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Does undernutrition still prevail among nursing home residents?
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
2013 (English)In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 32, no 4, 562-568 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND & AIMS

During recent years public awareness about malnutrition has increased and collective initiatives have been undertaken. Simultaneously, the number of older adults is increasing, and the elderly care has been placed under pressure. The aim was to assess the nutritional situation and one-year mortality among nursing home (NH) residents, and compare with historical data.

METHODS

Mini Nutritional Assessment-Short Form (MNA-SF), ADL Barthel Index (BI), Short Portable Mental Status Questionnaire (SPMSQ), EQ-5D, Charlson Comorbidity Index (CCI), and blood samples were collected from 172 NH residents (86.3 ± 8 years, 70% women). Mortality data was taken from NH records. Nutritional data from 166 NH residents (83.8 ± 8 years, 61% women) examined in 1996 was retrieved for historical comparison.

RESULTS

The prevalence of malnutrition was 30%, as compared to 71% in the historical data set, corresponding to a present average body mass index of 23.7 ± 5.1 compared with 22.3 ± 4.2 kg/m(2) (p < 0.01). Reduced nutritional status was associated with decline in function (p < 0.001) and cognition (p < 0.01). One-year mortality was 24%. Regression analyses indicated high age (OR = 1.09, 95% CI (1.03-1.16)), high scores in CCI (OR = 1.54, (1.19-1.99)), low BMI (OR = 2.47, (1.14-5.38)) and malnutrition (OR = 2.37, (1.07-5.26)) to be independently associated with one-year mortality.

CONCLUSIONS

Malnutrition still prevails and is associated with deteriorated cognition, function and increased mortality. A possible improvement in nutritional status in NH residents over time was observed.

Place, publisher, year, edition, pages
2013. Vol. 32, no 4, 562-568 p.
National Category
Geriatrics
Identifiers
URN: urn:nbn:se:uu:diva-187331DOI: 10.1016/j.clnu.2012.10.007ISI: 000321726300011PubMedID: 23137706OAI: oai:DiVA.org:uu-187331DiVA: diva2:574343
Available from: 2012-12-05 Created: 2012-12-05 Last updated: 2017-12-07Bibliographically approved
In thesis
1. Implementation strategies for nutritional guidelines in nursing homes: Effects on care staff and residents
Open this publication in new window or tab >>Implementation strategies for nutritional guidelines in nursing homes: Effects on care staff and residents
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Introduction: The number of older adults (≥ 65 years) is increasing in Sweden. At the same time, the elderly care system is being restructured with an increased care burden in nursing homes (NHs). Several studies report a high prevalence of malnutrition among older adults. In recent years public awareness about malnutrition has increased and collective initiatives have been undertaken. However, we lack knowledge regarding how to implement these initiatives to achieve real improvements in practice.

Aims: The overall aims of the thesis are to update our knowledge of the nutritional situation in municipal elderly care and to evaluate different implementation strategies (external facilitation and educational outreach visits) for implementing nutritional guidelines in the NH setting.

Methods: Residents and staff of altogether eight NH units participated in the studies. The two implementation strategies were external facilitation (EF) and educational outreach visits (EOV). The EF strategy was a one-year, multifaceted intervention that included support, guidance, practice audits and feedback in four NH units. The EOV strategy comprised one three-hour lecture about the nutritional guidelines in four other NH units. Both strategies were targeted to selected NH teams, which consisted of a unit manager, a nurse and 5-10 care staff.

Results: In paper I, the prevalence of malnutrition in the NH setting remained high, i.e., 30% were malnourished and 63% at risk of malnutrition, and malnutrition was associated with deterioration in function and cognition and one-year mortality. However, possible improvements in nutritional status among NH residents over time (from 1996 to 2010) were observed. In paper II, the EF strategy improved mealtime ambience compared to the EOV strategy with respect to arranging the table, offering a choice of beverage and more to drink, serving the meal, increasing social interactions between staff and residents, decreasing social interactions among staff and reducing noise from the kitchen. In paper III, the EF strategy may have been related to a delay in cognitive deterioration in a sub-sample of communicative NH residents. In paper IV, the EF strategy improved, on average, the ability and willingness of the staff to implement the guidelines, i.e., the staff experienced a clearer assignment of responsibilities regarding nutritional procedures and that they had more time, tools and support from leadership. Moreover, the staff felt that they experienced less resistance from work colleagues, that their knowledge and experience were valued, that the guidelines worked in practice and that the implementation of guidelines was not labourious. 

Conclusions: Malnutrition is prevalent in Swedish nursing homes. Implementation of nutritional guidelines by an external facilitator, as compared to traditional methods, may be more effective on mealtime ambience, provide better preconditions for change among the staff, and may have positive effects on cognition among residents.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2017. 85 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1288
Keyword
implementation, clinical guidelines, malnutrition, nursing home
National Category
Nutrition and Dietetics
Research subject
Medical Science
Identifiers
urn:nbn:se:uu:diva-312229 (URN)978-91-554-9789-7 (ISBN)
Public defence
2017-02-24, hörsal Auditorium Minus, Museum Gustavianum, Akademigatan 3, Uppsala, 09:15 (Swedish)
Opponent
Supervisors
Available from: 2017-02-02 Created: 2017-01-08 Last updated: 2017-02-02

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Törmä, JohannaWinblad, UlrikaCederholm, TommySaletti, Anja

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