Nature, nurture, nutrition: Interdisciplinary programs to address the prevention of malnutrition and dehydration

Musson, Nan; Kincaid, Jean; Ryan, Pat; Glussman, Betty; Varone, Litha; Gamarra, Nydia; Wilson, Reba; Reefe, William; Silverman, Michael

doi:10.1007/bf02412651

Cited by 51 publications

(30 citation statements)

References 13 publications

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“…Recent federal regulations allow both community and VA facilities to train non-nursing staff to assist with feeding in an effort to augment existing, often limited, nurse aide staffing levels. Several studies have highlighted the potential benefits of these types of training programs for improving nutritional care quality [35][36][37][38][39].…”

Section: Original Researchmentioning

confidence: 99%

A staff training and management intervention in VA long-term care: impact on feeding assistance care quality

Simmons¹,

Durkin²,

Shotwell³

et al. 2013

Behav. Med. Pract. Policy Res.

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Efforts to translate efficacious interventions into longterm care practice have had limited success due to the lack of consideration of key translational intervention components. A multi-faceted intervention was implemented in two veteran affairs facilities to improve feeding assistance care. There were three study phases: baseline, intervention, and follow-up. During each phase, trained research staff conducted standardized observations of 12 meals/participant to assess feeding assistance care quality. The staff received three initial training sessions followed by six consecutive weeks of feedback sessions wherein the observation-based care process measures were shared with the staff. There were significant, but modest, improvements in mealtime feeding assistance care processes, and most of the improvements were maintained during follow-up. A multi-faceted intervention resulted in significant, but modest, improvements in mealtime feeding assistance care quality. Organizational (staff schedules, communication) and environmental (dining location) barriers were identified that interfered with improvement efforts.

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Section: Original Researchmentioning

confidence: 99%

A staff training and management intervention in VA long-term care: impact on feeding assistance care quality

Simmons¹,

Durkin²,

Shotwell³

et al. 2013

Behav. Med. Pract. Policy Res.

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“…Indirectly, it may improve nutritional status, and perhaps maximize host resistance. An example of such a program, where nurses and volunteers are taught to feed slowly and safely, is the Silver Spoons Program begun at the Miami VAMC [93].…”

Section: Preventing Aspiration Pneumoniamentioning

confidence: 99%

Predictors of Aspiration Pneumonia: How Important Is Dysphagia?

et al. 1998

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Aspiration pneumonia is a major cause of morbidity and mortality among the elderly who are hospitalized or in nursing homes. Multiple risk factors for pneumonia have been identified, but no study has effectively compared the relative risk of factors in several different categories, including dysphagia. In this prospective outcomes study, 189 elderly subjects were recruited from the outpatient clinics, inpatient acute care wards, and the nursing home care center at the VA Medical Center in Ann Arbor, Michigan. They were given a variety of assessments to determine oropharyngeal and esophageal swallowing and feeding status, functional status, medical status, and oral/dental status. The subjects were followed for up to 4 years for an outcome of verified aspiration pneumonia. Bivariate analyses identified several factors as significantly associated with pneumonia. Logistic regression analyses then identified the significant predictors of aspiration pneumonia. The best predictors, in one or more groups of subjects, were dependent for feeding, dependent for oral care, number of decayed teeth, tube feeding, more than one medical diagnosis, number of medications, and smoking. The role that each of the significant predictors might play was described in relation to the pathogenesis of aspiration pneumonia. Dysphagia was concluded to be an important risk for aspiration pneumonia, but generally not sufficient to cause pneumonia unless other risk factors are present as well. A dependency upon others for feeding emerged as the dominant risk factor, with an odds ratio of 19.98 in a logistic regression model that excluded tube-fed patients.

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“…[15][16][17] Faced with these realities, many institutions welcome the presence and assistance of family members, privately hired caregivers, and/or volunteers at mealtime. 1,18 The participation of such individuals at mealtime has been reported to yield positive outcomes both in terms of nutritional and social outcomes for patients. 1,18 In one study, hospitalized elderly individuals who were fed by volunteers were recorded to eat 58.9% of their recommended daily nutritional intake in comparison with only 32.5% eaten by individuals fed by nurses.…”

mentioning

confidence: 98%

“…1,18 The participation of such individuals at mealtime has been reported to yield positive outcomes both in terms of nutritional and social outcomes for patients. 1,18 In one study, hospitalized elderly individuals who were fed by volunteers were recorded to eat 58.9% of their recommended daily nutritional intake in comparison with only 32.5% eaten by individuals fed by nurses. 19 The current research initiative took place at the Baycrest, a 900-bed multilevel, geriatric teaching and research center, whose clientele includes more than 200 residents requiring some form of mealtime assistance.…”

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confidence: 98%

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Insights Regarding Mealtime Assistance for Individuals in Long-term Care

Steele

Rivera

Bernick

et al. 2007

Topics in Geriatric Rehabilitation

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Focus groups were conducted with staff in a geriatric care facility who provided mealtime assistance during a quarantine that prevented family members from entering the facility. The volunteers' accounts reflected 3 primary themes that influenced their experience as mealtime assistants. First, the role of volunteer-recipient relationships emerged as paramount in facilitating optimal mealtime care. Strong reinforcement was derived from small signs of gratitude and awareness in the residents' nonverbal behaviors. This fostered the volunteers' sense of fiduciary responsibility toward the resident, thereby facilitating a meaningful and successful mealtime experience. Second, it was clear that the experience of being a mealtime assistant evolved over time, with changes in volunteer attitude mediated directly by the relationships that developed between volunteers and recipients. Lastly, the data reflect a strong awareness among volunteers of the challenges faced by nursing staff on a daily basis with respect to meeting the mealtime needs of residents in long-term care institutions, and a concern that nursing staff have insufficient time to develop intimate relationships with residents at the mealtime. These data strongly suggest that volunteer-assisted mealtime programs that focus primarily on social relationships can enhance the mealtime experience for residents in long-term care institutions.Data for this study were collected at Baycrest (www.baycrest.org), a geriatric care facility in Toronto, Canada. The second and third authors held a primary affiliation with Baycrest at the time of data collection. The authors recognize the contributions of Sonia Reichman, Susan Romeril, Carol Robertson, Pia Kontos, and Minn Yoon to the design, conduct, and analysis of the study. In addition, the authors acknowledge the T HE need for assistance at mealtimes is alarmingly common in long-term care institutions, with published estimates ranging from 45% to 80% of the institutionalized elderly. 1-3 Musson et al 1 have reported that it is typical for a single nursing staff member to be responsible for assisting 8-10 patients per meal, with the types of required assistance

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Nature, nurture, nutrition: Interdisciplinary programs to address the prevention of malnutrition and dehydration

Cited by 51 publications

References 13 publications

A staff training and management intervention in VA long-term care: impact on feeding assistance care quality

A staff training and management intervention in VA long-term care: impact on feeding assistance care quality

Predictors of Aspiration Pneumonia: How Important Is Dysphagia?

Insights Regarding Mealtime Assistance for Individuals in Long-term Care

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