Changes in malnutrition and quality of nutritional care among aged residents in all nursing homes and assisted living facilities in Helsinki 2003-2011

Relationship between oral frailty, health-related quality of life, and survival among long-term care residents

PURPOSE

We evaluated oral frailty (OFr) and its association with health-related quality of life (HRQoL), energy and protein intake, and survival among older long-term care residents.

METHODS

This cross-sectional study with a 3-year follow-up for survival assessed 349 residents in long-term care facilities (73% female, mean age 82 years). We defined OFr with six signs (dry mouth, food residue on oral surfaces, unclear speech, inability to keep mouth open or pain expression during the clinical oral examination, diet pureed/soft) and OFr severity was categorized as Group 1, (mild) = 0-1 signs, Group 2 (moderate) = 2-4 signs, and Group 3 (severe) = 5-6 signs. We measured HRQoL with 15D instrument, and energy and protein intake by a 1- to 2-day food record. Mortality was retrieved from central registers on March 2021.

RESULTS

Of the residents, 15% had 0-1, 67% 2-4 and 18% 5-6 OFr signs. HRQoL decreased linearly from Group 1 to Group 3. OFr correlated with such dimensions of HRQoL as mobility, eating, speech, excretion, usual activities, mental function, and vitality. We found no association between OFr categories and energy and protein intake. Survival decreased linearly from Group 1 to Group 3.

CONCLUSIONS

OFr was common among older long-term care residents and OFr severity predicts poorer outcomes. The six oral signs denoting OFr may be used at the bedside to screen residents at risk for OFr.

Time to act! - A cross-sectional study on how nutritional risk increases during hospitalization and associates with worse outcome

BACKGROUND & AIMS

Nutritional risk is prevalent, and it develops negatively during hospital stay. The aim of this cohort study was to assess the association of nutritional risk with total costs of hospital care, length of stay, and in-hospital mortality.

METHODS

Cross-sectional study with hospitalized patients (n = 3053). Nutritional risk screening 2002 and outcome were investigated. Chi-square, Fisher, and Mann-Whitney tests, univariable and multivariable generalized linear and binary logistic regression models were used.

RESULTS

Nutritional risk was detected in 18% (184/1024) of those patients assessed at admission while the number of patients at risk increased 3-fold (47%,152/265) in those screened 14 days after admission (odds ratio 6.25; 95% CI 4.58-8.53, p < 0.001). Nutritionally at-risk patients had 5.6 days longer length of stay (p < 0.001) and 9% higher adjusted total costs compared with non-risk patients (p < 0.001). Adjusted overall risk for in-hospital mortality was 4.4 (95% CI 2.44-7.92, p < 0.001) for patients at nutritional risk. The screening rate was between 52% and 68%, and only 4% of the nutritionally at-risk patients had dietitian consultation during their hospital stay.

CONCLUSIONS

The number of patients with nutritional risk increased clearly during hospitalization associating with a four times higher in-hospital mortality and substantially increased hospital costs. The results demonstrate that the nutritional risk and its detrimental influence on the outcome increases during hospitalization emphasizing the importance to screen patients at admission and repeated weekly.

Nutritional Care for Institutionalized Persons with Dementia: An Integrative Review

BACKGROUND

Older people are at risk of malnutrition, especially when they suffer from cognitive impairment. Guidelines that orient nursing care in this regard need to be updated. The aim of this review is to address the best available evidence on interventions that can benefit nutritional nursing care for institutionalized older adults with dementia.

METHODS

Integrative review using the Dimensions and Eureka search engines, and the PubMed, Embase, Scielo, CINAHL, and ScienceDirect databases. We searched from the year 2015 through to 2021. We employed the MMAT guidelines for mixed, qualitative, and quantitative studies, and the PRISMA, CASP, and JBI guidelines to value the reviews.

RESULTS

A total of 55 studies met the inclusion criteria. The best available evidence to support nutritional nursing care for institutionalized older adults with dementia highlights several aspects related to the assessment and caring interventions that are focused on people with dementia, their caregivers, and their context.

CONCLUSIONS

Both the assessment and nutritional care interventions for older people with dementia should consider the patient-caregiver dyad as the subject of care and understand the context as a fundamental part of it. The analysis of the context should look further than the immediate environment.

Neglecting the care of older people in residential care settings: A national document analysis of complaints reported to the Finnish supervisory authority

Neglecting to provide older people with the care they need in residential care settings leads to human suffering and increased service needs. Research is lacking on neglect in older people's residential care and one way to assess the key issues is to study complaints. The aim of this study was to analyse official complaints related to allegations of neglect in residential care settings caring for older people in Finland. The data covered 317 complaints that were recorded in the national database in 2018 and 2019. The analysis of the complaints yielded 2,922 observations of neglect in older people's care in residential care settings. Based on our results, most of the complaints were made by family members when the patients were alive and their motivation was to improve the care their relative received, as well as the care of others, in the residential care home. The complaints focused on neglecting clinical care, including restricting older people's movements, not providing daily activities and not paying sufficient attention to their hygiene and secretions. Other complaints included issues relating to nutrition, medication, communication and issues that compromised their privacy, respect and dignity. Nearly three of four complaints identified staffing issues in relation to neglect and most of the complaints concerned private, rather than public, residential care homes. Although the complaints only concerned a small proportion of the annual care provided, more attention should be paid to care practices that prevent neglect in residential care and to multi-level monitoring for dignified care.

Mobility Limitation in Older Adults Residing in Nursing Homes in Brazil Associated With Advanced Age and Poor Nutritional Status: An Observational Study

BACKGROUND AND PURPOSE

Mobility is a basic human need, and its limitation compromises health status, especially in older adults from developing countries and residing in nursing homes. This study aims to determine the prevalence and factors associated with mobility limitation in older adults residing in nursing homes.

METHODS

A cross-sectional study was conducted with 305 older adults (≥60 years) residing in 10 nursing homes in Northeast Brazil. Mobility limitation was evaluated using the "walking" item of the Barthel index. Sociodemographic/economic data concerning the participants and institutions, as well as conditions that could influence the mobility state of the older adults, were collected. The χ2 test and multiple logistic regression were performed using a significance level of 5%.

RESULTS AND DISCUSSION

The prevalence of mobility limitation was 65.6% (95% confidence interval [CI], 59.6-70.4). Walking dependence was identified in 39.7% of the sample (26.9% wheelchair users and 12.8% bedridden), while 25.9% walked with assistance (16.7% with maximal assistance and 9.2% with minimal assistance). Mobility limitation was significantly associated with malnutrition/risk of malnutrition (1.86, 95% CI, 1.54-2.26, P < .001) and age ≥81 years (1.35, 95% CI, 1.12-1.63, P = .002).

CONCLUSION

Mobility limitation has a high prevalence among older adults residing in nursing homes in Brazil, and is associated with advanced age and poor nutritional status. Health professionals should advocate for the maintenance of mobility and adequate nutritional support.

Oral hygiene and health-related quality of life in institutionalized older people

Aim

We evaluated oral hygiene level and its association with oral health and general health-related quality of life (HRQoL) among older residents in long-term care facilities.

Findings

Only one-fifth of residents had good oral hygiene. Poor oral hygiene was associated with poor oral health and diminished HRQoL.

Message

Oral hygiene, oral health, and HRQoL may be improved with oral care education of caregivers, professional cooperation, and regular oral healthcare of older residents in long-term care facilities.

Purpose

We evaluated the level of oral hygiene and its association with oral health status and need for oral treatment among older residents in long-term care facilities. In addition, the association between oral hygiene level and health-related quality of life (HRQoL) was explored.

Methods

This cross-sectional study assessed 231 dentate residents in long-term care facilities (71% female, mean age 81 years, 70% had dementia). Nurses assessed residents and completed questionnaires on participants’ background information, diagnoses, oral healthcare habits, and HRQoL with the 15D instrument. Two qualified dentists performed clinical oral examinations (number of teeth, plaque index, periodontal condition, open caries lesions, and dry mouth). We used a modified plaque index (PI) to measure the level of oral hygiene (good, moderate, and poor) and calculated the clinical Asymptotic Dental Score (ADS) to determine the oral inflammation burden.

Results

Of the residents, 21% had good, 35% moderate, and 44% poor oral hygiene according to PI. Poor oral hygiene was associated with poorer cognitive status (P = 0.010) and higher oral inflammation burden (P < 0.001). Moreover, poor oral hygiene was associated with poorer HRQoL in a correlation analysis adjusted for age and gender.

Conclusions

Oral hygiene of older individuals in long-term care is insufficient. Poor oral hygiene is a marker for poor HRQoL. Residents also have a high burden of oral inflammatory diseases and a need for dental care. Older residents’ oral hygiene and HRQoL may be improved with oral care education of caregivers and regular dental check-ups.

A health concept with a social potential: an interview study with nursing home residents

BACKGROUND

A qualitative, interview-based study was embedded in a randomized intervention trial, the Older People Exercise and Nutrition (OPEN) study. Participants in the OPEN study were encouraged to conduct sessions of sit-to-stand (STS) exercises combined with Oral Nutritional Supplements (ONS) intake. The aim was to describe the older persons' perceptions and experiences of being given the daily opportunity to perform the STS exercise and drink ONS.

METHODS

In-depth interviews were conducted in six nursing homes with the participants using a semi-structured interview guide. One or two individual interviews were performed with each included participant. Twenty-three NH residents (16 women and 7 men) participated in the qualitative study. Their ages ranged between 76 and 96 years, and their Mini Mental State Examination (MMSE) scored between 8 and 29. The transcribed interviews and field notes written during the visits were analyzed inductively following a constant comparative method described in Grounded Theory.

RESULTS

The exercise and nutritional intervention was described as highly practical by the NH residents, who claimed it also had a social aspect as they felt acknowledged and empowered to engage others in the combined intervention. Experiences of the intervention ranged from neutral to mainly positive and could be sorted into 5 categories: 1. Perceived hopes and expectations, 2. Health-related driving forces, 3. Appreciated daily activities, 4. A concept easy to perform and integrate into daily life, 5. A beneficial health concept for all. The intervention created perceived benefits on various health aspects due to participants feeling energized and stronger. An overall theme was identified as A health concept with a social potential, as participants feel acknowledged and strong enough to help others.

CONCLUSIONS

The intervention was described by participants as a health concept that could potentially be beneficial for a broader spectrum of NH residents. The findings indicate that health concepts, such as STS/ONS, might contribute to a more meaningful day for older people, even vulnerable NH residents approaching the end of life.

TRIAL REGISTRATION

ClinicalTrials.govIdentifier: NCT02702037 . Date of trial registration February 26, 2016.

Changes in prevalence of loneliness over time in institutional settings, and associated factors

OBJECTIVES

The aim of this study was to examine changes in the prevalence of loneliness over time from 2011 to 2017 in long-term care facilities; and its related factors.

MATERIAL AND METHODS

Repeated cross-sectional studies exploring loneliness and its associated factors among residents in long-term care facilities were conducted in Helsinki, Finland in 2011 (N = 4966) and 2017 (N = 3767). Residents in temporary respite care or with severe cognitive impairment, and those unable or refusing to respond to the loneliness item were excluded. The total number of participants in this analysis was 1563 in 2011, and 1367 in 2017. In both samples, we used the same loneliness measurement by asking "Do you suffer from loneliness?" (never/sometimes/often or always). When comparing the samples in order to reduce the effect of confounding between them, we used propensity score matching. A multivariable logistic regression model explored the relationship between various characteristics and loneliness.

RESULTS

Loneliness showed no change in prevalence over time: propensity score-adjusted loneliness was 36 % in 2011 and 2017. In the multivariate logistic regression model, feeling depressed was the only independent characteristic associated with loneliness. Of the respondents who did not feel depressed, 24 % suffered from loneliness at least sometimes. Among the respondents who felt depressed, the respective figure was 55 %.

CONCLUSION

Loneliness is common in institutional settings. It remained stable, and not decreased over time. Because loneliness impairs the well-being, quality of life and health of residents, it needs to be addressed. Screening loneliness and developing interventions to alleviate it, is essential.

Burden of Oral Symptoms and Health-Related Quality of Life in Long-Term Care Settings in Helsinki, Finland

OBJECTIVES

Poor oral health may complicate eating and deteriorate nutritional status. However, little is known about how the burden of oral symptoms (OS) is associated with the health-related quality of life (HRQoL) of vulnerable older people in institutional settings. This study explores how the burden of certain OS (chewing problems, swallowing difficulties, dry mouth) is associated with functioning, morbidity, nutritional status and eating habits. It also examines the association between the OS burden and HRQoL.

DESIGN

A cross-sectional study in 2017.

SETTING

All long-term care wards in Helsinki, Finland.

PARTICIPANTS

2401 older residents (74% females, mean age 83.9).

MEASUREMENTS

Nurses assessed the residents and completed questionnaires on the participants' demographics, functional status, diagnoses, OS and eating habits. Nutritional status was assessed using the Mini Nutritional Assessment (MNA) and HRQoL with a 15-dimensional instrument (15D).

RESULTS

Of the residents, 25.4% had one OS and 16.6% two or three OS. OS burden was associated linearly with poorer cognitive and physical functioning and a higher number of comorbidities, edentulousness without dentures, and less frequent teeth brushing/denture cleaning. OS burden was also associated with malnutrition, lower BMI and eating less during main meals. In the multivariate analyses adjusted for various confounding factors, a higher number of OS was associated with lower HRQoL. OS burden correlated with nearly all dimensions of HRQoL.

CONCLUSION

Oral symptoms are associated with generic HRQoL. Therefore, OS should be regularly assessed and managed in daily care.

Associations between Nutritional Status and Health-Related Quality of Life among Long-Term Care Residents in Helsinki

OBJECTIVES

We evaluated the associations between nutritional status and health-related quality-of-life (HRQoL) among older long-term care residents in Helsinki.

DESIGN AND PARTICIPANTS

All 3767 older (≥65 years) long-term care residents in Helsinki in 2017 were invited to participate in this cross-sectional study. After refusals and exclusions of residents without sufficient information, 2160 residents remained.

MEASUREMENTS

Data on characteristics, nutritional status (Mini Nutritional Assessment, MNA) and HRQoL (15D) were collected by trained nurses.

RESULTS

Of the participants, 64% were at-risk of malnutrition and 18% suffered from malnutrition. Residents in the "malnourished" group were more dependent in activities of daily living (ADL) functioning, suffered more often from dementia, had lower cognitive level, used less medications, and were eating more often inadequately. HRQoL was statistically significantly associated with MNA total score in both female and male residents. There was a curvilinear correlation between MNA and 15D score in females: 0.50 (95% CI 0.46 to 0.53) and males: 0.56 (95% CI 0.50 to 0.61). In partial correlation analysis, all dimensions of 15D, except for sleeping and breathing, were positively associated with MNA score. In these analyses no significant differences emerged between males and females when the results were adjusted for age and dementia.

CONCLUSIONS

Nutrition plays an important role in HRQoL among older long-term care residents.