Linköping University Medical Dissertations No. 951 Nutritional Intervention in Elderly People Admitted to Resident Homes

The aim was to investigate the effects of an intervention, based on education given to staff and implementation of an individualized nutritional programme given to the residents, to compare assessments on admission with a previous study, and to perform diagnostic test and inter-rater reliability of the Mini Nutritional Assessment (MNA). A further aim was to identify and describe factors with regard to appetite among the residents. Upon admission, and after a four month intervention period, residents were classified as being either protein energy malnourished (PEM), or not, based on anthropometry and biochemical measurements. On both occasions, the Activity Index and the Mini Mental State Examination were used. In order to identify individuals in need of nutritional care, the MNA was performed. Information about medical data was obtained. A total of 127 residents were consecutively admitted to eight resident homes in a municipality in Sweden. Three resident homes constituted the experimental unit (n = 68) and five the control unit (n = 59). Fifteen residents were interviewed using a qualitative method, to investigate what affects their appetite

Nutritional Intervention in Elderly People Admitted to Resident Homes

The aim was to investigate the effects of an intervention, based on education given to staff and implementation of an individualized nutritional programme given to the residents, to compare assessments on admission with a previous study, and to perform diagnostic test and inter-rater reliability of the Mini Nutritional Assessment (MNA). A further aim was to identify and describe factors with regard to appetite among the residents. Upon admission, and after a four month intervention period, residents were classified as being either protein energy malnourished (PEM), or not, based on anthropometry and biochemical measurements. On both occasions, the Activity Index and the Mini Mental State Examination were used. In order to identify individuals in need of nutritional care, the MNA was performed. Information about medical data was obtained. A total of 127 residents were consecutively admitted to eight resident homes in a municipality in Sweden. Three resident homes constituted the experimental unit (n = 68) and five the control unit (n = 59). Fifteen residents were interviewed using a qualitative method, to investigate what affects their appetite. On admission 32 % of the residents were classified as PEM, which was similar to in the previous study. A higher frequency of residents in the present study had severe medical diseases and cognitive impairment, compared with the previous study, indicating changed admission criteria in the present study. Between the experimental and the control groups, no differences were seen in any specific anthropometric or biochemical variable. Within the groups, statistically significant differences were seen, as the number of PEM residents in the experimental group decreased, and motor activity and overall cognitive function improved. In the control group, motor activity deteriorated. This indicates that the intervention improved nutritional status and functional capacity in the residents. Diagnostic sensitivity was 73 % regarding MNA versus PEM, and 89 % regarding MNA short form (MNA-SF) versus MNA, which indicates a rather high degree of sensitivity in both tests. Inter-rater reliability of MNA, carried out by simultaneous assessments by registered nurses and researcher showed a moderate agreement of 62 % (kappa 0.41). The interview study showed that the willingness to eat was what affected the residents´ appetite. The willingness to eat contains internal factors, dependent on mood and personal values, as well as external factors, dependent on wholesomeness, food, eating environment and meal fellowship. When planning and realizing residents´ nutritional care, factors affecting the residents´ appetite have to be taken into consideration. In conclusion, the results show that it is important to implement and develop strategies for individual nutritional care, in order to prevent and treat malnutrition in elderly people, which is in line with recommendations given by the European Society of Parenteral and Enteral Nutrition (ESPEN) and with the Swedish goal of nursing actions

The Willingness to eat : An investigation of appetite among elderly people

The aim of this study was to identify and describe factors of importance with regard to appetite among elderly people. A qualitative approach was used and the method was grounded theory. Fifteen elderly people were interviewed using a method with two overall questions. The results show that the willingness to eat plays a central role in appetite among elderly people. The appetite is a state on a sliding scale, from good to poor appetite. Factors affecting the appetite include six categories: mood, personal values, wholesomeness, food, eating environment and meal fellowship. When planning and realizing nursing actions concerning eating, the willingness to eat has to be observed. The desire within every individual has to be given consideration, including all factors as well as how they affect each other. The willingness to eat contains internal factors dependent on mood and personal values, as well as external factors dependent on wholesomeness, food, eating environment and meal fellowship. These factors contain qualitative dimensions, which affect elderly people's appetites as well as their quality of life to a varying extent. Through this, it can be seen that there is a connection between their desire or willingness to eat and their will to live.</p

A nutritional nursing care model introduced to elderly people admitted to resident homes

11th INTERNATIONAL NURSING RESEARCH CONFERENCE Madrid, November 14th – 16th 2007 PAPER TITLE: A Nutritional Nursing Care Model introduced to Elderly People admitted to Resident Homes AUTHOR/S: Lennart Christensson, RN, PhD and Kerstin Wikby, RN PhD. WORK PLACE: School of Health Sciences, Department of Nursing, Jönköping University. ADDRESS: Box 1026, 551 11 Jönköping, Sweden TELEPHONE: +46 36 101249 FAX: +46 36 101250 E-MAIL: [email protected] Malnutrition among the elderly is a multidimensional concept, involving medical, psychological and social factors. Fulfilling nutritional requirements in residents with eating problems is often a challenge for both the person in need of help and for the care giver. Objectives: The primary objective of this study was to determine whether educating care givers have effects on the improvement of nutritional status among elderly people, newly admitted to resident homes. Methods: The study was based on an earlier single-case study, where a model for nutritional nursing care was developed. In this study a pre-post test design was used, including 62 residents in the experimental (20 men, 42 women) and 53 in the control group (14 men, 39 women). The residents were newly admitted to a resident home and were consecutively included in the study. Mean age was 85 years. At admission and after four months protein-energy malnutrition (PEM) was assessed, using a combination of anthropometry (weight index, arm muscle circumference and triceps skinfold thickness) and biochemical measurements (serum protein and transthyretin). Functional capacity and overall cognitive function were also assessed. In the experimental unit, a nutritional nursing care model was introduced and the staff received education about nutritional needs, and how to individualise nutritional care. Findings: Twenty residents in the experimental and 17 in the control group were assessed as PEM at admission. After four months the number of residents assessed as PEM decreased to seven in the experimental (p=0.004), and to ten in the control group (p=0.1). Motor activity (p=0.006) and cognitive function (p=0.02) increased in the experimental group, while motor activity decreased in the control group (p=0.02). The care givers in the experimental group estimated the extra work, caused by the changed way of work during the meals, to 11/2 minute per resident and day. Discussion: Individualised actions directed towards PEM residents are in line with the recommendation by the European Society of Parenteral and Enteral Nutrition (ESPEN) and with the Swedish goals of nursing action. Nursing actions towards nutritional problems include more than merely to offer a standard care plan, such as giving oral supplementation. As the nutritional problems often demands a deeper analysis of the underlying causes, individualized nursing actions may be a more optimal approach. This study shows that implementing an individualised nutritional programme increase nutritional status, motor activity and cognitive function in PEM residents. The nutritional care programme was implemented with a minimum of extra work.</p

Lived experience of women with gestational diabetes mellitus living in China: a qualitative interview study

ObjectiveTo explore the lived experience of women with gestational diabetes mellitus (GDM) living in China in order to add knowledge about how the Chinese women suffer from GDM.DesignA qualitative interpretive interview study. Data were collected with a snowball sampling technique. Phenomenological hermeneutics was used as the analysis method based on Ricoeur’s phenomenological hermeneutical interpretation theory.SettingThe study was performed at the participants’ work places, or at the obstetric clinics or wards at two provincial hospitals and one municipal hospital in the southeast of China.ParticipantsInclusion criteria were age ≥18 years, diagnosis of GDM without other pregnancy complications, in 34th gestational weeks—postpartum 4th weeks and speaking Mandarin Chinese without speech impediment. 62 women, who met the inclusion criteria, took part in the study.ResultsThe lived experience of the women with GDM living in China was formulated into a main theme: ‘longing for caring care’. The main theme was derived from four themes: being stricken by GDM, wishing to receive caring GDM care, being left alone to struggle with GDM and trying to adjust and adapt to life with GDM.ConclusionThe eagerness for caring care in China was highlighted. The lack of caring care could be one of the possible reasons why the professional–patient relations were deteriorating in China. It could be useful for health providers and health policymakers to receive education and training about caring care. Using the health metaphor of balance and ‘patient participation’ and ‘patient-centred’ approaches may benefit women with GDM and thus improve the quality of care in China.</jats:sec

The two-step Mini Nutritional Assessment (MNA) Procedure in Community Resident Homes

Aims and objectivities.  The aims were to test internal consistency and interrater reliability of Mini Nutritional Assessment during implementation of Mini Nutritional Assessment in community residential homes and to test sensitivity, specificity and diagnostic predictivity of Mini Nutritional Assessment-short form vs. Mini Nutritional Assessment.Background.  There is a need in clinical practice to assess nutritional status in older people and to identify those who could benefit from early intervention.Methods.  The two-step Mini Nutritional Assessment procedure (Mini Nutritional Assessment-short form and Mini Nutritional Assessment) was used in 127 older people admitted to eight residential homes. In three of those homes (A, B and C), registered nurses simultaneously performed the assessment procedure, after receiving education and training. The intention was to offer the registered nurses a tool for independent practice use.Results.  Internal consistency was 0·68 (Cronbach's alpha) (n = 127). In residential home A, B and C, the registered nurses carried out Mini Nutritional Assessment in 45 residents out of 68. The agreement level between the author's and the registered nurses’ assessments was 62% (kappa 0·41). In residential home A, B and C, the agreement level was 89%, 89% and 44%, respectively. Sensitivity, specificity and diagnostic predictivity of Mini Nutritional Assessment-short form vs. Mini Nutritional Assessment were 89%, 82% and 92%, respectively.Conclusions.  The two-step Mini Nutritional Assessment procedure seems to be a useful tool to identify residents in need of nutritional interventions, despite the registered nurses not carrying out Mini Nutritional Assessment in all residents and the low agreement in residential home C. It indicates that to implement and use Mini Nutritional Assessment in nursing care demands the creating necessary staff resources, such as adequate staffing, sufficient education and continual supervision.Relevance to clinical practice.  Because of the high sensitivity of Mini Nutritional Assessment-short form and Mini Nutritional Assessment, Mini Nutritional Assessment-short form alone might be sufficient for practice use, as its simplicity might increase its usefulness.</p

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 whowere newly admitted to community residential homes (cohort 2), and to compare the results with a previous studyperformed in the same municipality four years earlier (cohort 1). One hundred and twenty-seven people, 65 yearsof age, or older, newly admitted to residential homes in a municipality in the southern part of Sweden, wereconsecutively included. Nutritional status was assessed, using a combination of anthropometry and serum proteinmeasurements and by Mini Nutritional Assessment (MNA). The results showed that 32 % of the residents incohort 2 were assessed as protein-energy malnourished (PEM), compared with 38 % in cohort 1. Body massindex, psychological stress or acute disease, and reduced fluid intake were items in MNA which had power topredict PEM. Residents in cohort 2, diagnosed as having severe medical diseases, increased as well as residentswith neuropsychological problems. Simultaneously, the number living in residential homes decreased, ascompared to cohort 1. These differences indicate that the admission criteria have changed between cohorts 1 and 2.</p