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Nishioka S, Kokura Y, Momosaki R, Taketani Y. Measures for Identifying Malnutrition in Geriatric Rehabilitation: A Scoping Review. Nutrients 2024; 16:223. [PMID: 38257116 PMCID: PMC10820477 DOI: 10.3390/nu16020223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/08/2024] [Accepted: 01/09/2024] [Indexed: 01/24/2024] Open
Abstract
Malnutrition is a common condition in geriatric rehabilitation settings; however, the accuracy and predictive validity of the measures to identify malnutrition have not been established. The current scoping review followed the Joanna Briggs Institute's evidence synthesis manual and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews checklist. Literature published through September 2023 was searched using MEDLINE and CINAHL. The inclusion criteria selected studies reporting malnutrition measures, which include static body weight and weight loss. Identified tools were classified as nutritional screening tools, nutritional assessment tools, or diagnostic criteria. The domains of each tool/criterion and their accuracy and predictive validity were extracted. Fifty-six articles fulfilled the inclusion criteria, and six nutritional screening tools, three nutritional assessment tools, and three diagnostic criteria for malnutrition were identified. These measures consisted of various phenotypes, e.g., weight loss, causes such as inflammation/disease, and risk factors of malnutrition, e.g., functional impairment. The predictive validity of nutritional screening tools (n = 6) and malnutrition diagnostic criteria (n = 5) were inconsistently reported, whereas those for nutritional assessment tools were scarce (n = 1). These findings highlight the need to distinguish the functional impairment of nutritional origin from that of non-nutritional origin in nutritional assessment procedures, and the need to study the accuracy and the predictive validity of these measures in geriatric rehabilitation patients.
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Affiliation(s)
- Shinta Nishioka
- Department of Clinical Nutrition and Food Service, Nagasaki Rehabilitation Hospital, 4-11, Gin-yamachi, Nagasaki 850-0854, Japan
- Department of Clinical Nutrition and Food Management, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Kuramoto-cho, Tokushima 770-8503, Japan;
| | - Yoji Kokura
- Department of Nutrition Management, Keiju Hatogaoka Integrated Facility for Medical and Long-Term Care, 15-39-8, Mugigaura, Anamizu, Hosu-gun 927-0023, Japan;
| | - Ryo Momosaki
- Department of Rehabilitation Medicine, Mie University Graduate School of Medicine, 2-174, Edobashi, Tsu 514-8507, Mie, Japan;
| | - Yutaka Taketani
- Department of Clinical Nutrition and Food Management, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Kuramoto-cho, Tokushima 770-8503, Japan;
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Dent E, Wright ORL, Woo J, Hoogendijk EO. Malnutrition in older adults. Lancet 2023; 401:951-966. [PMID: 36716756 DOI: 10.1016/s0140-6736(22)02612-5] [Citation(s) in RCA: 76] [Impact Index Per Article: 76.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 11/15/2022] [Accepted: 12/01/2022] [Indexed: 01/29/2023]
Abstract
Malnutrition is a highly prevalent condition in older adults, and poses a substantial burden on health, social, and aged-care systems. Older adults are vulnerable to malnutrition due to age-related physiological decline, reduced access to nutritious food, and comorbidity. Clinical guidelines recommend routine screening for malnutrition in all older adults, together with nutritional assessment and individually tailored nutritional support for older adults with a positive screening test. Nutritional support includes offering individualised nutritional advice and counselling; oral nutritional supplements; fortified foods; and enteral or parenteral nutrition as required. However, in clinical practice, the incorporation of nutritional guidelines is inadequate and low-value care is commonplace. This Review discusses the current evidence on identification and treatment of malnutrition in older adults, identifies gaps between evidence and practice in clinical care, and offers practical strategies to translate evidence-based knowledge into improved nutritional care. We also provide an overview of the prevalence, causes, and risk factors of malnutrition in older adults across health-care settings.
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Affiliation(s)
- Elsa Dent
- Research Centre for Public Health, Equity & Human Flourishing, Torrens University Australia, Adelaide, SA, Australia.
| | - Olivia R L Wright
- School of Human Movement and Nutrition Sciences, The University of Queensland, St. Lucia, QLD, Australia
| | - Jean Woo
- Department of Medicine and Therapeutics and Centre for Nutritional Studies, Faculty of Medicine, The Chinese University of Hong Kong, Ma Liu Shui, Hong Kong Special Administrative Region, China
| | - Emiel O Hoogendijk
- Department of Epidemiology & Data Science and Department of General Practice, Location VU University Medical Center, Amsterdam UMC, Amsterdam, Netherlands; Amsterdam Public Health research institute and Ageing & Later Life Research Program, Amsterdam UMC, Amsterdam, Netherlands; Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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Nishioka S, Wakabayashi H. Interaction between malnutrition and physical disability in older adults: is there a malnutrition-disability cycle? Nutr Rev 2023; 81:191-205. [PMID: 35831980 DOI: 10.1093/nutrit/nuac047] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Malnutrition and physical disability are urgent issues in super-aging societies and the 2 phenomena are closely linked in older adults. Both conditions have common underlying causes, including physiological changes due to aging and burdens imposed by disease or injury. Accordingly, a concept of the malnutrition-disability cycle was generated and a comprehensive literature search was performed. There was insufficient evidence to prove an interrelationship between malnutrition and physical disabilities, because of the study design and poor quality, among other factors. However, some evidence exists for the interaction between low body mass index and swallowing disorders, and the effects of some malnutrition and disability components. This review provides the rationale for this interaction, the concept of a malnutrition-disability cycle is proposed, and the available evidence is critically appraise.
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Affiliation(s)
- Shinta Nishioka
- is with the Department of Clinical Nutrition and Food Services, Nagasaki Rehabilitation Hospital, Nagasaki City, Nagasaki, Japan
| | - Hidetaka Wakabayashi
- is with the Department of Rehabilitation Medicine, Tokyo Women's Medical University Hospital, Tokyo, Japan
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De Luca V, Femminella GD, Patalano R, Formosa V, Lorusso G, Rivetta C, Di Lullo F, Mercurio L, Rea T, Salvatore E, Korkmaz Yaylagul N, Apostolo J, Silva RC, Dantas C, van Staalduinen WH, Liotta G, Iaccarino G, Triassi M, Illario M. Assessment Tools of Biopsychosocial Frailty Dimensions in Community-Dwelling Older Adults: A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16050. [PMID: 36498125 PMCID: PMC9739796 DOI: 10.3390/ijerph192316050] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/21/2022] [Accepted: 11/29/2022] [Indexed: 06/17/2023]
Abstract
Frailty is a complex interplay between several factors, including physiological changes in ageing, multimorbidities, malnutrition, living environment, genetics, and lifestyle. Early screening for frailty risk factors in community-dwelling older people allows for preventive interventions on the clinical and social determinants of frailty, which allows adverse events to be avoided. By conducting a narrative review of the literature employing the International Narrative Systematic Assessment tool, the authors aimed to develop an updated framework for the main measurement tools to assess frailty risks in older adults, paying attention to use in the community and primary care settings. This search focused on the biopsychosocial domains of frailty that are covered in the SUNFRAIL tool. The study selected 178 reviews (polypharmacy: 20; nutrition: 13; physical activity: 74; medical visits: 0; falls: 39; cognitive decline: 12; loneliness: 15; social support: 5; economic constraints: 0) published between January 2010 and December 2021. Within the selected reviews, 123 assessment tools were identified (polypharmacy: 15; nutrition: 15; physical activity: 25; medical visits: 0; falls: 26; cognitive decline: 18; loneliness: 9; social support: 15; economic constraints: 0). The narrative review allowed us to evaluate assessment tools of frailty domains to be adopted for multidimensional health promotion and prevention interventions in community and primary care.
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Affiliation(s)
- Vincenzo De Luca
- Dipartimento di Sanità Pubblica, Università degli Studi di Napoli Federico II, 80131 Napoli, Italy
| | - Grazia Daniela Femminella
- Dipartimento di Scienze Mediche Traslazionali, Università degli Studi di Napoli Federico II, 80131 Napoli, Italy
| | - Roberta Patalano
- Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, 80131 Napoli, Italy
| | - Valeria Formosa
- Specializzazione in Igiene e Medicina Preventiva, Università degli Studi di Roma Tor Vergata, 00133 Roma, Italy
| | - Grazia Lorusso
- Specializzazione in Igiene e Medicina Preventiva, Università degli Studi di Roma Tor Vergata, 00133 Roma, Italy
| | - Cristiano Rivetta
- Specializzazione in Igiene e Medicina Preventiva, Università degli Studi di Roma Tor Vergata, 00133 Roma, Italy
| | - Federica Di Lullo
- Specializzazione in Igiene e Medicina Preventiva, Università degli Studi di Roma Tor Vergata, 00133 Roma, Italy
| | - Lorenzo Mercurio
- Dipartimento di Sanità Pubblica, Università degli Studi di Napoli Federico II, 80131 Napoli, Italy
| | - Teresa Rea
- Dipartimento di Sanità Pubblica, Università degli Studi di Napoli Federico II, 80131 Napoli, Italy
| | - Elena Salvatore
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli Federico II, 80131 Napoli, Italy
| | | | - Joao Apostolo
- Health Sciences Research Unit: Nursing (UICISA:E), Nursing School of Coimbra (ESEnfC), Avenida Bissaya Barreto, 3004-011 Coimbra, Portugal
| | - Rosa Carla Silva
- Health Sciences Research Unit: Nursing (UICISA:E), Nursing School of Coimbra (ESEnfC), Avenida Bissaya Barreto, 3004-011 Coimbra, Portugal
| | | | | | - Giuseppe Liotta
- Dipartimento di Biomedicina e Prevenzione, Università degli Studi di Roma Tor Vergata, 00133 Roma, Italy
| | - Guido Iaccarino
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli Federico II, 80131 Napoli, Italy
| | - Maria Triassi
- Dipartimento di Sanità Pubblica, Università degli Studi di Napoli Federico II, 80131 Napoli, Italy
| | - Maddalena Illario
- Dipartimento di Sanità Pubblica, Università degli Studi di Napoli Federico II, 80131 Napoli, Italy
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Göransson C, Wengström Y, Hälleberg-Nyman M, Langius-Eklöf A, Ziegert K, Blomberg K. An app for supporting older people receiving home care - usage, aspects of health and health literacy: a quasi-experimental study. BMC Med Inform Decis Mak 2020; 20:226. [PMID: 32933500 PMCID: PMC7493150 DOI: 10.1186/s12911-020-01246-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 09/03/2020] [Indexed: 01/21/2023] Open
Abstract
Background During the last decade, there has been an increase in studies describing use of mHealth, using smartphones with apps, in the healthcare system by a variety of populations. Despite this, few interventions including apps are targeting older people receiving home care. Developing mobile technology to its full potential of being interactive in real time remains a challenge. The current study is part of a larger project for identifying and managing health concerns via an app by using real-time data. The aim of the study was to describe older people’s usage of an app and to evaluate the impact of usage on aspects of health and health literacy over time. Methods A quasi-experimental design was employed. Seventeen older people self-reported health concerns via Interaktor twice a week for 3-months and answered questionnaires at baseline, the end of the intervention and at a 6–month follow-up. Logged data on app usage and data on Sense of Coherence, Health Index, Nutrition Form for the Elderly, Geriatric Depression Scale-20, Swedish Communicative and Critical Health Literacy and Swedish Functional Health Literacy were collected and analysed using descriptive and non-parametric inferential statistics. Results The median usage of the app as intended was 96%. Pain was one of the most reported health concerns and was also the health concern that triggered an alert (n = 33). The older people’s communicative and critical health literacy improved significantly over time. Regarding the scores of Sense of Coherence, Health Index, Nutritional Form for the Elderly, Geriatric Depression Scale-20 and Swedish Functional Health Literacy scale, there were no significant differences over time. Conclusions The high app usage showed that an app may be a suitable tool for some older people living alone and receiving home care. The results indicate that the usage of Interaktor can support older people by significantly improving their communicative and critical health literacy. Aspects of health were not shown to be affected by the usage of the app. Further research with larger sample is needed for evaluation the effect on health literacy, and which aspects of health of importance to support by an app.
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Affiliation(s)
- Carina Göransson
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, 701 82, Örebro, Sweden. .,School of Health and Welfare, Halmstad University, 302 18, Halmstad, Sweden.
| | - Yvonne Wengström
- Theme Cancer, Karolinska University Hospital, 141 86, Stockholm, Sweden.,Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska, Institutet, 171 77, Stockholm, Sweden
| | - Maria Hälleberg-Nyman
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, 701 82, Örebro, Sweden
| | - Ann Langius-Eklöf
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska, Institutet, 171 77, Stockholm, Sweden
| | - Kristina Ziegert
- School of Health and Welfare, Halmstad University, 302 18, Halmstad, Sweden
| | - Karin Blomberg
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, 701 82, Örebro, Sweden
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Power L, Mullally D, Gibney ER, Clarke M, Visser M, Volkert D, Bardon L, de van der Schueren MAE, Corish CA. A review of the validity of malnutrition screening tools used in older adults in community and healthcare settings - A MaNuEL study. Clin Nutr ESPEN 2019; 24:1-13. [PMID: 29576345 DOI: 10.1016/j.clnesp.2018.02.005] [Citation(s) in RCA: 113] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 02/16/2018] [Indexed: 01/10/2023]
Abstract
BACKGROUND Older adults are at increased risk of malnutrition compared to their younger counterparts. Malnutrition screening should be conducted using a valid malnutrition screening tool. An aim of the Healthy Diet for a Healthy Life (HDHL) Joint Programming Initiative (JPI) 'Malnutrition in the Elderly Knowledge Hub' (MaNuEL) was to review the reported validity of existing malnutrition screening tools used in older adults. METHODS A literature search was conducted to identify validation studies of malnutrition screening tools in older populations in community, rehabilitation, residential care and hospital settings. A database of screening tools was created containing information on how each tool was validated. RESULTS Seventy-four articles containing 119 validation studies of 34 malnutrition screening tools used in older adults were identified across the settings. Twenty-three of these tools were designed for older adults. Sensitivity and specificity ranged from 6 to 100% and 12-100% respectively. Seventeen different reference standards were used in criterion validation studies. Acceptable reference standards were used in 68 studies; 38 compared the tool against the Mini Nutritional Assessment-Full Form (MNA-FF), 16 used clinical assessment by a nutrition-trained professional and 14 used the Subjective Global Assessment (SGA). Twenty-five studies used inappropriate reference standards. Predictive validity was measured in 14 studies and was weak across all settings. CONCLUSIONS Validation results differed significantly between tools, and also between studies using the same tool in different settings. Many studies have not been appropriately conducted, leaving the true validity of some tools unclear. Certain tools appear to be more valid for use in specific settings.
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Affiliation(s)
- Lauren Power
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland; UCD Institute of Food and Health, University College Dublin, Dublin, Ireland.
| | - Deirdre Mullally
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland; UCD Institute of Food and Health, University College Dublin, Dublin, Ireland.
| | - Eileen R Gibney
- UCD Institute of Food and Health, University College Dublin, Dublin, Ireland; School of Agriculture and Food Science, University College Dublin, Dublin, Ireland.
| | - Michelle Clarke
- UCD Institute of Food and Health, University College Dublin, Dublin, Ireland; School of Agriculture and Food Science, University College Dublin, Dublin, Ireland.
| | - Marjolein Visser
- Department of Nutrition and Dietetics, VU University Medical Centre, Amsterdam, The Netherlands; Department of Health Sciences, Faculty of Earth and Life Sciences, Vrije Universiteit Amsterdam, Amsterdam Public Health Institute, Amsterdam, The Netherlands.
| | - Dorothee Volkert
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany.
| | - Laura Bardon
- UCD Institute of Food and Health, University College Dublin, Dublin, Ireland; School of Agriculture and Food Science, University College Dublin, Dublin, Ireland.
| | - Marian A E de van der Schueren
- Department of Nutrition and Dietetics, VU University Medical Centre, Amsterdam, The Netherlands; Department of Nutrition and Health, HAN University of Applied Sciences, Nijmegen, The Netherlands.
| | - Clare A Corish
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland; UCD Institute of Food and Health, University College Dublin, Dublin, Ireland.
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Håkonsen SJ, Pedersen PU, Bygholm A, Peters MD, Bjerrum M. Speaking the same language: Development of a Nutrition Minimum Data Set for healthcare professionals in primary healthcare. Health Informatics J 2019; 26:248-263. [PMID: 30681037 DOI: 10.1177/1460458218824707] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Providing the best possible nutritional care requires accurate and precise communication between healthcare professionals. Developing a Nutrition Minimum Data Set will inform professionals in primary healthcare of which core elements should be documented and facilitate a standardized approach to the documentation of nutritional care. A two-step methodological approach was utilized in this study: (1) a systematic scoping review was conducted to map evidence underpinning the development of a Minimum Data Set and (2) the datasources were categorized using the inductive content analysis approach. A total of 32 items were identified in the datasources. Five categories were inductively derived from the data: (1) physiologic measurements, (2) ability to eat, (3) intake, (4) stress factors and (5) factors which indirectly affect intake and needs. Organizing the documentation following the structure presented in this Minimum Data Set will contribute to a standardized terminology, which may lead to increased quality of documentation, increased continuity of care and improved health outcomes.
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Miller J, Wells L, Nwulu U, Currow D, Johnson MJ, Skipworth RJE. Validated screening tools for the assessment of cachexia, sarcopenia, and malnutrition: a systematic review. Am J Clin Nutr 2018; 108:1196-1208. [PMID: 30541096 DOI: 10.1093/ajcn/nqy244] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 08/17/2018] [Indexed: 11/13/2022] Open
Abstract
Background There is great overlap between the presentation of cachexia, sarcopenia, and malnutrition. Distinguishing between these conditions would allow for better targeted treatment for patients. Objectives The aim was to systematically review validated screening tools for cachexia, sarcopenia, and malnutrition in adults and, if a combined tool is absent, make suggestions for the generation of a novel screening tool. Design A systematic search was performed in Ovid Medline, EMBASE, CINAHL, and Web of Science. Two reviewers performed data extraction independently. Each tool was judged for validity against a reference method. Psychometric evaluation was performed as was appraisal of the tools' ability to assess the patient against consensus definitions. Results Thirty-eight studies described 22 validated screening tools. The Cachexia score (CASCO) was the only validated screening tool for cachexia and performed well against the consensus definition. Two tools assessed sarcopenia [the Short Portable Sarcopenia Measure (SPSM) and the SARC-F (Strength, Assistance with walking, Rise from a chair, Climb stairs, and Falls)] and scored well against the 1998 Baumgartner definition. The SPSM required large amounts of equipment, and the SARC-F had a low sensitivity. Nineteen tools screened for malnutrition. The 3-Minute Nutrition Score performed best, meeting consensus definition criteria (European Society for Clinical Nutrition and Metabolism) and having a sensitivity and specificity of >80%. No tool contained all of the currently accepted components to screen for all 3 conditions. Only 3 tools were validated against cross-sectional imaging, a clinical tool that is gaining wider interest in body-composition analysis. Conclusions No single validated screening tool can be implemented for the simultaneous assessment of cachexia, sarcopenia, and malnutrition. The development of a tool that encompasses consensus definition criteria and directs clinicians toward the underlying diagnosis would be optimal to target treatment and improve outcomes. We propose that tool should incorporate a stepwise assessment of nutritional status, oral intake, disease status, age, muscle mass and function, and metabolic derangement.
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Affiliation(s)
- Janice Miller
- Clinical Surgery, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Liz Wells
- Diabetes, Endocrinology, and Metabolism, Hull Royal Infirmary, Hull, United Kingdom
| | - Ugochinyere Nwulu
- Wolfson Palliative Care Research Center, Hull York Medical School, University of Hull, Hull, United Kingdom
| | - David Currow
- Wolfson Palliative Care Research Center, Hull York Medical School, University of Hull, Hull, United Kingdom.,Improving Palliative Care through Clinical Trials (IMPACCT), Faculty of Health, University of Technology, Sydney, New South Wales, Australia
| | - Miriam J Johnson
- Wolfson Palliative Care Research Center, Hull York Medical School, University of Hull, Hull, United Kingdom
| | - Richard J E Skipworth
- Clinical Surgery, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
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Power L, de van der Schueren MAE, Leij-Halfwerk S, Bauer J, Clarke M, Visser M, Volkert D, Bardon L, Gibney E, Corish CA. Development and application of a scoring system to rate malnutrition screening tools used in older adults in community and healthcare settings - A MaNuEL study. Clin Nutr 2018; 38:1807-1819. [PMID: 30119984 DOI: 10.1016/j.clnu.2018.07.022] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 06/26/2018] [Accepted: 07/20/2018] [Indexed: 01/27/2023]
Abstract
RATIONALE Many malnutrition screening tools are used to screen for risk of malnutrition in older adults. An aim of the Joint Programming Initiative (JPI) 'A Healthy Diet for a Healthy Life' (HDHL) MalNutrition in the ELderly Knowledge hub (MaNuEL) is to devise recommendations on the best tools to screen for risk of malnutrition in older adults in community and healthcare settings across Europe. The aim of this paper was to develop and apply a scoring system to rate malnutrition screening tools. METHODS Using a targeted literature search strategy, 48 malnutrition screening tools used to screen for risk of malnutrition in older adults were identified across community, rehabilitation, residential care and hospital settings. Criteria to rate each tool were developed; these were based on published evidence and expert opinion. These criteria were translated into a scoring system. RESULTS The scoring system had three equally weighted sections; validation, parameters and practicability, and was applied to all 48 tools. Overall, the highest scoring tools per setting for screening for risk of malnutrition in older adults were i) DETERMINE your health checklist for the community setting; ii) the Nutritional Form for the Elderly (NUFFE) for the rehabilitation setting; iii) the Short Nutritional Assessment Questionnaire-Residential Care (SNAQRC) for residential care and iv) both the Malnutrition Screening Tool (MST) and the Mini Nutritional Assessment Short Form Version 1 (MNA-SF-V1) for the hospital setting. CONCLUSION Setting-specific tools are more appropriate for use with older adults. These findings will inform recommendations for the optimal screening of geriatric malnutrition across Europe.
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Affiliation(s)
- Lauren Power
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland; UCD Institute of Food and Health, University College Dublin, Dublin, Ireland.
| | - Marian A E de van der Schueren
- Department of Nutrition and Health, HAN University of Applied Sciences, Nijmegen, the Netherlands; Department of Nutrition and Dietetics, VU University Medical Centre, Amsterdam, the Netherlands.
| | - Susanne Leij-Halfwerk
- Department of Nutrition and Health, HAN University of Applied Sciences, Nijmegen, the Netherlands.
| | - Jürgen Bauer
- Centre for Geriatric Medicine, Ruprecht-Karls-Universität, Heidelberg, Germany.
| | - Michelle Clarke
- UCD Institute of Food and Health, University College Dublin, Dublin, Ireland; School of Agriculture and Food Science, University College Dublin, Dublin, Ireland.
| | - Marjolein Visser
- Department of Health Sciences, Faculty of Sciences, Vrije Universiteit Amsterdam, Amsterdam Public Health Institute, Amsterdam, the Netherlands.
| | - Dorothee Volkert
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany.
| | - Laura Bardon
- UCD Institute of Food and Health, University College Dublin, Dublin, Ireland; School of Agriculture and Food Science, University College Dublin, Dublin, Ireland.
| | - Eileen Gibney
- UCD Institute of Food and Health, University College Dublin, Dublin, Ireland; School of Agriculture and Food Science, University College Dublin, Dublin, Ireland.
| | - Clare A Corish
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland; UCD Institute of Food and Health, University College Dublin, Dublin, Ireland.
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Håkonsen SJ, Pedersen PU, Bjerrum M, Bygholm A, Peters MD. Nursing Minimum Data Sets for documenting nutritional care for adults in primary healthcare: a scoping review. ACTA ACUST UNITED AC 2018; 16:117-139. [DOI: 10.11124/jbisrir-2017-003386] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Tomstad S, Dale B, Sundsli K, Saevareid HI, Söderhamn U. Who often feels lonely? A cross-sectional study about loneliness and its related factors among older home-dwelling people. Int J Older People Nurs 2017; 12. [PMID: 28752653 DOI: 10.1111/opn.12162] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 06/16/2017] [Indexed: 11/27/2022]
Abstract
AIM AND OBJECTIVES To investigate the prevalence of individuals who often feel lonely among a sample of Norwegian older home-dwelling people aged ≥65 years old, as well as to identify any possible factors explaining their loneliness. BACKGROUND Loneliness is known to be common among older people. To identify those older adults who are lonely, and to acquire knowledge about the complexity of their loneliness, is important to provide them with adequate help and support. DESIGN This study employed a cross-sectional design. METHOD A questionnaire was mailed to a randomised sample of 6,033 older home-dwelling persons aged ≥65 years. A total of 2,052 persons returned the questionnaire and were included in the study. The questionnaire consisted of questions asking whether the subjects often felt lonely or not, as well as health-related and background questions and instruments to measure the participants' sense of coherence, mental problems, nutritional screening and self-care ability. The data were analysed using univariate and multivariate statistical methods. RESULTS A total of 11.6% of the participants reported often feeling lonely. Six factors emerged to be independently associated with often feeling lonely among the respondents: Living alone, not being satisfied with life, having mental problems, a weak sense of coherence, not having contact with neighbours and being at risk for undernutrition. CONCLUSIONS The study shows that often feeling lonely among older home-dwelling persons is a health-related problem that includes social, psychological and physical aspects. Moreover, these persons have limited resources to overcome feelings of loneliness. IMPLICATIONS FOR PRACTICE Lasting loneliness among older home-dwelling persons requires an overall, person-centred and time-consuming approach by nurses. Nurses with advanced knowledge on geriatric nursing may be required to offer appropriate care and support. Healthcare leaders and politicians should offer possibilities for adequate assessment, support and help.
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Affiliation(s)
- Solveig Tomstad
- Centre for Care Research, Southern Norway, Faculty of Health and Sport Sciences, University of Agder, Grimstad, Norway
| | - Bjørg Dale
- Centre for Care Research, Southern Norway, Faculty of Health and Sport Sciences, University of Agder, Grimstad, Norway
| | - Kari Sundsli
- Centre for Care Research, Southern Norway, Faculty of Health and Sport Sciences, University of Agder, Grimstad, Norway
| | - Hans Inge Saevareid
- Centre for Care Research, Southern Norway, Faculty of Health and Sport Sciences, University of Agder, Grimstad, Norway
| | - Ulrika Söderhamn
- Centre for Care Research, Southern Norway, Faculty of Health and Sport Sciences, University of Agder, Grimstad, Norway
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Marshall S. Protein-energy malnutrition in the rehabilitation setting: Evidence to improve identification. Maturitas 2016; 86:77-85. [DOI: 10.1016/j.maturitas.2016.01.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 01/19/2016] [Accepted: 01/21/2016] [Indexed: 01/19/2023]
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Hamirudin AH, Charlton K, Walton K. Outcomes related to nutrition screening in community living older adults: A systematic literature review. Arch Gerontol Geriatr 2016; 62:9-25. [DOI: 10.1016/j.archger.2015.09.007] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 09/18/2015] [Accepted: 09/20/2015] [Indexed: 01/04/2023]
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Lera L, Sánchez H, Ángel B, Albala C. Mini Nutritional Assessment Short-Form: Validation in Five Latin American Cities. SABE Study. J Nutr Health Aging 2016; 20:797-805. [PMID: 27709228 DOI: 10.1007/s12603-016-0696-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To validate the short-form of the MNA (MNA-SF) and the cut-off point of 31 cm for calf circumference (CC) in older people in Latin America. METHODS A cross-sectional study was conducted with 5,722 community-dwelling older subjects (range: 60-102 years) in Latin America´s five main cities: Sao Paulo (Brazil), Santiago (Chile), Havana (Cuba), Mexico DF (Mexico) and Montevideo (Uruguay). All participants underwent an interview, which included anthropometric measurements, completing the MNA and obtaining socio-demographic, nutrition and health information. The short-form of the MNA consists of only six questions from the original 18. It has two versions: one using body mass index (BMI) and the second using CC as a surrogate. Cohen's Kappa was calculated to assess the agreement between the MNA and the MNA-SF; diagnostic tests were performed, and Receiver-operating characteristic (ROC) curves were developed. Criterion-related validity was assessed in the Chilean sample. RESULTS Both version of the MNA-SF showed high sensitivity and specificity with the MNA, showing good accuracy (0.88), although higher values were estimated for malnutrition and risk of malnutrition in the total sample by sex. The cut-off point of 31 cm for CC showed high sensitivity (74.6-94.4%), specificity (72.6-100%) and good area under the ROC curve (0.87-0.95) when compared with BMI. There was good agreement between MNA and both version of MNA-SF for identifying persons with malnutrition or a risk of malnutrition in the five cities (Kappa coefficient: 0.6193-0.7852). CONCLUSION Both versions of the MNA-SF are population-screening tools of easy and fast application, with good accuracy for assessing malnutrition and risk of malnutrition in Latin American older people.
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Affiliation(s)
- L Lera
- Dr. Lydia Lera, Public Health Nutrition Unit, Institute of Nutrition and Food Technology (INTA) - University of Chile, Santiago de Chile, Chile,
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Dale B, Söderhamn U. Nutritional self-care among a group of older home-living people in rural Southern Norway. J Multidiscip Healthc 2015; 8:67-74. [PMID: 25670905 PMCID: PMC4315559 DOI: 10.2147/jmdh.s75521] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Older home-living people are an at-risk group for undernutrition, particularly those who are living alone. Lack of knowledge about healthy dietary habits, altered taste sensation, and declined health status are shown to be some of the factors related to undernutrition. The aims of this study were to explore how a small group of older people in Southern Norway perceived their nutritional self-care. Methods An exploratory qualitative approach, combined with a simple self-report questionnaire, was used. Five persons living in rural areas in Southern Norway, who in a former study were screened and found to be at risk for undernutrition, participated. Qualitative data assessed by means of individual self-care talks in the persons’ own homes were analyzed using directed content analysis. A simple self-report questionnaire containing demographic variables, two health-related questions, and the Nutritional Form For the Elderly (NUFFE-NO) instrument was filled out at baseline and 6 months after the self-care talks. Results The qualitative data showed that the participants had adequate knowledge about healthy and nutritious diets. They were aware of and motivated to adapt their diet to their current state of health and to perform the necessary actions to maintain an optimal nutritional status and nutritional self-care. Conclusion Older people living at home are a diverse group. However, this study showed that they may have sufficient knowledge, willingness, and ability to perform nutritional self-care, even if they live alone and have several chronic illnesses and impaired health.
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Affiliation(s)
- Bjørg Dale
- Centre for Caring Research - Southern Norway, Faculty of Health and Sport Sciences, University of Agder, Grimstad, Norway
| | - Ulrika Söderhamn
- Centre for Caring Research - Southern Norway, Faculty of Health and Sport Sciences, University of Agder, Grimstad, Norway
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Reliability and validity of the Chinese version of the Nutritional Form For the Elderly. Public Health Nutr 2015; 18:2559-64. [DOI: 10.1017/s1368980014003267] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectiveThe present study aimed to translate the English version of the Nutritional Form For the Elderly into Simplified Chinese, as well as to test the reliability (homogeneity and stability) and validity (content and construct validity) of the Chinese version of the Nutritional Form For the Elderly (NUFFE-CHI).DesignThe study adopted a cross-sectional design. The English version of the NUFFE was translated into Simplified Chinese and a questionnaire survey was conducted. The data were analysed with statistical methods to estimate the homogeneity, stability, content and construct validity.SettingJinzhou City, China.SubjectsA total number of 701 community-dwelling older adults answered the questionnaire, including background variables and the NUFFE-CHI. A small group of the participants (n 50) completed the NUFFE-CHI twice for test–retest reliability.ResultsCronbach’s α was 0·65 and the split-half reliability was 0·67. Item-to-total correlation analyses showed that the scale has sufficient internal consistency. The test–retest reliability regarding the total scores of NUFFE-CHI was reflected in an intra-class correlation coefficient of 0·88. The intra-class correlation coefficients between the test and retest of the NUFFE-CHI items varied between 0·43 and 0·98. A content validity index of 0·83 explained good content validity. Construct validity was demonstrated in an exploratory factor analysis with a six-factor solution, explaining 57·65 % of the variance.ConclusionsThis first testing of the NUFFE-CHI indicates sufficient evidence for reliability, content and construct validity. Further testing studies regarding homogeneity, concurrent validity, sensitivity and specificity are required before the NUFFE-CHI can be used as a screening instrument in clinical settings and in research.
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van Bokhorst-de van der Schueren MAE, Guaitoli PR, Jansma EP, de Vet HCW. Nutrition screening tools: Does one size fit all? A systematic review of screening tools for the hospital setting. Clin Nutr 2014; 33:39-58. [PMID: 23688831 DOI: 10.1016/j.clnu.2013.04.008] [Citation(s) in RCA: 325] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 04/04/2013] [Accepted: 04/06/2013] [Indexed: 01/04/2023]
Affiliation(s)
| | - Patrícia Realino Guaitoli
- Dept. of Nutrition and Dietetics, Internal Medicine, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands.
| | - Elise P Jansma
- Medical Library, VU Amsterdam University Library, PO Box 7057, 1007 MB Amsterdam, The Netherlands.
| | - Henrica C W de Vet
- Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands.
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van Bokhorst-de van der Schueren MAE, Guaitoli PR, Jansma EP, de Vet HCW. A systematic review of malnutrition screening tools for the nursing home setting. J Am Med Dir Assoc 2013; 15:171-184. [PMID: 24290910 DOI: 10.1016/j.jamda.2013.10.006] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Revised: 09/11/2013] [Accepted: 10/04/2013] [Indexed: 10/26/2022]
Abstract
RATIONALE Malnutrition screening among nursing home residents is often performed with tools developed for use among older subjects, and sometimes with tools designed for an adult population. Only a few tools have been designed specifically for the nursing home setting. This systematic review assesses the criterion and predictive validity of malnutrition screening tools used in nursing homes. METHODS The databases MEDLINE, CINAHL, and EMBASE were searched on January 30, 2013, for manuscripts including search terms for malnutrition, screening or assessment tools, and setting. Articles were eligible for inclusion if they expressed criterion validity (how well can a tool assess nutritional status) or predictive validity (how well can a tool predict clinical outcome) of malnutrition screening tools in a nursing home population. Included were articles that had been published in the English, German, French, Dutch, Spanish, or Portuguese language. RESULTS The search yielded 8313 references. Of these, 24 met the inclusion criteria and were available; 2 extra manuscripts were retrieved by reference checking. Twenty tools were identified. Seventeen studies reported on criterion validity, and 9 on predictive validity. Four of the tools had been designed specifically for use in long term care. None of the tools, not even the ones specifically designed for the nursing home setting, performed (on average) better than "fair" in either assessing the residents' nutritional status or in predicting malnutrition-related outcomes. CONCLUSION The use of existing screening tools for the nursing home population carries limitations, as none performs better than "fair" in assessing nutritional status or in predicting outcome. Also, no superior tool can be pointed out. This systematic review implies that further considerations regarding malnutrition screening among nursing home residents are required.
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Affiliation(s)
- Marian A E van Bokhorst-de van der Schueren
- Department of Nutrition and Dietetics, Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands; Department of Nutrition, Sports, and Health, HAN University of Applied Sciences, Nijmegen, The Netherlands.
| | - Patrícia Realino Guaitoli
- Department of Nutrition and Dietetics, Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Elise P Jansma
- Medical Library, VU Amsterdam University Library, Amsterdam, The Netherlands
| | - Henrica C W de Vet
- Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
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Tomstad ST, Söderhamn U, Espnes GA, Söderhamn O. Nutritional self-care in two older Norwegian males: a case study. Clin Interv Aging 2013; 8:609-20. [PMID: 23807843 PMCID: PMC3686329 DOI: 10.2147/cia.s45458] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Knowledge about how to support nutritional self-care in the vulnerable elderly living in their own homes is an important area for health care professionals. The aim of this case study was to evaluate the effects of nutritional intervention by comparing perceived health, sense of coherence, self-care ability, and nutritional risk in two older home-dwelling individuals before, during, and after intervention and to describe their experiences of nutritional self-care before and after intervention. METHODS A study circle was established to support nutritional self-care in two older home-dwelling individuals (≥65 years of age), who participated in three meetings arranged by health professionals over a period of six months. The effects of this study circle were evaluated using the Nutritional Form For the Elderly, the Self-care Ability Scale for the Elderly (SASE), the Appraisal of Self-care Agency scale, the Sense of Coherence (SOC) scale, and responses to a number of health-related questions. Qualitative interviews were performed before and after intervention to interpret the changes that occurred during intervention. RESULTS A reduced risk of undernutrition was found for both participants. A higher total score on the SASE was obtained for one participant, along with a slightly stronger preference for self-care to maintain sufficient food intake, was evident. For the other participant, total score on the SASE decreased, but the SOC score improved after intervention. Decreased mobility was reported, but this did not influence his food intake. The study circle was an opportunity to express personal views and opinions about food intake and meals. CONCLUSION An organized meeting place for dialogue between older home-dwelling individuals and health care professionals can stimulate the older person's engagement, consciousness, and learning about nutritional self-care, and thereby be of importance in reducing the risk of undernutrition.
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Affiliation(s)
- Solveig T Tomstad
- Department of Social Work and Health Science, Faculty of Social Sciences and Technology Management, Norwegian University of Science and Technology, Trondheim, Norway.
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Tomstad ST, Söderhamn U, Espnes GA, Söderhamn O. Lived experiences of self-care among older, home-dwelling individuals identified to be at risk of undernutrition. J Multidiscip Healthc 2012; 5:319-27. [PMID: 23271914 PMCID: PMC3526862 DOI: 10.2147/jmdh.s38474] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction In a society where most older people live in their own homes, it may be expected of older individuals to exercise their potential to take care of themselves in daily life. Nutrition is a central aspect of self-care, and groups of older, home-dwelling people are at risk of undernutrition. Aim The aim of this study was to describe the lived experiences of self-care and features that influence health and self-care among older, home-dwelling individuals identified to be at risk of undernutrition. Methods Qualitative interviews were performed with eleven home-dwelling individuals who had been identified as being at risk of undernutrition. The interviews were recorded, transcribed verbatim, and analyzed with a descriptive phenomenological method. Findings Self-care as a lived experience among older, home-dwelling individuals identified to be at risk of undernutrition is about being aware of food choices and making decisions about taking healthy steps or not. In the presence of health problems, the appetite often decreases. Being able to take care of oneself in daily life is important, as is receiving help when needing it. Working at being physically and socially active and engaged may stimulate the appetite. Having company at meals is important and missed when living alone. Being present and taking each day by day, as well as considering oneself in the light of past time and previous experiences and looking ahead, is central, even when having fears for the future and the end of life. Conclusion Health care professionals should be aware of these findings in order to support self-care in older people, and they should pay attention to the social aspects at meals.
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Affiliation(s)
- Solveig T Tomstad
- Department of Social Work and Health Science, Norwegian University of Science and Technology, Trondheim, Norway ; Centre for Caring Research - Southern Norway, University of Agder, Grimstad, Norway
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Söderhamn U, Dale B, Sundsli K, Söderhamn O. Nutritional screening of older home-dwelling Norwegians: a comparison between two instruments. Clin Interv Aging 2012; 7:383-91. [PMID: 23049250 PMCID: PMC3459573 DOI: 10.2147/cia.s35986] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background It is important to obtain knowledge about the prevalence of nutritional risk and associated factors among older home-dwelling people in order to be able to meet nutritional challenges in this group in the future and to plan appropriate interventions. The aim of this survey was to investigate the prevalence of home-dwelling older people at nutritional risk and to identify associated factors using two different nutritional screening instruments as self-report instruments. Methods This study had a cross-sectional design. A postal questionnaire, including the Norwegian versions of the Nutritional Form for the Elderly (NUFFE-NO) and Mini Nutritional Assessment – Short Form (MNA-SF), background variables, and health-related questions was sent to a randomized sample of 6033 home-dwelling older people in southern Norway. A total of 2106 (34.9%) subjects were included in the study. Data were analyzed using descriptive statistics and logistic regression analyses. Results When using the NUFFE-NO and MNA-SF, 426 (22.3%) and 258 (13.5%) older persons, respectively, were identified to be at nutritional risk. The risk of undernutrition increased with age. Several predictors for being at risk of undernutrition, including chronic disease/handicap and receiving family help, as well as protective factors, including sufficient food intake and having social contacts, were identified. Conclusion Health professionals must be aware of older people’s vulnerability to risk of undernutrition, perform screening, and have a plan for preventing under-nutrition. For that purpose, MNA-SF and NUFFE-NO can be suggested for screening older people living at home.
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Affiliation(s)
- Ulrika Söderhamn
- Centre for Caring Research-Southern Norway, Faculty of Health and Sport Sciences, University of Agder, Grimstad, Norway.
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Söderhamn U, Dale B, Sundsli K, Tomstad ST, Söderhamn O. Psychometric testing of the Norwegian version of the Nutritional Form For the Elderly among older home-dwelling people. J Multidiscip Healthc 2012; 5:121-8. [PMID: 22791993 PMCID: PMC3392698 DOI: 10.2147/jmdh.s32502] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Nutritional screening instruments need to be evaluated in terms of reliability and validity and being able to demonstrate sensitivity and specificity for use in clinical practice and research. The aims of this study were to test the reliability and validity of the Norwegian version of the Nutritional Form For the Elderly (NUFFE-NO) in a sample of older home-dwelling people, and to use the short form of the Mini Nutritional Assessment (MNA-SF) as a standard. Methods A postal questionnaire, including the two instruments, background variables, and health-related questions, was sent to 6033 home-dwelling older people (65+ years) in southern Norway. In total, 2106 persons responded and were included. Data were analyzed statistically regarding homogeneity, concurrent and construct validity, sensitivity, and specificity of NUFFE-NO. Results A Cronbach’s alpha coefficient of 0.71 and significant item-to-total correlations were obtained as measures of homogeneity. Concurrent validity was assessed by a correlation coefficient of −0.37 (P < 0.001) between NUFFE-NO and MNA-SF. NUFFE-NO could separate known nutritional at-risk groups as a measure of construct validity. A cut-off point of ≥4 for identification of older people at nutritional risk was found for NUFFE-NO with MNA-SF as a standard. Conclusion NUFFE-NO shows adequate psychometric properties regarding homogeneity and construct validity. MNA-SF was not found to be the most suitable standard to use, because a low correlation coefficient was obtained as a measure of concurrent validity and a lower cut-off point was found compared with another study using the Mini Nutritional Assessment (MNA®) as a standard for NUFFE-NO. The obtained cut-off point of ≥4 is not recommended for use in practice or research, because many false positive nutritional at-risk persons would then be identified. Further studies with suitable design have to be performed among older home-dwelling people using the MNA as a standard.
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Affiliation(s)
- Ulrika Söderhamn
- Center for Caring Research, Southern Norway, Faculty of Health and Sport Sciences, University of Agder, Grimstad, Norway
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Sundsli K, Söderhamn U, Espnes GA, Söderhamn O. Ability for self-care in urban living older people in southern Norway. J Multidiscip Healthc 2012; 5:85-95. [PMID: 22536079 PMCID: PMC3333801 DOI: 10.2147/jmdh.s29388] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The number of older people living in urban environments throughout the world will increase in the coming years. There is a trend in most European countries towards improved health among older people, and increased life expectancy for both women and men. Norway has experienced less increase in life expectancy than some other European countries, and it is therefore important to investigate older urban Norwegian people’s health and ways of living in a self-care environment, with special regard to health promotion. Aim The aim of this study was to describe self-care ability among home-dwelling older (65+ years) individuals living in urban areas in southern Norway in relation to general living conditions, sense of coherence (SOC), screened nutritional state, physical activity, perceived self-reported health, mental health, and perceived life situation. Methods In 2010, a randomized sample of 1044 men and women aged 65+ years who were living in urban areas in southern Norway answered a postal questionnaire consisting of five instruments, some background variables, and 17 health-related questions. Univariate and multivariate statistical methods were used in the analyses of the data. Results The mean age of the participants was 74.8 years (SD = 7.1). Eighty-three percent of the participants had higher abilities to care for themselves. Self-care agency, perceived good health, being active, being frequently active, good mental health, not being at risk of undernutrition, and satisfaction with life were all positively related to self-care ability. Negative factors were perceived helplessness, receiving home nursing, being anxious, and being at a more advanced age. People aged 85+ years had worse mental health, were less physically active, and more at risk of undernutrition. Conclusion Health professionals should focus on the health-promoting factors that reinforce older people’s ability to care for themselves, and be aware of important symptoms and signs associated with a reduction in a person’s self-care ability. Politicians should assume responsibility for health care with a special regard to senior citizens.
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Affiliation(s)
- Kari Sundsli
- Department of Social Work and Health Science, Faculty of Social Sciences and Technology Management, NTNU, Trondheim, Norway
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Tomstad ST, Söderhamn U, Espnes GA, Söderhamn O. Living alone, receiving help, helplessness, and inactivity are strongly related to risk of undernutrition among older home-dwelling people. Int J Gen Med 2012; 5:231-40. [PMID: 22419884 PMCID: PMC3302765 DOI: 10.2147/ijgm.s28507] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Being at risk of undernutrition is a global problem among older people. Undernutrition can be considered inadequate nutritional status, characterized by insufficient food intake and weight loss. There is a lack of Norwegian studies focusing on being at risk of undernutrition and self-care ability, sense of coherence, and health-related issues among older home-dwelling people. Aim To describe the prevalence of being at risk of undernutrition among a group of older home-dwelling individuals in Norway, and to relate the results to reported self-care ability, sense of coherence, perceived health and other health-related issues. Methods A cross-sectional design was applied. A questionnaire with instruments for nutritional screening, self-care ability, and sense of coherence, and health-related questions was sent to a randomized sample of 450 persons (aged 65+ years) in southern Norway. The study group included 158 (35.1%) participants. Data were analysed using statistical methods. Results The results showed that 19% of the participants were at medium risk of undernutrition and 1.3% at high risk. Due to the low response rate it can be expected that the nonparticipants can be at risk of undernutrition. The nutritional at-risk group had lower self-care ability and weaker sense of coherence. Living alone, receiving help regularly to manage daily life, not being active and perceived helplessness emerged as predictors for being at risk of undernutrition. The results indicate difficulties in identifying people at nutritional risk and supporting self-care activities to maintain a good nutritional status. Conclusion Health care professionals have to be able to identify older home-dwelling people at risk of undernutrition, support self-care activities to enable people at risk to maintain a sufficient nutritional status, and be aware that older people living alone, who receive help, feel helpless, and are inactive are especially vulnerable.
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Affiliation(s)
- Solveig T Tomstad
- Department of Social Work and Health Science, Faculty of Sciences and Technology Management, NTNU, Trondheim, Norway and Centre for Caring Research - Southern Norway, Faculty of Health and Sport Sciences, University of Agder, Grimstad, Norway
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Tomstad ST, Söderhamn U, Espnes GA, Söderhamn O. Testing two self-care-related instruments among older home-dwelling people in Norway. Int J Older People Nurs 2012; 8:189-98. [PMID: 22276973 DOI: 10.1111/j.1748-3743.2011.00307.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Older persons' ability and agency for self-care is an important issue. Therefore, the development of reliable and valid instruments to measure self-care with regard to both clinical nursing practice and personal health is important for nursing research and practice. Aim and objective. To test reliability and validity of the Norwegian versions of the two self-care-related instruments, the Self-care Ability Scale for the Elderly (SASE) and the Nutritional Form For the Elderly (NUFFE) among older home-dwelling individuals. METHODS A postal questionnaire that contained these instruments, background variables, health-related questions and two other self-care-related instruments was completed by a randomised sample of 158 older persons in southern Norway. Reliability was assessed as internal consistency and validity as concurrent and construct validity. RESULTS SASE reached a Cronbach's alpha coefficient of 0.85 and significant Spearman's rank correlations for 16 of 17 items. For NUFFE, a Cronbach's alpha coefficient of 0.64 was obtained and significant correlations for 13 of 15 items. Validity was supported for both instruments. An appropriate cut-off was found for SASE. For NUFFE, a low cut-off point was obtained. CONCLUSIONS SASE was shown to have sufficient psychometric properties and can be used in research and clinical practice among older persons. Implications for practice. The psychometric properties of NUFFE can be assessed as sufficient, but further studies are needed regarding the cut-off point.
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Affiliation(s)
- Solveig T Tomstad
- Department of Social Work and Health Science, Faculty of Social Sciences and Technology Management, NTNU, Trondheim, Norway.
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Dale B, Söderhamn U, Söderhamn O. Self-care ability among home-dwelling older people in rural areas in southern Norway. Scand J Caring Sci 2011; 26:113-22. [DOI: 10.1111/j.1471-6712.2011.00917.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Söderhamn U, Flateland S, Jessen L, Söderhamn O. Perceived health and risk of undernutrition: a comparison of different nutritional screening results in older patients. J Clin Nurs 2011; 20:2162-71. [DOI: 10.1111/j.1365-2702.2010.03677.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Söderhamn U, Christensson L, Idvall E, Johansson A, Bachrach-Lindström M. Factors associated with nutritional risk in 75-year-old community living people. Int J Older People Nurs 2010; 7:3-10. [DOI: 10.1111/j.1748-3743.2010.00242.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Söderhamn U, Flateland S, Jessen L, Söderhamn O. Norwegian version of the Nutritional Form for the Elderly: sufficient psychometric properties for performing institutional screening of elderly patients. Nutr Res 2010; 29:761-7. [PMID: 19932864 DOI: 10.1016/j.nutres.2009.10.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2009] [Revised: 10/09/2009] [Accepted: 10/12/2009] [Indexed: 11/17/2022]
Abstract
The objective of this study was to test if the Norwegian version of the nutritional screening instrument entitled Nutritional Form for the Elderly (NUFFE-NO) demonstrates sufficient evidence of reliability and validity, including sensitivity and specificity, when applied to a select group of elderly hospital patients. The hypothesis was that NUFFE-NO has sufficient psychometric properties to be used as a screening instrument. The model used for the testing procedure was designed to test reliability (homogeneity and stability) and validity (criterion-related, concurrent validity, and construct validity) including sensitivity and specificity in a cross-sectional study. One-hundred fifty-eight patients were interviewed using the nutritional screening instruments NUFFE-NO and Mini Nutritional Assessment (MNA). They were interviewed once again (using NUFFE-NO) 2 to 4 days afterward. Background variables were collected. Data from the patients' records were collected regarding the nutritional screening instrument Nutrition Risk Screening 2002. Anthropometric measurements were performed. A Cronbach alpha coefficient of .77 was obtained. A majority of the items showed good or very good agreement in a test-retest. A high correlation coefficient (as a measurement of concurrent validity) was estimated between NUFFE-NO and MNA. The NUFFE-NO could separate groups with expected high and low scores, which supported construct validity. Calculated sensitivity and specificity values for NUFFE-NO, with MNA as a criterion and receiver operating characteristic curves with areas 0.79 and 0.80, showed appropriate cutoff points for measuring low, medium, and high risk for undernutrition. In conclusion, NUFFE-NO was shown to have sufficient psychometric properties for performing an institutional screening of elderly hospital patients.
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Affiliation(s)
- Ulrika Söderhamn
- University of Agder, Faculty of Health and Sport, Arendal, Norway.
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Söderhamn U, Söderhamn O. A successful way for performing nutritional nursing assessment in older patients. J Clin Nurs 2009; 18:431-9. [PMID: 19191991 DOI: 10.1111/j.1365-2702.2008.02378.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
AIM The aim of this study was to obtain increased knowledge and understanding about what can be promoting and facilitating for nurses to perform nutritional nursing assessment in older patients. BACKGROUND The frequency of older patients at nutritional risk or suffering from undernutrition is high in hospitals. Studies have shown frequent lack of awareness about signs of undernutrition as all patients are, for example, not weighed. Nurses' descriptions about nutritional problems have also been found to be often vague and unspecific. DESIGN A qualitative design was used. METHODS Ten conveniently chosen registered nurses, working with older patients in two hospitals in western Sweden were interviewed. Four of the interviews were performed during 2003 and six during 2006. The interviews were analysed according to a Gadamerian-based hermeneutic research method. RESULTS The analyses revealed that promoting aspects for performing nutritional nursing assessment in older patients were to get information by dialogues, by observations and controls, by collaboration with other caregivers and professionals and by performing continuous follow-ups. Necessary conditions, beside knowledge and consciousness about nutritional issues, were to have interest, give time to listen to the patient's story and furthermore, be sensitive to the patient's wishes, be able to assess the patient's motivation to eat and have an ethical awareness. CONCLUSIONS A successful way that promoted the performance of nutritional nursing assessment in older patients was to use different approaches as interactive dialogues, observations, controls and collaboration in team. Such a nutritional nursing assessment was an ongoing process during the patient's hospital stay. RELEVANCE TO CLINICAL PRACTICE These results highlight that nurses have an important role in identifying eating problems in older patients, which has to be a prioritized issue in the care of older people.
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Affiliation(s)
- Ulrika Söderhamn
- University of Agder, Faculty of Health and Sport, Arendal, Norway.
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Gombos T, Kertész K, Csíkos A, Söderhamn U, Söderhamn O, Prohászka Z. Nutritional form for the elderly is a reliable and valid instrument for the determination of undernutrition risk, and it is associated with health-related quality of life. Nutr Res 2009; 28:59-65. [PMID: 19083389 DOI: 10.1016/j.nutres.2007.12.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2007] [Revised: 11/26/2007] [Accepted: 12/02/2007] [Indexed: 01/27/2023]
Abstract
Undernutrition is a common problem associated with clinical complications such as impaired immune response, reduced muscle strength, impaired wound healing, and susceptibility to infections; therefore, it is an important treatment target to reduce morbidity and mortality associated with chronic diseases and aging. The aim of the present study was to apply a reliable and valid instrument for the determination of undernutrition risk in an in-hospital patient population and to describe possible associations between risk of undernutrition and some aspects of health-related quality of life in patients with chronic diseases. Fifty-six adult patients with different chronic diseases were interviewed with NUFFE questionnaire and the EQ-5D. Anthropometric measurements were performed. Reliability and validity of the NUFFE instrument was tested, and its correlation with EQ-5D was calculated. Euro-Qol scores correlated significantly with the total NUFFE scores and with the items constructing the most important factor of the instrument, explaining 53.74% of its variance. Nutritional form for the elderly was shown to be a reliable instrument in the study group because its internal consistency measured by Cronbach alpha was 0.62, and the item-total score correlations were significant for the half of the items. Criterion-related validity, concurrent validity, and construct validity of NUFFE were established. We have shown that impaired level of health-related quality of life is an important determinant of risk for undernutrition. Nutritional form for the elderly is an appropriate instrument to estimate undernutrition risk in a general, in-hospital patient population with various chronic diseases and to identify "at risk" patients who may benefit from professional dietary interventions to reduce undernutrition-related complications.
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Affiliation(s)
- Tímea Gombos
- IIIrd Department of Internal Medicine, Faculty of Medicine, Semmelweis University, 1125 Budapest, Hungary.
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Ferreira LS, Nascimento LFC, Marucci MFN. Use of the mini nutritional assessment tool in elderly people from long-term institutions of southeast of Brazil. J Nutr Health Aging 2008; 12:213-7. [PMID: 18309445 DOI: 10.1007/bf02982623] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND the Mini Nutritional Assessment (MNA) is a multidimensional method of nutritional evaluation that allows the diagnosis of malnutrition and risk of malnutrition in elderly people, it is important to mention that this method has not been well studied in Brazil. OBJECTIVE to verify the use of the MNA in elderly people that has been living in long term institutions for elderly people. DESIGN transversal study. PARTICIPANTS 89 people (>/= 60 years), being 64.0% men. The average of age for both genders was 73.7 +/- 9.1 years old, being 72.8 +/- 8.9 years old for men, and 75.3 +/- 9.3 years old for women. SETTING long-term institutions for elderly people located in the Southeast of Brazil. METHODS it was calculated the sensibility, specificity, and positive and negative predictive values. It was data to set up a ROC curve to verify the accuracy of the MNA. The variable used as a "standard" for the nutritional diagnosis of the elderly people was the corrected arm muscle area because it is able to provide information or an estimative of the muscle reserve of a person being considered a good indicator of malnutrition in elderly people. RESULTS the sensibility was 84.0%, the specificity was 36.0%, the positive predictive value was 77.0%, and the negative predictive value was 47.0%; the area of the ROC curve was 0.71 (71.0%). CONCLUSION the MNA method has showed accuracy, and sensibility when dealing with the diagnosis of malnutrition and risk of malnutrition in institutionalized elderly groups of the Southeastern region of Brazil, however, it presented a low specificity.
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Affiliation(s)
- L S Ferreira
- Department of Nutrition - School of Public Health-University of São Paulo, Brazil.
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Söderhamn U, Bachrach-Lindström M, Ek AC. Nutritional screening and perceived health in a group of geriatric rehabilitation patients. J Clin Nurs 2007; 16:1997-2006. [PMID: 17331091 DOI: 10.1111/j.1365-2702.2006.01805.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES (i) To perform a nutritional screening using the Nutritional Form For the Elderly and relate the results to perceived health in a group of geriatric rehabilitation patients; and (ii) to compare the screening results and nurses' nutritional notes in the nursing documentation. BACKGROUND Undernutrition is an under-recognized problem among older patients. Using a screening instrument is a way to detect patients at risk for undernutrition. DESIGN A cross-sectional study conducted in Sweden. METHODS A sample of 147 geriatric rehabilitation patients was consecutively included and was interviewed with the screening instrument, questions about background variables, perceived health and health-related issues. Higher screening scores indicate higher risk for undernutrition. Parametric and nonparametric statistical tests were used. When nurses' nutritional notes in the nursing documentation were corresponding to the content in any of the response alternatives for each screening item, the notes were marked as existent. RESULTS The screening results showed that 55% of the patients were at medium risk and 14% at high risk for undernutrition. Patients in perceived ill health had higher screening scores than those in perceived good health. Associations were also found between receiving help, perceiving helplessness, not being active and not feeling satisfied and higher screening scores. The content of nine of 15 items in the instrument was mentioned in a number of nursing records. CONCLUSIONS The prevalence of older patients at medium or high risk for undernutrition was high. To be at high risk for undernutrition was associated with perceived ill health. Nurses' nutritional notes in the nursing documentation showed deficiencies, indicating that all patients at medium or high risk for undernutrition were not identified. RELEVANCE TO CLINICAL PRACTICE The results suggest that nurses need a screening instrument to highlight older nutritional at-risk patients in need of further awareness and investigation.
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Affiliation(s)
- Ulrika Söderhamn
- Division of Nursing Science, Department of Medicine and Care, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
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Söderhamn U, Bachrach-Lindström M, Ek AC. Self-care ability and sense of coherence in older nutritional at-risk patients. Eur J Clin Nutr 2007; 62:96-103. [PMID: 17327868 DOI: 10.1038/sj.ejcn.1602691] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To investigate self-care ability and sense of coherence in geriatric rehabilitation patients nutritionally screened using the Nutritional Form For the Elderly and to relate the patients' perceived health to self-care ability and sense of coherence. DESIGN Cross-sectional study. SETTING A geriatric rehabilitation ward in a hospital in western Sweden. SUBJECTS A sample of 172 consecutively recruited patients (65+ years) fulfilled the inclusion criteria. One hundred forty-four patients were included in the study because 16 patients refused to take part and 12 could not complete the entire data collection procedure. METHODS Interviews, using one instrument for nutritional screening and other instruments measuring self-care ability and sense of coherence and one question about perceived health, were performed. RESULTS Patients at medium or high risk for undernutrition had lower self-care ability (P<0.001) and weaker sense of coherence (P=0.007) than patients at low risk for undernutrition. Lower self-care ability, being single and admitted from another hospital ward was found to be predictors for being at medium or high risk for undernutrition. Patients who perceived good health had higher self-care ability (P<0.001) and stronger sense of coherence (P<0.001) than patients who perceived ill health. CONCLUSIONS There is an indication that older patients at low risk for undernutrition have a greater capability to care for themselves than patients at medium or high risk for undernutrition. Perceived ill health in older patients is associated with lower self-care ability and weaker sense of coherence.
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Affiliation(s)
- U Söderhamn
- Department of Medicine, Norra Alvsborgs Länssjukhus, Trollhättan, Sweden.
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Abstract
AIM This paper reports a review analysing the use of factor analysis in papers in Journal of Advanced Nursing. BACKGROUND Factor analysis is a multivariate statistical method for reducing large numbers of variables to fewer underlying dimensions. There are several methods of factor analysis with principal components analysis being the most commonly applied. Factor analysis has been used by researchers in nursing for many years but the standards for use and reporting are variable. METHOD Papers using factor analysis in Journal of Advanced Nursing were retrieved from 1982 to the end of 2004. The search term 'factor analysis' was used in the CINAHL database and applied specifically to Journal of Advanced Nursing in December 2004. Retrieved papers were included in the review if they came from Journal of Advanced Nursing and used factor analysis as part of the method of the reported study. RESULTS One hundred and twenty-four papers were retrieved as a result of the initial search criteria of which 116 were from Journal of Advanced Nursing. Screening of papers for the use of factor analysis left 100 papers for review. Principal components analysis was the most commonly used method of factor analysis; Eigenvalues greater than one was the most commonly applied criterion for selecting the number of factors followed by orthogonal rotation to achieve simple structure. The majority of papers did not report the whole factor solution and there were papers that did not specify anything beyond the fact that they carried out factor analysis. Confirmatory factor analysis was rarely used and exploratory methods other than principal components analysis were also rarely used. CONCLUSIONS Factor analysis is quite commonly used in nursing research reported in Journal of Advanced Nursing. While some papers are exemplary there is room for improvement in the reporting of all aspects of factor analysis.
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Affiliation(s)
- Roger Watson
- Graduate Division of Nursing and Midwifery School of Nursing and Midwifery, The University of Sheffield, Sheffield, UK.
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Abstract
AIM This paper reports a literature review to examine the range of published tools available for use by nurses to screen or assess nutritional status of older adults, and the extent to which validity, reliability, sensitivity, specificity and acceptability of the tools has been addressed. BACKGROUND The incidence of malnutrition in older adults is high. One method by which malnutrition or risk of malnutrition can be detected is by the use of nutritional screening or assessment tools. METHODS A comprehensive literature review methodology was employed. A variety of electronic databases were searched for the period 1982-2002. Search terms incorporating nutrition, screening, validity, reliability and sensitivity and specificity were combined to retrieve relevant literature. In addition, manual searches were conducted and articles retrieved from those listed in key papers. In this paper, nutritional screening or assessment tools are described as tools which use a questionnaire-type format containing more than one risk factor for malnutrition, and give a quantitative or categorical assessment of risk. RESULTS Seventy-one nutritional tools were located, 21 of which were identified as designated for use with an older population. A wide variety of risk factors for malnutrition are used with the tools, ranging from objective measurements to subjective assessment. Some tools identify an action plan based on the score obtained. Many tools appear not to have been subjected to validity and/or reliability testing but are used clinically. CONCLUSIONS As malnutrition is present in the older adult population, nutritional assessment and screening tools can be useful to highlight those in need of a nutritional care plan. However, many have not been subjected to evaluation and consequently may not demonstrate sensitivity and/or specificity in clinical use. The decision to use a particular tool should therefore be considered carefully.
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Affiliation(s)
- Sue M Green
- School of Nursing and Midwifery, University of Southampton, Southampton, UK.
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Jordan S, Snow D, Hayes C, Williams A. Introducing a nutrition screening tool: an exploratory study in a district general hospital. J Adv Nurs 2003; 44:12-23. [PMID: 12956665 DOI: 10.1046/j.1365-2648.2003.02763.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Concerns have been raised that patients' nutrition is a neglected aspect of care. Accordingly, 'nutrition screening tools' have been devised to ensure that all patients are assessed by nurses and, where appropriate, referred to dieticians. The tool adopted in our hospital was the 'Nursing Nutritional Screening Tool'. AIM To investigate the impact of this screening tool on: nutrition-related nursing documentation; patient care at mealtimes; dietician referral. METHODS This study was conducted on two similar general medical wards in a United Kingdom (UK) district general hospital, with the help of staff and patients (n = 175) admitted during two study periods, May 1999 and January 2000. Data were collected over 28 days before and after introduction of the screening tool on one of the wards. For both wards, in each stage of the study, data were collected b: review of patients' notes, non-participant observations of mealtimes. Frequencies of dietician referral and documentation of weight were compared by cross-tabulations and chi2 tests. Nine months later, the findings were discussed with ward sisters in a group interview. FINDINGS Introduction of the screening tool impacted on the process but not the outcomes of screening. Use of the screening tool increased the frequency of nutrition-related documentation: the proportion of patients with weights recorded increased on the intervention ward (P < 0.001), and decreased on the comparator ward. Frequency of dietician referral decreased on both wards, but differences were statistically insignificant. There was no observable change in patient care at mealtimes. The nurses in charge of the wards felt that introduction of the screening tool had raised awareness of nutrition-related care. CONCLUSIONS Meeting patients' nutritional needs is a complex aspect of care which may benefit from introduction of structured guidelines. However, the potential of screening tools to improve care is limited by diverse factors, which warrant further exploration.
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Affiliation(s)
- Sue Jordan
- School of Health Science, University of Wales, Swansea, UK.
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