutionalized people and for people who are living alone to eliminate the negative impact of an impowerished environment on patient's cognitive functioning.
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Affiliation(s)
| | - Pavol Prokop
- Faculty of EducationDepartment of BiologyTrnava UniversityTrnavaSlovakia
- Institute of ZoologySlovak Academy of SciencesBratislavaSlovakia
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21
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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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Kijowska V, Szczerbińska K. Prevalence of cognitive impairment among long-term care residents: a comparison between nursing homes and residential homes in Poland. Eur Geriatr Med 2018; 9:467-476. [DOI: 10.1007/s41999-018-0062-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 04/30/2018] [Indexed: 11/29/2022]
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Combe N, Henry O, Lopez C, Vaysse C, Fonseca I, Ribaud D, Driss F, Simon N, Le Guillou C, Mendy F. Hospital Diet Enriched With Rapeseed or Sunflower Oils Is Associated With a Decrease in Plasma 16:1n-7 and Some Metabolic Disorders in the Elderly. Lipids 2018; 53:145-155. [PMID: 29394449 DOI: 10.1002/lipd.12012] [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: 11/17/2017] [Accepted: 11/18/2017] [Indexed: 11/06/2022]
Abstract
We recently demonstrated that the prevalence of dysglycemia was high among hospitalized elderly people who were fed a low fat diet (27.7% of energy) and was positively associated with plasma 16:1n-7, an indicator of de novo lipogenesis (DNL). Fatty acids in the DNL pathway have been shown to be associated with a higher risk of metabolic syndrome (MetS). The purpose of this study was to investigate the potential beneficial effects of fat enrichment (up to 34.1%en) of the hospital diet in 111 patients (30 men and 81 women, 84 ± 7 years) during 6 weeks. Based on gender, they were randomly given a diet supplemented either with rapeseed oil (RO) or with sunflower oil (SO). Fatty acids of cholesteryl esters and erythrocyte phospholipids and markers of metabolic disorders were evaluated before and after dietary intervention. Both enriched diets significantly, and to a similar extent, decreased (1) the overall prevalence of dysglycemia (by 25-33%) and MetS (by 31-43%) and (2) plasma 16:1n-7 mol% in men and women. Dysglycemia prevalence adjusted by the diets was reduced in men versus baseline; no change was found in women. Enrichment of the diet with RO or SO resulted in a difference in fatty acid compositions, that is, EPA (mol%) and the omega-3 index increased with RO, while proportions of 18:1n-7, 18:1n-9, and EPA decreased with SO. These findings highlight the need for adequate fat intake in the elderly. For supplementation of the hospital diet, RO, which led to a higher proportion of circulating n-3 polyunsaturated fatty acids (PUFA) and is known to be beneficial, may be preferred to SO.
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Affiliation(s)
- Nicole Combe
- ITERG, Unité de Nutrition, Métabolisme & Santé, Université Bordeaux 2, 33076 Bordeaux, France
| | - Olivier Henry
- Groupe Hospitalier Henri Mondor, Hôpital Emile Roux, 94450 Limeil-Brévannes, France
| | - Carlos Lopez
- Institut de l'Elevage, 149 rue de Bercy, 75595 Paris, France
| | - Carole Vaysse
- ITERG, Unité de Nutrition, Métabolisme & Santé, Université Bordeaux 2, 33076 Bordeaux, France
| | - Isabelle Fonseca
- Groupe Hospitalier Henri Mondor, Hôpital Emile Roux, 94450 Limeil-Brévannes, France
| | - Danièle Ribaud
- Institut de l'Elevage, 149 rue de Bercy, 75595 Paris, France
| | - Fathi Driss
- Laboratoire d'Hormonologie/Géné. Mol., Hôpital Bichat, Claude Bernard, Paris, France
| | - Noëmie Simon
- Terres Univia, 11 rue de Monceau, 75008 Paris, France
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Tombini M, Sicari M, Pellegrino G, Ursini F, Insardá P, Di Lazzaro V. Nutritional Status of Patients with Alzheimer's Disease and Their Caregivers. J Alzheimers Dis 2018; 54:1619-1627. [PMID: 27636839 DOI: 10.3233/jad-160261] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Malnutrition is one of the most important conditions that negatively affects the health of elder people, particularly in patients with dementia. OBJECTIVE To provide an assessment of nutritional status of patients affected by Alzheimer's disease (AD) living at home and of their caregivers by means of Mini Nutritional Assessment (MNA), and to explore the influence of different factors on nutrition. METHODS 90 patients affected by AD living at home and 90 age- and sex-matched caregivers were enrolled. Patients and caregivers, coming from an urban-rural fringe of Southern Italy, were assessed using full MNA, Mini-Mental State Examination, Geriatric Depression Scale- short form, Activity of Daily Living, and Instrumental Activities of Daily Living scales. RESULTS Malnutrition was found with high prevalence in patients affected by AD of different severity (more than 95% of patients were malnourished or at risk of malnutrition), and associated with reduced functional status. An altered nutrition was also recognized with high rate in the group of caregivers (23.3% were malnourished and 41.1% at risk of malnutrition) and the worse nutritional condition was correlated with higher age and lower functional and cognitive status and education. A positive correlation between MNA score of AD patients and caregivers was found. CONCLUSION Corrective measures should be taken in order to early identify nutritional deficiencies and risk of malnutrition observed with high rate in both groups of AD patients and their caregivers; in these subjects a nutrition education program and intervention policies are mandatory to restore nutritional status.
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Affiliation(s)
- Mario Tombini
- Department of Medicine, Unit of Neurology, Neurophysiology, Neurobiology, Campus Bio-Medico University, Rome, Italy
| | - Maura Sicari
- Centro Nutrizione Clinica e Umana, Reggio Calabria, Italy
| | - Giovanni Pellegrino
- Department of Medicine, Unit of Neurology, Neurophysiology, Neurobiology, Campus Bio-Medico University, Rome, Italy.,Multimodal Functional Imaging Laboratory, Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Francesca Ursini
- Department of Medicine, Unit of Neurology, Neurophysiology, Neurobiology, Campus Bio-Medico University, Rome, Italy
| | | | - Vincenzo Di Lazzaro
- Department of Medicine, Unit of Neurology, Neurophysiology, Neurobiology, Campus Bio-Medico University, Rome, Italy
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Zimmermann J, Pfaff H. Influence of Nurse Staffing Levels on Resident Weight Loss Within German Nursing Homes. Res Gerontol Nurs 2018; 11:48-56. [DOI: 10.3928/19404921-20180109-01] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 11/22/2017] [Indexed: 11/20/2022]
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26
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Bauer S, Halfens RJ, Lohrmann C. Changes in nutritional status in nursing home residents and associated factors in nutritional status decline: a secondary data analysis. J Adv Nurs 2017; 73:2420-2429. [DOI: 10.1111/jan.13297] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2017] [Indexed: 01/07/2023]
Affiliation(s)
- Silvia Bauer
- Department of Nursing Science; Medical University of Graz; Austria
| | - Ruud J.G. Halfens
- Department of Health Services Research - Focusing on Value-based Care and Ageing School for Public Health and Primary Care (CAPHRI); Maastricht University; the Netherlands
| | - Christa Lohrmann
- Department of Nursing Science; Medical University of Graz; Austria
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Robb L, Walsh CM, Nel M, Nel A, Odendaal H, van Aardt R. Malnutrition in the elderly residing in long-term care facilities: a cross sectional survey using the Mini Nutritional Assessment (MNA®) screening tool. SOUTH AFRICAN JOURNAL OF CLINICAL NUTRITION 2016. [DOI: 10.1080/16070658.2016.1248062] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Liska Robb
- Department of Nutrition and Dietetics, University of the Free State, Bloemfontein, South Africa
| | - Corinna May Walsh
- Department of Nutrition and Dietetics, University of the Free State, Bloemfontein, South Africa
| | - Mariette Nel
- Department of Biostatistics, University of the Free State, Bloemfontein, South Africa
| | - Annica Nel
- Department of Nutrition and Dietetics, University of the Free State, Bloemfontein, South Africa
| | - Hester Odendaal
- Department of Nutrition and Dietetics, University of the Free State, Bloemfontein, South Africa
| | - Reon van Aardt
- Department of Nutrition and Dietetics, University of the Free State, Bloemfontein, South Africa
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28
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Björk S, Juthberg C, Lindkvist M, Wimo A, Sandman PO, Winblad B, Edvardsson D. Exploring the prevalence and variance of cognitive impairment, pain, neuropsychiatric symptoms and ADL dependency among persons living in nursing homes; a cross-sectional study. BMC Geriatr 2016; 16:154. [PMID: 27549203 PMCID: PMC4994232 DOI: 10.1186/s12877-016-0328-9] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 08/15/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Earlier studies in nursing homes show a high prevalence of cognitive impairment, dependency in activities of daily living (ADL), pain, and neuropsychiatric symptoms among residents. The aim of this study was to explore the prevalence of the above among residents in a nationally representative sample of Swedish nursing homes, and to investigate whether pain and neuropsychiatric symptoms differ in relation to gender, cognitive function, ADL-capacity, type of nursing-home unit and length of stay. METHODS Cross-sectional data from 188 randomly selected nursing homes were collected. A total of 4831 residents were assessed for cognitive and ADL function, pain and neuropsychiatric symptoms. Data were analysed using descriptive statistics and the chi-square test. RESULTS The results show the following: the prevalence of cognitive impairment was 67 %, 56 % of residents were ADL-dependent, 48 % exhibited pain and 92 % exhibited neuropsychiatric symptoms. The prevalence of pain did not differ significantly between male and female residents, but pain was more prevalent among cognitively impaired and ADL-dependent residents. Pain prevalence was not significantly different between residents in special care units for people with dementia (SCU) and general units, or between shorter-and longer-stay residents. Furthermore, the prevalence of neuropsychiatric symptoms did not differ significantly between male and female residents, between ADL capacities or in relation to length of stay. However, residents with cognitive impairment and residents in SCUs had a significantly higher prevalence of neuropsychiatric symptoms than residents without cognitive impairment and residents in general units. CONCLUSIONS The prevalence rates ascertained in this study could contribute to a greater understanding of the needs of nursing-home residents, and may provide nursing home staff and managers with trustworthy assessment scales and benchmark values for further quality assessment purposes, clinical development work and initiating future nursing assessments.
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Affiliation(s)
- Sabine Björk
- Department of Nursing, Umeå University, Umeå, Sweden.
| | | | - Marie Lindkvist
- Department of Statistics, Umeå School of Business and Economics, Umeå University, Umeå, Sweden.,Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Anders Wimo
- Department of Neurobiology, Care Sciences and Society, Division of Neurogeriatrics, Karolinska Institutet, Stockholm, Sweden
| | - Per-Olof Sandman
- Department of Nursing, Umeå University, Umeå, Sweden.,Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden.,Department of Health Sciences, Luleå University of Technology, Luleå, Sweden
| | - Bengt Winblad
- Department of Neurobiology, Care Sciences and Society, Division of Neurogeriatrics, Karolinska Institutet, Stockholm, Sweden
| | - David Edvardsson
- Department of Nursing, Umeå University, Umeå, Sweden.,School of Nursing and Midwifery, La Trobe University, Melbourne, Australia
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[Vitamins and nutritional supplements in older persons: How to diagnose and when to substitute?]. Internist (Berl) 2016; 56:1318-24. [PMID: 26349908 DOI: 10.1007/s00108-015-3778-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Despite an excellent food supply in Germany, a large percentage of older persons living at home or institutionalized older persons suffer from or are at risk for malnutrition. The purpose of this article is to highlight the association between nutrient deficiencies and age-related diseases and give rational recommendations for substitution. Both malnutrition and low levels of specific nutrients are associated with cognitive and functional impairment, dementia, and depression in older persons. Most prevalent are deficiencies in vitamin B1, vitamin B12, and vitamin D. Serum levels are often misleading and show false negative results in vitamin B1 and B12 deficiencies; therefore, determination of erythrocyte transketolase activity (ETKA) and the thiamine pyrophosphate (TPP) effect for vitamin B1 and of methylmalonic acid and holotranscobalamine for vitamin B12 is recommended. Prophylactic supplementation with vitamins is not supported by prospective trials; however, positive data from observational studies support a Mediterranean diet combined with intake of vitamins, antioxidants, and unsaturated fatty acids. Older persons should be regularly screened for malnutrition and the threshold for determination of vitamin B1, B12, and vitamin D should be low. Vitamin substitution should be reserved for proven deficits. There is now data regarding cognition from prospective trials on effects of a healthy diet combined with other life-style factors like physical and cognitive activity.
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Chen LY, Liu LK, Hwang AC, Lin MH, Peng LN, Chen LK, Lan CF, Chang PL. Impact of Malnutrition on Physical, Cognitive Function and Mortality among Older Men Living in Veteran Homes by Minimum Data Set: A Prospective Cohort Study in Taiwan. J Nutr Health Aging 2016; 20:41-7. [PMID: 26728932 DOI: 10.1007/s12603-016-0674-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To evaluate the prevalence of malnutrition and its impact on mortality, functional decline and cognitive impairment among elder residents in long-term care settings. DESIGNS A prospective cohort study. SETTINGS Two veteran homes in Taiwan. PARTICIPANTS A total of 1,248 male residents aged equal or more than 65 years. MEASUREMENTS Charlson's comorbidity index (CCI), Minimum data set (MDS), resident assessment protocols (RAP), Activity of daily living-Hierarchy scale, Cognitive Performance Scale, MDS Social engagement scale. RESULTS The mean age of participants is 83.1 ± 5.1 years, and the prevalence of malnutrition was 6.1%. Inadequate dietary content (57.9%) and unintentional weight loss (31.6%) account for the majority of malnutrition identified by MDS tool. Higher 18-month mortality rate (25% vs. 14.2%), higher baseline CCI (median 1 vs. 0), and higher baseline sum of RAP triggers (median 8.5 vs. 5) were noted among residents with malnutrition. Furthermore, malnutrition was shown predictive for functional decline (OR: 3.096, 95% CI: 1.715-5.587) and potential cognitive improvement (OR: 2.469, 95% CI: 1.188-5.128) among survivors after adjustment for age, body mass index and CCI. CONCLUSION Malnutrition among elder men residing in veteran homes was associated with multimorbidities and higher care complexity, and was predictive for mortality and functional decline.
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Affiliation(s)
- L-Y Chen
- Liang-Kung Chen, MD, PhD, Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, No. 201, Sec. 2nd, Shih-Pai Rd. Taipei, Taiwan 11217, Tel: +886-2-28757830, Fax: +886-2-28757711, E-mail:
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Changes in Oxidative Stress and Inflammatory Biomarkers in Fragile Adults over Fifty Years of Age and in Elderly People Exclusively Fed Enteral Nutrition. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2015; 2015:5709312. [PMID: 26697137 PMCID: PMC4678080 DOI: 10.1155/2016/5709312] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 08/14/2015] [Accepted: 08/16/2015] [Indexed: 12/18/2022]
Abstract
We aim to evaluate whether exclusive feeding of an enteral formula enriched with n-3 long chain polyunsaturated fatty acids (n-3 LC-PUFA) affects oxidative stress and the antioxidant defence system and may improve the levels of some relevant inflammatory, and cardiovascular biomarkers in frail adults over fifty years of age and in elderly subjects. Fifty-five patients were divided into two groups and were exclusively fed a newly designed normoproteic and isocaloric enteral formula enriched with eicosapentaenoic (98 mg/d) and docosahexaenoic acids (46 mg/d) (n = 26) or a reference enteral diet (n = 29). Oxidative, inflammatory and cardiovascular risk biomarkers and red blood cell fatty acid profiles were determined at the beginning and after 90 and 180 days of feeding. The n-3 LC-PUFA percentage tended to be higher (P = 0.053) in the experimental group than in the reference group. Administration of the n-3 LC-PUFA diet did not increase oxidative stress or modify plasma antioxidant capacity but decreased antioxidant enzymatic activities. MMP-9 plasma concentration decreased with both formulae, whereas tPAI-1 tended to decrease (P = 0.116) with the administration of the experimental formula. In conclusion, administration of the new n-3 LC-PUFA-enriched product for 6 months did not negatively alter the oxidative status and improved some cardiovascular risk biomarkers.
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Henry O, Vaysse C, Lopez C, Driss F, Fonseca I, Simon N, Guillou CL, Masselin‐Silvin S, David J, Combe N, Mendy F. Relationships between plasma and erythrocyte fatty acids in the de novo lipogenesis pathway, and metabolic disorders in French elderly patients. EUR J LIPID SCI TECH 2015. [DOI: 10.1002/ejlt.201500213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Olivier Henry
- Groupe Hospitalier Henri MondorHôpital Emile RouxLimeil–BrevannesFrance
| | - Carole Vaysse
- ITERGUnité de NutritionMétabolisme & SantéUniversité Bordeaux 2BordeauxFrance
| | | | - Fathi Driss
- Laboratoire d'Hormonologie/Géné. Mol. Hôpital BichatClaude BernardParisFrance
| | - Isabelle Fonseca
- Groupe Hospitalier Henri MondorHôpital Emile RouxLimeil–BrevannesFrance
| | | | | | | | | | - Nicole Combe
- ITERGUnité de NutritionMétabolisme & SantéUniversité Bordeaux 2BordeauxFrance
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Mastronuzzi T, Paci C, Portincasa P, Montanaro N, Grattagliano I. Assessing the nutritional status of older individuals in family practice: Evaluation and implications for management. Clin Nutr 2015; 34:1184-1188. [PMID: 25547985 DOI: 10.1016/j.clnu.2014.12.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 08/18/2014] [Accepted: 12/11/2014] [Indexed: 01/03/2023]
Abstract
BACKGROUND & AIMS Malnutrition is emerging as a multidimensional concern of ageing with a high prevalence among nursing home residents. This study investigated the extent of malnutrition among old subjects in family practice and its relationship with major complications. METHODS Over 75 years old subjects (n = 274) filled the Mini Nutritional Assessment questionnaire. Appearance of major events in the following 6 months were registered. RESULTS MNA scored were 11.5 ± 3.1, with 175 (64%) subjects showing no malnutrition, 69 (25%) resulted at risk, and 30 (11%) malnourished. Within at risk group, 1.4% was resident, 7% bed rested, 8% had a history of major bone fracture, 33% was demented and 24.6% hospitalized at least once in the last year. Among malnourished patients, 10% was resident, ten bed rested with 70% showing multiple bedsores, 20% have had bone fractures, 60% were demented and 13% hospital admitted in the previous year. In over 90% of them, malnutrition had neither diagnosed nor considered before. During follow-up, a significantly higher number of major events including death occurred in the malnourished group. By multivariate logistic regression, n = 56 (20.4%) patients resulted at risk of major complications. The sensitivity of the questionnaire in identifying these patients was 84% with the cut-off value of 7 associated with the highest prediction (positive predictive value, 0.92; negative predictive value, 0.71) yielding a specificity of 92%. CONCLUSIONS The prevalence of malnutrition is high among older subjects in the setting of family practice. The Mini Nutritional Assessment allows to identify malnourished subjects better than BMI and effectively predicts the risk of major events.
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Affiliation(s)
| | - Claudio Paci
- Italian College of General Practitioners, Bari, Italy
| | - Piero Portincasa
- Department of Biosciences and Human Oncology (DIMO), Clinica Medica 'A. Murri', University of Bari Medical School, Policlinico Hospital, Bari, Italy
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Dupuy C, de Souto Barreto P, Ghisolfi A, Guyonnet S, Dorigny B, Vellas B, Rolland Y. Indicators of oral nutritional supplements prescription in nursing home residents: A cross-sectional study. Clin Nutr 2015; 35:1047-52. [PMID: 26243061 DOI: 10.1016/j.clnu.2015.07.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 06/21/2015] [Accepted: 07/15/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND & AIMS Identifying factors associated with oral nutritional supplement (ONS) prescription in nursing homes (NH) may help to treat malnutrition in this very old and vulnerable population. OBJECTIVES The aim of the study was to investigate if resident-related and NH-related characteristics were associated with ONS prescription. DESIGN Cross-sectional study using medical and demographic data from 6275 NH residents and data on the structure and organization (e.g., presence of a dietitian, organization of the meal) of 175 NHs in southwestern France. The main outcome measure was ONS prescription (dichotomous variable: yes/no). RESULTS ONS were prescribed for 7.8% (n = 489) of NH residents. In a multivariate binary logistic regression, resident-related factors associated with the prescription of ONS were age, clinical markers of undernutrition (body mass index and weight loss), disability in activities of daily living, pain, pressure sores, and hospitalization in the last 12 months. NH-related factors associated with ONS prescription were: presence of a dietitian (Odds Ratio (OR): 1.46, 95% Confidence Interval: 1.18-1.88), NH coordinating physician with specific training in geriatrics (OR: 2.58, 95% CI: 1.48-4.49), organization of evening snack (OR: 1.63, 95% CI: 1.28-2.07), number of general practitioners per NH bed (OR: 0.49, 95% CI: 0.38-0.64 intermediate tertile; OR:0.77, 95% CI:0.59-1.06 highest tertile. Reference category: lowest tertile) and number of drug prescriptions (OR: 0.97, 95% CI: 0.94-0.99). CONCLUSIONS Both resident's characteristics and NH characteristics were associated with ONS prescription independently of each other. Our results showed that NH organizational aspects are associated with ONS prescribing, suggesting that modifiable aspects may contribute to achieve optimal nutritional status in the NH setting.
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Affiliation(s)
- Charlotte Dupuy
- Gérontopôle, Department of Internal Medicine and Geriatrics, Toulouse University Hospital, Toulouse, F-31059, France; INSERM U1027, University of Toulouse III, Toulouse, France.
| | - Philipe de Souto Barreto
- Gérontopôle, Department of Internal Medicine and Geriatrics, Toulouse University Hospital, Toulouse, F-31059, France; INSERM U1027, University of Toulouse III, Toulouse, France
| | - Anne Ghisolfi
- Gérontopôle, Department of Internal Medicine and Geriatrics, Toulouse University Hospital, Toulouse, F-31059, France; INSERM U1027, University of Toulouse III, Toulouse, France
| | - Sophie Guyonnet
- Gérontopôle, Department of Internal Medicine and Geriatrics, Toulouse University Hospital, Toulouse, F-31059, France; INSERM U1027, University of Toulouse III, Toulouse, France
| | - Béatrice Dorigny
- Nutricia Advanced Medical Nutrition, Danone Research, Saint-Ouen, France
| | - Bruno Vellas
- Gérontopôle, Department of Internal Medicine and Geriatrics, Toulouse University Hospital, Toulouse, F-31059, France; INSERM U1027, University of Toulouse III, Toulouse, France
| | - Yves Rolland
- Gérontopôle, Department of Internal Medicine and Geriatrics, Toulouse University Hospital, Toulouse, F-31059, France; INSERM U1027, University of Toulouse III, Toulouse, France
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Malnutrition According to Mini Nutritional Assessment Is Associated With Severe Functional Impairment in Geriatric Patients Before and up to 6 Months After Hip Fracture. J Am Med Dir Assoc 2015; 16:661-7. [DOI: 10.1016/j.jamda.2015.03.002] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 02/26/2015] [Accepted: 03/02/2015] [Indexed: 12/28/2022]
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Briggs R, Holmerová I, Martin F, O’Neill D. Towards standards of medical care for physicians in nursing homes. Eur Geriatr Med 2015. [DOI: 10.1016/j.eurger.2015.04.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Santos ALMD, Amaral TMDSPFD, Borges NPGFB. Undernutrition and associated factors in a Portuguese older adult community. REV NUTR 2015. [DOI: 10.1590/1415-52732015000300001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE: To evaluate the prevalence of undernutrition in older adults aged >75 years living in communities and to identify the main factors independently associated with undernutrition. METHODS: A cross-sectional study was conducted using a random sample of family physicians' medical records of 86 older adults aged >75 years living in the community studied. Their nutritional status was evaluated using the Mini Nutritional Assessment. RESULTS: A total of 10.5% of the elderly were undernourished and 41.9% were at undernutrition risk. According to the logistic regression multivariable model, the following characteristics: being widowed (OR=6.7; 95%CI=1.8-24.6); being institutionalized (OR=12.6; 95%CI=1.7-90.5); or having a negative self-perception of health (OR=15.0; 95%CI=3.3-69.1) were independently associated with a significant increase of undernutrition risk. CONCLUSION: The current study shows that undernutrition is highly prevalent in Portuguese older adults aged >75 years living in communities. The major factors independently associated with their undernutrition are being widowed and institutionalized and having negative self-perception of health. The results obtained show that undernutrition and its associated factors are very serious problems for older adults and a challenge in their health care.
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Meyer S, Gräske J, Worch A, Wolf-Ostermann K. Nutritional status of care-dependent people with dementia in shared-housing arrangements - a one-year follow-up. Scand J Caring Sci 2015; 29:785-92. [DOI: 10.1111/scs.12210] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2014] [Accepted: 11/19/2014] [Indexed: 01/03/2023]
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Jobse I, Liao Y, Bartram M, Delantonio K, Uter W, Stehle P, Sieber CC, Volkert D. Compliance of nursing home residents with a nutrient- and energy-dense oral nutritional supplement determines effects on nutritional status. J Nutr Health Aging 2015; 19:356-64. [PMID: 25732222 DOI: 10.1007/s12603-014-0544-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Administration of oral nutritional supplements (ONS) is an effective strategy to treat and avoid malnutrition, a persisting issue in nursing homes. However, little is known about compliance in the NH population. This study aimed to analyse the effects of compliance of NH residents with a low-volume, nutrient- and energy-dense ONS on nutritional status and to identify residents' characteristics associated with compliance. DESIGN AND SETTING Randomized, controlled trial in nursing homes. PARTICIPANTS AND INTERVENTION 87 nursing home residents (87 ± 6y, 91% female) with malnutrition or at risk of malnutrition were randomly allocated to an intervention group (IG) receiving 2 x 125 ml ONS (2.4 kcal/ml)/d for 12 weeks, or the control group (CG) with usual care. MEASUREMENTS ONS intake was recorded daily and compliance calculated. Low and high compliance were defined as ≤ 30% and ≥ 80% of provided ONS actually consumed, respectively. Body weight (BW), BMI, upper-arm (UAC) and calf-circumference (CC) and MNA-SF were assessed at baseline and after 12 weeks. Associations between compliance and changes of nutritional parameters and residents' characteristics were analysed. RESULTS Compliance was high in 35.7% and low in 28.6% of the IG (n=42). BW change was significantly higher in subjects with high compliance (median +3.0 (interquartile range +2.1;+3.8) kg, n=15) than in those with low compliance (-0.2 (-2.2;+1.6) kg, n=12) and CG (-0.1 (-1.2; +0.6) kg, n=35; p<0.001), and significantly correlated with compliance in IG (r=0.691; p<0.001). Significant differences and correlations were also identified for BMI, UAC and MNA-SF. High compliance was more often observed in residents with malnutrition (66.7 vs. 27.3%) and chewing difficulties (77.8 vs. 24.2%) than in those without these conditions. Low compliance was more prevalent in residents who were immobile (45.0 vs. 13.6%), depressed (33.3 vs. 6.7%) or had gastrointestinal complaints (50.0 vs. 17.9%) (all p<0.05). CONCLUSIONS A high compliance of nursing home residents with a low volume, nutrient- and energy dense ONS was related to a significantly improved nutritional status in comparison to low compliance and therefore enhanced the effectiveness of ONS. A higher compliance may be achieved by consideration of different residents' characteristics.
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Affiliation(s)
- I Jobse
- Dr. Inken Jobse, Institute for Biomedicine of Aging (IBA), Friedrich-Alexander-Universität Erlangen-Nürnberg, Koberger Str. 60, D-90408 Nürnberg, Germany, Tel. +49 911 5302 96150, Fax + 49 911 5302 96151, E-mail:
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Kaehr E, Visvanathan R, Malmstrom TK, Morley JE. Frailty in Nursing Homes: The FRAIL-NH Scale. J Am Med Dir Assoc 2015; 16:87-9. [DOI: 10.1016/j.jamda.2014.12.002] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 12/01/2014] [Indexed: 10/24/2022]
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Need-based nutritional intervention is effective in improving handgrip strength and Barthel Index scores of older people living in a nursing home: a randomized controlled trial. Int J Nurs Stud 2015; 52:904-12. [PMID: 25698120 DOI: 10.1016/j.ijnurstu.2015.01.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Revised: 01/10/2015] [Accepted: 01/12/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND Nutritional status is associated with physical functioning in older people. Protein-energy malnutrition can limit functional performance. OBJECTIVES This study examined the effectiveness of a "need-based intervention" on improving the physical functioning of older adults living in nursing homes. DESIGN A 24-week randomized, double-blind, controlled trial. SETTINGS A privately managed geriatric nursing home in Taiwan. PARTICIPANTS Ninety-two persons who were ≥65 years old, ≤25 kg/m(2), >1 month residence, non-bed-ridden, without acute infection, and able to self-feed or receive oral feeding. METHODS Qualified participants were stratified by gender and then randomly assigned to either the control group (n=45) or the intervention group (n=47). Each participant in the intervention group would receive a 50 g/day soy-protein-based nutritional supplement when he/she was rated as undernourished, defined as Mini Nutritional Assessment score ≤24 and body mass index ≤24 kg/m(2). The supplement contained 9.5 g protein, 250 kcal energy, and all essential micronutrients. The supplementation would be suspended if either one of the two "at risk" conditions was not met at the next measurement (every 4 weeks). Handgrip strength and Barthel Index were measured at baseline, mid-point (week 12), and end-point (week 24) of the trial. Results were analyzed with Student's t-test and by the Generalized Estimating Equations controlled for nutritional status. RESULTS The intervention significantly improved (a) handgrip strength of the older adults at weeks 12 and 24, and (b) the overall Barthel Index at week 24 (all p<0.05) according to the Generalized Estimating Equations. CONCLUSIONS "Need-based intervention" can be an effective and useful strategy for improving the physical functioning of older adults living in nursing homes, without adverse effects. The results probably are the indirect results of the improved nutritional status. The study highlights the importance of routine screening and timely intervention in geriatric care. The applicability of this need-based strategy to community-living older adults is an important issue and should be evaluated. We can probably reap a greater benefit by eliminating the risk of malnutrition at the emerging stage.
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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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Turjamaa R, Hartikainen S, Kangasniemi M, Pietilä AM. Is it time for a comprehensive approach in older home care clients’ care planning in Finland? Scand J Caring Sci 2014; 29:317-24. [DOI: 10.1111/scs.12165] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 06/15/2014] [Indexed: 11/26/2022]
Affiliation(s)
- Riitta Turjamaa
- Department of Nursing Science; Faculty of Health Sciences; University of Eastern Finland; Kuopio Finland
| | - Sirpa Hartikainen
- Faculty of Health Sciences; Research Centre of Geriatric Care; School of Pharmacy; University of Eastern Finland; Kuopio Finland
| | - Mari Kangasniemi
- Department of Nursing Science; Faculty of Health Sciences; University of Eastern Finland; Kuopio Finland
| | - Anna-Maija Pietilä
- Department of Nursing Science; Faculty of Health Sciences; University of Eastern Finland; Kuopio Finland
- Department of Nursing Science; Faculty of Health Sciences; University of Eastern Finland and Health Care Services; Kuopio Finland
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Izawa S, Enoki H, Hasegawa J, Hirose T, Kuzuya M. Factors associated with deterioration of mini nutritional assessment-short form status of nursing home residents during a 2-year period. J Nutr Health Aging 2014; 18:372-7. [PMID: 24676317 DOI: 10.1007/s12603-013-0400-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE A number of other studies have been conducted to verify the Mini Nutritional Assessment (MNA) or the MNA short form (MNA-SF) as a nutritional assessment/screening tool in various clinical settings or communities. However, there are few longitudinal studies using these tools to analyze which factors affect the incidence of deteriorating nutritional status. We tried to identify the factors associated with deterioration of MNA-SF status of nursing home residents during a 2-year period. METHODS Participants were 392 people with a mean age of 84.3 in 12 nursing homes in Japan. The factors associated with deterioration in MNA-SF categories during the study period compared to stable/improved MNA-SF categories were identified. RESULTS At baseline, 19.9% of the participants were malnourished and 60.2% were at risk of malnutrition, according to the MNA-SF classification. After 2 years, 66.3% participants maintained and 6.1% participants improved their nutritional status according to the MNA-SF classification, while 27.6% showed deterioration in MNA-SF status. Stepwise logistic-regression procedure indicated that basic ADL impairment and hospitalization during the follow-up period were associated with declining MNA-SF status. CONCLUSIONS Poor basic ADL status and hospitalization during the follow-up period were associated with malnutrition and risk of malnutrition as assessed by MNA-SF of nursing homes residents during a 2-year period.
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Affiliation(s)
- S Izawa
- S. Izawa, Department of Health and Nutrition, Faculty of Psychological and Physical Science, Aichi Gakuin University,12 Araike, Iwasaki-cho, Nisshin, Aichi 470-0195, Japan. TEL: +81-561-73-1111; FAX: +81-561-73-1142. E-mail address:
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Schrader E, Baumgärtel C, Gueldenzoph H, Stehle P, Uter W, Sieber CC, Volkert D. Nutritional status according to Mini Nutritional Assessment is related to functional status in geriatric patients--independent of health status. J Nutr Health Aging 2014; 18:257-63. [PMID: 24626752 DOI: 10.1007/s12603-013-0394-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the relationship between nutritional and functional status in acute geriatric patients including mobility and considering health status. DESIGN Cross-sectional study. SETTING Hospital. PARTICIPANTS 205 geriatric patients (median age 82.0 (IQR: 80-86) years, 69.3% women). MEASUREMENTS Nutritional status was determined by Mini Nutritional Assessment (MNA) and patients were categorized as well-nourished (≥ 24 points), at risk of malnutrition (17-23.5 points) or as malnourished (< 17 points). Functional status was determined by Barthel Index (BI) and Timed 'Up and Go' Test (TUG) and related to MNA categories. Using binary multiple logistic regression the impact of nutritional status on functional status was examined, adjusted for health status. RESULTS 60.3% of the patients were at risk of malnutrition and 29.8% were malnourished. Ability to perform basic activities of daily living (ADL) decreased with declining nutritional status. The proportion of patients unable to perform the TUG increased with worsening of nutritional status (45.0% vs. 50.4% vs. 77.0%, p<0.01). After adjusting for age, gender, number of diagnoses, disease severity and cognitive function, a higher MNA score significantly lowered the risk of being dependent in ADL (OR 0.85, 95 % CI 0.77-0.94) and inability to perform the TUG (OR 0.90, 95 % CI 0.82-0.99). CONCLUSION Nutritional status according to MNA was related to ADL as well as to mobility in acute geriatric patients. This association remained after adjusting for health status.
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Affiliation(s)
- E Schrader
- Eva Schrader, Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
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Ugajin M, Yamaki K, Hirasawa N, Kobayashi T, Yagi T. Prognostic value of severity indicators of nursing-home-acquired pneumonia versus community-acquired pneumonia in elderly patients. Clin Interv Aging 2014; 9:267-74. [PMID: 24611004 PMCID: PMC3929165 DOI: 10.2147/cia.s58682] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The credibility of prognostic indicators in nursing-home-acquired pneumonia (NHAP) is not clear. We previously reported a simple prognostic indicator in community-acquired pneumonia (CAP): blood urea nitrogen to serum albumin (B/A) ratio. This retrospective study investigated the prognostic value of severity indicators in NHAP versus CAP in elderly patients. METHODS Patients aged ≥65 years and hospitalized because of NHAP or CAP within the previous 3 years were enrolled. Demographics, coexisting illnesses, laboratory and microbiological findings, and severity scores (confusion, urea, respiratory rate, blood pressure, and age ≥65 [CURB-65] scale; age, dehydration, respiratory failure, orientation disturbance, and pressure [A-DROP] scale; and pneumonia severity index [PSI]) were retrieved from medical records. The primary outcome was mortality within 28 days of admission. RESULTS In total, 138 NHAP and 307 CAP patients were enrolled. Mortality was higher in NHAP (18.1%) than in CAP (4.6%) (P<0.001). Patients with NHAP were older and had lower functional status and a higher rate of do-not-resuscitate orders, heart failure, and cerebrovascular diseases. The NHAP patients more frequently had typical bacterial pathogens. Using the receiver-operating characteristics curve for predicting mortality, the area under the curve in NHAP was 0.70 for the A-DROP scale, 0.69 for the CURB-65 scale, 0.67 for the PSI class, and 0.65 for the B/A ratio. The area under the curve in CAP was 0.73 for the A-DROP scale, 0.76 for the CURB-65 scale, 0.81 for the PSI class, and 0.83 for the B/A ratio. CONCLUSION Patient mortality was greater in NHAP than in CAP. Patient characteristics, coexisting illnesses, and detected pathogens differed greatly between NHAP and CAP. The existing severity indicators had less prognostic value for NHAP than for CAP.
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Affiliation(s)
- Motoi Ugajin
- Department of Respiratory Medicine, Ichinomiya-Nishi Hospital, Ichinomiya City, Japan
| | - Kenichi Yamaki
- Department of Respiratory Medicine, Ichinomiya-Nishi Hospital, Ichinomiya City, Japan
| | - Natsuko Hirasawa
- Department of Respiratory Medicine, Ichinomiya-Nishi Hospital, Ichinomiya City, Japan
| | - Takanori Kobayashi
- Department of Respiratory Medicine, Ichinomiya-Nishi Hospital, Ichinomiya City, Japan
| | - Takeo Yagi
- Department of Respiratory Medicine, Ichinomiya-Nishi Hospital, Ichinomiya City, Japan
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Stange I, Bartram M, Liao Y, Poeschl K, Kolpatzik S, Uter W, Sieber CC, Stehle P, Volkert D. Effects of a Low-Volume, Nutrient- and Energy-Dense Oral Nutritional Supplement on Nutritional and Functional Status: A Randomized, Controlled Trial in Nursing Home Residents. J Am Med Dir Assoc 2013; 14:628.e1-8. [DOI: 10.1016/j.jamda.2013.05.011] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2013] [Revised: 05/09/2013] [Accepted: 05/10/2013] [Indexed: 02/07/2023]
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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: 1.0] [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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Affiliation(s)
- J M Bauer
- Geriatrisches Zentrum Oldenburg, Rahel-Straus-Straβe, Oldenburg, Germany.
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