Eating difficulties, assisted eating and nutritional status in elderly (⩾65 years) patients in hospital rehabilitation

Department of Nursing, Faculty of Medicine, Lund University, P.O. Box 198, SE-221 00, Lund, Sweden.
International Journal of Nursing Studies (Impact Factor: 2.25). 04/2002; 39(3):341-51. DOI: 10.1016/S0020-7489(01)00025-6
Source: PubMed

ABSTRACT This study describes frequencies and associations between eating difficulties, assisted eating and nutritional status in 520 elderly patients in hospital rehabilitation. Eating difficulties were observed during a meal and nutritional status was assessed with Subjective Global Assessment form. Eighty-two percent of patients had one or more eating difficulties, 36% had assisted eating and 46% malnutrition. Three components of eating were focused upon ingestion, deglutition, and energy (eating and intake). Deglutition and ingestion difficulties and low energy were associated with assisted eating, and low energy associated with malnutrition. Underestimation of low energy puts patients at risk of having or developing malnutrition.

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    • "This protocol has been applied in a Swedish study and a principal component analysis showed that the instrument was comprised of three components: ingestion, deglutition and energy. This version of the instrument has not been tested for reliability (Westergren et al. 2002b). "
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    ABSTRACT: To examine eating difficulties among stroke patients - a comparison between women and men. Gender differences have been reported in studies of stroke, but the findings are inconclusive and few of these studies have specifically focused on gender differences in eating difficulties. This study was a descriptive, cross-sectional, comparative study. Patients with stroke were recruited at a general hospital in Sweden. To detect eating difficulties, individual observations of the patients were made during one meal using a structured observation protocol. Assessment also included measurements of nutritional and oral status, degree of independence, stroke severity, neglect and well-being. One hundred and four patients (53·8% women) were included in the study. The proportion of stroke patients with one or more eating difficulties was 81·7%. The most common eating difficulties were 'managing food on the plate' (66·3%), 'food consumption' (54·8%) and 'sitting position' (45·2%). Women had lower 'food consumption', more severe stroke (p = 0·003), worse functional status (p = 0·001) and lower quality of life (QoL) (p=0·038) than men. More women than men were malnourished and living alone. After adjustment for functional status and motor arm, the odds ratio of having difficulties with food consumption was four times higher among women than men (1·7-9·4, confidence interval 95%). More women than men with stroke suffered from inadequate food consumption. The women had more severe strokes, experienced poorer QoL and showed lower functional status than the men. In the rehabilitation process of women with stroke, these factors should be taken into consideration. Structured observation of meals, including assessment of food consumption, might be necessary in acute stroke care to detect patients, especially women, who might need closer supervision and nutritional intervention.
    Journal of Clinical Nursing 09/2011; 20(17-18):2563-72. DOI:10.1111/j.1365-2702.2011.03812.x · 1.23 Impact Factor
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    • "ng food on the plate , transporting food to the mouth , opening and closing the mouth , manipulating food in the mouth , swallowing , food consumption , reduced alertness and aberrant eating speed . Each item was rated as ' good , normal ' or ' changed , difficulties or aids needed ' . This protocol has previously been applied in a Swedish study ( Westergren et al . 2002b ) . A guide with instructions of how to rate was available and applied during data collection . For instance , if the participant did not eat a ' normal portion of food ' it was rated as an eating difficulty regarding the item ' food consumption ' . A principal component analysis of the instru - ment was carried out by Westergren et al "
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    ABSTRACT: This paper is a report of a study comparing eating difficulties among patients 3 months after stroke in relation to the acute phase. There is limited knowledge of patients with eating problems early after stroke, hence the progress of eating abilities needs to be further explored. From March 2007 to June 2008 36 stroke patients with 2-7 eating difficulties or problems with reduced alertness or swallowing in the acute phase were included. Eating difficulties were detected using a structured protocol of observation of meals. In addition, stroke severity (National Institute of Health Stroke Scale), functional status (Barthel Index), unilateral neglect (Line Bisection test and Letter Cancellation test), psychological well-being (The Well-being Questionnaire-12), nutritional status (Mini Nutritional Assessment) and oral status (Revised Oral Assessment Guide) were assessed. There were 36 participants (58% female) with a median age of 74·5 years. The proportion of eating difficulties decreased significantly from the acute phase to the 3-month follow-up in 'sitting position', 'managing food on the plate' and 'manipulating food in the mouth' and increased regarding inadequate food consumption. Improvements were shown at 3 months in stroke severity, functional status, nutritional status and neglect. Oral status and psychological well-being remained unchanged. The majority of eating problems persisted 3 months after stroke despite a marked improvement in most of the physical functions. The unchanged psychological well-being and sustained problems with food consumption indicate that factors other than physical function should be taken into account regarding eating difficulties poststroke.
    Journal of Advanced Nursing 07/2011; 68(3):580-9. DOI:10.1111/j.1365-2648.2011.05759.x · 1.69 Impact Factor
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    • "It is well known that elderly hospital patients are at high risk for developing undernutrition [1] [2] [3]. Performing a nutritional screening in hospitals is therefore a recommended method for identifying at-risk patients and should be undertaken after the patients' admission [4]. "
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    ABSTRACT: The objective of this study was to test if the Norwegian version of the nutritional screening instrument entitled Nutritional Form for the Elderly (NUFFE-NO) demonstrates sufficient evidence of reliability and validity, including sensitivity and specificity, when applied to a select group of elderly hospital patients. The hypothesis was that NUFFE-NO has sufficient psychometric properties to be used as a screening instrument. The model used for the testing procedure was designed to test reliability (homogeneity and stability) and validity (criterion-related, concurrent validity, and construct validity) including sensitivity and specificity in a cross-sectional study. One-hundred fifty-eight patients were interviewed using the nutritional screening instruments NUFFE-NO and Mini Nutritional Assessment (MNA). They were interviewed once again (using NUFFE-NO) 2 to 4 days afterward. Background variables were collected. Data from the patients' records were collected regarding the nutritional screening instrument Nutrition Risk Screening 2002. Anthropometric measurements were performed. A Cronbach alpha coefficient of .77 was obtained. A majority of the items showed good or very good agreement in a test-retest. A high correlation coefficient (as a measurement of concurrent validity) was estimated between NUFFE-NO and MNA. The NUFFE-NO could separate groups with expected high and low scores, which supported construct validity. Calculated sensitivity and specificity values for NUFFE-NO, with MNA as a criterion and receiver operating characteristic curves with areas 0.79 and 0.80, showed appropriate cutoff points for measuring low, medium, and high risk for undernutrition. In conclusion, NUFFE-NO was shown to have sufficient psychometric properties for performing an institutional screening of elderly hospital patients.
    Nutrition research 11/2009; 29(11):761-7. DOI:10.1016/j.nutres.2009.10.010 · 2.59 Impact Factor
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