Changing the food environment: the effect of trained volunteers on mealtime care for older people in hospital (original) (raw)
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Malnutrition and nutritional care practices in hospital wards for older people
Journal of Advanced Nursing, 2010
Aims. This paper is a report of a study conducted to gain a better insight into the current nutritional care practices in Belgian hospital wards for older people, and to study the association between these practices and the prevalence of malnutrition. Background. In 1999, the Council of Europe assessed nutritional care practices and support in 12 European countries and showed them to be sparse and inconsistent. At the time of research, no studies had described the association between nutritional care practices and malnutrition prevalence in Belgium. Methods. In 2007, a cross-sectional survey was carried out in a representative sample of Belgian hospital wards for older people. In total, 2094 patients from 140 wards for older people were included. Results. The overall prevalence rate of malnutrition in wards for older people was 31AE9%. Nutritional care practices such as nutritional screening and assessment, use of a standardized screening instrument and a nutritional protocol were suboptimal. Multilevel analysis revealed that ward characteristics explained for 9AE1% whether a patient was malnourished or not. None of the registered nutritional care practices could explain a patient's individual risk. Conclusion. Malnutrition is a frequently occurring problem on hospital wards for older people. Increased consciousness among healthcare professionals and hospital policy makers of the importance of nutritional care will contribute to further improvement in care quality.
The journal of nutrition, health & aging, 2016
Background: Malnutrition is common in older adults and is associated with high costs and adverse outcomes. The prevalence, predictors and outcomes of malnutrition on admission to hospital are not clear for this population. Design: Prospective Cohort Study. Setting: Six hospital sites (five public, one private). Participants: In total, 606 older adults aged 70+ were included. All elective and acute admissions to any speciality were eligible. Day-case admissions and those moribund on admission were excluded. Measurements: Sociodemographic and clinical data, including nutritional status (Mini-Nutritional Assessment-short form), was collected within 36 hours of admission. Outcome data was collected prospectively on length of stay, in-hospital mortality and new institutionalisation. Results: The mean age was 79.7; 51% were female; 29% were elective admissions; 67% were admitted to a medical specialty. Nutrition scores were available for 602/606; 37% had a 'normal' status, 45% were 'at-risk', and 18% were 'malnourished'. Malnutrition was more common in females, acute admissions, older patients and those who were widowed/ separated. Dementia, functional dependency, comorbidity and frailty independently predicted a) malnutrition and b) being at-risk of malnutrition, compared to normal status (p < .001). Malnutrition was associated with outcomes including an increased length of stay (p < .001), new institutionalisation (p =<0.001) and in-hospital mortality (p < .001). Conclusions: These findings support the prioritisation of nutritional screening in clinical practice and public health policy, for all patients ≥70 on admission to hospital, and in particular for people with dementia, increased functional dependency and/or multi-morbidity, and those who are frail.
Barriers to nutritional care for the undernourished hospitalised elderly: perspectives of nurses
Journal of Clinical Nursing, 2014
To identify what nurses experience as barriers to ensuring adequate nutritional care for the undernourished hospitalized elderly. Background. Undernutrition occurs frequently among the hospitalised elderly and can result in a variety of negative consequences if not treated. Nevertheless, undernutrition is often unrecognised and undertreated. Nurses have a great responsibility for nutritional care, as this is part of the patient's basic needs. Exploring nurses' experiences of preventing and treating undernourishment among older patients in hospitals is therefore highly relevant. Design. A focus group study was employed based on a hermeneutic phenomenological methodological approach. Methods. Four focus group interviews with totally 16 nurses working in one large university hospital in Norway were conducted in spring 2012. The nurses were recruited from seven somatic wards, all with a high proportion of older (≥70 years) inpatients. The data were analysed in the three interpretative contexts: self-understanding, a critical common-sense understanding and a theoretical understanding. Results. We identified five themes that reflect barriers the nurses experience in relation to ensuring adequate nutritional care for the undernourished elderly: loneliness in nutritional care, a need for competence in nutritional care, low flexibility in food service practices, system failure in nutritional care and nutritional care is being ignored. Conclusions. The results imply that nutritional care at the university hospital has its limits within the hospital structure and organisation, but also regarding the nurses' competence. Moreover, the barriers revealed that the undernourished elderly are not identified and treated properly as stipulated in the recommendations in the national guidelines on the prevention and treatment of undernutrition. Relevance to clinical practice. The barriers revealed in this study are valuable when considering improvements to nutritional care practices on hospital wards to What does this paper contribute to the wider global clinical community? enable undernourished older inpatients to be identified and treated properly.
Clinical Nutrition, 2010
Background & Aims: In Belgium, general data on the prevalence of malnutrition are lacking. Prevalence rates are necessary to gain insight into the magnitude of malnutrition and to establish a nutrition policy that takes the limited health care resources into account. This study aimed to obtain insight into the prevalence of malnutrition in Belgian elderly hospital wards and to identify factors associated with the malnutrition prevalence.
The journal of nutrition, health & aging, 2002
Up to 65% of elderly patients are protein-energy undernourished at admission or acquire nutritional deficits while hospitalised. The aims of this project were: 1) to assess the quality of care concerning nutrition among geriatric units; 2) to assess the impact of implementive nutritional interventions on nutritional status and on the length of hospitalisation. Two hundred and six patients consecutively admitted in a geriatric unit of a general hospital were studied prospectively for 6 months (from January to June 2001). All patients underwent a comprehensive geriatric assessment. For the first 3 months the nutritional status of the patients on admission and at discharge were assessed without particular recommendations for nutritional intervention. A standardised nutritional intervention was proposed for the last 3 months. Median value of Mini-Nutritional Assessment was 19 points (ranged from 9 to 29), mean admission s prealbumin concentration (PAB) was 0.179 g/l, and C-reactive prot...
The Journal of Nutrition Health and Aging
Up to 65% of elderly patients are protein-energy undernourished at admission or acquire nutritional deficits while hospitalised. The aims of this project were: 1) to assess the quality of care concerning nutrition among geriatric units; 2) to assess the impact of implementive nutritional interventions on nutritional status and on the length of hospitalisation. Two hundred and six patients consecutively admitted in a geriatric unit of a general hospital were studied prospectively for 6 months (from January to June 2001). All patients underwent a comprehensive geriatric assessment. For the first 3 months the nutritional status of the patients on admission and at discharge were assessed without particular recommendations for nutritional intervention. A standardised nutritional intervention was proposed for the last 3 months. Median value of Mini-Nutritional Assessment was 19 points (ranged from 9 to 29), mean admission s prealbumin concentration (PAB) was 0.179 g/l, and C-reactive prot...
Nurses needed: Identifying malnutrition in hospitalized older adults
The American population is aging with one in every seven Americans over the age of 65. Throughout the healthcare continuum, this segment of the population is faced with the burden of malnutrition brought on by many factors including aging, inadequate food intake, and acute and chronic medical conditions. The loss of lean body mass, strength, and functionality compound malnutrition leading to weakness, hospitalizations, and overall decreased ability to perform activities of daily living. Up to 60% of hospitalized older adults are malnourished but many patients go unrecognized and undertreated. Nurses are in a pivotal position to change this trajectory. Nurses are often the first to identify patients in need of nutrition intervention and are integral to encouraging nutritional intake from admission through discharge. Effective nutrition screening can be conducted by nurses in minimal time as part of the admission process through the use of a screening tool that is simple, fast, reliable, and valid. As part of the collaborative health care team, nurses can effectively communicate nutrition screening results through the use of the electronic health record and when prescribed, ensure that nutrition interventions occur within the targeted timeframe. Nurses can develop procedures to provide patients with meal assistance, reliable access to food and snacks across all shifts, and help bridge nutritional gaps through oral nutritional supplements all in an effort to address malnutrition.
Malnutrition Screening and Assessment in Hospitalised Older People: A Review
The journal of nutrition, health & aging, 2019
Malnutrition (undernutrition) remains one of the most serious health problems for older people worldwide. Many factors contribute to malnutrition in older people, including: loss of appetite, polypharmacy, dementia, frailty, poor dentition, swallowing difficulties, social isolation, and poverty. Malnutrition is common in the hospital setting, yet often remains undetected by medical staff. The objective of this review is to compare the validity and reliability of Nutritional Screening Tools (NSTs) for older adults in the hospital setting. We also provide an overview of the various nutritional screening and assessment tools used to identify malnutrition in hospitalised older adults. These include: Subjective Global Assessment (SGA), the Mini Nutritional Assessment (MNA), MNA-short form (MNA-SF), Malnutrition Universal Screening Tool (MUST), Simplified Nutritional Appetite Questionnaire (SNAQ), Geriatric Nutrition Risk Index (GNRI) and anthropometric measurements. The prevalence and outcomes of malnutrition in hospitalised older adults are also addressed.
Malnutrition prevalence and nutrition issues in residential aged care facilities
2008
Objectives: To determine the prevalence of malnutrition and investigate nutritional issues in a sample of older people living in residential aged care facilities (RACFs). Method: This study forms the descriptive component of a pretest post-test designed study conducted in eight RACFs. The Subject Global Assessment tool was used to determine the prevalence of malnutrition in 350 residents. Results: Nearly 70% of residents were women and 79.4% of all residents were classified as high care. Half the residents were well nourished (50.5%) with 43.1% moderately malnourished and 6.4% severely malnourished. Prevalence of malnutrition was significantly higher for residents receiving higher level care (odds ratio (OR) = 2.9 (95% confidence interval (CI): 1.7-5.2; P < 0.001)) and older than 90 years (OR = 3.0 (95% CI: 1.8-5.1; P < 0.001)). Of the residents considered to be malnourished, very few (17.8%) had been seen by a dietitian in the past 6 months or were receiving commercial supplements (29.2%). Conclusions: There is a need for systematic, coordinated and multidisciplinary approaches to nutritional care for older people in residential care.
Malnutrition upon hospital admission in geriatric Patients: Why assess it
Objective: To assess the prevalence of malnutrition according to the new ESPEN definition in a population of geriatric hospital patients and to determine how malnutrition affects the length of hospital stay (LOS) and hospital mortality. Design: A retrospective analysis of data gathered during nutritional screening surveys carried out three consecutive years, from 2012 to 2014, in an Italian geriatric research hospital (INRCA, Ancona) was performed. On the day of the study, demographic data, data on clinical conditions and the nutritional status of newly admitted patients were collected. Patients were screened for malnutrition risk using the Malnutrition Universal Screening Tool (MUST). Subsequently, malnutrition was diagnosed, for subjects at high risk, following the criteria suggested by the European Association for Clinical Nutrition and Metabolism [body mass index (BMI) < 18.5 kg/m 2 or different combinations of unintentional weight loss over time and BMI values]. Sensitivity, specificity, positive and negative predictive value of MUST compared to ESPEN criteria were assessed. The characteristics of patients with a diagnosis of malnutrition were compared to those of non-malnourished patients. The impact of malnutrition on LOS and hospital mortality was investigated through logistic and linear regression models. setting: The study was performed in an Italian geriatric research hospital (INRCA, Ancona). subjects: Two hundred eighty-four newly hospitalized geriatric patients from acute care wards (mean age 82.8 ± 8.7 years), who gave their written consent to participate in the study, were enrolled. results: According to the MUST, high risk of malnutrition at hospitalization was found in 28.2% of patients. Malnutrition was diagnosed in 24.6% of subjects. The malnutrition was an independent predictor of both the LOS and hospital mortality. The multivariate analyses—linear and logistic regression—were performed considering different potential confounders contemporarily. The results showed that the malnutrition is an independent predictor of LOS and hospital mortality. Malnourished subjects were hospitalized almost 3 days longer compared to non-malnourished patients (p = 0.047; CI 0.04–5.80). The risk of death during hospitalization was 55% higher for malnourished patients (p = 0.037; CI 0.21–0.95).