Improving Nutritional Status of Older Persons with Dementia Using a National Preventive Care Program.

OBJECTIVE: The aim of the study was to investigate the outcome of change in body weight associated with use of a structured preventive care process among persons with dementia assessed as at risk of malnutrition or malnourished. The preventive care process is a pedagogical model used in the Senior Alert (SA) quality register, where nutrition is one of the prioritized areas and includes four steps: assessment, analysis of underlying causes, actions performed and outcome. DESIGN: An analysis of data from SA with a pre-post design was performed. SETTING: The participants were living in ordinary housing or special housing in Sweden. PARTICIPANTS: 1912 persons, 65 years and older, registered in both SA and the dementia quality register Svedem were included. INTERVENTION: A national preventive care program including individualized actions. MEASUREMENTS: The Mini Nutritional Assessment-Short Form was used to assess nutritional status at baseline. Body weight was measured during baseline and follow-up (7-106 days after baseline). RESULTS: 74.3% persons were malnourished or at risk of malnutrition. Those at risk of malnutrition or malnourished who were registered in all four steps of the preventive care process, increased in body weight from baseline (Md 60.0 kg) to follow-up (Md 62.0 kg) (p=0.013). In those with incomplete registration no increase in body weight was found. CONCLUSION: Using all steps in the structured preventive care process seems to improve nutritional status of persons with dementia assessed as at risk of malnutrition or malnourished. This study contributes to the development of evidence-based practice regarding malnutrition and persons with dementia.

Who will become malnourished? A prospective study of factors associated with malnutrition in older persons living at home.

OBJECTIVES: To describe the nutritional status of older persons living at home, to investigate factors of importance for nutritional status, and to describe possible relationships between nutritional status and health-related quality of life (HRQoL). DESIGN: A longitudinal study using data from older persons born between 1916 and 1925. Data were collected at three occasions separated by four-year intervals. SETTING: Data collection was carried out in the participants' own homes. An experimenter administered all tests and conducted the interviews. PARTICIPANTS: A randomized selection from the Swedish Twin Register included 258 persons, all still living at home. MEASUREMENTS: Nutritional status was assessed using the Mini Nutritional Assessment (MNA), cognitive function using the Mini-Mental State Examination (MMSE) and HRQoL using the Nottingham Health Profile (NHP). Questions covering physical, psychological and social factors that may have an impact on nutritional status were also posed. RESULTS: Approximately 17% of participants were assessed as being at risk for malnutrition or as being malnourished. Cognitive impairment, reduced perceived health, recent hospital stay and receiving meals-on-wheels were factors associated with being at risk for malnutrition. CONCLUSION: Being at risk for malnutrition is common in older persons living at home, and many factors related to frailty increase this risk in later life. Making use of knowledge of these factors when giving care to older persons may be important in preventing nutritional problems.

Adapting "the Staff Attitudes to Nutritional Nursing Care scale" to geriatric nursing care.

OBJECTIVE: A positive attitude is assumed to be important in nursing staff's help and support of elderly people during meals. As there is no specific tool for measuring staff's attitudes regarding important issues within eating and nutrition, the SANN (Staff Attitudes to Nutritional Nursing Care) scale was developed. The scale was developed and tested in nursing staff working at resident homes, and the number of items was reduced from 63 to 19 with five underlying factors. The aim of this study was to describe how the SANN scale was adapted and tested in nursing staff working in different types of elderly care. DESIGN: The raw 63-item version went through minor changes, and one unclear worded item was excluded. The changed raw 62-item version was answered by 188 nursing staff working at six hospital care clinics and 64 staff working at one resident home. RESULTS: The analysis reduced the 62 items to 18, and the adapted scale was named the SANN-G scale, G standing for "geriatric care". A rotated factor analysis gave a five-factor solution, explaining 54% of the variance. The scale achieved good internal reliability, with a Cronbach's alpha of 0.83. Fourteen items fulfilled inclusion criteria in both the SANN and the SANN-G scales. CONCLUSION: The SANN-G scale is practicable for use in staff working in different types of elderly care. It can be used to explore existing attitudes and identify areas with a low degree of prevailing positive attitudes as well as to evaluate whether and how attitudes change after nutritional education and intervention.

Nutritional status in elderly people admitted to community residential homes: comparisons between two cohorts.

The aim was to describe nutritional status and socio-demographic and medical data in people who were newly admitted to community residential homes (cohort 2), and to compare the results with a previous study performed in the same municipality four years earlier (cohort 1). One hundred and twenty-seven people, 65 years of age, or older, newly admitted to residential homes in a municipality in the southern part of Sweden, were consecutively included. Nutritional status was assessed, using a combination of anthropometry and serum protein measurements and by Mini Nutritional Assessment (MNA). The results showed that 32% of the residents in cohort 2 were assessed as protein-energy malnourished (PEM), compared with 38% in cohort 1. Body mass index, psychological stress or acute disease, and reduced fluid intake were items in MNA which had power to predict PEM. Residents in cohort 2, diagnosed as having severe medical diseases, increased as well as residents with neuropsychological problems. Simultaneously, the number living in residential homes decreased, as compared to cohort 1. These differences indicate that the admission criteria have changed between cohorts 1 and 2.

Measurement of perceived health problems as a means of detecting elderly people at risk of malnutrition.

BACKGROUND: As nutritional preventative measures are more effective in elderly people assessed as non protein-energy malnourished (non-PEM) than such interventions are in those who are malnourished, early detection of those at risk of malnutrition is important. OBJECTIVE: This study tests the hypothesis that health problems measured by the Nottingham Health Profile (NHP) can predict residents at risk of malnutrition. DESIGN: Nutritional status was assessed in 261 residents newly admitted to municipal care using a combination of anthropometry and serum protein measurements. From this sample, 20 non-PEM residents, simultaneously assessed as moderately malnourished according to a subjective method, were consecutively included. Using a paired matched design, 20 other non-PEM residents, who were simultaneously subjectively assessed as well nourished, completed the pairs. RESULTS: Univariate logistic regression analyses showed that the dimensions of emotional reactions, energy, pain, physical mobility and sleep had significant power to predict residents at risk of malnutrition. In the multiple logistic regression analysis, energy had the highest explanatory power. CONCLUSION: Non-PEM residents, assessed as moderately malnourished according to the Subjective Global Assessment, perceived significantly greater health problems than non-PEM residents subjectively assessed as well nourished. Measurement of health problems adds important information to that used in early detection of residents at risk of malnutrition.

Evaluation of nutritional assessment techniques in elderly people newly admitted to municipal care.

OBJECTIVES: To evaluate the Subjective Global Assessment (SGA) and the Mini Nutritional Assessment (MNA) with regard to validity using a combination of anthropometric and serum-protein measurements as standard criteria to assess protein-energy malnutrition (PEM). DESIGN: Cross-sectional study with consecutive selection of residents aged >or=65 y. SETTING: A municipality in the south of Sweden. SUBJECTS: During a year, starting in October 1996, 148 females and 113 males, aged >or=65-104 y of age, newly admitted to special types of housing for the elderly, were included in the study. RESULTS: According to SGA, 53% were assessed as malnourished or moderately malnourished on admission. The corresponding figure from MNA was 79% malnourished or at risk of malnutrition. Both tools indicated that anthropometric values and serum proteins were significantly lower in residents classified as being malnourished (P<0.05). Sensitivity in detecting PEM was in SGA 0.93 and in MNA 0.96 and specificity was 0.61 and 0.26, respectively. Using regression analysis, weight index and serum albumin were the best objective nutritional parameters in predicting the SGA- and MNA classifications. Item 'muscle wasting' in SGA and 'self-experienced health status' in MNA showed most predictive power concerning the odds of being assessed as malnourished. CONCLUSIONS: SGA was shown to be the more useful tool in detecting residents with established malnutrition and MNA in detecting residents who need preventive nutritional measures.

Individually adjusted meals for older people with protein-energy malnutrition: a single-case study.

The objective of this study was to investigate the effect of a 3-month intervention programme consisting of meals based on individual nutritional requirements in residents assessed as protein-energy malnourished on admission to a municipal care Institution. Using a single-case design, 11 malnourished residents were given individual care aimed at fulfilling their personal requirements for energy intake during a period of 12 weeks. The residents were selected from a sample of 261 newly admitted older adults of whom 87 were assessed to be malnourished on admission. Nutritional status, including anthropometric and biochemical variables and functional capacities were assessed before, during, and after the intervention. Energy intake was recorded every day. Body weight, and serum concentration of albumin and transthyretin were measured every other week. During a 3-month period, the mean value of energy intake reached the calculated energy requirement in 10 residents. Eight residents increased in weight, triceps skin-fold thickness, and transthyretin concentration. Nine residents increased in arm muscle circumference, and 10 showed increased serum albumin concentration and functional capacity. We conclude that nursing care based on individual nutritional requirements, resources, and desires improves nutritional status and functional capacity in a group of malnourished residents.

Malnutrition in elderly people newly admitted to a community resident home.

The purpose of this study was to assess nutritional status in elderly people, newly admitted to a community resident home, and to describe the characteristics of residents with protein-energy malnutrition (PEM). The participants were 261 people, 65 to 103 years of age (M= 84.8+/-7.1 in women, 82.5+/-6.4 in men) who during one year entered special types of housing for the elderly in a municipality in the south of Sweden. During the first two weeks after admission nutritional status was assessed using weight index, triceps skinfold thickness, arm muscle circumference, serum albumin and transthyretin. Demographic and sociomedical data and eating-related factors were collected by using structured interviews and studying residents records. PEM was found in 29% of the residents who entered municipal care from their own homes, 33% among those moving within municipal care and 43% of the residents who entered from hospital care. Pressure sores or leg ulcers, psychological stress or acute disease in the previous 3 months, reduced fluid intake, deteriorated appetite, reduced mobility, need of help during meals and gastrointestinal symptoms were factors associated with PEM.