A foodservice approach to enhance energy intake of elderly subacute patients: a pilot study to assess impact on patient outcomes and cost

Nutrition interventions for body composition, physical function, cognition in hospitalized older adults: A systematic review of individuals 75 years and older

BACKGROUND

Globally, the oldest old population is expected to triple by 2050. Hospitalization and malnutrition can result in progressive functional decline in older adults. Minimizing the impact of hospitalization on functional status in older adults has the potential to maintain independence, reduce health and social care costs, and maximize years in a healthy state. This study aimed to systematically review the literature to identify nutritional interventions that target physical function, body composition, and cognition in the older population (≥ 75 years).

METHODS

A systematic review was conducted to evaluate the efficacy of nutritional interventions on physical function, body composition, and cognition in adults aged ≥ 75 years or mean age ≥80 years. Searches of PubMed (National Institutes of Health, National Library of Medicine), Scopus (Elsevier), EMBASE (Elsevier), Cumulative Index to Nursing and Allied Health Literature (CINAHL) with Full Text (EBSCOhost), and PsycInfo (EBSCOhost) were conducted. Screening, data extraction, and quality assessment were performed in duplicate and independently (CRD42022355984; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=355984).

RESULTS

Of 8311 citations identified, 2939 duplicates were excluded. From 5372 citations, 189 articles underwent full-text review leaving a total of 12 studies for inclusion. Interventions were food-based, protein-based, carbohydrate-based, personalized, or used parenteral nutrition. Ten studies monitored anthropometric or body composition changes with three showing maintenance or improvements in lean mass, body mass index, triceps skinfold, and mid-upper arm circumference compared with the control group. Six studies monitored physical function but only the largest study found a beneficial effect on activities of daily living. Two of three studies showed the beneficial effects of nutritional intervention on cognition.

CONCLUSION

There are few, high-quality, nutrition-based interventions in older adults ≥75 years. Despite heterogeneity, our findings suggest that large, longer-term (>2 weeks) nutritional interventions have the potential to maintain body composition, physical function, and cognition in adults aged 75 years and older during hospitalization.

Nutrition Intervention Informed by Indirect Calorimetry Compared to Predictive Equations to Achieve Weight Goals in Geriatric Rehabilitation Inpatients: The NEED Study

OBJECTIVES

To assess if nutritional interventions informed by indirect calorimetry (IC), compared to predictive equations, show greater improvements in achieving weight goals, muscle mass, strength, physical and functional performance.

DESIGN

Quasi-experimental study.

SETTING AND PARTICIPANTS

Geriatric rehabilitation inpatients referred to dietitian.

INTERVENTION AND MEASUREMENTS

Patients were allocated based on admission ward to either the IC or equation (EQ) group. Measured resting metabolic rate (RMR) by IC was communicated to the treating dietitian for the IC group but concealed for the EQ group. Achieving weight goals was determined by comparing individualised weight goals with weight changes from inclusion to discharge (weight gain/loss: >2% change, maintenance: ≤2%). Muscle mass, strength, physical and functional performance were assessed at admission and discharge. Food intake was assessed twice over three-days at inclusion and before discharge using plate waste observation.

RESULTS

Fifty-three patients were included (IC n=22; EQ n=31; age: 84.3±8.4 years). The measured RMR was lower than the estimated RMR within both groups [mean difference IC -282 (95%CI -490;-203), EQ -273 (-381;-42) kcal/day)] and comparable between-groups (median IC 1271 [interquartile range 1111;1446] versus EQ 1302 [1135;1397] kcal/day, p=0.800). Energy targets in the IC group were lower than the EQ group [mean difference -317 (95%CI -479;-155) kcal/day]. There were no between-group differences in energy intake, achieving weight goals, changes in muscle mass, strength, physical and functional performance.

CONCLUSIONS

In geriatric rehabilitation inpatients, nutritional interventions informed by IC compared to predictive equations showed no greater improvement in achieving weight goals, muscle mass, strength, physical and functional performance. IC facilitates more accurate determination of energy targets in this population. However, evidence for the potential benefits of its use in nutrition interventions was limited by a lack of agreement between patients' energy intake and energy targets.

Foodservice systems and mealtime models in rehabilitation: Scoping review

AIMS

To describe current foodservice systems and mealtime care utilized in the rehabilitation setting. A secondary aim was to identify commonly used outcome measures in foodservice research in the rehabilitation setting.

DESIGN

A scoping review.

DATA SOURCES

PubMed, CINAHL, Scopus, Embase, PsycINFO and Cochrane were searched until January 2022.

REVIEW METHODS

The review was conducted according to Joanna Briggs Institute's methodology for scoping reviews. Included studies were conducted in the inpatient rehabilitation setting, adult population ≥18 years old and provided a description of at least one element of the foodservice system, food and menu, waste and/or eating environment.

RESULTS

Of 5882 articles screened, 37 articles were included, reporting 31 unique studies. Most rehabilitation units had cook-fresh production methods (50%), used decentralized bulk delivery methods (67%) had a communal dining room (67%) and had a 3-week menu cycle (71%). Mealtime care was predominantly provided by nursing staff, however few studies reported on specific activities. Nutritional intake was a key outcome measure across included studies (43%), with only six papers reporting on rehabilitation outcomes. Of the intervention studies (n = 9), all were aimed at improving nutritional intake through menu or mealtime care modifications; few (n = 3) studied changes in rehabilitation outcomes.

CONCLUSION

This scoping review identified a considerable lack of reporting of foodservice and mealtime care systems used in rehabilitation settings in the available literature. Further investigation is required to understand what models of mealtime care are provided to patients and to understand the impact of changes to foodservice and mealtime systems on patient outcomes.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution was necessary for this review.

Hospital Food Service Strategies to Improve Food Intakes among Inpatients: A Systematic Review

This review aims to identify hospital food service strategies to improve food consumption among hospitalized patients. A systematic search that met the inclusion and exclusion criteria was manually conducted through Web of Science and Scopus by an author, and the ambiguities were clarified by two senior authors. The quality assessment was separately conducted by two authors, and the ambiguities were clarified with all the involved authors. Qualitative synthesis was used to analyze and summarized the findings. A total of 2432 articles were identified by searching the databases, and 36 studies were included. The majority of the studies applied menu modifications and meal composition interventions (n = 12, 33.3%), or included the implementation of the new food service system (n = 8, 22.2%), protected mealtimes, mealtime assistance and environmental intervention (n = 7, 19.4%), and attractive meal presentation (n = 3, 8.3%). Previous studies that used multidisciplinary approaches reported a significant improvement in food intake, nutritional status, patient satisfaction and quality of life (n = 6, 16.7%). In conclusion, it is suggested that healthcare institutions consider applying one or more of the listed intervention strategies to enhance their foodservice operation in the future.

Nutrition interventions implemented in hospital to lower risk of sarcopenia in older adults: A systematic review of randomised controlled trials

AIM

There is no standardised interventional approach to preventing or treating sarcopenia in older adults in hospital. The aim of this review was to systematically identify and synthesise the effects of nutritional interventions on markers of sarcopenia in hospitalised patients aged 65 years and older.

METHODS

Four databases were searched using terms for intervention, population and setting. Eligibility screening of title and abstract and then full-text papers was competed in duplicate, independently. The final included papers were assessed for quality, and outcome data extracted independently and in duplicate. Outcome data were synthesised by meta-analysis, where possible, or narratively.

RESULTS

Seven hundred and thirty-two articles were screened for eligibility yielding six studies for inclusion. All studies provided oral nutritional support that aimed to increase protein intake ranging from an additional 10 to 40 g/d, each with a unique formulation of amino acids and/or micronutrients; three studies combined nutritional intervention with an enhanced physical activity program. Five studies measured hand grip strength, the mean difference was 1.97 kg (95% CI 0.55-3.39, P = .006) greater in the intervention group (n = 166) compared with control group (n = 165). Assessment of muscle mass and activities of daily living were heterogeneous and the changes inconsistent between studies.

CONCLUSIONS

Few studies inform nutritional management of inpatients with sarcopenia or at risk of sarcopenia. High quality, large intervention trials are needed urgently to identify the optimal nutrition and physical activity intervention combinations to manage sarcopenia in older hospitalised adults. These studies need to include outcome measures of physical function and muscle quality.

A Prospective Study Identifying a Change in Energy and Protein Intake of Older Adults during Inpatient Rehabilitation

Understanding older patients' dietary intake patterns may improve the timing of strategies to address hospital malnutrition. The aims of this study were to explore longitudinally the change in daily energy (kJ/day) and protein (g/day) intake, and associated factors. Data were derived using a 5-point scale to visually estimate plate waste, and known nutrient composition data. Analyses determined the change in intake between admission and day 14, and admission, day 14 and day 28, respectively. Data were available for 39 participants between admission and day 14 (median (interquartile range) age 82 (78⁻87) years; 54% male) and 12 participants between admission, day 14 and day 28 (median (IQR) age 79 (69⁻84) years; 58% male). From admission to day 14 there was a significant increase in the mean (SD) daily intake of energy (6177 (1879) kJ/day vs. 7213 (1903), p < 0.001) and protein (63.7 (23) g/day vs. 76.4 (23.0) g/day, p = 0.003) but no change from admission to day 14 to day 28. There was a significant inverse relationship between amount consumed at admission and change in intake. Variability in elderly patients' intake over time has implications for the timing of nutritional care and data collection in research studies.