Nutritional status of older people in long term care settings: current status and future directions

Cowan, David; Roberts, Julia; Fitzpatrick, Joanne; While, Alison; Baldwin, Julie

doi:10.1016/s0020-7489(03)00131-7

Cited by 85 publications

(75 citation statements)

References 51 publications

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“…Organizational factors causing malnutrition were described in the review by Cowan et al. (20). Here we explored only procedures concerning screening, prevention or treatment of malnutrition, and means in terms of staff ratio and recourse to a dietician.…”

Section: Discussionmentioning

confidence: 99%

“…Among organizational factors described by Cowan et al (20), staff communication and enforcement of regulations are both necessary to enforce these procedures. In nursing homes it has been clearly shown that weight loss and the observation of large amounts of food remaining on plates were related to decreased energy and protein intake (25,34).…”

Section: Discussionmentioning

confidence: 99%

“…Nutrition policies in these establishments have to address the needs of these residents. Among them, staff recognition of nutritional problems (17)(18)(19), meal delivery organization (19)(20)(21)(22)(23) and access to dental care (13,14,24) have been identified as main targets for improvement.…”

Section: Introductionmentioning

confidence: 99%

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Undernutrition in geriatric institutions in South-West France: Policies and risk factors

et al. 2009

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Objective: This study aimed to describe the nutritional status of geriatric home residents according to their place of dwelling and to identify institutional factors associated with higher rates of undernutrition. Method: Results:The estimated prevalence of undernutrition was 19.1 (95% CI: 14.0-24.2) with a higher rate in long-term care (48.0 % (95% CI: 15.9-80.2) than in nursing homes (14.5 % (95% CI: 10.6-18.4), p< .0001). In univariate analyses the risk of undernutrition was higher in long-term care (P < .0001), in settings with better weighing equipment (P < .0001), higher * Manuscript 2 staff ratio (P = .0001), higher rate of subjects needing help for eating (P < .0001) and was lower in settings with a higher rate of training in nutrition screening (P = .0001) and management (P < .0001). In nursing homes, each item of the MNA-Short Form was independently predictive of undernutrition. In multivariate analyses in nursing homes only, better weighing equipment (OR adj 2.34, 95% CI 1.39-4.12, P = .0017) and higher staff ratio (OR adj 1.03, 95% CI 1.00-1.05, P = .0230) were associated with higher rates of undernutrition.Conclusions: Undernutrition in institutions was linked to the resident health problems with little evidence in favor of the influence of institutional policies

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Undernutrition in geriatric institutions in South-West France: Policies and risk factors

et al. 2009

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“…The lack of nutritional training for long term care has been highlighted (Cowan et al 2004) and in Scotland was recently one of the Care Commission's themes for inspection. In Kumlien & Axelsson's (2002) study, 80% of stroke residents in nursing homes were identified as having some form of dependence in eating and yet nursing assessment of these problems was 'vague'.…”

Section: Discussionmentioning

confidence: 99%

The evidence-base for stroke education in care homes

Smith

Craig

Weir

et al. 2008

Nurse Education Today

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TitleThe Evidence-base for Stroke Education in Care Homes Research Questions 1. What are registered care home nurses' educational priorities regarding stroke care? 2. What are senior care home assistants' educational priorities regarding stroke care? 3. How do care home nurses conceive stroke care will be delivered in 2010? Study DesignThis was a two-year study using focus groups, stroke guidelines, professional recommendations and stroke literature for the development of a questionnaire survey for data collection. Workshops provided study feedback to participants. Data were collected in 2005-06. Study SiteGreater Glasgow NHS Health Board. Population and SampleA stratified random selection of 16 private, 3 voluntary and 6 NHS continuing care homes from which a sample of 115 trained nurses and 19 senior care assistants was drawn. ResultsThe overall response rate for care home nurses was 64.3% and for senior care assistants, 73.6%. Both care home nurses and senior care assistants preferred accredited stroke education. Care home nurses wanted more training in stroke assessment, rehabilitation and acute interventions whereas senior care assistants wanted more in managing depression, general stroke information and communicating with dysphasic residents. Senior care assistants needed more information on multidisciplinary team working while care home nurses were more concerned with ethical decision-making, accountability and goal setting. ConclusionsCare home staff need and want more stroke training. They are clear that stroke education should be to the benefit of their resident population. Guidelines on stroke care should be developed for care homes and these should incorporate support for continuing professional learning in relation to the resident who has had a stroke.Keywords: stroke, education, care homes, nurses, senior care assistants What this paper adds: This paper provides an evidence-based description of care home staff's educational needs in stroke. It contributes to the case for a specific career framework in stroke for all healthcare professionals regardless of care setting.

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“…This under-nutrition is considered to result, at least in part, from low protein intakes (1,3) . Various studies demonstrate the value of a variety of strategies based on improving food and dining experiences for increasing protein intakes (3,4) .…”

mentioning

confidence: 99%

Individual differences in protein intakes following the addition of sauce to an older persons' lunch meal, and effects at lunch are sustained over the following meal

Appleton

2017

Proc. Nutr. Soc.

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Protein-specific under-nutrition is considered to affect 10-20 % of UK older adults (1) , with potential detriments to health and wellbeing (1,2) . This under-nutrition is considered to result, at least in part, from low protein intakes (1,3) . Various studies demonstrate the value of a variety of strategies based on improving food and dining experiences for increasing protein intakes (3,4) . Our studies demonstrate increased protein intakes in older adults following the addition of sauce to a lunch meal (5,6) , but while effects are largely demonstrated in the manipulated meal, benefits may be easily reduced by compensation or adjustment at subsequent (nonmanipulated) meals. This study investigated the impact of adding sauce to an older persons' lunch meal on intake at that meal and at the following meal.Using a repeated measures design, 56 community-dwelling older adults consumed a traditional hot lunch meal with sauce and without sauce on two separate occasions, and intakes at lunch and at the following evening buffet meal were measured.In the whole group (final N = 52), significantly more protein was consumed at the lunch meal with sauce compared to without sauce (t(51) = 2·09, p = 0·04). Individual differences however, were also found. For some participants (N = 26), significantly higher protein and energy intakes were found following sauce (12·3 g protein, 381kJ), while for others (N = 19), the addition of sauce resulted in lower protein and energy intakes (7 g protein, 297kJ). Seven participants demonstrated no effect. Intakes at the evening meal and overall (lunch + evening meal) also followed the same pattern: those who responded to the sauce manipulation with an increase in protein intake consumed more protein and energy overall following the sauce (11 g protein, 420kJ), while those who consumed less protein at lunch following the sauce manipulation did so again overall (7 g protein, 350kJ). Compensation for earlier intakes was thus very poor (0-17 %) for both groups.An absence of effects in overall intakes in these data have previously been reported (7) having analysed the group as a whole at both lunch and evening meal. Investigating individual responses however, there are strong individual differences, and sustained effects over time. These findings suggest that the addition of sauce to an older persons' lunch meal can increase protein intakes at that meal, as has previously been demonstrated (5,6) , but that this intervention is more beneficial for some than for others. Furthermore, effects were sustained across the following meal, thus benefits that were found, were maintained. Poor compensation for earlier intakes in older adults has previously been reported (4) , but this study also extends this earlier work through consideration of protein intake during meals.

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Nutritional status of older people in long term care settings: current status and future directions

Cited by 85 publications

References 51 publications

Undernutrition in geriatric institutions in South-West France: Policies and risk factors

Undernutrition in geriatric institutions in South-West France: Policies and risk factors

The evidence-base for stroke education in care homes

Individual differences in protein intakes following the addition of sauce to an older persons' lunch meal, and effects at lunch are sustained over the following meal

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