Risk factors associated with malnutrition in older adults living in Italian nursing homes: a cross-sectional study.

Malnutrition is a significant problem among older adults living in nursing homes: Malnourished residents are at increased risk of hospitalization and mortality. Multiple factors determine malnutrition, and the extant literature has focused attention on individual factors such as aging, sex, and dependence in activities of daily living. However, little evidence is available on factors influenced by nursing care. Exploring the relationship between the nutritional status of nursing home residents and certain individual factors, including those potentially influenced by nursing care, was the aim of this cross-sectional study. A total of 186 nursing home residents was enrolled in the study; in addition, 18 nurses were involved in the data collection process. Twenty-one percent of the residents had an adequate nutritional status, 43% were at risk of malnutrition, and 36% were malnourished. Multivariate analysis revealed that those independent factors associated with malnutrition, once adjusted for age, sex, and dependence in activities of daily living, were: having had a stroke, being dependent in activities of daily living, eating half or less of food provided at mealtimes, and having their weight checked only every 3 months or longer. Nursing care projects may be effective in reducing the risk of malnutrition among nursing home residents. However, further research is needed to develop knowledge of the factors associated with malnutrition and those influenced by care delivered in nursing homes.

The effectiveness of multistrategies on disruptive vocalization of people with dementia in institutions: a multicentered observational study.

The aim of this study was to evaluate the effectiveness of the daily interventions used by the nurses on disruptive vocalization (DV). DV includes all types of disturbing or unacceptable vocal expression: repetitive vocalization, verbal or nonverbal utterances, presented as inappropriate language, repeated and insistent demands, repeated calling out, shouting, complaining, or moaning that does not pertain to their circumstances or environment. A convenience sample of five nursing homes from the north of Italy, in the Friuli Venezia Giulia region, was included in the study. A randomized selection of 87 daily shifts was selected. Institutionalized patients with dementia, but with no associated psychiatric disorders, were eligible. Nurses involved in the study added patients progressively. Nurses involved were asked to keep diaries to record strategies and durations for each episode of DV encountered during the allotted shift. In the total amount of observation time (36,540 minutes), 23.6% (8,653 minutes) of nursing care time involved working with and managing DV patients. The nurses recorded an average of 6.5 (302/46) vocalizations on morning shifts and 7.3 (302/41) during afternoon shifts, with an average duration of about a quarter of an hour each. Managing DV with multistrategies reduces the duration of the DV episode and increases the perceived effectiveness of management.