Patient-reported dietetic care post hospital for free-living patients: a Canadian Malnutrition Task Force Study.

BACKGROUND: Transitions out of hospital can influence recovery. Ideally, malnourished patients should be followed by someone with nutrition expertise, specifically a dietitian, post discharge from hospital. Predictors of dietetic care post discharge are currently unknown. The present study aimed to determine the patient factors independently associated with 30-days post hospital discharge dietetic care for free-living patients who transitioned to the community. METHODOLOGY: Nine hundred and twenty-two medical or surgical adult patients were recruited in 16 acute care hospitals in eight Canadian provinces on admission. Eligible patients could speak English or French, provide their written consent, were anticipated to have a hospital stay of ≥2 days and were not considered palliative. Telephone interviews were completed with 747 (81%) participants using a standardised questionnaire to determine whether dietetic care occurred post discharge; 544 patients discharged to the community were included in the multivariate analyses, excluding those who were admitted to nursing homes or rehabilitation facilities. Covariates during and post hospitalisation were collected prospectively and used in logistic regression analyses to determine independent patient-level predictors. RESULTS: Dietetic care post discharge was reported by 61/544 (11%) of participants and was associated with severe malnutrition [Subjective Global Assessment category C: odd's ratio (OR) 2.43 (1.23-4.83)], weight loss post discharge [(OR 2.86 (1.45-5.62)], comorbidity [(OR 1.09 (1.02-1.17)] and a dietitian consultation on admission [(OR 3.41 (1.95-5.97)]. CONCLUSIONS: Dietetic care post discharge occurs in few patients, despite the known high prevalence of malnutrition on admission and discharge. Dietetic care in hospital was the most influential predictor of post-hospital care.

Prevalence and predictors of weight change post discharge from hospital: a study of the Canadian Malnutrition Task Force.

BACKGROUND/OBJECTIVES: Little is known about factors associated with weight change post discharge from hospital; yet poor nutritional status in the transition from hospital to community can result in readmission. This exploratory study aimed to determine the factors associated with weight change 30 days post discharge defined as weight gain (WG; 5+ pounds), weight loss (WL; 5+pounds) or weight stable (WS). SUBJECTS/METHODS: A total of 922 medical or surgical patients were recruited from 16 acute care hospitals in 8 Canadian provinces. Telephone interviews were completed with 747 (81%) participants 30 days post discharge using a standardized questionnaire that included: self-reported weight change, assessment of appetite, usage of healthcare services and supports for food-related activities of daily living. Covariates collected during hospitalization, including nutritional status at discharge evaluated by subjective global assessment (SGA), were used in logistic regressions. RESULTS: Among the 747 patients, 26% reported WL, 16.7% had WG and 57.2% were WS. Those with WG were: younger (odds ratio (OR) 0.77 (0.69, 0.85)), male (OR 1.71 (1.12, 2.61)), malnourished at discharge (SGA B OR 2.13 (1.36, 3.33), SGA C OR 2.76 (1.19, 6.62)), and had a good appetite based on the low OR for fair/poor appetite (OR 0.28 (0.11, 0.66)). WL was associated with being on a special diet (OR 1.45 (1.07,1.96)) and reporting fair/poor appetite (OR 2.67 (1.76, 4.07)). CONCLUSIONS: Weight change was relatively common with WL predominating. Several variables were identified to be predictors of WL or weight gain, with appetite being common to both. Future work to further define and confirm these associations is warranted.

Intakes of folate, vitamin B6 and B12 and risk of depression in community-dwelling older adults: the Quebec Longitudinal Study on Nutrition and Aging.

BACKGROUND/OBJECTIVES: Depression can decrease quality of life and affect health outcomes in older population. We investigated whether different intake levels of folate, vitamin B6 and B12 were associated with a 3-year depression incidence among generally healthy, community-dwelling older men and women. SUBJECTS/METHODS: Participants in the Québec Longitudinal Study on Nutrition and Aging (NuAge), free of depression (that is, 30-item Geriatric Depression Scale (GDS) <11) at baseline (N=1368; 74 ± 4 years old; 50.5% women), were screened annually for incident depression (GDS ⩾ 11) or antidepressant medication. Tertiles of intakes (food only and food+supplements) were obtained from the mean of three non-consecutive 24-h recalls at baseline. Sex-stratified multiple logistic regression models were adjusted for age, physical activity, physical functioning, stressful life events and total energy intake. RESULTS: Over 3 years, 170 participants were identified as depressed. Women in the highest tertile of B6 intake from food were 43% less likely to become depressed when adjusting for demographic and health factors (multivariate odds ratio (OR) 0.57, 95% confidence interval (CI) 0.39-0.96), but adjustment for energy intake attenuated the effect. Men in the highest tertile of dietary B12 intake had decreased risk of depression (energy-adjusted multivariate OR 0.42, 95% CI 0.20-0.90). No other association was observed. CONCLUSIONS: This study provides some evidence of decreased depression risk among women with higher intakes of vitamin B6 from food, which was dependent on total energy intake, and among men with higher intakes of B12 from food, independently of energy intake.

Barriers to food intake in acute care hospitals: a report of the Canadian Malnutrition Task Force.

BACKGROUND: Poor food intake is common in acute care patients and can exacerbate or develop into malnutrition, influencing both recovery and outcome. Yet, research on barriers and how they can be alleviated is lacking. The present study aimed to (i) describe the prevalence of food intake barriers in diverse hospitals and (ii) determine whether patient, care or hospital characteristics are associated with the experience of these barriers. METHODS: Patients (n = 890; 87%) completed a validated questionnaire on barriers to food intake, including perceptions of food quality, just before their discharge from a medical or surgical unit in each of 18 hospitals across Canada. Scores were created for barrier domains. Associations between these barriers and selected patient characteristics collected at admission or throughout the hospital stay and site characteristics were determined using bivariate analyses. RESULTS: Common barriers were being interrupted at meals (41.8%), not being given food when a meal was missed (69.2%), not wanting ordered food (58%), loss of appetite (63.9%) and feeling too sick (42.7%) or tired (41.1%) to eat. Younger patients were more likely (P < 0.0001) to report being disturbed at meals (44.6%) than older patients (33.9%) and missing a meal for tests (39.0% versus 31.0%, P < 0.05). Patients who were malnourished, women, those with more comorbidity, and those who ate <50% of the meal reported several barriers across domains. CONCLUSIONS: The present study confirms that barriers to food intake are common in acute care hospitals. This analysis also identifies that specific patient subgroups are more likely to experience food intake barriers. Because self-reported low food intake in hospital was associated with several barriers, it is relevant to consider assessing, intervening and monitoring barriers to food intake during the hospital stay.

Dietary patterns and incidence of depression in a cohort of community-dwelling older Canadians.

OBJECTIVES: To investigate the association of dietary patterns with a 3-year incidence of depression among healthy older adults. DESIGN: Multiple logistic regression models adjusted for age, sex, marital status, smoking, education, total energy intake, physical activity, body mass index, hypertension, functional autonomy, cognitive functioning, social activities, and stressful life events. Energy and macronutrient intakes were also analyzed as potential predictors of depression. SETTING: Cities of Montréal, Laval, and Sherbrooke in Quebec, CA. PARTICIPANTS: Community-dwelling older adults, free of depression at baseline (N=1,358, 67-84 y), followed for 3y in the Québec Longitudinal Study on Nutrition and Aging (NuAge). MEASUREMENTS: Dietary patterns derived from principal components analysis of three 24 h-recalls at baseline, and depression incidence as measured by the 30-item Geriatric Depression Scale (≥11) and/or use of antidepressants at follow-up years. RESULTS: 170 people (63% women) became depressed over the 3 years. People in the highest tertile of adherence to the "varied diet" had lower risk of depression before adjustment (OR 0.58, 98% C.I. 0.38-0.86) but not significant once age and sex were controlled. No other dietary pattern was associated with the incidence of depression. The highest tertile of energy intake was associated with lower depression incidence after controlling for all confounders (OR 0.55, 95%CI 0.34-0.87). CONCLUSION: Among healthy older adults, dietary patterns do not appear to be related to depression. Those who eat less, however, possibly reflecting declining health, are at higher risk of becoming depressed.

Validity and reliability of the new Canadian Nutrition Screening Tool in the 'real-world' hospital setting.

BACKGROUND/OBJECTIVES: Nutrition screening should be initiated on hospital admission by non-dietitians. This research aimed to validate and assess the reliability of the Canadian Nutrition Screening Tool (CNST) in the 'real-world' hospital setting. SUBJECTS/METHODS: Adult patients were admitted to surgical and medical wards only (no palliative patients). Study 1--Nutrition Care in Canadian Hospitals (n=1014): development of the CNST (3 items: weight loss, decrease food intake, body mass index (BMI)) and exploratory assessment of its criterion and predictive validity. Study 2--Inter-rater reliability and criterion validity assessment of the tool completed by untrained nursing personnel or diet technician (DT) (n=150). Subjective Global Assessment performed by site coordinators was used as a gold standard for comparison. RESULTS: Study 1: The CNST completed by site coordinators showed good sensitivity (91.7%) and specificity (74.8%). Study 2: In the subsample of untrained personnel (160 nurses; one DT), tool's reliability was excellent (Kappa=0.88), sensitivity was good (>90%) but specificity was low (47.8%). However, using a two-item ('yes' on both weight change and food intake) version of the tool improved the specificity (85.9%). BMI was thus removed to promote feasibility. The final two-item tool (study 1 sample) has a good predictive validity: length of stay (P<0.001), 30-day readmission (P=0.02; X(2) 5.92) and mortality (P<0.001). CONCLUSIONS: The simple and reliable CNST shows good sensitivity and specificity and significantly predicts adverse outcomes. Completion by several untrained nursing personnel confirms its utility in the nursing admission assessment.

Providing quality nutrition care in acute care hospitals: perspectives of nutrition care personnel.

BACKGROUND: Malnutrition is common in acute care hospitals worldwide and nutritional status can deteriorate during hospitalisation. The aim of the present qualitative study was to identify enablers and challenges and, specifically, the activities, processes and resources, from the perspective of nutrition care personnel, required to provide quality nutrition care. METHODS: Eight hospitals participating in the Nutrition Care in Canadian Hospitals study provided focus group data (n = 8 focus groups; 91 participants; dietitians, dietetic interns, diet technicians and menu clerks), which were analysed thematically. RESULTS: Five themes emerged from the data: (i) developing a nutrition culture, where nutrition practice is considered important to recovery of patients and teams work together to achieve nutrition goals; (ii) using effective tools, such as screening, evidence-based protocols, quality, timely and accurate patient information, and appropriate and quality food; (iii) creating effective systems to support delivery of care, such as communications, food production and delivery; (iv) being responsive to care needs, via flexible food systems, appropriate menus and meal supplements, up to date clinical care and including patient and family in the care processes; and (v) uniting the right person with the right task, by delineating roles, training staff, providing sufficient time to undertake these important tasks and holding staff accountable for their care. CONCLUSIONS: The findings of the present study are consistent with other work and provide guidance towards improving the nutrition culture in hospitals. Further empirical work on how to support successful implementation of nutrition care processes is needed.

Baseline determinants of global diet quality in older men and women from the NuAge cohort.

UNLABELLED: Judicious food choices are of prime importance during aging. OBJECTIVES: This study was conducted to identify individual and collective attributes determining global diet quality (DQ). METHODOLOGY: Participants were 1,793 adults (52% women) from the NuAge study on nutrition and successful aging. Subjects aged 67 to 84 years in relatively good health were recruited from the Québec Medicare Database. Sociodemographic, affective, and cognitive data, health conditions, perceived physical health and functional status, dietary habits and dietary attributes and community resources were obtained using questionnaires. Body weight and height were measured and body mass index (BMI) was calculated. Three non-consecutive 24-hour diet recalls were collected at recruitment. DQ, assessed using the Canadian Healthy Eating Index (C-HEI, /100), was computed on the mean intakes from the diet recalls. Analyses were stratified by gender. Variables significantly related to DQ in bivariate analyses (p<.05) were entered into backward stepwise multiple regression analyses. RESULTS: Among men, the final model showed higher education (ß=0.23, p=.01), diet knowledge (ß=0.96, p<.0001), number of daily meals (ß=1.91, p=.02) and perceived physical health (ß=0.06, p=.01) to be positive determinants of DQ, whereas alcohol consumption (ß=-2.25, p=.05), wearing dentures (ß=-2.31, p=.01) and eating regularly in restaurants (ß=-1.65, p=.03) were negative determinants of DQ (adjusted R2 = 13.7%). Among women, higher education (ß=0.29, p=.002), diet knowledge (ß=0.54, p=.002), number of daily meals (ß=3.61, p<.0001), and hunger (ß=0.61, p<.0001) were positive determinants of global DQ; greater BMI (ß=-0.16, p=.03) and chewing problems (ß=-0.48, p=.03) were negative determinants of DQ (adjusted R2 = 7.8%). DISCUSSION: These results point to several key factors influencing global DQ in older adults and also show gender-based differences. More research must be done to better understand how these factors change with aging and exert their impact on diet, particularly since variance in DQ was largely unexplained. As diet knowledge was an independent predictor for both genders, targeted, sustainable interventions are needed to ensure good diet quality as people age.

The Phenotype of Frailty Predicts Disability and Mortality among Mexican Community-Dwelling Elderly.

BACKGROUND: Frailty represents a major public health priority in Western countries. Specific social and cultural factors may influence the prevalence and predictive value for negative health-related events of this syndrome. OBJECTIVE: To determine the prevalence and predictive value of the phenotype of frailty among community-dwelling Mexican American older persons. DESIGN, SETTING AND PARTICIPANTS: Two-year longitudinal study of 5,644 men and women aged 60 years and older participating in the Mexican Health and Aging Study. MEASUREMENTS: The Frailty index used in the present study was a modified version of the operational definition proposed in the Cardiovascular Health Study (CHS). Frailty was defined by the presence of at least three of the four following criteria: weight loss, weakness, exhaustion, slowness, and low physical activity. The main outcomes were incident disability and mortality. Chi-square, ANOVA and multiple logistic regression analyses were used to test the prognostic value of frailty for the outcomes of interest. RESULTS: The mean age of the study sample was 68.7 (SD 6.9) years. Thirty-seven percent of participants (n=2,102) met the definition of frailty. Frail subjects were significantly older, and more likely to be women than non-frail participants. They also presented lower education, more chronic diseases, lower income, and poorer self-reported health status. After adjusting for potential confounders, frailty was found to be a predictor of incident mobility disability (odds ratio [OR] 1.91, 95% confidence interval [CI] 1.37-2.66), activities of daily living (ADL) disability (OR 9.33; 95%CI 3.37-25.82), and instrumental ADL (IADL) disability (OR 1.81, 95%CI 1.23-2.68). The risk of mortality among frail participants was almost three-fold higher than in non-frail ones. CONCLUSION: The prevalence of frailty is higher in this elderly population than what previously reported in other cohorts. The phenotype of frailty was confirmed to be a predictor for adverse health-related outcomes (including mobility, ADL, and IADL disability). Further studies in Latin American countries are needed to identify frailty and develop adapted interventions for the prevention of adverse outcomes in older persons.

Knee height to predict stature in North American Caucasian frail free-living elderly receiving community services.

CONTEXT: Height is an important component of anthropometric assessment. Valid measures of height are difficult to obtain in the frail elderly. Equations to predict height, using knee height, were proposed for healthy but not for frail elderly. OBJECTIVE: The objectives of this study were to 1) develop and validate equations to predict height (measured and reported) in the frail elderly, 2) to verify the accuracy and reliability of equations, and 3) to compare predicted values with those predicted from existing equations for the healthy elderly. DESIGN AND SETTING: This is a secondary analysis of data from three cross-sectional studies and three randomized community trials in the Sherbrooke area, Quebec, Canada. PARTICIPANTS: Subjects (n=599) were Caucasian, aged 60 and over, and receiving community or Meals-on-Wheels services. ANALYSES: Variables associated with measured and reported heights were entered in multiple linear regression models (n = 409) to identify independent prediction factors. Reliability assessment and agreement analysis were performed with a sub-group of subjects (n=190). RESULTS: Knee height and age in men (R(2) = .718), and with the addition of weight and hip circumference in women (R(2) = .593), were identified as predictors of measured height. For reported height, knee height was a predictor in men (R(2) = .693), while weight was another predictor in women (R(2) = .540). These models predicted height just as well in the validation group (R(2) = .514 to .623). Errors of estimates ranged from +/- 3.31 cm to +/- 5.06 cm. Predicted values were closer to directly measured values in the frail elderly as compared to values obtained with equations in the healthy elderly which differed significantly. CONCLUSIONS: Equations were developed to predict measured and reported height in the frail elderly. These equations can be used when height cannot be measured directly or when postural problems (for measured height) or cognitive disorders (for reported height) can cause unreliable measurements.

IANA task force on nutrition and cognitive decline with aging.

Cognitive impairment can be influenced by a number of factors. The potential effect of nutrition has become a topic of increasing scientific and public interest. In particular, there are arguments that nutrients (food and/or supplements) such as vitamins, trace minerals, lipids, can affect the risk of cognitive decline and dementia, especially in frail elderly people at risk of deficiencies. Our objective in this paper is to review data relating diet to risk of cognitive decline and dementia, especially Alzheimer's disease (AD). We chose to focus our statements on homocysteine-related vitamins (B-vitamins), antioxidant nutrients (vitamins E and C, carotenoids, flavonoids, enzymatic cofactors) and dietary lipids. Results of epidemiological studies may sometimes appeared conflicting; however, certain associations are frequently found. High intake of saturated and trans-unsaturated (hydrogenated) fats were positively associated with increased risk of AD, whereas intake of polyunsaturated and monounsaturated fats were protective against cognitive decline in the elderly in prospective studies. Fish consumption has been associated with lower risk of AD in longitudinal cohort studies. Moreover, epidemiologic data suggest a protective role of the B-vitamins, especially vitamins B9 and B12, on cognitive decline and dementia. Finally, the results on antioxidant nutrients may suggest the importance of having a balanced combination of several antioxidant nutrients to exert a significant effect on the prevention of cognitive decline and dementia, while taking into account the potential adverse effects of these nutrients. There is no lack of attractive hypotheses to support research on the relationships between nutrition and cognitive decline. It is important to stress the need to develop further prospective studies of sufficiently long duration, including subjects whose diet is monitored at a sufficiently early stage or at least before disease or cognitive decline exist. Meta analyses should be developed, and on the basis of their results the most appropriate interventional studies can be planned. These studies must control for the greatest number of known confounding factors and take into account the impact of the standard social determinants of food habits, such as the regional cultures, social status, and educational level.

Quality of life in type 2 diabetes patients under intensive multitherapy.

AIM: To assess the impact of an intensive multitherapy (IMT) on perceived quality of life (QOL), attitudes, knowledge and diabetes self-management in patients with poorly controlled type 2 diabetes. METHODS: A 12-month randomized trial was conducted in 72 patients with type 2 diabetes, HbA1c>or=8%, blood pressure (BP)>130/80 mmHg and dyslipidemia. Subjects were assigned to the IMT or control group, each n=36. IMT consisted in monthly visits including clinical and biochemical assessment, education sessions on diet, physical exercise, medical management of diabetes and associated diseases and adjustments in medication. Control patients were under the care of their physicians. We developed and validated a diabetes-specific questionnaire assessing QOL, attitudes, knowledge, diabetes self-management and socio-demographic data for this study. Outcomes were measured at 0, 6 and 12 months. RESULTS: Subjects were 54.8+/-8.1 years old (duration of diabetes: 10.3+/-7.2 years). At baseline, questionnaires showed no difference in QOL between groups. At 12 months, QOL improved significantly in the IMT group when compared to controls (+13.2+/-10.3/+5.6+/-13.2%, P=0.003), particularly with respect to the satisfaction scale (+25.3+/-13.9/+5.4+/-21.7%, P<0.001). QOL was not affected by complications or hypoglycaemic episodes. QOL scores improved in IMT subjects who began insulin therapy during the trial. Attitude scores, in the high normal range at baseline, did not change. Knowledge (+18.2+/-26.3/+8.9+/-30.4%, P=0.047) and diabetes self-management (+22.6+/-35.3/+6.8+/-20.1%, P<0.001) improved. CONCLUSIONS: In poorly controlled subjects, QOL improved statistically despite the inherent constraints imposed by IMT.

Meals-on-wheels improves energy and nutrient intake in a frail free-living elderly population.

BACKGROUND: With the increasing life expectancy and associated health care cost in the elderly population, it is fundamental to study and improve interventions that help older persons to have a better and healthier life in their home for a longer period. OBJECTIVES: Evaluate the effect of Meals-on-Wheels (MOW) on dietary intakes of frail elderly. DESIGN: An untreated control group quasi-experimental design with pretest and post-test was used to compare users (n = 20) and non-users (n = 31) of MOW. Descriptive and dietary data were compared at pretest and 8 weeks later. Analysis of Covariance (ANCOVA) was used to control for initial differences between groups. RESULTS: Both groups were similar at pretest except for weight (p = 0.028) and weekly number of meals eaten outside the home (p = 0.008). In both groups, dietary intakes at pretest were below Estimated Average Requirements (EAR) for the same nutrients. At post-test, intake of most nutrients increased in the Experimental group in comparison with the Control group. After controlling with the ANCOVA model, increases were significant for energy (p = 0.050), protein (p = 0.030), lipid (p = 0.034) and thiamin (p = 0.035). Provision of MOW did not permit to achieve a low risk of nutrient inadequacy in the Experimental group. CONCLUSIONS: MOW programs improve dietary intakes of recipients. However, a more intensive intervention is needed to prevent nutrient deficiencies in this group.

Determinants of handgrip strength in free-living elderly at risk of malnutrition.

PURPOSE: Handgrip strength is necessary for performing activities of daily living, which, in turn, are required to maintain functional autonomy. The purpose of this study was to determine anthropometric and personal factors that affect handgrip strength in a group of free-living elderly at risk of malnutrition. METHOD: The factors associated with handgrip strength (Pearson r, t-test, alpha = 0.10) were entered in a multiple linear regression model (n = 166) to identify the independent prediction factors. Reliability of the model was verified with a sub-group of 65 subjects randomly selected from the initial sample. RESULTS: Both groups were statistically similar regarding all factors studied even though the validation group (n = 65) had more men (32%) compared to the development group (n = 166; 22%). Bivariate analyses showed that handgrip strength was associated with sex, age, pain, hand circumference, and waist-hip ratio. Multiple linear regression analysis identified age, pain, and sex as independent determinants of handgrip strength (R2 = 0.16). This model predicted handgrip strength better in the validation group (R2 = 0.29). CONCLUSIONS: As previously shown, women have a smaller handgrip strength than men. In addition, handgrip strength decreases with increasing age and the presence of pain. Emphasis should be placed on the importance of strategies to relieve pain in the free-living frail elderly population.

Implications of day-to-day variability on measurements of usual food and nutrient intakes.

Day-to-day variability in dietary intake makes it difficult to measure accurately the "usual" intake of foods and nutrients. The objectives of the present study were to estimate within- and between-subject variability for foods and nutrients by adjusted and unadjusted models and to assess the number of days required to assess nutrient and food group intakes accurately by two different methods. Adult men and women aged 18-65 y (n = 1543) in the Food Habits of Canadians Study provided a 24-h recall. A repeat interview was conducted in a subsample to estimate components of variability. Within- and between-subject variability were determined by mixed model procedure (crude and adjusted for age, gender, education, smoking, family size and season). The number of days required to obtain various degrees of accuracy was ascertained by two methods, one that uses the variance ratio for groups and one that considers within-subject variability alone for individuals. Variance ratios were higher using the adjusted compared with the unadjusted method (e.g., for men, energy 1.07 vs. 0.49). More days were required to reflect usual intake with accuracy using the adjusted model (energy 5 vs. 2 d), indicating the need to control for confounders to obtain reliable estimates of intakes.

Validity and reliability of simple nutrition screening tools adapted to the elderly population in healthcare facilities.

This study was conducted to assess the validity and the reliability of simple tools to screen the protein-energy malnutrition (PEM) risk among the elderly population in healthcare facilities. An initial screening tool, made up of nine PEM risk factors, was previously developed to be validated. This tool was quite complex and showed low validity results. A stepwise regression analysis determined significant risk factors (P < or = 0.05) among those included in the initial tool. These were the foundation to develop two simplified screening tools. One included Body Mass Index (BMI) and % weight loss over time. The second included BMI and albumin. Both tools classified subjects in low or high PEM risk levels. In the present study, the simple tools were assessed in a sample of 142 elderly subjects divided into two categories: acute care elderly (ACE, n=72) and long-term care elderly (LTCE, n=70). The simple tools were administered by a dietetic technician and a nurse with the purpose of assessing inter-rater and test-retest reliabilities. The criterion validity of the simple tools were assessed in comparison to in-depth nutritional assessments carried out by a dietitian. The validity results were ranked between 60.5% and 91.7%. The reliability scores showed levels of agreement of 70.8% to 93.1% and kappa coefficients ranking between 0.59(+/-0.07) and 0.79(+/-0.05). Simple tools are now available for efficiently screening the PEM risk among the elderly population on a healthcare facility-wide basis.

Simple nutrition screening tools for healthcare facilities: development and validity assessment.

The purpose of nutrition screening is to identify individuals at high nutritional risk. Given that dietitians cannot always carry out screening in health-care facilities, tools should be simple and based on data obtained from the nursing admission questionnaire. This study was conducted to develop timely and valid tools for screening protein-energy malnutrition (PEM). A dietetic technician administered an initial screening tool to 160 subjects recruited from two settings. This tool comprised nine PEM risk factors. The sample included 54 adults in acute care, 57 elderly adults in acute care, and 49 elderly adults in long-term care. Dietitians performed comprehensive nutritional assessments to determine the validity of this screening tool. Stepwise regression analysis revealed significant risk factors among those included in the initial screening. These risk factors were considered during development of the first simple screening tool, which encompassed body mass index (BMI) and percentage of weight loss, and classified subjects as having low or high PEM risk levels. A second tool using BMI and albumin level was tested in cases where an albumin measurement was available upon admission. These simple tools had validity indices of 75.9% or higher, except in adults in acute care; sensitivity was low in this group. The tools proved helpful in establishing dietitians' priorities for involvement and in initiating early nutritional care.

Validity of self-reported height and weight estimates in cognitively-intact and impaired elderly individuals.

OBJECTIVE: A high prevalence of undernutrition has been observed in the elderly, particularly in cognitively impaired or demented individuals. Self-reported height and weight were tested as simple and non-invasive methods to efficiently screen individuals at risk. DESIGN: Cross-sectional study. PARTICIPANTS: A subset of subjects (n=465) participating in the longitudinal follow-up phase of the Canadian Study of Health and Aging (CSHA) and comprising cognitively intact and impaired individuals as well as demented subjects. MEASUREMENTS: Self-reported values of height and weight were compared to direct standard measurements using Pearson's correlation coefficients and linear regressions by cognitive status. Estimation bias was determined using paired Student t-tests. Sensitivity and specificity of body mass index (BMI) derived from self-reported data were calculated. RESULTS: Self-reported and measured weights were highly correlated (r>.90) in all three categories of cognitive status. A tendency to underestimate their weight was observed in overweight women. Correlations of recalled to measured height were excellent in normal (r=.91) and good in cognitively impaired (r=.86) and demented (r=.85) subjects. A systematic overestimation of recalled height was observed, particularly among individuals of short stature. Self-reported BMI showed excellent sensitivity (>93%) in detecting underweight individuals in all three categories. CONCLUSION: Self-reported height and weight data can be obtained in normal and cognitively-impaired elderly persons as well as in mild or moderate cases of dementia and can be used as a valid tool to screen for risk of undernutrition.

"Outings to your taste": a nutrition program for the elderly.

"Outings to Your Taste" is an innovative program that aims to improve the nutritional status and social network of elderly people who receive home-delivered meals. This article examines participation in one of the program's components, outings to community restaurants. Participation data were collected on-site and information about client characteristics was collected in at-home interview surveys of targeted clients (n = 144). While about half of the clients had tried at least one outing, more than 25% of them participated in at least one third of the outings offered to them. Results indicate that the program attracted a variety of clients in terms of sociodemographic, health, and social isolation characteristics.

Nutrition risk factors for institutionalization in a free-living functionally dependent elderly population.

Risk factors for institutionalization of frail elderly have been studied but the role of nutritional status has not been addressed. A prospective cohort of 288 frail elderly (81 male; 207 female; mean age: 78.2 +/- 7.6 years) were recruited from the current list of those receiving home help services and followed for 3-5 years. At baseline, height, weight, and arm muscle circumference were measured. Self-reported weight loss prior to baseline, energy, and protein intake were recorded. Covariates included sociodemographic factors, social network variables, functional and health status. Cox's multivariate survival analysis was used to identify independent predictors of institutionalization. Over the period of observation, 46% of subjects were institutionalized. Univariate predictors included weight loss >/=5 kg, functional status, and not living alone. In multivariate analysis, weight loss significantly increased the likelihood of institutionalization [Hazard Ratio (HR) = 1.71 (95% CI: 1.08-2.73)] as did limited functional capacities [HR = 1.26 (95% CI: 1.02-1.55)]. Among the free-living frail elderly, weight loss >/=5 kg is an important predictor of early institutionalization after controlling for social network, health, and functional status.