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  • 1.
    Berglund, Fanny
    et al.
    Dept Hlth & Med Serv, Luleå, Sweden..
    Törmä, Johanna
    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. Dept Hlth & Med Serv, Luleå, Sweden..
    Wennberg, Maria
    Umeå Univ, Dept Publ Hlth & Clin Med, Umeå, Sweden..
    Wennberg, Patrik
    Umeå Univ, Dept Publ Hlth & Clin Med, Umeå, Sweden..
    Oskarsson, Viktor
    Umeå Univ, Dept Publ Hlth & Clin Med, Umeå, Sweden.;Umeå Univ, Dept Publ Hlth & Clin Med, Sect Med, Pitea Res Unit, SE-90187 Umeå, Sweden..
    Dietary habits among snus users: a population-based cross-sectional study2023In: Food & Nutrition Research, ISSN 1654-6628, E-ISSN 1654-661X, Vol. 67, article id 9537Article in journal (Refereed)
    Abstract [en]

    Background: The dietary habits among snus users are largely unknown and have not been accounted for in observational studies on the health effects of snus use.

    Aim: To examine whether snus users eat unhealthier than never tobacco users.

    Methods: A total of 3,397 male participants, examined between 1994 and 2014 in the Northern Sweden Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA) study, were included. Snus use and dietary habits were self-reported using questionnaires, from which intakes of different food groups, macronutrients, and a healthy diet score (HDS) were calculated (the latter as a proxy for overall diet quality). The association between snus use and dietary habits was examined by quantile regression models.

    Results: In the multivariable-adjusted model, current snus users had a lower HDS (median difference: -0.86 [95% confidence interval: -1.32, -0.40]) than never tobacco users. Snus users also consumed fewer weekly servings of fruits and berries (median difference: -1.03 [-1.65, -0.40]), and their estimated percentage of energy intake con -sisted of less carbohydrates (median difference: -1.43 [-2.12, -0.74]) and of more total fat (median difference: 0.99 [0.30, 1.67]), saturated fat (median difference: 0.67 [0.29, 1.05]), monounsaturated fat (median difference: 0.44 [0.20, 0.68]), trans fat (median difference: 0.03 [0.01, 0.06]), and alcohol (median difference: 0.21 [0.02, 0.40]).

    Conclusion: We observed that snus users had an unhealthier diet than never tobacco users. Future studies on the association between snus use and health outcomes should, therefore, consider diet as a potential confounder.

    Download full text (pdf)
    FULLTEXT01
  • 2.
    Törmä, Johanna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Implementation strategies for nutritional guidelines in nursing homes: Effects on care staff and residents2017Doctoral 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.

    List of papers
    1. Does undernutrition still prevail among nursing home residents?
    Open this publication in new window or tab >>Does undernutrition still prevail among nursing home residents?
    2013 (English)In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 32, no 4, p. 562-568Article 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.

    National Category
    Geriatrics
    Identifiers
    urn:nbn:se:uu:diva-187331 (URN)10.1016/j.clnu.2012.10.007 (DOI)000321726300011 ()23137706 (PubMedID)
    Available from: 2012-12-05 Created: 2012-12-05 Last updated: 2018-02-22Bibliographically approved
    2. The effects of nutritional guideline implementation on nursing home staff performance: a controlled trial
    Open this publication in new window or tab >>The effects of nutritional guideline implementation on nursing home staff performance: a controlled trial
    2018 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 32, no 2, p. 622-633Article in journal (Refereed) Published
    Abstract [en]

    Rationale: Suboptimal nutritional practices in elderly caresettings may be resolved by an efficient introduction ofnutritional guidelines.Aims: To compare two different implementation strate-gies, external facilitation (EF) and educational outreachvisits (EOVs), when introducing nutritional guidelines innursing homes (NHs), and study the impact on staffperformance.Methodological design: A quasi-experimental study withbaseline and follow-up measurements.Outcome measures: The primary outcome was staff perfor-mance as a function of mealtime ambience and food ser-vice routines.Interventions/research methods: The EF strategy was a 1-year,multifaceted intervention that included support, guidance,practice audit and feedback in two NH units. The EOVstrategy comprised one-three-hour lecture about nutri-tional guidelines in two other NH units. Both strategieswere targeted to selected NH teams, which consisted of aunit manager, a nurse and 5–10 care staff. Mealtime ambi-ence was evaluated by 47 observations using a structuredmealtime instrument. Food service routines were evalu-ated by 109 food records performed by the staff.Results: Mealtime ambience was more strongly improvedin the EF group than in the EOV group after the imple-mentation. Factors improved were laying a table(p = 0.03), offering a choice of beverage (p = 0.02), theserving of the meal (p = 0.02), interactions between staffand residents (p = 0.02) and less noise from the kitchen(p = 0.01). Food service routines remained unchanged inboth groups.Conclusions: An EF strategy that included guidance, auditand feedback improved mealtime ambience when nutri-tional guidelines were introduced in a nursing home set-ting, whereas food service routines were unchanged bythe EF strategy.

    National Category
    Nutrition and Dietetics
    Identifiers
    urn:nbn:se:uu:diva-312221 (URN)10.1111/scs.12487 (DOI)000436254800018 ()
    Available from: 2017-01-08 Created: 2017-01-08 Last updated: 2022-01-29Bibliographically approved
    3. Strategies to implement community guidelines on nutrition and their long-term clinical effects in nursing home residents
    Open this publication in new window or tab >>Strategies to implement community guidelines on nutrition and their long-term clinical effects in nursing home residents
    2015 (English)In: The Journal of Nutrition, Health & Aging, ISSN 1279-7707, E-ISSN 1760-4788, Vol. 19, no 1, p. 70-76Article in journal (Refereed) Published
    Abstract [en]

    Objectives: Studies on implementation techniques that focus on nutrition in the setting of elderly care are scarce. The aims of this study were to compare two implementation strategies i.e., external facilitation ( EF) and educational outreach visits ( EOVs), in order to introduce nutritional guidelines ( e.g. screening, food quality and mealtime ambience), into a nursing home ( NH) setting and to evaluate the clinical outcomes. Design: A controlled study with baseline and follow-up measurements. Setting: Four NHs. Participants: A total of 101 NH residents. Intervention: The EF was a one-year, multifaceted intervention that included support, guidance, practice audits, and feedback that were provided to two NHs. The EOVs performed at the other NHs consisted of one session of three hours of lectures about the guidelines. Both interventions targeted a team of the unit manager, the head nurse, and 5-10 of the care staff. Measurements: The outcomes were nutritional status ( Mini Nutritional Assessment-Short Form, MNA-SF), body mass index ( BMI), functional ability ( Barthel Index, BI), cognitive function ( Short Portable Mental Status Questionnaire, SPMSQ, performed in a subgroup of communicative NH residents), health-related quality of life ( EQ-5D), and the levels of certain biochemical markers like for example vitamin D, albumin and insulin-like growth factor 1. Results: After a median of 18 months, nutritional parameters ( MNA-SF and BMI) remained unchanged in both groups. While there were no differences in most outcomes between the two groups, the cognitive ability of those in the EOV group deteriorated more than in individuals in the EF group ( p=0.008). Multiple linear regression analyses indicated that the intervention group assignment ( EF) was independently from other potentially related factors associated with less cognitive decline. Conclusion: An extended model of implementation of nutritional guidelines, including guidance and feedback to NH staff, did not affect nutritional status but may be associated with a delayed cognitive decline in communicative NH residents.

    Keywords
    Implementation, nutrition, clinical guidelines, nursing home, cognition
    National Category
    Geriatrics Nutrition and Dietetics
    Identifiers
    urn:nbn:se:uu:diva-245203 (URN)10.1007/s12603-014-0522-4 (DOI)000348024800010 ()25560819 (PubMedID)
    Available from: 2015-02-25 Created: 2015-02-25 Last updated: 2018-02-22Bibliographically approved
    4. Is it possible to influence ability, willingness and understanding among nursing home care staff to implement nutritional guidelines?: A comparison of a facilitated and an educational strategy
    Open this publication in new window or tab >>Is it possible to influence ability, willingness and understanding among nursing home care staff to implement nutritional guidelines?: A comparison of a facilitated and an educational strategy
    Show others...
    2021 (English)In: International Journal of Older People Nursing, ISSN 1748-3735, E-ISSN 1748-3743, Vol. 16, no 3, article id e12367Article in journal (Refereed) Published
    Abstract [en]

    Background: Translating nutrition knowledge into care practice is challenging since multiple factors can affect the implementation process. This study examined the impact of two implementation strategies, that is external facilitation (EF) and educational outreach visits (EOVs), on the organisational context and individual factors when implementing nutritional guidelines in a nursing home (NH) setting.

    Methods: The EF strategy was a one-year, multifaceted (including support, guidance, a practice audit and feedback) intervention given to four NH units. The EOV strategy was a three-hour lecture about the nutritional guidelines given to four other NH units. Both strategies were directed at selected NH teams, consisting of a unit manager, a nurse and 5-10 care staff. A questionnaire was distributed, before and after the interventions, to evaluate the prerequisites for the staff to use the guidelines. Three conditions were used to examine the organisational context and the individual factors: the staff's ability and willingness to implement the nutritional guidelines and their understanding of them. Confirmatory factor analysis and structural equation models were used for the data analysis.

    Results: The results indicated that on average, there was a significant increase in the staff's ability to implement the nutritional guidelines in the EF group. The staff exposed to the EF strategy experienced better resources to implement the guidelines in terms of time, tools and support from leadership and a clearer assignment of responsibility regarding nutrition procedures. There was no change in staff's willingness and understanding of the guidelines in the EF group. On average, no significant changes were observed for the staff's ability, willingness or understanding in the EOV group.

    Conclusions: A long-term, active and flexible implementation strategy (i.e. EF) affected the care staff's ability to implement the nutritional guidelines in an NH setting. No such impact was observed for the more passive, educational approach (i.e. EOV).

    Place, publisher, year, edition, pages
    John Wiley & Sons, 2021
    National Category
    Nutrition and Dietetics
    Identifiers
    urn:nbn:se:uu:diva-312227 (URN)10.1111/opn.12367 (DOI)000620913100001 ()33624452 (PubMedID)
    Available from: 2017-01-08 Created: 2017-01-08 Last updated: 2022-08-30Bibliographically approved
    Download full text (pdf)
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  • 3.
    Törmä, Johanna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research. Reg Norrbotten, Dept Dev, Robertsviksgatan 7, SE-97189 Luleå, Sweden..
    Lundqvist, Robert
    Umeå Univ, Dept Publ Hlth & Clin Med, Sunderby Res Unit, Umeå, Sweden..
    Eliasson, Mats
    Umeå Univ, Dept Publ Hlth & Clin Med, Sunderby Res Unit, Sect Med, Umeå, Sweden..
    Nilsson, Lena Maria
    Umeå Univ, Dept Epidemiol & Global Hlth, Umeå, Sweden..
    Oskarsson, Viktor
    Umeå Univ, Dept Publ Hlth & Clin Med, Pitea Res Unit, Sect Med, Umeå, Sweden..
    Wennberg, Maria
    Umeå Univ, Dept Publ Hlth & Clin Med, Sect Sustainable Hlth, Umeå, Sweden..
    Comparison of dietary trends between two counties with and without a cardiovascular prevention programme: a population-based cross-sectional study in northern Sweden2022In: Public Health Nutrition, ISSN 1368-9800, E-ISSN 1475-2727, Vol. 25, no 7, p. 1835-1843Article in journal (Refereed)
    Abstract [en]

    Objective: To compare temporal trends, over a 20-year period, in dietary habits between a county (Vasterbotten) with a CVD prevention programme and a county (Norrbotten) without such a programme.

    Design: Cross-sectional data from the Northern Sweden MONICA study (survey period 1994, 1999, 2004, 2009 and 2014). Dietary habits were assessed by a semi-quantitative FFQ.

    Setting: Counties of Norrbotten and Vasterbotten, Northern Sweden.

    Participants: Five thousand four hundred Swedish adults (mean age 56 center dot 9 years; 51 center dot 2 % women) from Vasterbotten (47 %) and Norrbotten (53 %).

    Results: No differences in temporal trend for estimated percentage of energy intake from total carbohydrates, total fat, total protein and alcohol were observed between the counties (P (for interaction) >= 0 center dot 33). There were no between-county difference in temporal trends for overall diet quality (assessed by the Healthy Diet Score; P (for interaction) = 0 center dot 36). Nor were there any between-county differences for the intake of whole grain products, fruits, vegetables, fish, sweetened beverages or fried potatoes (P (for interaction) >= 0 center dot 09). Consumption of meat (P (for interaction) = 0 center dot 05) increased to a greater extent in Norrbotten from 2009 and onwards, mainly in men (sex-specific analyses, P (for interaction) = 0 center dot 04). Men in Vasterbotten decreased their intake of sweets to a greater extent than men in Norrbotten (P (for interaction) < 0 center dot 01).

    Conclusions: Over a 20-year period in northern Sweden, only small differences in dietary habits were observed in favour of a county with a CVD prevention programme compared with a county without such a programme.

    Download full text (pdf)
    FULLTEXT01
  • 4.
    Törmä, Johanna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Pingel, Ronnie
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Statistics.
    Cederholm, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Saletti, Anja
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Winblad, Ulrika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Is it possible to influence ability, willingness and understanding among nursing home care staff to implement nutritional guidelines?: A comparison of a facilitated and an educational strategy2021In: International Journal of Older People Nursing, ISSN 1748-3735, E-ISSN 1748-3743, Vol. 16, no 3, article id e12367Article in journal (Refereed)
    Abstract [en]

    Background: Translating nutrition knowledge into care practice is challenging since multiple factors can affect the implementation process. This study examined the impact of two implementation strategies, that is external facilitation (EF) and educational outreach visits (EOVs), on the organisational context and individual factors when implementing nutritional guidelines in a nursing home (NH) setting.

    Methods: The EF strategy was a one-year, multifaceted (including support, guidance, a practice audit and feedback) intervention given to four NH units. The EOV strategy was a three-hour lecture about the nutritional guidelines given to four other NH units. Both strategies were directed at selected NH teams, consisting of a unit manager, a nurse and 5-10 care staff. A questionnaire was distributed, before and after the interventions, to evaluate the prerequisites for the staff to use the guidelines. Three conditions were used to examine the organisational context and the individual factors: the staff's ability and willingness to implement the nutritional guidelines and their understanding of them. Confirmatory factor analysis and structural equation models were used for the data analysis.

    Results: The results indicated that on average, there was a significant increase in the staff's ability to implement the nutritional guidelines in the EF group. The staff exposed to the EF strategy experienced better resources to implement the guidelines in terms of time, tools and support from leadership and a clearer assignment of responsibility regarding nutrition procedures. There was no change in staff's willingness and understanding of the guidelines in the EF group. On average, no significant changes were observed for the staff's ability, willingness or understanding in the EOV group.

    Conclusions: A long-term, active and flexible implementation strategy (i.e. EF) affected the care staff's ability to implement the nutritional guidelines in an NH setting. No such impact was observed for the more passive, educational approach (i.e. EOV).

    Download full text (pdf)
    fulltext
  • 5.
    Törmä, Johanna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Winblad, Ulrika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Cederholm, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Saletti, Anja
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Does undernutrition still prevail among nursing home residents?2013In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 32, no 4, p. 562-568Article in journal (Refereed)
    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.

  • 6.
    Törmä, Johanna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Winblad, Ulrika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research. Health Services Research, Uppsala, Sweden; School of Public Health, Brown University, Providence, RI, USA.
    Saletti, Anja
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Cederholm, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    The effects of nutritional guideline implementation on nursing home staff performance: a controlled trial2018In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 32, no 2, p. 622-633Article in journal (Refereed)
    Abstract [en]

    Rationale: Suboptimal nutritional practices in elderly caresettings may be resolved by an efficient introduction ofnutritional guidelines.Aims: To compare two different implementation strate-gies, external facilitation (EF) and educational outreachvisits (EOVs), when introducing nutritional guidelines innursing homes (NHs), and study the impact on staffperformance.Methodological design: A quasi-experimental study withbaseline and follow-up measurements.Outcome measures: The primary outcome was staff perfor-mance as a function of mealtime ambience and food ser-vice routines.Interventions/research methods: The EF strategy was a 1-year,multifaceted intervention that included support, guidance,practice audit and feedback in two NH units. The EOVstrategy comprised one-three-hour lecture about nutri-tional guidelines in two other NH units. Both strategieswere targeted to selected NH teams, which consisted of aunit manager, a nurse and 5–10 care staff. Mealtime ambi-ence was evaluated by 47 observations using a structuredmealtime instrument. Food service routines were evalu-ated by 109 food records performed by the staff.Results: Mealtime ambience was more strongly improvedin the EF group than in the EOV group after the imple-mentation. Factors improved were laying a table(p = 0.03), offering a choice of beverage (p = 0.02), theserving of the meal (p = 0.02), interactions between staffand residents (p = 0.02) and less noise from the kitchen(p = 0.01). Food service routines remained unchanged inboth groups.Conclusions: An EF strategy that included guidance, auditand feedback improved mealtime ambience when nutri-tional guidelines were introduced in a nursing home set-ting, whereas food service routines were unchanged bythe EF strategy.

  • 7.
    Törmä, Johanna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Winblad, Ulrika Spångberg
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Saletti, Anja
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Cederholm, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Strategies to implement community guidelines on nutrition and their long-term clinical effects in nursing home residents2015In: The Journal of Nutrition, Health & Aging, ISSN 1279-7707, E-ISSN 1760-4788, Vol. 19, no 1, p. 70-76Article in journal (Refereed)
    Abstract [en]

    Objectives: Studies on implementation techniques that focus on nutrition in the setting of elderly care are scarce. The aims of this study were to compare two implementation strategies i.e., external facilitation ( EF) and educational outreach visits ( EOVs), in order to introduce nutritional guidelines ( e.g. screening, food quality and mealtime ambience), into a nursing home ( NH) setting and to evaluate the clinical outcomes. Design: A controlled study with baseline and follow-up measurements. Setting: Four NHs. Participants: A total of 101 NH residents. Intervention: The EF was a one-year, multifaceted intervention that included support, guidance, practice audits, and feedback that were provided to two NHs. The EOVs performed at the other NHs consisted of one session of three hours of lectures about the guidelines. Both interventions targeted a team of the unit manager, the head nurse, and 5-10 of the care staff. Measurements: The outcomes were nutritional status ( Mini Nutritional Assessment-Short Form, MNA-SF), body mass index ( BMI), functional ability ( Barthel Index, BI), cognitive function ( Short Portable Mental Status Questionnaire, SPMSQ, performed in a subgroup of communicative NH residents), health-related quality of life ( EQ-5D), and the levels of certain biochemical markers like for example vitamin D, albumin and insulin-like growth factor 1. Results: After a median of 18 months, nutritional parameters ( MNA-SF and BMI) remained unchanged in both groups. While there were no differences in most outcomes between the two groups, the cognitive ability of those in the EOV group deteriorated more than in individuals in the EF group ( p=0.008). Multiple linear regression analyses indicated that the intervention group assignment ( EF) was independently from other potentially related factors associated with less cognitive decline. Conclusion: An extended model of implementation of nutritional guidelines, including guidance and feedback to NH staff, did not affect nutritional status but may be associated with a delayed cognitive decline in communicative NH residents.

  • 8.
    Veronese, N.
    et al.
    Univ Padua, Geriatr Sect, Dept Med DIMED, Padua, Italy..
    Cereda, E.
    Fdn IRCCS Policlin San Matteo, Nutr & Dietet Serv, Pavia, Italy..
    Solmi, M.
    Univ Padua, Dept Neurosci, Padua, Italy..
    Fowler, S. A.
    Washington Univ, Becker Med Lib, St Louis, MO USA..
    Manzato, E.
    Univ Padua, Geriatr Sect, Dept Med DIMED, Padua, Italy.;Inst Neurosci, Natl Res Council, Padua, Italy..
    Maggi, S.
    Inst Neurosci, Natl Res Council, Padua, Italy..
    Manu, P.
    Zucker Hillside Hosp, North Shore Long Island Jewish Hlth Syst, Psychiat Res, Glen Oaks, NY USA.;Hofstra North Shore LIJ Sch Med, Hempstead, NY USA.;Feinstein Inst Med Res, Manhasset, NY USA.;Albert Einstein Coll Med, Bronx, NY 10467 USA..
    Abe, E.
    Gunma Univ, Grad Sch Hlth Sci, Maebashi, Gumma 371, Japan..
    Hayashi, K.
    Gunma Univ, Grad Sch Hlth Sci, Maebashi, Gumma 371, Japan..
    Allard, J. P.
    Univ Hlth Network, Toronto Gen Hosp, Toronto, ON, Canada.;Univ Toronto, Dept Med, Toronto, ON, Canada..
    Arendt, B. M.
    Univ Hlth Network, Toronto Gen Hosp, Toronto, ON, Canada..
    Beck, A.
    Herlev Univ Hosp, Res Unit Nutr EFFECT, DK-2730 Herlev, Denmark..
    Chan, M.
    Tan Tock Seng Hosp, Dept Geriatr Med, Singapore, Singapore..
    Audrey, Y. J. P.
    Tan Tock Seng Hosp, Dept Geriatr Med, Singapore, Singapore..
    Lin, W. -Y
    Hsu, H. -S
    Lin, C. -C
    Diekmann, R.
    Univ Erlangen Nurnberg, Inst Biomed Aging, Nurnberg, Germany..
    Kimyagarov, S.
    Gilad Geriatr Ctr, Ramat Gan, Israel..
    Miller, M.
    Flinders Univ S Australia, Nutr & Dietet, Adelaide, SA 5001, Australia..
    Cameron, I. D.
    Univ Sydney, Walsh Ctr Rehabil Res, Sydney, NSW 2006, Australia..
    Pitkala, K. H.
    Univ Helsinki, Cent Hosp, Dept Gen Practice, Unit Primary Hlth Care, Helsinki, Finland..
    Lee, J.
    Chinese Univ Hong Kong, SH Ho Ctr Gerontol & Geriatr, Hong Kong, Hong Kong, Peoples R China.;Chinese Univ Hong Kong, Dept Med & Therapeut, Hong Kong, Hong Kong, Peoples R China..
    Woo, J.
    Chinese Univ Hong Kong, SH Ho Ctr Gerontol & Geriatr, Hong Kong, Hong Kong, Peoples R China.;Chinese Univ Hong Kong, Dept Med & Therapeut, Hong Kong, Hong Kong, Peoples R China..
    Nakamura, K.
    Niigata Univ, Grad Sch Med & Dent Sci, Div Prevent Med, Niigata, Niigata, Japan..
    Smiley, D.
    Emory Univ, Sch Med, Dept Med, Div Endocrinol & Metab, Atlanta, GA 30322 USA..
    Umpierrez, G.
    Emory Univ, Sch Med, Dept Med, Div Endocrinol & Metab, Atlanta, GA 30322 USA..
    Rondanelli, M.
    Univ Pavia, Dept Publ Hlth Expt & Forens Med, Sect Human Nutr, Endocrinol & Nutr Unit, Pavia, Italy..
    Sund-Levander, M.
    Linkoping Univ, Fac Hlth Sci, Linkoping, Sweden..
    Valentini, L.
    Univ Appl Sci, Sect Dietet, Dept Agr & Food Sci, Neubrandenburg, Germany..
    Schindler, K.
    Med Univ Vienna, Div Endocrinol & Metab, Dept Internal Med 3, Vienna, Austria..
    Törmä, Johanna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Volpato, S.
    Univ Ferrara, Dept Med Sci, I-44100 Ferrara, Italy..
    Zuliani, G.
    Univ Ferrara, Dept Med Sci, I-44100 Ferrara, Italy..
    Wong, M.
    Chinese Univ Hong Kong, Dept Med & Therapeut, Hong Kong, Hong Kong, Peoples R China..
    Lok, K.
    Chinese Univ Hong Kong, Dept Med & Therapeut, Hong Kong, Hong Kong, Peoples R China..
    Kane, J. M.
    Zucker Hillside Hosp, North Shore Long Island Jewish Hlth Syst, Psychiat Res, Glen Oaks, NY USA.;Hofstra North Shore LIJ Sch Med, Hempstead, NY USA.;Feinstein Inst Med Res, Manhasset, NY USA.;Albert Einstein Coll Med, Bronx, NY 10467 USA..
    Sergi, G.
    Univ Padua, Geriatr Sect, Dept Med DIMED, Padua, Italy..
    Correll, C. U.
    Zucker Hillside Hosp, North Shore Long Island Jewish Hlth Syst, Psychiat Res, Glen Oaks, NY USA.;Hofstra North Shore LIJ Sch Med, Hempstead, NY USA.;Feinstein Inst Med Res, Manhasset, NY USA.;Albert Einstein Coll Med, Bronx, NY 10467 USA..
    Inverse relationship between body mass index and mortality in older nursing home residents: a meta-analysis of 19,538 elderly subjects2015In: Obesity Reviews, ISSN 1467-7881, E-ISSN 1467-789X, Vol. 16, no 11, p. 1001-1015Article, review/survey (Refereed)
    Abstract [en]

    Body mass index (BMI) and mortality in old adults from the general population have been related in a U-shaped or J-shaped curve. However, limited information is available for elderly nursing home populations, particularly about specific cause of death. A systematic PubMed/EMBASE/CINAHL/SCOPUS search until 31 May 2014 without language restrictions was conducted. As no published study reported mortality in standard BMI groups (<18.5, 18.5-24.9, 25-29.9, 30kg/m(2)), the most adjusted hazard ratios (HRs) according to a pre-defined list of covariates were obtained from authors and pooled by random-effect model across each BMI category. Out of 342 hits, 20 studies including 19,538 older nursing home residents with 5,223 deaths during a median of 2 years of follow-up were meta-analysed. Compared with normal weight, all-cause mortality HRs were 1.41 (95% CI=1.26-1.58) for underweight, 0.85 (95% CI=0.73-0.99) for overweight and 0.74 (95% CI=0.57-0.96) for obesity. Underweight was a risk factor for higher mortality caused by infections (HR=1.65 [95% CI=1.13-2.40]). RR results corroborated primary HR results, with additionally lower infection-related mortality in overweight and obese than in normal-weight individuals. Like in the general population, underweight is a risk factor for mortality in old nursing home residents. However, uniquely, not only overweight but also obesity is protective, which has relevant nutritional goal implications in this population/setting.

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