Dutch nutrition and care professionals’ experiences with undernutrition awareness, monitoring, and treatment among community-dwelling older adults: a qualitative study

Abstract

Background: Undernutrition can negatively affect community-dwelling older adults' health and quality of life. Undernutrition management guidelines have been developed in the Netherlands for the primary care setting, however, the application of these guidelines remain unsatisfactory. The current study therefore aims to explore qualitatively the experiences of Dutch nutrition and care professionals and researchers with undernutrition awareness, monitoring, and treatment among community-dwelling older adults. Methods: We telephonically interviewed 22 Dutch nutrition and care professionals and researchers. Our semi-structured interview guide elicited answers that we audiotaped and transcribed verbatim. The interviews were coded using grounded theory and content analysis with the qualitative analysis software MAXQDA, after which the codes were categorized into themes. Results: The interviews resulted in six themes relevant to the topics of interest: undernutrition awareness, monitoring, and treatment. These were: (1) adverse changes in nutrition behaviour; (2) limited undernutrition awareness; (3) unclear monitoring responsibilities and procedures; (4) lack of awareness, time, and priority as monitoring barriers; (5) lack of treatment personalization and justification; (6) lack of timely treatment implementation and evaluation. Conclusions: The experts' experiences imply that undernutrition awareness is limited, among both older adults and care professionals. In addition, the interviewees are unclear about which professionals are responsible for monitoring and which monitoring procedures are preferred. The dietitians feel that they become involved too late, leading to decreased treatment effectiveness. In general, the interviewees desire a coherent and feasible allocation of responsibilities regarding undernutrition monitoring and treatment. This implies that the available guidelines on undernutrition management require more attention and facilitation.

Undernutrition: who cares? Perspectives of dietitians and older adults on undernutrition

“…Unawareness of undernutrition and its health risks reduces the effectiveness of dietetic treatment, and this barrier has been found earlier [4]. It may be related to misperception of what is healthy or a sufficient diet at old age.…”

“…Nutrition education specifically targeted at older adults may increase undernutrition awareness [4]. By increased awareness, older adults may become more responsive to dietitians' messages.…”

“…Although guidelines for undernutrition management in the elderly have been developed for the primary and secondary care setting [10,11], a recent qualitative study found a lack of knowledge and awareness about undernutrition among other care professionals, which hampers timely treatment [4]. Furthermore, according to these interviewed professionals, there was a lack of awareness about undernutrition and its consequences among older adults themselves.…”

“…Ziylan et al interviewed health care professionals only and focused on their perceptions regarding these barriers [4]. To our knowledge, there are no studies that have studied these barriers during dietetic treatment for undernutrition by interviewing older adults themselves.…”

“…Undernutrition may be caused by a number of factors such as acute or chronic disease, dental and swallowing problems, changes in sensory perception and appetite, loneliness, and difficulties with meal preparation and grocery shopping [2][3][4]. Negative consequences of undernutrition such as loss of weight and lean body mass may improve with energy and protein supplementation, and with dietetic counselling with or without oral nutritional supplements (ONS) [5,6].…”