Identifying reliable predictors of protein-energy malnutrition in hospitalized frail older adults: A prospective longitudinal study

Prognostic Nutritional Index and Instant Nutritional Assessement Are Associated with Clinical Outcomes in a Geriatric Cohort of Acutely Inpatients

BACKGROUND

Among elderly inpatients, malnutrition is one of the most important predictive factors affecting length of stay (LOS), mortality, and risk of re-hospitalization.

METHODS

We conducted an observational, retrospective study on a cohort of 2206 acutely inpatients. Serum albumin and lymphocytes were evaluated. Instant Nutritional Assessment (INA) and the Prognostic Nutritional Index (PNI) were calculated to predict in-hospital mortality, LOS, and risk of rehospitalization.

RESULTS

An inverse relationship between LOS, serum albumin, and PNI were found. Deceased patients had lower albumin levels, lower PNI values, and third- and fourth-degree INA scores. An accurate predictor of mortality was PNI (AUC = 0.785) after ROC curve analysis; both lower PNI values (HR = 3.56) and third- and fourth-degree INA scores (HR = 3.12) could be independent risk factors for mortality during hospitalization after Cox regression analysis. Moreover, among 309 subjects with a lower PNI value or third- and fourth-class INA, hospitalization was re-hospitalization.

CONCLUSIONS

PNI and INA are two simple and quick-to-calculate tools that can help in classifying the condition of hospitalized elderly patients also based on their nutritional status, or in assessing their mortality risk. A poor nutritional status at the time of discharge may represent an important risk factor for rehospitalization in the following thirty days. This study confirms the importance of evaluating nutritional status at the time of hospitalization, especially in older patients. This study also confirms the importance for adequate training of doctors and nurses regarding the importance of maintaining a good nutritional status as an integral part of the therapeutic process of hospitalization in acute departments.

Dietary assessment methods for measurement of oral intake in acute care and critically ill hospitalised patients: a scoping review

Quantification of oral intake within the hospital setting is required to guide nutrition care. Multiple dietary assessment methods are available, yet details regarding their application in the acute care setting are scarce. This scoping review, conducted in accordance with JBI methodology, describes dietary assessment methods used to measure oral intake in acute and critical care hospital patients. The search was run across four databases to identify primary research conducted in adult acute or critical care settings from 1st of January 2000-15th March 2023 which quantified oral diet with any dietary assessment method. In total, 155 articles were included, predominantly from the acute care setting (n = 153, 99%). Studies were mainly single-centre (n = 138, 88%) and of observational design (n = 135, 87%). Estimated plate waste (n = 59, 38%) and food records (n = 43, 28%) were the most frequent assessment methods with energy and protein the main nutrients quantified (n = 81, 52%). Validation was completed in 23 (15%) studies, with the majority of these using a reference method reliant on estimation (n = 17, 74%). A quarter of studies (n = 39) quantified completion (either as complete versus incomplete or degree of completeness) and four studies (2.5%) explored factors influencing completion. Findings indicate a lack of high-quality evidence to guide selection and application of existing dietary assessment methods to quantify oral intake with a particular absence of evidence in the critical care setting. Further validation of existing tools and identification of factors influencing completion is needed to guide the optimal approach to quantification of oral intake in both research and clinical contexts.

The C-reactive protein Albumin ratio was not consistently associated with cardiovascular and all-cause mortality in two community-based cohorts of 70-year-olds

C-reactive protein (CRP)/Albumin ratio (CAR) seems to mirror disease severity and prognosis in several acute disorders particularly in elderly patients, which we aimed to study. As method we use a prospective study design; the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS; n = 912, women 50%; mean age 70 years, baseline 2001 and 2004, median follow-up 15.0 years, end of follow-up 2019) and the Uppsala Longitudinal Study of Adult Men (ULSAM, n = 924 mean age 71 years, baseline 1991-1995, median follow-up 15.6 years, end of follow-up 2016). Serum samples were used for analyses of CRP and Albumin. Cox regression analyses were performed for cardiovascular and all-cause mortality in models adjusting for several factors (age; physical activity; Interleukin-6; cardiovascular (CVD) risk factors: smoking, BMI level, systolic blood pressure, LDL-cholesterol, and diabetes), with 95% confidence interval (CI). When adjusting for age and CVD risk factors, CAR was significantly associated with cardiovascular mortality for meta-analyzed results from PIVUS and ULSAM, HR 1.09 (95% 1.01-1.18), but neither in PIVUS (HR 1.14, 95% CI 0.99-1.31) nor in ULSAM (1.07, 95% CI 0.98-1.17). Additionally, CAR was significantly associated with all-cause mortality in ULSAM 1.31 (95% CI 1.12-1.54) but not in PIVUS HRs 1.01 (95% 0.089-1.15). The predictive value of CAR was similar to CRP alone in PIVUS and ULSAM and slightly better than albumin for the prediction of CVD-mortality in ULSAM. In conclusion, CAR was not consistently associated with cardiovascular and all-cause mortality in the two cohorts. The prognostic value of CAR for long-term CVD-mortality was similar to CRP.

Are Energy and Protein Intakes Lower Than Requirements in Older Adults? An Urgent Issue in Hospitals and Nursing Homes

Energy and protein intakes lower than requirements are associated with worsening health outcomes. Here we set out to evaluate gaps between energy and protein intakes and requirements in older adults in hospitals and in nursing homes (NH). A cross-sectional study included 360 inpatients and residents aged 75 years and older in two acute care wards; i.e., a multidisciplinary care unit (MCU) and a geriatric care unit (GCU), a geriatric rehabilitation unit (GRU), and two NH. Intakes were measured for three days. Requirements were based on French National Health Authority recommendations. Energy and protein intakes were under the minimum requirement of 30 kcal/kg/day and 1.2 g/kg/day in 89.5% and 100% of MCU patients, respectively, 75.5% and 64.2% of GCU patients, 92.7% and 90.9% of GRU patients, and 83.8% and 83.8 of NH residents. Intake-to-requirement gaps were not significantly associated with malnutrition, except in the GCU group where non-malnourished patients had higher energy gaps than malnourished patients. Intakes fell dramatically short of requirements in older adults in both hospital and NH settings irrespective of malnutrition status. A new paradigm based on a patient-centered approach should be developed to adapt meals served in hospital and in NH.

Hospital Services to Improve Nutritional Intake and Reduce Food Waste: A Systematic Review

BACKGROUND AND AIMS

Patients' nutritional intake is a crucial issue in modern hospitals, where the high prevalence of disease-related malnutrition may worsen clinical outcomes. On the other hand, food waste raises concerns in terms of sustainability and environmental burden. We conducted a systematic review to ascertain which hospital services could overcome both issues.

METHODS

A systematic literature search following PRISMA guidelines was conducted across MEDLINE, Web of Science, and Scopus for randomised controlled trials (RCTs) and observational studies comparing the effect of hospital strategies on energy intake, protein intake, and plate/food waste. The quality of included studies was assessed using the Newcastle-Ottawa Scale for cohort studies and the Cochrane Risk of Bias tool from the Cochrane Handbook for Systematic Reviews of Interventions for RCTs.

RESULTS

Nineteen studies were included, assessing as many hospital strategies such as food service systems-including catering and room service-(n = 9), protected mealtimes and volunteer feeding assistance (n = 4), food presentation strategies (n = 3), nutritional counseling and education (n = 2), plant-based proteins meal (n = 1). Given the heterogeneity of the included studies, the results were narratively analysed.

CONCLUSIONS

Although the results should be confirmed by prospective and large sample-size studies, the personalisation of the meal and efficient room service may improve nutritional intake while decreasing food waste. Clinical nutritionist staff-especially dietitians-may increase food intake reducing food waste through active monitoring of the patients' nutritional needs.

Clinical applications of body composition and functional status tools for nutrition assessment of hospitalized adults: A systematic review

BACKGROUND

No global consensus exists on diagnostic criteria for malnutrition. Muscular deficits and functional impairments are major components of available malnutrition diagnostic frameworks because these facets of nutrition status significantly impact outcomes. The purpose of this review is to explore which body composition assessment (BCA) and functional status assessment (FSA) tools are being used for nutrition assessment (NA) and monitoring the response to nutrition interventions (RNIs) in adult inpatients.

METHODS

A literature search of Embase, Medline (Ovid), Web of Science, and Cochrane Central was performed to identify studies that used BCA and/or FSA tools for NA (along with an accepted NA diagnostic framework) and/or for monitoring RNI in adult inpatients.

RESULTS

The search yielded 3667 articles; 94 were included in the review. The number of studies using BCA and/or FSA tools for NA was 47 and also 47 for monitoring RNI. Seventy-nine percent of studies used bioimpedance for BCA, and 97% that included FSA utilized handgrip strength. When compared against sets of diagnostic criteria, many of the BCA and FSA tools showed promising associations with nutrition status.

CONCLUSION

Bioimpedance methods are the most widely used bedside BCA tools, and handgrip strength is the most widely used FSA tool; however, these methods are being used with a variety of protocols, algorithms, and interpretation practices in heterogeneous populations. To create a standardized nutrition status assessment process there is a need for validation studies on bedside methods and the development of globally standardized assessment protocols in clinical inpatient settings.

Intermittent Fasting: Potential Utility in the Treatment of Chronic Pain across the Clinical Spectrum

Dietary behavior can have a consequential and wide-ranging influence on human health. Intermittent fasting, which involves intermittent restriction in energy intake, has been shown to have beneficial cellular, physiological, and system-wide effects in animal and human studies. Despite the potential utility in preventing, slowing, and reversing disease processes, the clinical application of intermittent fasting remains limited. The health benefits associated with the simple implementation of a 12 to 16 h fast suggest a promising role in the treatment of chronic pain. A literature review was completed to characterize the physiologic benefits of intermittent fasting and to relate the evidence to the mechanisms underlying chronic pain. Research on different fasting regimens is outlined and an overview of research demonstrating the benefits of intermittent fasting across diverse health conditions is provided. Data on the physiologic effects of intermittent fasting are summarized. The physiology of different pain states is reviewed and the possible implications for intermittent fasting in the treatment of chronic pain through non-invasive management, prehabilitation, and rehabilitation following injury and invasive procedures are presented. Evidence indicates the potential utility of intermittent fasting in the comprehensive management of chronic pain and warrants further investigation.

Social Relationships, Food Security, Protein Intake, and Hospitalization in Homebound Older Adults: A PATH Analysis

The objective of this study was to measure direct and indirect relationships between food insecurity (FI), protein intake, social relationships, depressive symptoms, and their impact on hospitalization among home-delivered meal (HDM) recipients, compared to controls, using structural equation modeling. The analysis used data from the National Outcomes Evaluation Study (2015-2017) of the OAANSP. HDM recipients' mean usual protein intake was significantly higher than controls, but both groups had mean intakes below recommendations. Eating alone was inversely associated with lower protein intake and greater hospitalizations in controls. FI, prevalent in 25.1% of HDM recipient and 16% of controls, was associated with lower protein intake in both groups. Receiving instrumental social support was directly associated with lesser severity of FI in recipients. and more depressive symptoms only in controls. HDM recipients and controls may be at high risk for protein insufficiency, underscored by high prevalence of FI.

Clinical and nutritional predictors of hospital readmission within 30 days

BACKGROUND/OBJECTIVES

Identify clinical, sociodemographic, and nutritional predictors of hospital readmission within 30 days.

SUBJECTS/METHODS

A longitudinal study was conducted with patients hospitalised at a public institution in Recife, Brazil. Sociodemographic (age, sex, race, and place of residence), clinical (diagnosis, comorbidities, medications, polypharmacy, hospital outcome, hospital stay, and occurrence of readmission within 30 days), and nutritional (% of weight loss, body mass index, arm circumference [AC], and calf circumference [CC]) characteristics were collected from the nutritional assessment files and patient charts. Nutritional risk was determined using the 2002 Nutritional Risk Screening tool and the diagnosis of malnutrition was based on the GLIM criteria.

RESULTS

The sample was composed of 252 patients, 58 (23.0%; CI_95%: 17.2-28.8%) of whom were readmitted within 30 days after discharge from hospital, 135 (53.5%; CI_95%: 46.7-60.5%) were at nutritional risk and 107 (42.4%; CI_95%: 35.6-49.3%) were malnourished. In the bivariate analysis, polypharmacy, nutritional risk, malnutrition, low AC, and low CC were associated with readmission. In the multivariate analysis, low CC was considered an independent risk factor, increasing the likelihood of hospital readmission nearly fourfold. In contrast, the absence of polypharmacy was a protective favour, reducing the likelihood of readmission by 81%.

CONCLUSIONS

The use of six medications or more and low calf circumference are risk factors for hospital readmission within 30 days after discharge.

Malnutrition and Inadequate Eating Behaviour during Hospital Stay in Geriatrics-An Explorative Analyses of NutritionDay Data in Two Hospitals

(1) Background: Malnutrition in hospitalized patients is prevalent worldwide, but the severity of the issue is often underestimated by practitioners. The purpose of this study is to investigate the prevalence of malnutrition and inadequate eating behaviour in a geriatric sample. (2) Methods: Two hospitals participated with six wards on nutritionDay in 2017, 2018 and 2019. Nutritional status, food intake, and nutritional interventions were analyzed for all patients ≥ 65 years (n = 156), using the official nutritionDay questionnaires. Malnutrition risk is identified by Malnutrition Universal Screening Tool (MUST), malnutrition by the ESPEN criteria (European Society of Clinical Nutrition and Metabolism). (3) Results: According to MUST (n = 136) 16.9% (n = 23) were at medium risk of malnutrition, 33.8% (n = 46) at high risk of malnutrition, 28.1% (n = 38) were malnourished. Overall, 62.8% (n = 98) showed an inadequate eating behaviour during hospital stay. Moreover, patients with inadequate nutrition had significantly worse self-reported health statuses (p = 0.001; r = -0.276), were less able to walk on nutritionDay (p = 0.002; r = -0.255), had eaten little in the week before admission to hospital (p < 0.001; r = -0.313), and had an increased length of stay (p = 0.036; r = -0.174). (4) Conclusion: To identify malnourished patients is a significant barrier for practitioners seeking to administer specific, tailored interventions. Malnutrition screening protocols must be improved, just as nutrition monitoring in general.

The role of nurse staffing in the performance of function-preserving processes during acute hospitalization: A cross-sectional study

BACKGROUND

Performance of function-preserving hospitalization processes related to patient mobility, use of continence aids and food intake is significantly associated with outcomes in older adults. Nurses are the front-line personnel responsible for promoting performance of such processes. The degree to which nurse staffing is related to this performance is unclear.

OBJECTIVE

To identify nurse-staffing characteristics and nursing-related care needs associated with older patients' mobility, continence care and food intake during acute hospitalization.

DESIGN

Cross-sectional study using survey data from the Hospitalization Process Effects on Functional Outcomes and Recovery (HoPE-FOR) cohort study combined with day-level administrative nurse staffing data and clinical day-level aggregated data for all patients hospitalized during the HoPE-FOR study period.

SETTING

Internal medicine units in two medical centers in Israel.

PARTICIPANTS

Eight hundred seventy-three older adults.

METHODS

Mobility, continence care and food intake were assessed within 2 days of admission using validated questionnaires. Nurse-to-patient ratios and nursing-skill mix (i.e. registered nurses (RNs), nurse aides, nurses with advanced clinical training and RNs with an academic degree) were assessed using administrative data. Decision trees were developed for mobility, continence care and food intake, applying classification and regression-tree analysis.

RESULTS

The mobility decision tree identified three characteristics subdividing patients into six nodes: pre-admission functioning, pre-admission activity level and percentage of nurses with advanced training. The percentage of nurses with advanced training classified low-functioning patients into those walking in corridors versus walking or sitting only inside the room. The continence-care classification decision tree identified two characteristics that subdivided the patients into four nodes: pre-admission functioning and bladder control. Nurse-to-patient-ratio variables and patients' nursing-related care needs did not contribute to this classification. The food-intake decision tree identified four characteristics-pre-admission functioning, gender, percentage of nurses with advanced training and percentage of nurse aides-subdividing patients into eight nodes. Low-functioning patients exposed to a higher percentage of nurses with advanced training had food-intake scores 14% higher than patients exposed to a lower percentage of nurses with advanced training. Independent men exposed to a higher percentage of nurse aides had a 14% higher habitual daily in-hospital food-intake score than independent men exposed to a lower percentage of nurse aides.

CONCLUSIONS

A higher percentage of nurses with post-graduate education is associated with better performance of mobility and food intake of hospitalized older adults. To maintain the potential benefits of highly trained staff, education levels should be considered in scheduling and assignment decision-making processes in internal medicine units. Tweetable abstract: A higher percentage of nurses with post-graduate education is associated with better mobility and food intake of hospitalized older adults.

Influence of Geriatric Patients' Food Preferences on the Selection of Discharge Destination

Background

The nonprotein calorie/nitrogen (NPC/N) ratio of food remains poorly investigated. Thus, this study examined the nutritional factors that influence the choice of discharge destination for geriatric patients.

Methods

We retrospectively investigated the patient characteristics, clinical laboratory test results, and hospital food consumption of 65 geriatric patients (80.0 ± 8.2 years; 31 males, 34 females), who were receiving oral nutritional support at a small mixed-care hospital and further explored their discharge destinations. The NPC/N ratios were calculated according to the menus for the meals provided during the first 4 weeks after admission. For logistic regression analysis, the objective variables were discharge destinations (i.e., nursing care facilities including home or medical institutions) whereas the predictor variables were age, sex, nursing care level, hospitalization duration, serum albumin level (Alb), estimated glomerular filtration rate (eGFR), and NPC/N ratio.

Results

Compared with age and nursing care level, sex (partial regression coefficient (B) = -5.140, P = 0.002), hospitalization duration (B = 0.077, P = 0.004), Alb (B = 3.223, P = 0.013), eGFR (B = -0.071, P = 0.019), and NPC/N ratio (B = -0.224, P = 0.001) are significantly correlated with the selection of discharge destination.

Conclusions

For geriatric patients who went to medical institutions, the need for prolonged hospitalization, male sex, hospitalization duration, stable serum Alb, low eGFR, low NPC/N ratio (i.e., high protein proportion), and the quantity of hospital food consumed were the possible factors that influence their discharge destination.

Predictive factors of a prolonged length of stay in a community Nursing-Led unit: A retrospective cohort study

AIMS AND OBJECTIVES

To describe the care provided to patients admitted into a community Nursing-Led inpatient unit and to identify factors predicting a length of stay exceeding an established threshold.

BACKGROUND

Few studies have been conducted to describe the care provided in a Nursing-Led unit. No studies have investigated factors affecting length of stay in these services.

DESIGN

Retrospective cohort study.

METHODS

Consecutive patients admitted to a community Nursing-Led unit between 2009-2015 were enrolled. Sociodemographic, medical and nursing care (diagnoses and activities) variables were collected from electronic health records. Descriptive analysis and a backward stepwise logistic regression model were applied. The study followed the STROBE guidelines.

RESULTS

The study enrolled 904 patients (mean age: 77.7 years). The most frequent nursing diagnoses were bathing self-care deficit and impaired physical mobility. The nursing activities most provided were enteral medication administration and vital signs measurement. Approximately 37% of the patients had a length of stay longer than the established threshold. Nine covariates, including being discharged to home, having an impaired memory nursing diagnosis or being treated for advanced wound care, were found to be independent predictors of prolonged length of stay. Variables related to medical conditions did not affect the length-of-stay threshold.

CONCLUSIONS

The length of stay in the community Nursing-Led unit was mainly predicted by conditions related to sociodemographic factors, nursing complexity and functional status. This result confirms that the medical and nursing needs of a community Nursing-Led unit population substantively differ from those of hospitalised acute patients.

RELEVANCE TO CLINICAL PRACTICE

The nursing complexity and related nursing care to be provided may be adopted as a criterion to establish the appropriate length of stay in the community Nursing-Led unit for each individual patient.

Αcute effects of essential amino acid gel-based and whey protein supplements on appetite and energy intake in older women

Deficiencies in protein and energy intakes are partly responsible for age-related sarcopenia. We investigated the effects of supplements matched in essential amino acid (EAA) content (7.5 g) on energy intake and appetite. Ten women aged 69.2 ± 2.7 years completed 3 trials in a randomised, crossover design. Composite appetite scores, peptide-YY (PYY), and insulin responses to a 200-mL whey protein (WP) isolate (275 kJ), a 50-mL EAA gel (GEL, 478 kJ), or nothing as the control (CON) condition were investigated over 1 h, followed by an ad libitum breakfast. Energy intake at breakfast (CON, 1957 ± 713; WP, 1413 ± 623; GEL, 1963 ± 611 kJ) was higher in CON and GEL than in WP (both P = 0.006). After accounting for supplement energy content, energy intake in GEL was higher than in CON (P = 0.0006) and WP (P = 0.0008). Time-averaged area under the curve for composite appetite scores (CON, 74 ± 20; WP, 50 ± 22; GEL, 60 ± 16 mm) was higher in CON than WP (P = 0.015). Time-averaged area under the curve for PYY (CON, 87 ± 13; WP, 119 ± 27; GEL, 97 ± 22 pg·mL−1) was higher in WP than CON (P = 0.009) and GEL (P = 0.012). In conclusion, supplementation with WP facilitated an increase in protein intake, whereas supplementation with GEL increases in both energy and protein intakes, when consumed before an ad libitum breakfast. Such findings highlight potential gel-based EAA supplementation intake for addressing age-related sarcopenia.

Association Between Risk Factors and Intensive Nutritional Intervention Outcomes in Elderly Individuals

Background

The purpose of this study was to identify risk factors for intensive nutritional intervention outcomes in elderly undernourished patients to help reduce the number of patients with prolonged hospital stay or without recuperation of previous activities of daily living and quality of life.

Methods

In total, 230 patients who received interventions from a nutrition support team (NST) between January 2016 and July 2018 were included. Patients were classified into two groups based on NST intervention outcomes: patients with improved nutritional status were included in the successful group, whereas those whose nutritional status did not improve, as defined by progressive illness or death, were classified into the non-successful group. We assessed patient characteristics, laboratory data, and nutrition support methods.

Results

Our multivariate Cox proportional hazard analysis showed that: 1) The presence of peripheral parenteral nutrition (hazard ratio (HR): 1.80; 95% confidence interval (CI): 1.13 - 2.88) was identified as an independent risk factor for NST intervention outcomes; 2) The energy fill rate to total energy expenditure was < 66.0% (HR: 1.61; 95% CI: 0.98 - 2.66); and 3) A geriatric nutritional risk index score < 70.0 (HR: 1.54; 95% CI: 0.92 - 2.56) tended to be negatively associated with NST intervention outcomes.

Conclusions

In addition to the nutrition therapy provided by a traditional NST, patients with the risk factors require nutritional intervention. Elderly individuals should also receive nutrition care because they have been recuperating at their home or in long-term care facilities, to prevent experiencing adverse conditions.

May nutritional status worsen during hospital stay? A sub-group analysis from a cross-sectional study

Hospital malnutrition is a detrimental prognostic factor regarding hospital mortality, complications, and length of stay. However, the role of hospitalization itself on nutritional status has not been fully elucidated. We report the results of a secondary analysis from the dataset of a recent cross-sectional study at Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy. Data from patients evaluated at admission and discharge were collected and compared. One hundred thirty-nine patients were evaluated. Mean length of stay was 13.6 (± 7.7) days. Patients at risk of malnutrition, according to NRS-2002, were 75 (53.9%), while 63 (45.3%) were malnourished according to ESPEN Criteria. Compared to admission, at discharge, patients reported a significant decrease in Mid-Upper Arm Circumference (MUAC)-from 26.5 cm (± 3.6) to 25.9 cm (± 3.7) (p = 0.016), a reduction in Phase angle (PhA)-from 4.25° (± 1.20) to 4.01° (± 1.15) (p = 0.005), fat-free mass (FFM)-from 47.5 kg (± 9.19) to 44.9 kg (± 9.4) (p = 0.03) and fat-free mass index (FFMI)-from 16.9 kg/m² (± 2.3) to 15.8 kg/m² (± 2.7) (p = 0.04). Laboratory data showed a reduction of albumin-from 29.2 (± 5.7) to 28.0 (± 5.9) (p = 0.01) and Onodera's PNI- from 29.1 (± 5.6) to 27.6 kg (± 5.6) (p = 0.039). At the multivariate linear regression analysis, the variables significantly associated with a worsening of PhA at discharge are the PhA value at admission and the diagnosis of malnutrition according to ESPEN Criteria. Hospitalization leads to significative changes in nutritional status. A clinical concern should be raised about the quality of hospital food and meal times and on the need for a clinical nutritionist on the ward.

New insights into the anorexia of ageing: from prevention to treatment

PURPOSE OF REVIEW

Undernutrition in older adults is associated with frailty, functional decline, and mortality. The 'anorexia of ageing' is the age-related appetite and weight loss underpinning such undernutrition. This review examines the latest evidence for its prevention and treatment.

RECENT FINDINGS

Existing nutritional therapies for the anorexia of ageing include supporting nutritional intake with fortified food or supplements, including protein, omega-3 fatty acids, multivitamins, and vitamin D. The Mediterranean diet provides high fat intake and nutrient density in a moderate volume of colourful and flavoursome food and is strengthening in evidence for healthy ageing. Studies of the gut microbiome, which potentially regulates normal appetite by acting on the brain-gut communication axis, are pertinent. Utilisation of the genetic profile of individuals to determine nutritional needs is an exciting advancement of the past decade and may become common practice.

SUMMARY

Prevention or early treatment of the anorexia of ageing in older adults is critical. Latest evidence suggests that once significant weight loss has occurred, aggressive nutritional support may not result in improved outcomes.

Challenges of conducting research in long-term care facilities: a systematic review

Background

The aim of this review is to describe the challenges and barriers to conducting research in long-term care facilities.

Methods

A literature search was conducted in Ovid MEDLINE, Embase, Cochrane Central, PsycINFO and CINAHL. Keywords used included “long term care”, “nursing home”, “research”, “trial”, “challenge” and “barrier”, etc. Resulting references were screened in order to identify relevant studies that reported on challenges derived from first-hand experience of empirical research studies. Challenges were summarized and synthesized.

Results

Of 1723 references, 39 articles were selected for inclusion. To facilitate understanding we proposed a classification framework of 8 main themes to categorize the research challenges presented in the 39 studies, relating to the characteristics of facility/owner/administrator, resident, staff caregiver, family caregiver, investigator, ethical or legal concerns, methodology, and budgetary considerations.

Conclusions

Conducting research in long-term care facilities is full of challenges which can be categorized into 8 main themes. Investigators should be aware of all these challenges and specifically address them when planning their studies. Stakeholders should be involved from an early stage and flexibility should be built into both the methodology and research budget.

Electronic supplementary material

The online version of this article (10.1186/s12877-018-0934-9) contains supplementary material, which is available to authorized users.