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Yuruyen M, Polat O, Denizli BO, Cirak M, Polat H. Survival and factors affecting the survival of older adult patients in palliative care. Ir J Med Sci 2023; 192:1561-1567. [PMID: 36261749 DOI: 10.1007/s11845-022-03186-5] [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: 08/01/2022] [Accepted: 10/04/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE Investigate the survival and risk factors that affect the survival of aged patients in a palliative care center (PCC). METHODS A total of 180 inpatients (aged ≥ 65 years) who were admitted to a PCC from January 2018 to March 2020 were included. Information regarding patients' demographic characteristics, chronic diseases, length of hospital stay, nutrition provided at the first hospital stay, pressure wound, pain, and laboratory results were evaluated. RESULTS The patients 50% were women (n = 90). The mean age, mean comorbidity, and mean follow-up duration was 77.6 years, 3.4, and 115 days (median: 29 days), respectively. The mean NRS2002 score of patients was 4.0 ± 1.0 and the risk of malnutrition was 93%. The mortality rate of the patients was 91.7%. The life expectancy of patients without malignancy was higher than those with malignancy (p < 0.001). Enteral nutrition (EN) via percutaneous endoscopic gastrostomy (PEG) was associated with up to two-fold increase in the survival rates of patients with PCC (p = 0.049, HR: 2.029). High neutrophil/lymphocyte ratio (p = 0.002, HR: 1.017) and high ferritin (p = 0.001, HR: 1.000) and C-reactive protein (CRP) levels (p < 0.001, HR: 1.006) were adverse risk factors affecting life expectancy. Malignity reduced the survival rate of aged patients with PCC by 40% (p = 0.008). CONCLUSION EN via PEG was found to be a positive factor affecting survival rates of older adult patients in palliative care, whereas malignity, high neutrophil/lymphocyte ratio, high CRP and ferritin levels, and prolonged hospital stays were negative risk factors.
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Affiliation(s)
- Mehmet Yuruyen
- Department of Internal Medicine, University of Health Sciences, Bakırkoy Dr. Sadi Konuk Training and Research Hospital, Palliative Care Center, Istanbul, Turkey
| | - Ozlem Polat
- Department of Family Medicine, University of Health Sciences, Bakırkoy Dr. Sadi Konuk Training and Research Hospital, Palliative Care Center, 31147, Bakırkoy, Istanbul, Turkey.
| | - Betul Ondes Denizli
- Department of Family Medicine, University of Health Sciences, Bakırkoy Dr. Sadi Konuk Training and Research Hospital, Palliative Care Center, 31147, Bakırkoy, Istanbul, Turkey
| | - Musa Cirak
- Department of Neurosurgery, University of Health Sciences, Bakırkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Hakan Polat
- Department of Urology, University of Health Sciences, Bakırkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
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Mancin S, Sguanci M, Cattani D, Soekeland F, Axiak G, Mazzoleni B, De Marinis MG, Piredda M. Nutritional knowledge of nursing students: A systematic literature review. NURSE EDUCATION TODAY 2023; 126:105826. [PMID: 37121074 DOI: 10.1016/j.nedt.2023.105826] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 03/06/2023] [Accepted: 04/10/2023] [Indexed: 05/25/2023]
Abstract
OBJECTIVE To investigate basic, specific and self-care knowledge on nutrition in nursing students, through a literature review and by identifying studies that suggest teaching methodologies used to implement undergraduate nutrition teaching in nursing curricula. METHOD A systematic literature search was conducted in the PubMed, Embase, CINAHL, Scopus and Cochrane Library. The process of screening, selection and inclusion of the articles, as well as the assessment of risk of bias and methodological quality was independently conducted by two reviewers. Out of 1361 records identified, 23 were included in this review. RESULTS Nursing students showed poor knowledge of basic and specific nutrition demonstrating a lack of knowledge also about nutritional self-care. The implementation of alternative teaching methods, such as active teaching strategies improved the students' knowledge of the subject. CONCLUSION The use of nutrition-focused, especially active, teaching methodologies during undergraduate nursing education can remedy the lack of knowledge on this topic. This approach should also be used in postgraduate education.
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Affiliation(s)
- Stefano Mancin
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University,Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy; Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Viale Montpellier 1, 00128 Rome, Italy
| | - Marco Sguanci
- Research Unit of Nursing Science, Campus Bio-Medico di Roma University, Via Alvaro del Portillo 21, 00128 Rome, Italy
| | - Daniela Cattani
- Department of Biomedical Sciences, Humanitas University,Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy
| | - Fanny Soekeland
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Geoffrey Axiak
- Malta Leadership Institute, Valley Towers Suite 9, Valley Road, Birkirkara, Malta; University of Malta, Tal-Qroqq, Msida, Malta
| | - Beatrice Mazzoleni
- Department of Biomedical Sciences, Humanitas University,Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy.
| | - Maria Grazia De Marinis
- Research Unit of Nursing Science, Campus Bio-Medico di Roma University, Via Alvaro del Portillo 21, 00128 Rome, Italy; Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Roma, Italy
| | - Michela Piredda
- Research Unit of Nursing Science, Campus Bio-Medico di Roma University, Via Alvaro del Portillo 21, 00128 Rome, Italy
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Pradelli L, Zaniolo O, Sanfilippo A, Lezo A, Riso S, Zanetti M. Prevalence and economic cost of malnutrition in Italy: A systematic review and metanalysis from the Italian Society of Artificial Nutrition and Metabolism (SINPE). Nutrition 2023; 108:111943. [PMID: 36669368 DOI: 10.1016/j.nut.2022.111943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 11/14/2022] [Accepted: 12/08/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Disease-related malnutrition (DRM) is a major public health issue with dramatic consequences on outcomes. However, in Italy a comprehensive and updated overview on national prevalence, in both the adult and pediatric populations, and its burden on the health care environment, is missing. The aim of this systematic literature review and meta-analysis was to identify and summarize the available evidence regarding the prevalence of DRM in Italy from pediatric to adult and older ages, and to project its global costs on the health care system. METHODS We performed a systematic literature search for articles on epidemiology of DRM in Italy published up to June 2021. Studies reporting data on the prevalence of DRM in community-dwelling individuals with chronic diseases, nursing home patients, and hospitalized patients (medical, surgery, and oncology patients), were selected for inclusion. Methodological quality of the studies was assessed by two independent reviewers using published criteria. An epidemiologic meta-analysis to obtain an aggregate estimate of prevalence of DRM was performed and a model for estimating the cost of illness, based on the application of epidemiologic results to official national hospitalization data, and attribution of relevant unit costs in the national context was constructed. RESULTS Sixty-seven studies reporting on the prevalence of DRM in Italian populations were included in the final selection; meta-analytical pooling yields mean prevalence estimates of about 50% and 30% in adult and pediatric hospitalized populations, respectively, with even higher findings for residents of long-term care facilities. Modeled projections of DRM-attributable yearly economic effects on the Italian health care system exceed 10 billion € in base case analysis, with the most optimistic estimate still exceeding 2.5 billion €. CONCLUSION Although comparable in magnitude to data from previous studies in analogous international settings, the diffusion and effects of DRM in the Italian setting is impressive. Increased awareness of these data and proactive fostering of clinical nutrition services are warranted, as prompt identification and treatment of malnutrition have been shown to effectively improve clinical and economic results.
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Affiliation(s)
| | | | | | - Antonella Lezo
- Clinical Nutrition Unit, Children's Hospital "Regina Margherita," AOU Città della Salute e della Scienza, Turin, Italy
| | - Sergio Riso
- Clinical Nutrition and Dietetic Unit - "Maggiore della Carità" University Hospital, Novara, Italy
| | - Michela Zanetti
- Department of Medical, Surgical and Health Sciences, University of Trieste, Italy
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Leira J, Maseda A, Lorenzo-López L, Cibeira N, López-López R, Lodeiro L, Millán-Calenti JC. Dysphagia and its association with other health-related risk factors in institutionalized older people: A systematic review. Arch Gerontol Geriatr 2023; 110:104991. [PMID: 36906939 DOI: 10.1016/j.archger.2023.104991] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/21/2023] [Accepted: 03/05/2023] [Indexed: 03/09/2023]
Abstract
BACKGROUND Dysphagia is considered a geriatric syndrome that is characterized by inability to or difficulty in safely and effectively forming or moving the food bolus toward the esophagus. This pathology is very common and affects approximately 50% of institutionalized older people. Dysphagia is often accompanied by high nutritional, functional, social, and emotional risks. This relationship implies a higher rate of morbidity, disability, dependence, and mortality in this population. This review is aimed at studying the relationship between dysphagia and different health-related risk factors in institutionalized older people. METHOD We conducted a systematic review. The bibliographic search was performed in the Web of Science, Medline, and Scopus databases. Data extraction and methodological quality were evaluated by two independent researchers. RESULTS Twenty-nine studies met the inclusion and exclusion criteria. A clear relationship between the development and progression of dysphagia and a high nutritional, cognitive, functional, social, and emotional risk in institutionalized older adults was found. CONCLUSIONS There is an important relationship between these health conditions that shows the need for research and new approaches to considerations such as their prevention and treatment as well as the design of protocols and procedures that will help reduce the percentage of morbidity, disability, dependence, and mortality in older people.
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Affiliation(s)
- Julia Leira
- Gerontology and Geriatrics Research Group, Instituto de Investigación Biomédica de A Coruña (INIBIC), Universidade da Coruña, Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, 15071 A Coruña, Spain.
| | - Ana Maseda
- Gerontology and Geriatrics Research Group, Instituto de Investigación Biomédica de A Coruña (INIBIC), Universidade da Coruña, Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, 15071 A Coruña, Spain.
| | - Laura Lorenzo-López
- Gerontology and Geriatrics Research Group, Instituto de Investigación Biomédica de A Coruña (INIBIC), Universidade da Coruña, Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, 15071 A Coruña, Spain.
| | - Nuria Cibeira
- Gerontology and Geriatrics Research Group, Instituto de Investigación Biomédica de A Coruña (INIBIC), Universidade da Coruña, Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, 15071 A Coruña, Spain.
| | - Rocío López-López
- Gerontology and Geriatrics Research Group, Instituto de Investigación Biomédica de A Coruña (INIBIC), Universidade da Coruña, Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, 15071 A Coruña, Spain.
| | - Leire Lodeiro
- Gerontology and Geriatrics Research Group, Instituto de Investigación Biomédica de A Coruña (INIBIC), Universidade da Coruña, Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, 15071 A Coruña, Spain.
| | - José C Millán-Calenti
- Gerontology and Geriatrics Research Group, Instituto de Investigación Biomédica de A Coruña (INIBIC), Universidade da Coruña, Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, 15071 A Coruña, Spain.
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Castaldo A, Zanetti ES, Nobili A, Marano G, Zani M, Magri M, Verardi AA, Ianes A, Ardoino G, Gugiari MC, Lusignani M, Bonetti L. Food intake and prevalence of malnutrition in nursing homes. A multicenter observational study. JOURNAL OF GERONTOLOGY AND GERIATRICS 2022. [DOI: 10.36150/2499-6564-n497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Preoperative nutritional evaluation of prostate cancer patients undergoing laparoscopic radical prostatectomy. PLoS One 2022; 17:e0262630. [PMID: 35108317 PMCID: PMC8809613 DOI: 10.1371/journal.pone.0262630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 12/31/2021] [Indexed: 12/29/2022] Open
Abstract
Background and objective Prostate cancer (PCa) is one of the most common malignant tumors in men. Geriatric Nutritional Risk Index (GNRI) is an objective index for evaluating nutritional status of elderly people over 65 years old. The aim of the current study was to explore the correlation and predictive value between GNRI and postoperative recovery and complications in PCa patients undergoing laparoscopic radical prostatectomy (LRP). Methods Taking 98 as the GNRI boundary value, 96 PCa patients (aged≥65 y) undergoing LRP in the Department of Urology, Affiliated Hospital of North Sichuan Medical College from January 2018 to December 2020 were grouped into malnutrition group (MNg, 34 patients, 35.4%) and normal nutrition group (NNg, 62 patients, 64.6%). Basic information, laboratory examination indexes, operation conditions, postoperative complications and postoperative recovery indexes of patients were recorded and retrospectively analyzed. Clavien-Dindo Classification System (CDCS) was used to assess postoperative complications. T-test was used to analyze differences between the two groups. ROC curve was generated to determine the predictive value of GNRI for postoperative complications. Results Percentage of complications was significantly higher in MNg group compared with that in NNg group (P < 0.01). The average grade based on CDCS was significantly lower in NNg group compared with that in MNg group (P < 0.01). Body weight, Body Mass Index (BMI), preoperative hemoglobin value (HGB), serum albumin (ALB) values of MNg and NNg were significantly positively correlated with GNRI (P<0.01). Incidence and severity of postoperative complications of MNg patients were significantly higher compared with those of NNg patients (P<0.05). Average hospitalization cost of MNg patients was higher in MNg patients compared with that of NNg patients (P<0.05). Duration of post-anesthesia care unit (PACU), duration of antibiotic use and duration of indwelling drainage tube were longer in MNg patients compared with those in NNg patients (P<0.05). Furthermore, volume of indwelling drainage tube was higher in MNg patients compared with that in NNg patients (P<0.05). Conclusion GNRI is an effective and reliable tool for evaluation of preoperative nutritional status of prostate cancer patients. The findings showed that GNRI is correlated with postoperative recovery and complications, and is an effective predictive marker.
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Bardon LA, Corish CA, Lane M, Bizzaro MG, Loayza Villarroel K, Clarke M, Power LC, Gibney ER, Dominguez Castro P. Ageing rate of older adults affects the factors associated with, and the determinants of malnutrition in the community: a systematic review and narrative synthesis. BMC Geriatr 2021; 21:676. [PMID: 34863118 PMCID: PMC8642873 DOI: 10.1186/s12877-021-02583-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 10/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Malnutrition negatively impacts on health, quality of life and disease outcomes in older adults. The reported factors associated with, and determinants of malnutrition, are inconsistent between studies. These factors may vary according to differences in rate of ageing. This review critically examines the evidence for the most frequently reported sociodemographic factors and determinants of malnutrition and identifies differences according to rates of ageing. METHODS A systematic search of the PubMed Central and Embase databases was conducted in April 2019 to identify papers on ageing and poor nutritional status. Numerous factors were identified, including factors from demographic, food intake, lifestyle, social, physical functioning, psychological and disease-related domains. Where possible, community-dwelling populations assessed within the included studies (N = 68) were categorised according to their ageing rate: 'successful', 'usual' or 'accelerated'. RESULTS Low education level and unmarried status appear to be more frequently associated with malnutrition within the successful ageing category. Indicators of declining mobility and function are associated with malnutrition and increase in severity across the ageing categories. Falls and hospitalisation are associated with malnutrition irrespective of rate of ageing. Factors associated with malnutrition from the food intake, social and disease-related domains increase in severity in the accelerated ageing category. Having a cognitive impairment appears to be a determinant of malnutrition in successfully ageing populations whilst dementia is reported to be associated with malnutrition within usual and accelerated ageing populations. CONCLUSIONS This review summarises the factors associated with malnutrition and malnutrition risk reported in community-dwelling older adults focusing on differences identified according to rate of ageing. As the rate of ageing speeds up, an increasing number of factors are reported within the food intake, social and disease-related domains; these factors increase in severity in the accelerated ageing category. Knowledge of the specific factors and determinants associated with malnutrition according to older adults' ageing rate could contribute to the identification and prevention of malnutrition. As most studies included in this review were cross-sectional, longitudinal studies and meta-analyses comprehensively assessing potential contributory factors are required to establish the true determinants of malnutrition.
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Affiliation(s)
- Laura A Bardon
- School of Agriculture and Food Science, University College Dublin, Dublin, Republic of Ireland.
- Institute of Food and Health, University College Dublin, Dublin, Republic of Ireland.
| | - Clare A Corish
- Institute of Food and Health, University College Dublin, Dublin, Republic of Ireland
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Republic of Ireland
| | - Meabh Lane
- School of Agriculture and Food Science, University College Dublin, Dublin, Republic of Ireland
| | - Maria Gabriella Bizzaro
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Republic of Ireland
| | - Katherine Loayza Villarroel
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Republic of Ireland
| | - Michelle Clarke
- School of Agriculture and Food Science, University College Dublin, Dublin, Republic of Ireland
- Institute of Food and Health, University College Dublin, Dublin, Republic of Ireland
| | - Lauren C Power
- Institute of Food and Health, University College Dublin, Dublin, Republic of Ireland
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Republic of Ireland
| | - Eileen R Gibney
- School of Agriculture and Food Science, University College Dublin, Dublin, Republic of Ireland
- Institute of Food and Health, University College Dublin, Dublin, Republic of Ireland
| | - Patricia Dominguez Castro
- Institute of Food and Health, University College Dublin, Dublin, Republic of Ireland
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Republic of Ireland
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Association of overweight and obesity with the prevalence and incidence of pressure ulcers: A systematic review and meta-analysis. Clin Nutr 2021; 40:5089-5098. [PMID: 34455268 DOI: 10.1016/j.clnu.2021.08.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 08/04/2021] [Accepted: 08/06/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND & AIM Pressure ulcers challenge the health status, complicate medical conditions, and affect quality of life. The aim of this systematic review and meta-analysis was to investigate the role of obesity and body weight status, as potentially modifiable risk factors, in the incidence and prevalence of pressure ulcers. METHODS A systematic search of observational studies was performed to assess documents published between January 1990 and December 2019 in PubMed and Scopus. Finally, 17 articles with total sample size of 2228724 in the prevalence and 218178 in the incidence study were included in the meta-analysis. RESULTS The pooled data analysis showed no significant effect of obesity on odds of pressure ulcers' prevalence (OR 0.91, 95% CI 0.65 to 1.27, P = 0.579, I2 = 84.8%) or incidence (OR 0.97, 95% CI 0.56 to 1.66, P = 0.905, I2 = 89.8%) compared with non-obese individuals. Overweight was associated with significantly lower odds of prevalence of pressure ulcers compared to non-overweight individuals (OR 0.54, 95% CI 0.33 to 0.88, P = 0.014, I2 = 90.2%). The subgroup analyses showed significantly higher odds of prevalence (OR 2.38, 95% CI 1.72 to 3.29, P < 0.001, I2 = 63.4%) and incidence (OR 2.28, 95% CI 1.77 to 2.94, P < 0.001, I2 = 27.9%) of pressure ulcers in the underweight compared to normal weight groups. Pooled data analyses showed significantly lower odds of prevalence (OR 0.6, 95% CI 0.37 to 0.96, P = 0.034, I2 = 82%) and incidence (OR 0.72, 95% CI 0.53 to 0.98, P = 0.039, I2 = 67.1%) of pressure ulcers in the overweight than normal weight individuals. The findings showed no significant differences in the odds of prevalence or incidence of pressure ulcers in the obese and morbidly obese compared to normal weight individuals. CONCLUSION This systematic review and meta-analysis showed no significant effect of obesity or morbid obesity on the odds of pressure ulcers. Additionally, overweight was associated with lower odds of pressure ulcers while underweight significantly increased the odds of pressure injuries.
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Age-Related Changes to Eating and Swallowing Impact Frailty: Aspiration, Choking Risk, Modified Food Texture and Autonomy of Choice. Geriatrics (Basel) 2018; 3:geriatrics3040069. [PMID: 31011104 PMCID: PMC6371116 DOI: 10.3390/geriatrics3040069] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 10/04/2018] [Accepted: 10/09/2018] [Indexed: 12/02/2022] Open
Abstract
Reductions in muscle mass and strength are well known complications of advancing age. All muscles of the body are affected, including those critical to chewing and swallowing. A diagnosis of frailty and its features of weakness and unintentional weight loss are particularly relevant to the aging swallowing system. Age related changes to eating and swallowing function means that there is a natural tendency for elders to self-select ‘soft’ foods due to loss of dentition and fatigue on chewing. However, it is not well known that tooth loss and poor dental status is associated with increased choking risk, especially as people age. In fact, people over 65 years of age have seven times higher risk for choking on food than children aged 1–4 years of age. Texture modified foods are provided clinically to reduce choking risk and manage dysphagia. Although certain food textures offer greater swallowing safety, they significantly restrict food choice. This commentary paper will highlight age-related changes to the eating and swallowing system, noting especially those that are relevant for frail elders. Swallowing impairments also affect the ability to manage liquids, and aspiration risk in healthy and frail elders is also discussed. Modified food textures that are most often recommended by clinicians to maintain sufficient oral intake and reduce choking risk will be described, while also highlighting the nutritional challenges associated with these foods and offering some solutions. The ethical challenges associated with balancing the autonomy of choice of food textures with swallowing safety will be addressed.
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Johnson S, Nasser R, Rustad K, Chan J, Wist C, Siddique A, Tulloch H. Review of Nutrition Screening and Assessment Practices for Long-Term Care Residents. J Nutr Gerontol Geriatr 2018; 37:169-182. [PMID: 29952730 DOI: 10.1080/21551197.2018.1482811] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The older adult population in Canada is growing, creating a greater demand for long-term care (LTC) facilities. Seniors living in LTC are more vulnerable to malnutrition, making it important to implement nutrition screening tools on a routine basis. The purpose of this study was to explore the practices of Registered Dietitians (RDs) related to nutritional screening, nutritional assessment, and follow-ups conducted within LTC facilities. This study also explored possible barriers hindering the application of these practices. Nine RDs from two health regions in Southern Saskatchewan completed a phone interview to address nutrition care practices/policies and barriers in LTC facilities. Results showed a considerable amount of variability in nutrition care practices for screening and assessment with lack of time identified as the greatest barrier. These findings highlight the importance of having consistent policies and a sufficient amount of RDs available in LTC facilities to provide the expected level of nutrition care for residents.
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Affiliation(s)
- Shanthi Johnson
- a Department of Kinesiology, Faculty of Kinesiology and Health Studies , University of Regina , Regina , SK , Canada.,b Saskatchewan Population Health Evaluation Research Unit (SPHERU) , University of Regina , SK , Canada
| | - Roseann Nasser
- c Nutrition & Dietetics Practicum Program and Clinical Nutrition Services , Regina Qu'Appelle Health Region , Regina , SK , Canada.,d Department of Nutrition and Food Services , Regina Qu'Appelle Health Region , Regina , SK , Canada
| | - Kayla Rustad
- c Nutrition & Dietetics Practicum Program and Clinical Nutrition Services , Regina Qu'Appelle Health Region , Regina , SK , Canada.,d Department of Nutrition and Food Services , Regina Qu'Appelle Health Region , Regina , SK , Canada
| | - Jennifer Chan
- c Nutrition & Dietetics Practicum Program and Clinical Nutrition Services , Regina Qu'Appelle Health Region , Regina , SK , Canada.,d Department of Nutrition and Food Services , Regina Qu'Appelle Health Region , Regina , SK , Canada
| | - Christina Wist
- c Nutrition & Dietetics Practicum Program and Clinical Nutrition Services , Regina Qu'Appelle Health Region , Regina , SK , Canada.,d Department of Nutrition and Food Services , Regina Qu'Appelle Health Region , Regina , SK , Canada
| | - Aisha Siddique
- b Saskatchewan Population Health Evaluation Research Unit (SPHERU) , University of Regina , SK , Canada
| | - Heather Tulloch
- c Nutrition & Dietetics Practicum Program and Clinical Nutrition Services , Regina Qu'Appelle Health Region , Regina , SK , Canada.,d Department of Nutrition and Food Services , Regina Qu'Appelle Health Region , Regina , SK , Canada
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Kuo SM. Does Modification of the Large Intestinal Microbiome Contribute to the Anti-Inflammatory Activity of Fermentable Fiber? Curr Dev Nutr 2018; 2:nzx004. [PMID: 30377676 PMCID: PMC6201682 DOI: 10.3945/cdn.117.001180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Accepted: 11/21/2017] [Indexed: 12/16/2022] Open
Abstract
Fiber is an inadequately understood and insufficiently consumed nutrient. This review examines the possible causal relation between fiber-induced microbiome changes and the anti-inflammatory activity of fiber. To demonstrate the dominant role of fermentable plant fiber in shaping the intestinal microbiome, animal and human fiber-feeding studies are reviewed. Using culture-, PCR-, and sequencing-based microbial analyses, a higher prevalence of Bifidobacterium and Lactobacillus genera was observed from the feeding of different types of fermentable fiber. This finding was reported in studies performed on several host species including human. Health conditions and medications that are linked to intestinal microbial alterations likely also change the nutrient environment of the large intestine. The unique gene clusters of Bifidobacterium and Lactobacillus that enable the catabolism of plant glycans and the ability of Bifidobacterium and Lactobacillus to reduce the colonization of proteobacteria probably contribute to their prevalence in a fiber-rich intestinal environment. The fiber-induced microbiome changes could contribute to the anti-inflammatory activity of fiber. Although most studies did not measure fecal microbial density or total daily fecal microbial output (colon microbial load), limited evidence suggests that the increase in intestinal commensal microbial load plays an important role in the anti-inflammatory activity of fiber. Various probiotic supplements, including Bifidobacterium and Lactobacillus, showed anti-inflammatory activity only in the presence of fiber, which promoted microbial growth as indicated by increasing plasma short-chain fatty acids. Probiotics alone or pure fiber administered under sterile conditions showed no anti-inflammatory activity. The potential mechanisms that could mediate the anti-inflammatory effect of common microbial metabolites are reviewed, but more in vivo trials are needed. Future studies including simultaneous microbial composition and load measurements are also important.
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Affiliation(s)
- Shiu-Ming Kuo
- Department of Exercise and Nutrition Sciences, University at Buffalo, SUNY, Buffalo, NY
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12
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Lindmark U, Jansson H, Lannering C, Johansson L. Oral health matters for the nutritional status of older persons-A population-based study. J Clin Nurs 2018; 27:1143-1152. [DOI: 10.1111/jocn.14146] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2017] [Indexed: 01/01/2023]
Affiliation(s)
- Ulrika Lindmark
- Department of Natural Science and Biomedicine; Centre for Oral Health; Aging Research Network - Jönköping; School of Health and Welfare; Jönköping University; Jönköping Sweden
| | - Henrik Jansson
- Department of Natural Science and Biomedicine; Centre for Oral Health; Aging Research Network - Jönköping; School of Health and Welfare; Jönköping University; Jönköping Sweden
- Department of Periodontology; Centre of Oral Health Sciences; Malmö University; Malmö Sweden
| | - Christina Lannering
- Institute of Gerontology; Aging Research Network - Jönköping; School of Health and Welfare; Jönköping University; Jönköping Sweden
- Region Jönköping County, Futurum, Ryhov; Jönköping Sweden
| | - Linda Johansson
- Institute of Gerontology; Aging Research Network - Jönköping; School of Health and Welfare; Jönköping University; Jönköping Sweden
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Kim E, Kang H, Kim N. Effects of Nutritional Intervention in Long-Term Care in Korea. J Gerontol Nurs 2017; 43:55-64. [DOI: 10.3928/00989134-20161109-06] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 09/12/2016] [Indexed: 11/20/2022]
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14
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Cereda E, Klersy C, Andreola M, Pisati R, Schols JM, Caccialanza R, D'Andrea F. Cost-effectiveness of a disease-specific oral nutritional support for pressure ulcer healing. Clin Nutr 2017; 36:246-252. [DOI: 10.1016/j.clnu.2015.11.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 10/29/2015] [Accepted: 11/16/2015] [Indexed: 10/22/2022]
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15
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Skinnars Josefsson M, Nydahl M, Persson I, Mattsson Sydner Y. Quality Indicators of Nutritional Care Practice in Elderly Care. J Nutr Health Aging 2017; 21:1057-1064. [PMID: 29083448 PMCID: PMC5662708 DOI: 10.1007/s12603-017-0970-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 07/05/2017] [Indexed: 12/15/2022]
Abstract
OBJECTIVES The aim is to explore the effects of antecedent, structural and process quality indicators of nutritional care practice on meal satisfaction and screened nutritional status among older adults in residential care homes. DESIGN Data for this Swedish cross-sectional study regarding older adults living in residential care homes were collected by i) a national questionnaire, ii) records from the quality registry Senior Alert, iii) data from an Open Comparison survey of elderly care in 2013/2014. The data represented 1154 individuals in 117 of 290 Swedish municipalities. MEASUREMENTS Meal satisfaction (%) and adequate nutritional status, screened by the Mini Nutritional Assessment Short Form (MNA-SF), were the two outcome variables assessed through their association with population density of municipalities and residents' age, together with 12 quality indicators pertaining to structure and process domains in the Donabedian model of care. RESULTS Meal satisfaction was associated with rural and urban municipalities, with the structure quality indicators: local food policies, private meal providers, on-site cooking, availability of clinical/community dietitians, food service dietitians, and with the process quality indicators: meal choice, satisfaction surveys, and 'meal councils'. Adequate nutritional status was positively associated with availability of clinical/community dietitians, and energy and nutrient calculated menus, and negatively associated with chilled food production systems. CONCLUSION Municipality characteristics and structure quality indicators had the strongest associations with meal satisfaction, and quality indicators with local characteristics emerge as important for meal satisfaction. Nutritional competence appears vital for residents to be well-nourished.
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Affiliation(s)
- M Skinnars Josefsson
- Malin Skinnars Josefsson, MSc, Department of Food, Nutrition and Dietetics, Uppsala University, Box 560, 751 22 Uppsala, Sweden, , +46 18-471 23 95, +46 76-555 78 80
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16
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Cereda E, Pedrolli C, Klersy C, Bonardi C, Quarleri L, Cappello S, Turri A, Rondanelli M, Caccialanza R. Nutritional status in older persons according to healthcare setting: A systematic review and meta-analysis of prevalence data using MNA ®. Clin Nutr 2016; 35:1282-1290. [DOI: 10.1016/j.clnu.2016.03.008] [Citation(s) in RCA: 260] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 02/12/2016] [Accepted: 03/14/2016] [Indexed: 01/26/2023]
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17
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Agarwal E, Marshall S, Miller M, Isenring E. Optimising nutrition in residential aged care: A narrative review. Maturitas 2016; 92:70-78. [DOI: 10.1016/j.maturitas.2016.06.013] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 06/13/2016] [Accepted: 06/22/2016] [Indexed: 01/04/2023]
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18
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Neloska L, Damevska K, Nikolchev A, Pavleska L, Petreska-Zovic B, Kostov M. The Association between Malnutrition and Pressure Ulcers in Elderly in Long-Term Care Facility. Open Access Maced J Med Sci 2016; 4:423-427. [PMID: 27703567 PMCID: PMC5042627 DOI: 10.3889/oamjms.2016.094] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Revised: 07/12/2016] [Accepted: 07/14/2016] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND: Malnutrition is common in elderly and is a risk factor for pressure ulcers. AIM: The aim of the present study was to determine the prevalence of malnutrition in geriatric and palliative patients hospitalised in long-term care facility, and to examine the influence of nutritional status on the prevalence of pressure ulcers (PU). MATERIAL AND METHODS: Descriptive, observational and cross-sectional study including 2099 patients admitted to the Hospital during a 24 month period (January 2013 to December 2014). We recorded: demographic data, body mass index (BMI), Braden score, laboratory parameters of interest (albumin, total protein, RBC count, haemoglobin and iron levels) and presence or absence of malnutrition and pressure ulcers. RESULTS: The pressure ulcer prevalence was 12.9% (256 out of 2099). Based on the BMI classification, 61.7% of patients had a good nutritional status, 27.4% were undernourished, and 2.1% were considered malnourished. Nutritional status was statistically significantly different between patients with and without PU (p < 0.0001). This study also showed that hypoproteinemia, hypoalbuminemia, low RBC was positively associated with PU prevalence. CONCLUSION: The results highlight the impact of nutritional status on the prevalence of pressure ulcers in hospitalised geriatric and palliative population. It is of paramount importance to correctly evaluate the presence of malnutrition in patients at risk of pressure ulcers.
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Affiliation(s)
- Lenche Neloska
- Gerontology Institute "13 November Skopje", Skopje, Republic of Macedonia
| | - Katerina Damevska
- University Clinic of Dermatology, Medical Faculty, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
| | - Andjelka Nikolchev
- Gerontology Institute "13 November Skopje", Skopje, Republic of Macedonia
| | - Lidija Pavleska
- Gerontology Institute "13 November Skopje", Skopje, Republic of Macedonia
| | | | - Milenko Kostov
- University Clinic of Neurosurgery, Medical Faculty, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
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