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Malnutrition prevalence and nutrition issues in residential aged care facilities
Abstract
To determine the prevalence of malnutrition and investigate nutritional issues in a sample of older people living in residential aged care facilities (RACFs).
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.
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%).
There is a need for systematic, coordinated and multidisciplinary approaches to nutritional care for older people in residential care.
... As we age our functional, psychosocial, and physical capabilities decline and we are less able to complete activities of daily living, such as grocery shopping or meal preparation. Additionally, changes in brain function, cognition, psychological wellbeing or cardiovascular health for example, may develop into chronic conditions, or require polypharmacy, potentially leading to increased frailty and disability [1]. Similarly, changes to taste, smell and swallowing affects food satisfaction and intake, potentially leading to malnutrition or sarcopenia [2]. ...
... Kellett et al. measured malnutrition rates in RACF residents with up to 26% moderately malnourished and up to 7% severely malnourished [11,12]. In a study by Gaskill, Black [1] of 350 residents, almost half (43%) were moderately malnourished while 6% were severely malnourished. Further, a cross-sectional study by Chatindiara, Allen [8] indicated 48% of the sample size who were admitted to RACF from the community were malnourished or at risk of malnutrition (45%) at entry to RACF. ...
... A reduced ability to communicate due to cognitive and physical impairment can also affect the collection of qualitative outcome measures. However, individuals with mild or severe cognitive impairment may be excluded entirely, or, enrolled in a study by either a legal proxy (next of kin or legal guardians), or staff within the residential facility, i.e., the Director of Nursing or care staff [1,85]. Effective communication with the families and carers of potential participants is also important, particularly given the high proportion of those in long-term aged care who experience significant cognitive decline. ...
Malnutrition and frailty are preventable and reversible. However, a significant proportion of aged care residents live with malnutrition and frailty which have associated complications such as increased falls, hospitalizations, infections, and decreased quality of life. Nutrition and dietary interventions can prevent these issues, however, there a few interventions conducted in this setting and no consensus on the most utilized interventions to improve health outcomes. In a crude literature search, we identified 65 nutrition-related randomized controlled trials worldwide in the aged care setting from 2000 to 2024. Most interventions were conducted in Europe and were oral nutrition supplementation or dietary supplements and/or food fortification. With few published studies, progressing nutrition interventions in aged care may be assisted by the mapping and identification of the key barriers and challenges related to engagement and collaboration with stakeholders and participants and the logistics of the aged care environment including staffing workload and kitchen capacity. Nutrition researchers should consider using process evaluations and qualitative research to map barriers and enablers to implementation in hopes to improve future research.
... Malnutrition is associated with poorer overall health, increased utilisation of healthcare services, higher rates of falls and fractures, delayed wound healing, elevated infection risk, and accelerated mortality [7]. Despite such risks, many RAC facilities lack sufficient processes to systematically detect the nutritional status of residents, which places residents at risk of malnutrition [8]. ...
... The work of Kellett and colleagues reported malnutrition rates of between 20% and 26% in 101 RAC residents in 2012 [14]. The work by Gaskill in 2008 included 350 residents at eight RAC facilities and reported 6.4% of residents as severely malnourished and 43.1% at risk [8]. While these studies are important, they are now outdated and there is a concerning lack of current prevalence reporting. ...
Long-term or residential services are designed to support older people who experience challenges to their physical and mental health. These services play an important role in the health and well-being of older adults who are more susceptible to problems such as malnutrition. Estimates of the significance of malnutrition require up-to-date prevalence data to inform government strategies and regulation, but these data are not currently available in Australia. The aim of this study was to collect malnutrition prevalence data on a large sample of people living in residential aged care facilities in Australia. A secondary aim was to examine the relationship between malnutrition and anthropometry (body mass index (BMI) and weight loss). This prevalence study utilised baseline data collected as part of a longitudinal study of malnutrition in 10 Residential Aged Care facilities across three states in Australia (New South Wales, South Australia, and Queensland). The malnutrition status of eligible residents was assessed by dietitians and trained student dietitians using the Subjective Global Assessment (SGA) with residents categorised into SGA-A = well nourished, SGA-B = mildly/moderately malnourished, and SGA-C = severely malnourished. Other data were extracted from the electronic record. Of the 833 listed residents, 711 residents were eligible and had sufficient data to be included in the analysis. Residents were predominantly female (63%) with a mean (SD) age of 84 (8.36) years and a mean (SD) BMI of 26.74 (6.59) kg/m2. A total of 40% of residents were categorised as malnourished with 34% (n = 241) categorised as SGA-B, and 6% (n = 42) SGA-C. Compared to the SGA, BMI and weight loss categorisation of malnutrition demonstrated low sensitivity and high specificity. These findings provide recent, valid data on malnutrition prevalence and highlight the limitations of current Australian practices that rely on anthropometric measures that under-detect malnutrition. There is an urgent need to implement a feasible aged care resident screening program to address the highly prevalent condition of malnutrition in Australia.
... There are few studies looking at the extensiveness of vitamins in elderly diet; however, some studies do look at the extent to which vitamin risks pose a threat to its occupants. These studies examine how malnutrition is a growing issue in these establishments, mainly as a result of ineffective guidance policies (Gaskill et al., 2008;Verbrugghe et al., 2013). As found by Gaskill and her colleagues in eight distinct aged residential care facilities, "Half the residents were well nourished (50.5%) with 43.1% moderately malnourished and 6.4% severely malnourished." ...
... Shockingly, vitamin deficiency did not seem to be a problem at all since facilities had 0 dietary deficiency in Vitamin A and K and no conclusive deficiency risks in Vitamin D (ranged from 0 to 2) and Vitamin E (ranged from 0 to 1). This contrasts from what I found in my literature review since most of my other studies found malnutrition to be a growing concern in the elderly population (Gaskill et al., 2008;Verbrugghe et al., 2013). As I found no concern, this relates to my research question by showing that the overall prevalence of fat-soluble vitamins at these facilities were not characterized by vitamin deficiency. ...
Vitamin overdose is often not researched in comparison to its counterpart risk, malnutrition. As the general topic of vitamin overdose is already under-researched, I specifically looked at fat-soluble vitamins (Vitamins A, D, E, and K) in elderly care facilities in Georgia to determine if any posed the unrecognized risk of vitamin over supplementation. The examination of these risks are paramount since many elderly residents are dependent on the facility to provide food as well as their supplements. Thus, this would mean that even a facility-provided diet high in vitamins may assume a vitamin risk since supplementation on top of this diet is unnecessary and may lead to over supplementation. Other commonly researched risks are also explored by analyzing prevalence. Through a sequential mixed methods approach, I analyzed qualitative interviews on medical and dietary staff from 8 respective care facilities to determine dietary vitamin intake and content analyses on their meal plans for supplemental intake. The results of my study found that there were no conclusive vitamin deficiency risks, most vitamins were in the adequate range, and Vitamin A and potentially Vitamin D were at the highest risk for over supplementation. These factors may be due to the common emphasis of vitamins in diet (as opposed to supplements) and the frequent shift in supplement responsibility to medical professionals. Thus, future research should look at the extent of this issue in Georgia and potential prevention measures.
... The rate of malnutrition in nursing homes is persistently high, with studies suggesting approximately 50% of residents are malnourished [4,5]. Consequently, food services in a nursing home are often considered through a clinical lens with mealtimes as a vehicle for ensuring residents receive 'adequate nutrition and hydration' with the goal of preventing unintentional weight loss [6]. ...
... A recent study suggests that when residents are dissatisfied with the food service this increases their risk of malnutrition twenty-fold [16]. It is well established that malnutrition is multifactorial [4,5,17,18]; however, logic suggests that food has no nutritional value if left uneaten and residents are far more likely to eat if presented with food they enjoy in an environment conducive to eating [19]. Therefore, understanding the food service factors that contribute to increased satisfaction and, consequently, increased consumption is necessary to address the problem. ...
Resident satisfaction with food services contributes to health and wellbeing. Measuring resident satisfaction is important; however, the small number of existing food service satisfaction questionnaires (FSSQs) are outdated, lack rigorous psychometric testing and do not reflect the shift to person-centered care. This study aimed to develop a valid and reliable FSSQ. Content validity was established by conducting interviews with residents, a systematic literature review and consultation with an expert panel. Data from 387 residents were used to establish construct validity (Principal Components Analysis), internal consistency (Cronbach’s alpha) and temporal stability (Gwet’s AC). The result was a three factor, 25-item scale with good/excellent internal consistency: Factor One (13 items–good food/service, α = 0.896), Factor Two (seven items–resident choice/food availability α = 0.648) and Factor Three (five items–resident participation/staff assistance, α = 0.729). Temporal stability was good/very good (Gwet’s AC 0.6242–0.9799 (p < 0.001). This is the first FSSQ available to nursing homes that meets the COSMIN® standards for excellence and incorporates person-centered care. The questionnaire is simple to use and interpret, providing food service managers with an accurate and reliable measure of resident satisfaction and assisting them in providing a meal and dining experience that supports the health and wellbeing of residents.
... Patient populations at greatest risk are the oldest, the frail, and those requiring the highest levels of care. 8,9 Management of these issues and an emphasis on the promotion of optimal functional ability and general wellbeing requires the involvement of allied health professionals such as physiotherapists and dietitians. 10 The role of physiotherapy in aged care is well recognised with physiotherapy intervention resulting in reduction of falls and improvements in mobility, strength, balance, and exercise capacity. ...
... 8,[14][15][16] Currently, there is an undersupply of appropriately skilled allied health professionals employed in aged care, a situation that will worsen as the median age of the population rises. 5,9,17 In addition, aged care has been identified as an area in which many beginning health practitioners are reluctant to seek employment. 17 The exposure of physiotherapy and dietetic students to clinical placements in the aged care setting during their entry-level training may ameliorate these issues. ...
Purpose: As the population ages, the incidence and prevalence of chronic health issues requiring allied health management is increasing. Currently, there is an undersupply of appropriately skilled allied health professionals working in aged care. This has also been identified as a setting in which many beginning health practitioners are reluctant to seek employment. In order to address this workforce shortage, it is imperative that students are prepared for a possible future career within aged care facilities. Early clinical experience within this setting may increase student confidence, raise awareness of the need for services, and encourage students to consider working in aged care. At present, student clinical placements within aged care facilities are limited, potentially contributing to difficulties addressing workforce needs. The reasons for the lack of clinical placements and the relative contribution of the opinions, attitudes, training, and support needs of staff are unknown. The purpose of this study was to investigate the opinions, attitudes, support, and training needs of physiotherapists, dieticians, and managers working in residential aged care regarding allied health professional student clinical placements. Method: A written survey of allied health professionals (dieticians and physiotherapists, n=26) and managers (n=40) working in residential aged care was conducted. Responses were analysed using qualitative and quantitative methods. Results: Participants had generally positive attitudes towards student placements in residential aged care. Managers were significantly more positive regarding the scope for student clinical placements within their facilities than allied health professionals (p<0.05). The biggest barrier to student placements identified by both managers and allied health professionals was the nature of employment of allied health professionals in the sector. Participating allied health professionals also indicated that they required specific training in student supervision and the provision of clinical education. Conclusion: The attitudes and opinions of allied health professionals and managers did not appear to contribute to a lack of allied health professional student placements in aged care facilities. The main barriers to placement were the nature of allied health professional employment and a lack of staff experience in supervising students on clinical placement. Specific training and mentoring of allied health professionals may facilitate increased student placement capacity in the aged care setting.
... This has proven to be a problem in determining how many individuals in the residential care setting are at risk of, or are diagnosed with malnutrition, in particular PEM. This is evident in the disparity of reported malnutrition prevalence when using different diagnostic tools (Gaskill et al., 2008;Pauly et al., 2007). The Department of Health's Minimum Standards for Care Homes for Older People state that on admission to care homes, individuals must be weighed and that their diet preferences should be noted, however there is no universally accepted malnutrition assessment tool required for use in this setting. ...
... Appetite influences not only protein intake, but also total energy intake in older individuals. This has resulted in appetite often being studied in parallel to PEM (Agarwal et al., 2013;Bunn et al., 2018;Gaskill et al., 2008). An association has been previously reported between low protein intake and appetite in community-dwelling older adults (van der Meij et al., 2017), however, this association has been reported as more common in nursing home residents (Malafarina et al., 2013). ...
Malnutrition, in particular protein-energy malnutrition, is a highly prevalent condition in older adults, and is associated with low muscle mass and function, and increased prevalence of physical frailty. Malnutrition is often exacerbated in the residential care setting due to factors including lack of dentition and appetite, and increased prevalence of dementia and dysphagia. This review aims to provide an overview of the available literature in older adults in the residential care setting regarding the following: links between sarcopenia, frailty, and malnutrition (in particular, protein-energy malnutrition (PEM)), recognition and diagnosis of malnutrition, factors contributing to PEM, and the effectiveness of different forms of protein supplementation (in particular, oral nutritional supplementation (ONS) and protein-fortified foods (PFF)) to target PEM. This review found a lack of consensus on effective malnutrition diagnostic tools and lack of universal requirement for malnutrition screening in the residential care setting, making identifying and treating malnutrition in this population a challenge. When assessing the use of protein supplementation in the residential care setting, the two primary forms of supplementation were ONS and PFF. There is evidence that ONS and PFF increase protein and energy intakes in residential care setting, yet compliance with supplementation and their impact on functional status is unclear and conflicting. Further research comparing the use of ONS and PFF is needed to fully determine feasibility and efficacy of protein supplementation in the residential care setting.
... Among older adults who live in residential care, a high prevalence (30-50%) of malnutrition (inadequate nutrient and energy intake) has been reported. [19][20][21] Malnourished older adults tend to have more comorbidities than their peers who are well nourished, and the prevalence of malnutrition is likely to increase with increasing frailty. 22 Age-related loss of muscle mass and strength (sarcopenia) is considered to be both a component 23 and an additional cause of physical frailty with advancing age. 4 By definition, frailty is a framework for identifying increased vulnerability resulting from failure of multiple physiologic systems. ...
... This study reports the prevalence of both malnutrition and frailty at admission to residential aged care in the Waitemata DHB. The prevalence of malnutrition (48%) and frailty (76%) in the current study is similar to other observations among residential aged care residents, where up to 50% of older adults have been reported to be malnourished [19][20][21] and up to 76% as frail. 27 We also found nearly half (45%) of the participants were at risk of malnutrition and approximately one-quarter (24%) were at risk of frailty (pre-frail). ...
INTRODUCTIONMalnutrition is an under-recognised and under-treated problem often affecting older adults.
AIMThe aim of this study was to evaluate the prevalence of and factors associated with malnutrition and frailty among older adults at early admission to residential aged care.
METHODSA cross-sectional study was undertaken among eligible older adults within the first week of admission to residential aged care. Participants were assessed for malnutrition risk using the Mini Nutritional Assessment Short Form, frailty using the Fried phenotype criterion, muscle strength using a grip strength dynamometer and gait speed using a 2.4-m walk test. A Cox regression analysis was conducted to identify factors associated with malnutrition risk and frailty status.
RESULTSOf 174 participants (mean age 85.5 years, 61% women), two-thirds (66%) were admitted to residential aged care from the community. Most (93%) were either malnourished (48%) or at risk of malnutrition (45%). A total of 76% of participants were frail and 24% were pre-frail. Forty-three percent were both malnourished and frail. Low risk of malnutrition was associated with increases in muscle strength [0.96 (0.93–0.99)], gait speed [0.27 (0.10–0.73)] and pre-frailty status [0.32 (0.12–0.83)].
DISCUSSIONThis study provides preliminary evidence for high prevalence of malnutrition and frailty at admission to residential aged care. Almost all participants were malnourished or at nutrition risk. Findings highlight the need for strategies to prevent, detect and treat malnutrition in community health care and support nutrition screening at admission to residential aged care.
... There are multiple factors that may contribute to a loss of body weight, lean body mass and subsequently an increased risk of malnutrition in older adults (Gaskill et al. 2008). Some of these factors have been recognised as the "nine D's", which include dysfunction, drugs, dementia, dysgeusia, dysphagia, diarrhoea, depression, disease and poor dentition (Agarwal et al. 2016). ...
... Additionally, adequate intakes of vitamins and minerals that play key roles in the body's antioxidant defence system, wound healing, neurological function and bone health contribute to healthy ageing (National Health and Medical Research Council 2006). In Australian aged care homes, malnutrition rates were $50% in 2008-09, however no recent studies measuring malnutrition rates in this setting have been identified (Gaskill et al. 2008;Woods et al. 2009). ...
Food fortification is used as a nutrition support strategy in aged care homes, for residents who are malnourished or at risk of malnutrition. The aim of this review was to determine the scope and strength of published works exploring relationships between food fortification strategies, mode of delivery and sustainability in aged care homes. Literature from four databases and grey literature was searched. A total of 3152 articles were screened. Seventeen studies were included. Results showed that the majority of studies used pre-made food fortification, rather than fortifying foods on-site. There was heterogeneity across studies, including the mode of delivery and ingredients used for food fortification. Only two studies measured any aspect of costs. No clear sustainable strategies for implementing food fortification in this setting could be identified. Research is required to provide further insight into the acceptability and sustainability of food fortification interventions.
... 12 Other actors, such as informal caregivers and other health professionals, are also involved in nutrition-related care, whether in a multidisciplinary setting or not. [13][14][15][16] Dietetic expertise is adjacent to the expertise of many other disciplines, such as that of physicians, specialised nurses, nutrition assistants, etc. Dietitians are the nutritional experts, but they are not at the forefront of everyday care as they see patients much less frequently than nurses do, 17,18 and although physicians are not necessarily nutritional experts, they are often in charge and responsible for the treatment of patients. 19,20 The role of the dietitian, who is the expert on the management of malnutrition in the elderly, is therefore not always clear. ...
... To the best of our knowledge, there are no systematic review studies on this topic. 15,23,26 The roles of nurses and physicians in comparison with other health professionals have been studied when it comes to the topic of the management of malnutrition in the elderly. [27][28][29] The main question for this systematic review of the literature, therefore, is: What is the role of dietitians in the management of malnutrition in the elderly in comparison with other health professionals? ...
Aim
The prevalence of age‐related malnutrition is increasing in almost all Western countries. Because of their expertise, dietitians should have a central role in the management of malnutrition. This review aimed to synthesise the literature on the role of the dietitian in the management of malnutrition in the elderly in comparison with other health professionals.
Methods
In November 2018, a search of Embase, Medline Ovid, Cinahl Ebscohost, Cochrane Central, Web of Science and Google Scholar was undertaken using ‘dietitian’, ‘elderly’ and ‘malnutrition’ as the main search terms. Qualitative and quantitative empirical research studies that focussed on the role of dietitians as the (main) subject of the study were included. Data extraction and data synthesis were performed by the three authors using a thematic synthesis approach.
Results
Three themes emerged from the coding and synthesis of the 21 included studies. The first theme demonstrates that other health professionals' time for, and knowledge of, screening policies negatively affects the role of the dietitian. The second theme demonstrates that the importance of nutritional care is acknowledged. However, this does not always imply familiarity with dietetics nor does it always mean that other health professionals think involving dietitians is worth the effort. The third theme demonstrates that issues of workload appeared to be especially important in crossing or guarding role boundaries.
Conclusions
The role of dietitians in managing age‐related malnutrition is not always clear and coherent. Therefore, how dietitians shape their role to provide optimal management of malnutrition in the elderly is open to debate.
... Older people with dementia who live in residential aged care (nursing) homes are at great risk for malnutrition and dehydration (Bell, Lee, & Tamura, 2015;Mentes, Chang, & Morris, 2006). Estimates for Australia are that around half of these people are malnourished (Gaskill et al., 2008), similar to the UK (Russell & Elia, 2010), and at serious risk for dehydration Mentes et al., 2006). ...
... Improved infrastructure in the form of "a good water supply around the place, instead of going into the bathrooms to get tap water," was also considered as a possibility to facilitate effective hydration, as "people might like the fresher water" [S09-Diversional issues are prevalent in residential care (Gaskill et al., 2008;Hooper et al., 2016;Mentes et al., 2006). However, staff were not always aware of the finer details of these key issues, such as the relationship between dehydration and risk of UTI, delirium and falls (El-Sharkawy et al., 2017;Goldberg et al., 2014;Manz, 2007). ...
Aims and objectives:
To examine awareness of aged care home staff regarding daily food and fluid care needs of older people with dementia.
Background:
Older people in residential care frequently are malnourished, and many have dementia. Staff knowledge of the food and fluid needs of people with dementia is limited. Qualitative research on this topic is scarce but can provide insight into how nutrition and hydration care may be improved.
Design:
Qualitative, interview-based study.
Methods:
Eleven staff in a range of positions at one care home were interviewed regarding their perceptions of current and potential food/fluid care practices. Transcripts were coded and analysed thematically.
Results:
Key food and fluid issues reported by these staff members were weight loss and malnutrition, chewing and swallowing difficulties (dysphagia), and inadequate hydration. Staff identified a number of current care practices that they felt to be effective in facilitating older people's food and fluid intake, including responsiveness to their needs. Staff suggestions to facilitate food and fluid intake centred on improved composition and timing of meals, enhanced physical and social eating environment, and increased hydration opportunities. Staff commented on factors that may prevent changes to care practices, particularly the part-time workforce, and proposed changes to overcome such barriers.
Conclusions:
Staff were aware of key food and fluid issues experienced by the older people in their care and of a range of beneficial care practices, but lacked knowledge of many promising care practices and/or how to implement such practices.
Relevance to clinical practice:
Staff need to be supported to build on their existing knowledge around effective food and fluid care practices. The numerous ideas staff expressed for changing care practices can be leveraged by facilitating staff networking to work and learn together to implement evidence-based change.
... Similar healthcare challenges can be found in the rest of the world, with a malnutrition prevalence of 17.5% in nursing homes and a risk of malnutrition of 48.0% [5]. Older people often deal with the loss of taste, decreased appetite, pain and/or nausea, or swallowing and chewing problems [6,7]. Many older people do not consume sufficient protein, fibre, fruit, and vegetables despite living in a nursing home and getting all their meals catered [8][9][10]. ...
The values and ideologies underpinning mental health care are evolving, shifting from a narrow focus on symptom reduction to a broader emphasis on recovery, human rights, and enhancing quality of life. To overcome the risk that health care systems will pay lip service to these emerging values and remain stuck in familiar one-size-fits-all solutions in clinical guidelines, there is a need for reshaping the clinical and scientific inquiries, by broadening our research questions and the epistemic methods employed. In this paper, we use the models of “tame” and “wicked” problems to understand this mismatch between current clinical guidelines and emerging recovery-oriented health care. We use the example of decisions on deprescribing antipsychotic medication, with its multiple inherent dilemmas and paradoxes, as a wicked problem in need of transdisciplinary solutions. Finally, we emphasize the value of preserving people’s dignity of risk-taking and conclude that the focus must shift from ensuring adherence to how we can best support people’s efforts to pursue meaningful lives, in line with the values of contemporary, recovery-oriented mental health care.
... The prevalence of malnutrition in Chinese hospitalized elderly is between 40.9 % and 58.6 % [60]. Similarly, a cross-sectional study in India and a survey in older patients in Spain, a study on the prevalence and factors associated with malnutrition in elderly patients with malnutrition in the United States, a cross-sectional study in South Africa, and a study related to nutrition issues in the elderly living in Australia, all described the high prevalence of malnutrition in the elderly [22,41,71,74,102]. ...
Objectives
Early detection and management of malnutrition is essential for the general health and well-being of the elderly. Various studies have reported different types of malnutrition prevalence in the elderly. the present study was aimed to determine the prevalence of malnutrition in the world’ elderly through conducting a systematic review study and meta-analysis.
Study Design: systematic review and meta-analysis.
Methods
In this review study, data was extracted by searching in national and international databases of SID, MagIran, Google scholar, ScienceDirect, Scopus, PubMed and Web of Science (WoS) without time limit until August 25, 2023. For analysis, Begg and Mazumdar test at a significance level of 0.1 and the corresponding Funnel plot were used. Data analysis was performed with Comprehensive Meta-Analysis software (Version 2).
Results
In the review of 98 studies with a total sample size of 79976, the prevalence of malnutrition in the world's elderly was obtained as 18.6 % (95 % confidence interval: 16.4-21.1 %), so that the highest prevalence of malnutrition was in the elderly of Africa with 35.7 %, followed by the America with 20.3 %. According to the subgroup analysis regarding the indicators of malnutrition in the elderly, the highest prevalence of malnutrition in the elderly was obtained as 39.9 % according the NRS-2002 index.
Conclusion
Therefore, in addition to raising awareness among families about malnutrition in the elderly and its negative effects on the quality of life of the elderly, it is necessary to take the necessary measures to provide more care for the elderly and also to pay serious attention to the importance of nutrition during old age.
... Although there is extensive evidence that malnutrition is associated with increased morbidity and mortality, loss of autonomy, and reduced quality of life (Araújo & de, 2008;Gaskill et al., 2008;Pereira Machado & Coelho, 2011), in general, it has not been evaluated and monitored routinely and systematically in long-term care institutions for the elderly. ...
Malnutrition in aging is currently considered a public health problem characterized by a multifactorial physiological state. Diverse and complex factors can contribute to the risk of developing malnutrition or even worsening. This chapter aims to provide a conceptual overview of malnutrition in elderly individuals, covering aspects related to nutritional assessment, monitoring, and recommendations, as well as possible challenges in managing this condition in clinical nutrition. The management is complicated and challenging. Nutritionists should perform interventions based on recommendations to prevent or minimize malnutrition in elderly individuals. Depending on the environment and the condition of the elderly patient, different therapeutic approaches will be needed to manage malnutrition. All family and health professionals involved with elderly care must stay engaged in preventing or identifying malnutrition in these patients.
... Similar healthcare challenges can be found in the rest of the world, with a malnutrition prevalence of 17.5% in nursing homes and a risk of malnutrition of 48.0% [5]. Older people often deal with the loss of taste, decreased appetite, pain and/or nausea, or swallowing and chewing problems [6,7]. Many older people do not consume sufficient protein, fibre, fruit, and vegetables despite living in a nursing home and getting all their meals catered [8][9][10]. ...
Background
Healthy and sustainable food environments are urgently needed, also in nursing and residential care homes. Malnutrition in care homes is becoming an increasing problem as populations worldwide are ageing and many older people do not consume sufficient protein, fibre, fruit, and vegetables. Nursing homes also often experience a lot of food waste. A transition in the food environment like a nursing home, involves the participation of facility management and food service staff members. This study aims to map out their perceived barriers and facilitators for this transition.
Methods
A qualitative study using semi-structured interviews was conducted with food service staff members (n = 16), comprising of kitchen staff (n = 4), wait staff (n = 10), and facility management (n = 2) of two nursing homes in the Netherlands. Thematic analysis was used to derive content and meaning from transcribed interviews.
Results
Four main themes were identified. Theme 1: ‘Communication, transparency and accountability in the chain’, highlighting the lack of effective communication flows and a fragmented overview of the food service chain as a whole. Theme 2: ‘Understanding, knowledge and ability of the concepts healthy and sustainable’, revealing the gap in staff’s understanding of these abstract concepts, despite perceiving themselves as having sufficient knowledge and ability. Theme 3: ‘The pampering service mind-set’, highlighting the contradiction in the staff’s shared goal of proving the highest quality of life for residents while also pampering them in ways that may not align with promoting healthy and sustainable food choices. Theme 4: ‘Transition is important but hard to realize’, describing the barriers such as existing routines and a lack of resources as challenges to implementing changes in the food service.
Conclusions
Facilitators to transitioning nursing homes towards a healthy and sustainable food environment as perceived by staff members included transparent communication, accountability in the food supply chain, staff’s perceived ability and shared goal, while barriers included lack of understanding of the concepts healthy and sustainable, the current pampering mindset, and top-down decision-making. These findings provide valuable insights for nursing homes seeking to transition towards a healthier and more sustainable food environment.
... To date, the topic of food as a significant dimension of elderly care has primarily been studied from a nutritional perspective, typically exploring how a good meal should be constituted in terms of macronutrients and calories (Gaskill et al., 2008;Kenkmann et al., 2010;Khor et al., 2021;van der Pols-Vijlbrief et al., 2014). The reason for this focus is probably malnutrition, which is a considerable problem among frail older adults, whether living at home or in institutional care settings (Abbott et al., 2013;Landmark et al., 2014). ...
This study aims to advance our understanding of meals in Day Care Centers (DCCs) for older adults. By using a phenomenological approach, we aim to shed light on physical, sociocultural, and existential aspects of participants’ bodily experiences of meal situations. Based on a thematic analysis of qualitative data from seven weeks of ethnographic fieldwork in two DCCs for older adults in Sápmi, Norway (2021–2022), we explore how we can foster nourishing, meaningful, and diversity-sensitive meals, adjusted to the bodies cared for. In our conclusion, we argue that food should be considered an important part of care in DCCs—not only as a means to feed older adults but as a way to nourish the whole person cared for.
... A s the population ages, by 2057, 25% of the population will be older than 65 years, increasing the demand for aged care (1). Malnutrition is common in older adults in aged care with ~72% of residents at risk of malnutrition (2,3). Insufficient protein intake contributes to malnutrition, increasing morbidity, mortality, and health care costs due to increased risk of frailty and falls, pressure sores, impaired wound healing, delayed recovery from illness, and protracted hospital stay (4)(5)(6)(7)(8). ...
Objectives
Malnutrition, particularly protein insufficiency, is common in institutionalised older adults and increases morbidity, mortality, and costs. We aimed to determine whether 12 months supplementation using high-protein foods (milk, cheese, yoghurt) prevents malnutrition in older adults.
Design
Cluster randomised control study.
Setting
Sixty Australian aged care facilities.
Participants
Older adults living in aged care homes (n=654, mean age 86.7±7.2 years, 72% females).
Intervention
Facilities randomly allocated to a high-protein (n=30 intervention) or regular (n=30 controls) menu.
Measurements
Nutritional status assessed using the Mini Nutrition Assessment (MNA) tool and fasting morning blood samples (n=302) assayed for haemoglobin (Hb) and albumin. Food intake was monitored 3-monthly using visual plate waste assessment. Measurements at baseline and month 12 were analysed using random effects model accounting for clustering (facility), repeated measure and confounders.
Results
Addition of 11g of protein as 1.5 servings of high-protein foods daily preserved nutritional status that deteriorated in controls [MNA screen (−0.68, 95%CI: −1.03, −0.32, p<0.001) and total (−0.90, 95%CI: −1.45, −0.35, p=0.001) scores], resulting in group differences in MNA screen (0.62, 95%CI: 0.17, 1.06, p=0.007) and total (0.81, 95%CI: 0.11, 1.51, p=0.023) scores and group difference in Hb (3.60g/L, 95%CI: 0.18, 7.03, p=0.039), the net result of preservation with intervention (0.19g/L, 95%CI: −2.04, 2.42, p=0.896) and a decline in controls (−3.41g/L, 95%CI: −6.01, −0.82, p=0.010). No group differences were observed for serum albumin.
Conclusion
Consumption of high-protein foods is a pragmatic approach to maintaining nutritional status in older adults in aged-care.
... As previous studies showed that malnutrition is related to very old age (≤ 90 years vs. ≥ 91 years) [212], number of comorbidities (≤1 vs. ≥2) [67,117] and living status before admission (alone vs. together) [49], all regression analyses were adjusted for these variables (model 1). As most behavioural-cognitive problems are associated with each other, a full model was created which included in addition all five determinants (CS, DRS, RISE, ABS and CPS) (full model). ...
... Although the definition of malnutrition is debated (Cederholm et al., 2019), the general consensus is that malnutrition rates are higher in older people and higher still for older people in aged care. Depending on the definition, it is estimated that 1-8% of older Australians in the general community are malnourished while up to 68% of older Australians in aged care are at risk of malnutrition or malnourished (Banks et al., 2007; Dietitians Association of Australia, 2019; Gaskill et al., 2008;Isenring et al., 2012;Iuliano et al., 2017). Comparable community and aged care levels are reported elsewhere (Agarwal et al., 2013;Donini et al., 2008;Elia et al., 2005;Souminen et al., 2005;Tamura et al., 2013). ...
The effect of malnutrition beyond morbidity and mortality has become a critical area of investigation in older people with an increased focus on quality-of-life (QoL), but as yet the relationship between malnutrition and QoL remains to be reviewed in older people from aged care settings. The current study conducted a systematic review and meta-analyses of studies published between the years 1995 and 2020 examining the relationship between nutritional status and QoL or the effects of a nutrition-based intervention on QoL in older people in residential aged care. Based on searches of the databases MEDLINE, PsycINFO, Emcare, and Embase, 21 studies were identified. Meta-analyses of the cross-sectional and quasi-experimental studies revealed a significant positive relationship between nutritional status and QoL and that nutritional intervention significantly improved QoL. By contrast, meta-analysis of randomised controlled trials revealed a non-significant but improved trend post-intervention in QoL. Although the effect sizes were small, the present findings indicate that nutrition-based interventions improve QoL in older people in residential aged care and align with previous reviews based on findings from other aged settings. Future research is needed to determine causality and to better identify and control for confounding factors which may influence both nutritional status and QoL.
... This agrees with reports from Afolabi et al. (6) who reported that more than half of the elderly in their study were 58-68 years. The preponderance of under-70 older adults may be partly due to poor survival capacities among the elderly population entrenched in the extent of poverty in the country (20). ...
Background: A thorough nutritional assessment is necessary for successful diagnosis and development of appropriate/comprehensive treatment plans for malnutrition among older adults. Objective: This study assessed the anthropometric status and nutritional risks of older persons in Umuahia Metropolis, Abia state. Methods: The study was descriptive cross-sectional in design. A two-stage sampling technique was used to select 305 respondents. A structured questionnaire was used to elicit information on the relevant characteristics. Mini Nutritional Assessment (MNA) form and Malnutrition Universal Screening Tool (MUST) were used to categorize the respondents’ nutritional risk. Anthropometric values were compared with their standard recommendations. Descriptive statistics were computed for the categorical and continuous variables using SPSS version 25 Results: The study findings revealed that a good number (44.3%) of the older persons in the study area were between 60-64years, had family size of 4-6 members and earned income between N30,000 -50,000 (50.8%) and above N50,000 (45.9%). Majority of the respondents were normal or at low risk of nutrition using MNA (89.2%) and MUST (93.4%) classification. Similarly, most of the older adults had normal body mass index (74.4%), mid upper arm circumference (88.9%), waist hip ratio (65.2%) and calf circumference (85.6%) status. Conclusion: This study revealed that the respondents had normal/safe nutritional and health status using the various anthropometry and malnutrition assessment scales. Therefore, efforts to maintain healthy nutritional status and improve the socio-economic profile of older adults should be encouraged.
... Public health nutrition measures such as dietary guidelines are not appropriate for this population, where the main concern is adequate protein and energy intake [11]. Malnutrition remains an ongoing concern in Australian aged care homes, with reports that up to 50% of residents can be malnourished or at risk of malnutrition, although the literature is lacking recent data on malnutrition rates in this setting [12,13]. This has remained stubbornly high for more than two decades and requires better management. ...
The role of foodservices in aged care is difficult to understand, and strategies to improve the nutritional care of residents are often unsustainable. In particular, food-first strategies such as food fortification are poorly executed in everyday practice and its execution relies upon the foodservice system in aged care homes. The aim of this study was to explore the perspective of staff on the role of foodservices in aged care and gauge the level of skills, education, access, time, and ability to deliver food fortification. Semi-structured interviews were conducted with foodservice managers, foodservice workers, dietitians, carers, and other managers who work in aged care homes across Australia. Participants were recruited purposively through email and through snowballing. Interviews (n = 21) were recorded, transcribed verbatim, and analyzed using inductive thematic analysis. Three themes and six sub-themes were identified. The three themes include the role of foodservices being more than just serving food, teamwork between all staff to champion nutrition, and workplace culture that values continuous improvement. These themes identify how staff perceive the role of foodservices in aged care and provide an important perspective on the long-term sustainability of food fortification strategies and how to improve current practice.
... Evidence suggests malnutrition may be associated with poor functional and clinical outcomes, including institutionalization and mortality and may often be unrecognized [1]. The prevalence of malnutrition in acute care is estimated to be between 20% and 50%, compared to 10% and 30% in the community [3,4]. Reasons for malnutrition are myriadinadequate nutritional intake due to poor appetite, increased nutritional requirements from chronic disease, and malabsorption, as well as non-physiological factors [5]. ...
... 4 Similarly in residential aged care facilities (RACF) rates of malnutrition have been estimated to be as high as 50%. 6,7 As such, these are particularly important settings to target interventions which address malnutrition. ...
Aims
This review aimed to synthesise evidence on the impact of communal dining and/or dining room enhancement interventions on nutritional, clinical and functional outcomes of patients in hospital (acute or subacute), rehabilitation and residential aged‐care facility settings.
Methods
Five electronic databases were searched in March 2020. Included studies considered the impact of communal dining and/or dining room enhancements on outcomes related to malnutrition in hospital (acute or subacute), rehabilitation and residential aged care facility settings. Risk of bias was assessed using the Academy of Nutrition and Dietetics quality checklist. Overall quality was assessed using GRADEpro software. Outcome data were combined narratively for communal dining and dining room enhancements respectively.
Results
Eighteen articles from 17 unique studies were identified. Of these studies, one was a randomised control trial (moderate quality) and 16 were observational studies (all low quality). Communal dining interventions (four studies, n = 490) were associated with greater energy and protein intake and higher measures of quality of life than non‐communal mealtime settings. Dining room enhancement interventions (14 studies, n = 912), overall, contributed to increased intake of food, energy, protein and fluid.
Conclusions
Results indicate that communal dining and/or dining room enhancement has a positive impact on several outcomes of interest, however, most available evidence is of low quality. Therefore, there is a need for further large‐scale, well‐designed experimental studies to assess the potential impacts of these interventions.
... Feeding difficulties increase the risk of unintentional weight loss and subsequently cause a risk of malnutrition, which is associated with decreased mobility, high risk of falls, a reduction in the activities of daily living (Gaskill et al., 2008;Rullier et al., 2013;Sanders et al., 2018;Watterson et al., 2009;White et al., 1998), exacerbates ill health, increases hospital admissions, and lengthens of hospitalisation (Pirlich et al., 2006;Thomas et al., 2007;Visvanathan et al., 2004). These complications place further burden on individuals and nursing staff. ...
This review aimed to summarise the validity and reliability of feeding difficulties assessment tools for Individual with dementia. PubMed, PsycINFO, MEDLINE, CINAHL and Scopus were searched for feeding difficulty measurements studies published between 1990 and 2019. Sixteen publications were included and identified three tools: Edinburgh Feeding Evaluation in Dementia (EdFED), Feeding Behaviour Inventory (FBI), and Feeding Difficulty Index (FDI). Results showed the EdFED was translated and tested in various languages. The EdFED and FDI demonstrated high content and construct validity. The FBI was not validated. The EdFED had high inter-rater reliability, with Cronbach’s alpha ranging from 0.75 to 0.90. The FDI and FBI showed moderate inter-rater reliability. Although the EdFED has been tested and widely used, unlike FDI, which addresses multi-aspects of feeding difficulty. The FDI have higher clinical utility but future research needs to test the psychometric properties of FDI to determine its effectiveness in assessing feeding difficulties.
... Telephone-delivered dietetic counselling has been shown to be an effective method to deliver malnutrition-related care to older adults. Malnutrition has been shown to affect up to 50% of the residential aged care population 45 and up to 70% of hospitalised older patients. [46][47][48] In a systematic review (2018, n = 9 RCTs), clinical improvements following telephone-delivered consultation Cardiovascular disease risk 26 1 study, 199 participants 26 The cardiovascular disease risk reduced in telephone group, but rose in control patients (d = 0.12) ...
It is the position of Dietitians Australia that clients can receive high‐quality and effective dietetic services such as Medical Nutrition Therapy (MNT) delivered via telehealth. Outcomes of telehealth‐delivered dietetic consultations are comparable to those delivered in‐person, without requiring higher levels of additional training nor compromising quality of service provision. Dietitians Australia recommends that policy makers and healthcare funders broaden the recognition for telehealth‐delivered dietetic consultations as a responsive and cost‐effective alternative or complement to traditional in‐person delivery of dietetic services. The successful implementation of telehealth can help to address health and service inequalities, improve access to effective nutrition services, and support people with chronic disease to optimise their diet‐related health and well‐being, regardless of their location, income or literacy level, thereby addressing current inequities.
... Other conditions associated with aging, such as drug use, loneliness, depression, lack of oral health, low quality of life, in addition to chronic noncommunicable diseases, markedly increase the undernutrition risk [4]. It has been estimated that undernutrition affects between 20 and 50% of hospitalised patients [5] and 5 and 10% of patients living at home in the community [6], the great variations reported in different studies depends not only to differences in the population analysed, but also on the adopted definition. Recently a large study [7], that applies harmonized criteria to define malnutrition in different clinical settings and population, shows a great underestimation of the problem and confirms higher prevalence of malnutrition in residents of nursing homes and hospitalized patients evaluated by Mini Nutritional Assessment test (MNA). ...
Rationale:
Malnutrition often affects elderly patients and significantly contributes to the reduction in healthy life expectancy, causing high morbidity and mortality. In particular, protein malnutrition is one of the determinants of frailty and sarcopenia in elderly people.
Methods:
To investigate the role of amino acid supplementation in senior patients we performed an open-label randomized trial and administered a particular branched-chain amino acid enriched mixture (BCAAem) or provided diet advice in 155 elderly malnourished patients. They were followed for 2 months, assessing cognitive performance by Mini Mental State Examination (MMSE), muscle mass measured by anthropometry, strength measure by hand grip and performance measured by the Timed Up and Go (TUG) test, the 30 s Chair Sit to Stand (30-s CST) test and the 4 m gait speed test. Moreover we measured oxidative stress in plasma and mitochondrial production of ATP and electron flux in peripheral blood mononuclear cells.
Results:
Both groups improved in nutritional status, general health and muscle mass, strength and performance; treatment with BCAAem supplementation was more effective than simple diet advice in increasing MMSE (1.2 increase versus 0.2, p = 0.0171), ATP production (0.43 increase versus -0.1, p = 0.0001), electron flux (0.50 increase versus 0.01, p < 0.0001) and in maintaining low oxidative stress. The amelioration of clinical parameters as MMSE, balance, four meter walking test were associated to increased mitochondrial function.
Conclusions:
Overall, our findings show that sustaining nutritional support might be clinically relevant in increasing physical performance in elderly malnourished patients and that the use of specific BCAAem might ameliorate also cognitive performance thanks to an amelioration of mitochondria bioenergetics.
... A worldwide high prevalence of malnutrition, specifically protein-calorie undernutrition in older people living in aged-care or nursing homes, has been well described. [1][2][3][4][5] As the population aged over 65 years increases, prevention and early treatment of undernutrition could potentially avoid serious impacts on morbidity and mortality. A recent systematic review 6 on malnutrition in nursing homes found that approximately half the residents (47%-62%) were at risk of malnutrition and 20%-39% were malnourished. ...
Objectives
To observe the cascade of nutrient loss from meals planned to those provided and subsequently consumed by older people in residential care. A secondary aim was to determine the characteristics of residents with higher nutrient loss resulting in lower intake of key nutrients.
Design
A single-centre cross-sectional study.
Setting
An aged residential care facility in Christchurch, New Zealand.
Participants
All low and high level of care residents except those who are end of life, enterally fed or on short-term stay were invited to participate in the study. 54 of 60 selected residents who consumed all three main meals (breakfast, lunch and dinner) for three non-consecutive days were included in the analyses.
Main outcome measures
Nutrient contents of planned menu; nutrient contents of meals served and consumed using modified 3-day diet records; and percentage of planned nutrients served and consumed.
Results
Vitamins C, B12 and folate had the greatest total decay rates of 50% or more from that planned to be consumed to what was actually consumed, while unsaturated fats, beta carotene, iodine and zinc had the lowest decay rates of 25% or less. Male participants and lower care level residents consumed significantly more nutrients, compared with female participants and those receiving higher level care. Increased age, female gender, higher level of care, smaller meal size, pureed diet and lower body mass index were associated with larger decay rates and lower nutrient intakes.
Conclusions
Not all planned and served food and beverages are consumed, contributing to potential multiple nutrient deficiencies including energy and protein in the majority of aged-care residents. As a consequence, some nutrients may need to be oversupplied if consumption is to match planned intakes.
... The prevalence of malnutrition in elderly people in different countries in the world varies between 10% and 60% [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33]. Some of this difference is due to the variation in using measurement tools, study setting and demographic groups which has been studied [34][35][36]. ...
Background:
Malnutrition is occurred following a decrease or an imbalance in the absorption of energy, protein, vitamins, and minerals by collaboration of numerous factors. Thus, it has serious and life-threatening consequences. In order to plan for this issue, we need information on the burden of this problem.
Objective:
Thus, the aim is to determine the prevalence of malnutrition among elderly people in Iran.
Methods:
For this purpose, papers including original articles, reviews, theses, and conference proceedings on the prevalence of malnutrition among people aged 60 and older that have been published in national and international journals until September 2018 will be included without any language limitation. The following keywords along with their synonyms in Persian will be used in the literature search: malnutrition, elderly and Iran. At first, the screening process will be carried out based on the inclusion and exclusion criteria. Then, the full text of the remaining articles will be read carefully and eligible articles selected according to the objectives of the study. Next, the methodological quality of the selected papers will be reviewed and the required information extracted from those with acceptable quality. Finally, meta-analysis will be performed using the STATA software (version 14) when optimum criteria met. It should be noted that all stages of screening, selection, quality assessment of primary studies and data extraction will be performed by two reviewers independently.
Results:
This review is ongoing and will be finished at the end of 2019.
Conclusions:
It is targeted to provide comprehensive evidence about the prevalence of malnutrition among elderly people in Iran by doing this review. It can help the Iranian health managers and policymakers to make informed decisions for preventing the malnutrition and promoting the health status of elderly people.
Clinicaltrial:
PROSPERO registration number CRD42018115358; https://www.crd.york.ac.uk/PROSPERO.
... Prior work with SGA suggests malnourishment prevalence in LTC to range from 27% to 50%. 8,31,32 The difference in prevalence found between the PG-SGA vs. Pt-Global is potentially explained by the emphasis placed on various aspects of the assessment and that categorization based on PG-SGA is not standardized. The point score leads to symptoms and disease nutritional requirements being more highly scored (maximum score 36), with the physical exam scoring the least (maximum score 3). ...
The ideal tool for determination of malnutrition risk or malnutrition in long term care (LTC) is elusive. This study compares prevalence, association with resident risk factors and sensitivity (SE) and specificity (SP) of malnutrition or risk categorization in 638 residents from 32 LTC homes in Canada using four tools: the Mini-Nutritional Assessment Short Form (MNA-SF); Patient-Generated Subjective Global Assessment (PG-SGA) Global Category Rating and the Pt-Global webtool; and the interRAI Long Term Care Facility undernutrition trigger. Prevalence was most common with MNA-SF (53.7%) and lowest with InterRAI (28.9%), while the PG-SGA Global Category Rating (44%) was higher than the Pt-Global webtool (33.4%). Tools were consistently associated with resident covariates with few exceptions. The PG-SGA Global Category Rating demonstrated the best sensitivity and specificity when compared to all other tools. Further work to determine the predictive validity of this tool in LTC residents is required.
... The prevalence of malnutrition in elderly people in different countries of the world varies between 10% and 60% [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33]. Some of these differences are because of the variations in using the measurement tools, study setting, and demographic groups that have been studied [34][35][36]. ...
BACKGROUND
Malnutrition is occurred following a decrease or an imbalance in the absorption of energy, protein, vitamins, and minerals by collaboration of numerous factors. Thus, it has serious and life-threatening consequences. In order to plan for this issue, we need information on the burden of this problem.
OBJECTIVE
Thus, the aim is to determine the prevalence of malnutrition among elderly people in Iran.
METHODS
For this purpose, papers including original articles, reviews, theses, and conference proceedings on the prevalence of malnutrition among people aged 60 and older that have been published in national and international journals until September 2018 will be included without any language limitation. The following keywords along with their synonyms in Persian will be used in the literature search: malnutrition, elderly and Iran. At first, the screening process will be carried out based on the inclusion and exclusion criteria. Then, the full text of the remaining articles will be read carefully and eligible articles selected according to the objectives of the study. Next, the methodological quality of the selected papers will be reviewed and the required information extracted from those with acceptable quality. Finally, meta-analysis will be performed using the STATA software (version 14) when optimum criteria met. It should be noted that all stages of screening, selection, quality assessment of primary studies and data extraction will be performed by two reviewers independently.
RESULTS
This review is ongoing and will be finished at the end of 2019.
CONCLUSIONS
It is targeted to provide comprehensive evidence about the prevalence of malnutrition among elderly people in Iran by doing this review. It can help the Iranian health managers and policymakers to make informed decisions for preventing the malnutrition and promoting the health status of elderly people.
CLINICALTRIAL
PROSPERO registration number CRD42018115358; https://www.crd.york.ac.uk/PROSPERO
... In Asia, Europe, and the United States, the prevalence of poor nutrition is high among hospitalized and institutionalized older people and is increasing in community-living adults aged 65 years and older [1,2]. Similar trends are occurring in Australia [3,4], with~5%-10% of community-living older adults identified as being malnourished, and~30%-40% 'at risk' of malnutrition [5,6]. Poor nutrition, particularly energy and protein malnutrition, has significant negative consequences including reduced muscle, cognitive and immune dysfunction, greater hospitalizations (number and length of stay), and premature entry into age-care homes [7,8]; all contribute substantially to increasing national healthcare expenditures across the world [9][10][11]. ...
The effects of “standard (STD)” vs. “protein- and energy-enriched (HEHP)” food-service meals on the nutrient intake, nutritional status, functional capacity, and wellbeing of older adults was investigated using a 12 week, double-blinded, parallel group design. All participants received dietetics counseling and either an STD (2.3 MJ and 30 g protein per meal) or a HEHP (4.6 MJ and 60 g protein) hot lunchtime meal for at least 3 days/week; those who did not want food-service meals were included in the control group (CON). Twenty-nine participants completed the study (STD = 7; HEHP = 12; CON = 10). From baseline to week 12, the HEHP subjects increased their mean daily energy intake from 6151 ± 376 kJ to 8228 ± 642 kJ (p = 0.002 for effect of time) and protein intake from 67 ± 4 g to 86 ± 8 g (p = 0.014 for effect of time). The MNA (Mini Nutritional Assessment) score was increased significantly in HEHP by 4.0 ± 1.1 points (p = 0.001), but not in the STD and CON groups (2.8 ± 2.1 points and 1.8 ± 1.1 points, p > 0.05). No difference was found for other clinical outcomes between the groups. The findings indicate that provision of HEHP-fortified food-service meals can increase energy and protein intake and improve the nutritional status of nutritionally at-risk older people.
... 23 Currently there are over a quarter of a million older adults residing in Australian RAC facilities, 18 approximately a quarter of them will have diabetes. 2 The largest age group in RAC is still the oldest old (>85 years) 31 who are currently the 'depression babies', born in a time of food rationing and scarcity. This is likely to be significantly different to the experience of our younger RAC resident and prospective users of RAC, or 'baby boomers'; who have had abundant access to food and who, it is postulated, will likely present to RAC with obesity and comorbidity. ...
Aim:
The prevalence of diabetes in older adults in residential aged care (RAC) is twice that of community dwelling older adults. Older adults with diabetes have been highlighted as being at high risk of frailty and malnutrition, particularly when managed on a therapeutic diet. However, assumptions may be based on clinical presentation of our oldest old which may be at conflict with the clinical presentation of younger older adults. The aim of this retrospective audit was to identify the characteristics of aged care residents with diabetes, their comorbidities and malnutrition risk.
Methods:
Residents' with diabetes paper-based records were audited for demographic data, diet code, medical and medication history, malnutrition risk screening scores and anthropometric data.
Results:
A total of 295 residents with diabetes records were audited across 13 sites in South Australia. Younger older adults (65-74 years) were generally in a healthy weight range (23-30 kg/m2) or obese (>30 kg/m2) and had gained weight since admission to RAC; whereas the oldest old were more likely to have lost weight and had a lower body mass index range 22.6-28.9 kg/m2. An unexpected finding was the variability between RAC sites in dietary management of diabetes and potential inappropriate dietary management of malnutrition, as indicated by their food service diet codes.
Conclusions:
Findings suggest that younger older adults in RAC are more likely to be overweight which is maintained over a typical length of stay. Study findings indicate that diabetes management is inconsistent and highlights the need for mandated RAC menu guidelines.
... We have reported that 45% of 250 older, community dwelling recipients of domiciliary care services in Adelaide, South Australia were malnourished or 'at risk' of malnutrition (~5% and ~40%, respectively) (8). Higher rates of malnutrition have been reported in long-term aged-care facilities (nursing homes), sometimes as high as 85% (9,10), (11,12). ...
Ageing related changes in body weight and composition impact quality of life of older people. Therefore the aim of the retrospective study was to determine body weight, body mass index (BMI), nutritional status assessed by malnutrition universal screening tool (MUST), pain, and length of stay, of a cohort of elderly nursing home residents in Adelaide, South-Australia, as well as the factors associated with changes in body weight over 6–12 months. 1,020 residents aged 87 ± 8years were in the 6-months retrospective analysis, and a subset of 752 residents in the 12-months sub-group. The average weight and BMI for the overall cohort were 66 ± 16kg and 25 ± 6kg/m². Almost 30% of residents were at medium or high nutritional risk (14% and 16%). Body weight decreased 0.4 ± 4.1kg (0.5 ± 6.4%) over 6-months (P=0.006) and 0.9 ± 5.2kg (1.3 ± 7.8%) over 12-months (P<0.001). 46% of residents had marked weight change (≥ 5% loss or gain) over 12-months. Residents in the lowest BMI tertile (≤23kg/m²) were most likely to experience both marked weight change (52%) and weight reduction (30%). Weight loss was associated with higher pain scores (P=0.012) and greater length of stay in the nursing home (P=0.002). In conclusion on average these older people lost weight, with high rates of both substantial weight loss and gain, particularly among those in the lowest BMI tertile. Almost a third in the lowest BMI tertile lost 5% or more body weight, putting them at increased risk of undernurition-related morbidity, suggesting greatest attention to prevent and treat such morbidity should be focused on that group.
Malnutrition in aging is currently considered a public health problem characterized by a multifactorial physiological state. Diverse and complex factors can contribute to the risk of developing malnutrition or even worsening. This chapter aims to provide a conceptual overview of malnutrition in elderly individuals, covering aspects related to nutritional assessment, monitoring, and recommendations, as well as possible challenges in managing this condition in clinical nutrition. The management is complicated and challenging. Nutritionists should perform interventions based on recommendations to prevent or minimize malnutrition in elderly individuals. Depending on the environment and the condition of the elderly patient, different therapeutic approaches will be needed to manage malnutrition. All family and health professionals involved with elderly care must stay engaged in preventing or identifying malnutrition in these patients.
Personalised nutrition (PN) has emerged over the past twenty years as a promising area of research in the postgenomic era and has been popularized as the new big thing out of molecular biology. Advocates of PN claim that previous approaches to nutrition sought general and universal guidance that applied to all people. In contrast, they contend that PN operates with the principle that “one size does not fit all” when it comes to dietary guidance. While the molecular mechanisms studied within PN are new, the notion of a personal dietary regime guided by medical advice has a much longer history that can be traced back to Galen’s “On Food and Diet” or Ibn Sina’s (westernized as Avicenna) “Canon of Medicine”. Yet this history is either wholly ignored or misleadingly appropriated by PN proponents. This (mis)use of history, we argue helps to sustain the hype of the novelty of the proposed field and potential commodification of molecular advice that undermines longer histories of food management in premodern and non-Western cultures. Moreover, it elides how the longer history of nutritional advice always happened in a heavily moralized, gendered, and racialized context deeply entwined with collective technologies of power, not just individual advice. This article aims at offering a wider appreciation of this longer history to nuance the hype and exceptionalism surrounding contemporary claims.
Background and Objectives
The poor mental health of adults living in aged care needs addressing. Improvements to nutrition and exercise are important, but mental health requires a psychological approach. Self-determination theory finds that autonomy is essential to wellbeing while experiences of being controlled undermine it. A review of existing quantitative data could underscore the importance of autonomy in aged care, and a review of the qualitative literature could inform ways to promote autonomy and avoid control. Testing these possibilities was the objective of this research.
Research Design and Methods
We conducted a mixed methods systematic review of studies investigating autonomy, control, and indices of optimal functioning in aged care settings. The search identified 30 eligible reports (19 quantitative, 11 qualitative), including 141 quantitative effect sizes, 84 qualitative data items, and N = 2,668. Quantitative effects were pooled using three level meta-analytic structural equation models and the qualitative data were meta-synthesized using a grounded theory approach.
Results
As predicted, the meta-analysis showed a positive effect of aged care residents’ autonomy and their wellness, r = 0.33 [95% CI 0.27, 0.39], and a negative effect of control, r = -0.16 [95% CI -0.27, -0.06]. The meta-synthesis revealed seven primary and three sub-themes describing the nuanced ways autonomy, control, and help seeking are manifest in residential aged care settings.
Discussion and Implications
The results suggest that autonomy should be supported, and unnecessary external control should be minimized in residential aged care, and we discuss ways the sector could strive for both aims.
Background:
Malnutrition is a serious health risk facing older people living in residential aged care facilities. Aged care staff record observations and concerns about older people in electronic health records (EHR), including free-text progress notes. These insights are yet to be unleashed.
Objective:
This study explored the risk factors for malnutrition in structured and unstructured electronic health data.
Methods:
Data of weight loss and malnutrition were extracted from the de-identified EHR records of a large aged care organization in Australia. A literature review was conducted to identify causative factors for malnutrition. Natural language processing (NLP) techniques were applied to progress notes to extract these causative factors. The NLP performance was evaluated by the parameters of sensitivity, specificity and F1-Score.
Results:
The NLP methods were highly accurate in extracting the key data, values for 46 causative variables, from the free-text client progress notes. Thirty three percent (1,469 out of 4,405) of the clients were malnourished. The structured, tabulated data only recorded 48% of these malnourished clients, far less than that (82%) identified from the progress notes, suggesting the importance of using NLP technology to uncover the information from nursing notes to fully understand the health status of the vulnerable older people in residential aged care.
Conclusion:
This study identified 33% of older people suffered from malnutrition, lower than those reported in the similar setting in previous studies. Our study demonstrates that NLP technology is important for uncovering the key information about health risks for older people in residential aged care. Future research can apply NLP to predict other health risks for older people in this setting.
Objectives
To investigate the cross-sectional and prospective associations between behavior and cognitive problems and malnutrition in long-term care facilities (LTCF).
Design
Cross-sectional and prospective routine care cohort study.
Setting
6874 Residents in Dutch LTCFs (period 2005–2020).
Participants
Data were obtained from the InterRAI-LTCF instrument. Cross-sectional analyses on prevalence of malnutrition at admission included 3722 residents. Prospective analyses studied incident malnutrition during stay (total follow-up time 7104 years) and included data of 1826 residents with first measurement on admission (‘newly-admitted’) and n=3152 with first measurement on average ∼1 year after admission (‘existing’).
Measurements
InterRAI scales for communication problems (CS), aggressive behavior (ABS), social engagement (RISE), depressive symptoms (DRS), cognitive performance (CPS) and the total number of behavior and cognitive problems were investigated as independent variables and malnutrition (ESPEN 2015 definition) as dependent variable in regression analyses. Results were stratified for gender and group ‘newly-admitted’ vs. ‘existing’.
Results
On admission, 9.5% of residents was malnourished. In men, low social engagement was associated with prevalence of malnutrition. In women, all behavior and cognitive problems except depression were associated with malnutrition in the unadjusted analyses, but this attenuated in the full model taking all problems into account. The incidence of malnutrition during stay amounted to 8.9%. No significant associations of behavior and cognitive problems with malnutrition incidence were seen in ‘newly-admitted’ male residents while in ‘existing’ male residents all determinants were significantly associated. In ‘newly-admitted’ female residents CS, ABS and CPS, and in ‘existing’ female residents CS, RISE, ABS and CPS were significantly associated with incident malnutrition. All associations slightly attenuated after adjustment. Malnutrition incidence increased with increasing number of combined behavior and cognitive problems.
Conclusion
Residents with behavior and cognitive problems are at an increased risk of being malnourished at admission, or becoming malnourished during stay in a LTCF, especially residents with multiple behavior and cognitive problems.
Die Entwicklung der Pflegebedürftigkeit nach dem SGB XI hat in den letzten Jahren stark zugenommen. Daraus resultieren höhere Pflegebedarfe, die sich gleichzeitig auf einen verstärkenden Pflegepersonalmangel sowie auf hohe physische und psychische Belastungen pflegender Angehöriger bzw. Hauptpflegepersonen treffen. In diesem Kontext stellt sich die Frage, wie neue und assistive Technologien nicht nur in Pflegebedürftigkeit, sondern auch in der Förderung von Gesundheit, Gesundheitsförderung, Ressourcen, Autonomie und Selbstbestimmung unterstützend wirken können. Die Gestaltung der Lebenswelten pflegebedürftiger Menschen in häuslicher Umgebung oder Pflegeheimen, die auch neue Technologien einschließt, kann dazu beitragen, die präventiven Potenziale zu aktivieren und Pflegebedürftigkeit in Auswirkungen und Progression zu reduzieren
Aim
For residents in residential aged care, making choices in relation to food and mealtimes are opportunities to maintain a sense of self and autonomy. It is unknown, however, whether the concept of choice is adequately addressed in texts relating to residential aged care. The purpose of this review is to examine whether residents' right to make choices regarding the meals they eat, is discussed in grey literature including, policies, standards, reports and guidelines, which all impact practice in residential aged care.
Methods
Grey literature was located utilising; Google, Google Scholar and hand searching. Texts had to be in reference to residential aged care and were assessed using the Appraisal of Guidelines for Research and Evaluation II and Joanna Briggs Institute tools.
Results
Twenty-nine texts were included in the final review, consisting of, 12 policies and standards, 12 guidelines and 5 reports. Choice was discussed broadly in the majority of texts, with no definition included for the level of choice that should be provided by residential aged care. The use of alternative meals to provide choice was discussed; however, texts varied in their requirements and recommendations as to what constituted an adequate alternative.
Conclusions
The ambiguity surrounding choice affects the practices within residential aged care and ultimately the service provided to residents. With most recommendations being only general in nature, residential aged care homes are not provided with sufficient guidance for meal planning. To ensure residents' right to make choices in their meals is guaranteed, more definitive requirements and recommendations are needed.
Issue addressed
protein energy malnutrition (PEM) is a condition of involuntary weight and muscle loss caused by inadequate nutritional intake. In Australia, it is predominantly associated with chronic diseases, as are common in the older population. Given the ageing population of Australia, and the poor outcomes associated with PEM, there is a need to identify the contributing factors, and to explore strategies to prevent PEM.
Methods
two databases were searched for pertinent key words, including malnutrition, Australia and elderly, with relevant articles selected for inclusion. The citations and references of these articles were also searched for further articles.
Results
PEM is associated with increasing age and institutionalisation. The contributing factors are multifactorial, and include physiological, pathophysiological and structural causes. PEM is a significant public health issue for Australia, in terms of its consequences on both quality of life for older adults, and the burden on the healthcare system. However there are strategies that can be implemented at the community, organisation and policy level to prevent PEM.
Conclusion
PEM is a common problem for older Australians, and this has important physiological and public health consequences, especially in the context of the ageing Australian population. However there is significant scope for preventing PEM.
So what?
Readers can be advised that PEM is a significant public health issue that will increase in importance as the population continues to age. It is important that communities, organisations and governments develop strategies to prevent PEM.
Aims and objectives:
To explore the experiences of food choice and meal service in residential aged care facilities and its impact on autonomy, self-determination and quality of life from the perspectives of both residents and staff.
Background:
Globally, residential aged care is a principal provider of care for older people who can no longer live independently at home. Within this setting, lack of food choice has been identified as a significant factor impacting on residents' self-determination, sense of autonomy and quality of life.
Design:
This study used an exploratory descriptive qualitative approach guided by self-determination theory.
Method:
A total of 14 participants (seven residents and seven staff members) from two Australian residential aged care facilities were recruited through purposive and snowball sampling with assistance from one independent contact nurse at each facility. In-depth, semi-structured interviews were conducted, digitally recorded and transcribed. The COREQ checklist was used in this qualitative study.
Results:
Three main themes were identified from the interview data provided by residents and staff, which were as follows: (a) catering for the masses; (b) organisational barriers to providing choice; and (c) food impacts well-being.
Conclusions:
This study explored the experiences of food choice and service in residential aged care facilities, from the perspectives of both residents and staff. Results of interviews highlighted the importance of providing adequate food choice which has become an enduring issue that requires more attention and commitment to make a positive change for residents living in residential aged care facilities.
Relevance to clinical practice:
Nurses and other staff working in residential aged care facilities need to be aware of the importance of providing adequate food choice, including for residents who require modified diets. As advocates for residents, nursing staff must address the persistent lack of food choice. However, this will require a radical change in organisational culture and strong leadership.
Malnutrition and unintentional weight loss are known to occur in residential aged care facilities (RACFs). The use of oral nutritional supplements (ONS) and high-energy high-protein (HEHP) diets are two foodservice strategies that may be implemented in efforts to reduce unintentional weight loss in RACFs. This observational study aimed to determine whether incorporation of a structured high-energy high-protein diet (sHEHP) into the standard menu could reduce unintentional weight loss in RACF residents. RACFs in this study were facilities that provide long-term care to older adult residents. Weight change, body mass index and subjective global assessment scores of participants were measured at baseline and at six months across five RACFs receiving usual care with ONS or a sHEHP diet. Groups were different at baseline, with a high prevalence of severe malnutrition observed in the ONS group. Over the six-month period, there was a small but statistically significant difference in weight change within the groups: −1.64 ± 3.62 kg, ONS group; 0.56 ± 2.76 kg, sHEHP group, P = 0.0004. Both approaches investigated are feasible, however, future research using high-quality methods is needed to determine the most effective approach to deliver best practice nutrition care for residents into the future.
Preventing malnutrition and dehydration in older care home residents is a complex task, with both conditions remaining prevalent, despite numerous guidelines spanning several decades. This policy-mapping scoping review used snowballing search methods to locate publicly-available policies, reports and best practice guidelines relating to hydration and nutrition in UK residential care homes, to describe the existing knowledge base and pinpoint gaps in practice, interpretation and further investigation. The findings were synthesised narratively to identify solutions. Strategies for improvements to nutritional and hydration care include the development of age and population-specific nutrient and fluid intake guidelines, statutory regulation, contractual obligations for commissioners, appropriate menu-planning, the implementation and auditing of care, acknowledgment of residents’ eating and drinking experiences, effective screening, monitoring and treatment and staff training. The considerable body of existing knowledge is failing to influence practice, relating to translational issues of implementing knowledge into care at the point of delivery, and this is where future research and actions should focus.
Objective
Mealtimes directly impact the quality of life of residents in aged care. The objective of The Lantern Project is to improve the dining experience of aged care residents to reduce malnutrition risk through improving dietary intake, meal.
Methods
A transdisciplinary team of aged care professionals and resident advocates was formed as a collaboration collectively known as The Lantern Project.
Results
This paper outlines the journey and timeline of The Lantern Project collaboration since its inception and the interplay between the monthly stakeholder meetings and inter‐related research projects demonstrating improved outcomes.
Conclusion
Transdisciplinary collaboration offers well‐grounded benefits and realistic strategies sensitive to the complexity of the aged care setting.
Aim:
To evaluate the nutritional status of older adults with dementia who were living in long-term care settings.
Methods:
As a secondary analysis, this study used the data from the Nationwide Survey on Dementia Care in Korea that was conducted between December 1, 2010, and August 31, 2011, which surveyed 3472 older adults with dementia, aged ≥60 years (mean age: 81.24 years), who were residing in 248 randomly selected long-term care settings in South Korea. Twenty-three different variables that related to the participants' demographics, diseases, and functional and nutritional characteristics were selected. The nutritional status was assessed by using the Mini Nutritional Assessment (MNA). Descriptive statistics, an ANOVA, and a chi-squared test were used to analyze the data.
Results:
The mean MNA score of the participants was 17.90. The malnutrition rate was 38.4% (n = 1333), with 54.7% (n = 1900) of the participants at risk for malnutrition. The largest population with malnutrition resided in long-term care hospitals (47.9%), followed by nursing homes (34.1%), and group homes (25.9%). Being older and female, while exhibiting higher cognitive impairment, more neuropsychiatric symptoms, higher functional dependency, and a higher number of disabilities, were associated with poor nutritional status.
Conclusion:
The nutritional status of older adults with dementia who were living in long-term care settings in South Korea was poor and associated with multiple factors. Paying special attention to recognizing, assessing, preventing, and treating malnutrition in this population is necessary.
Objectives To ascertain Australian multistate prevalence and incidence of five commonly collected clinical indicators of aged-care home quality and to measure associations between these clinical indicators and levels of care needs and consumer and staff satisfaction.Methods A retrospective analysis of national audit data collected from 426 facilities between 2015 and 2016 was performed. Regression models were used to examine associations between five clinical indicators (falls, pressure injury, physical restraint, unplanned weight loss and polypharmacy) and level of care needs measured by the Aged Care Funding Instrument (ACFI) and consumer and care staff survey responses.Results With the exception of polypharmacy, commonly collected negative clinical outcomes were rare events. Compared with care homes with <25% of residents having high-level care needs (high ACFI), homes with 25<75% high-ACFI residents had more occurrences of all negative clinical outcomes except pressure injury. Homes with ≥75% high-ACFI residents reported the highest rates of polypharmacy (odds ratio 1.48, 95% confidence interval 1.39 - 1.57). Falls, unplanned weight loss and pressure injury were inversely associated with satisfaction scores adjusted for residents' level of care needs.Conclusions This first Australian study of multistate clinical indicator data suggests interpretation of clinical indicators of aged-care home quality requires consideration of the level of residents' care needs.What is known about the topic? Many Australian aged-care providers use quality indicators (QI) through benchmarking companies or in-house programs. The five most widely used aged-care clinical QIs in Australia are falls, pressure injury, physical restraint, unplanned weight loss and polypharmacy. Prevalence and incidence of these QIs are highly variable among Australian studies. A consistent message in the international literature is that residents' clinical characteristics influence QI outcomes at baseline and may continue to influence outcomes over time. Study of associations between Australian aged-care home characteristics and QI outcomes has been limited.What does this paper add? This is the first Australian study of multistate clinical QI data. It is also the first to consider the level of resident care needs in the interpretation of clinical QI outcomes and exploration of the association between level of consumer and staff satisfaction and QI outcomes.What are the implications for practitioners? Understanding the connections between aged-care home characteristics, consumer and staff perceptions and clinical QIs is crucial in the meaningful interpretation of QI outcomes in context. With the recent introduction of the National Aged Care Quality Indicator Program, it is timely to review national policy, to gauge current quality of care and the measure of care quality in the sector, and to develop directions for possible research to inform and resolve debates regarding the potential influence and unplanned effects that such a program may have.
Background
There is increasing concern regarding autonomy and quality of life for older people living in residential aged care. Failure to provide food choices and suitable dining environments has been reported to negatively impact their nutritional status, undermining their sense of autonomy and quality of life.
Aim
This paper presents an integrative review of studies on food choices in residential aged care and explores the relationships between food choices, autonomy and quality of life.
Methods
Search of nine databases CINAHL, PubMed, Scopus, PsycINFO, ProQuest, Cochrane, Embase, AMED, and Social Science Citation Index, identified nine primary articles. The Critical Appraisal Skill Program tool was used to examine the quality of these articles.
Findings
Three key themes were identified: (1) Prevalence of food choices and catering for residents’ preference; (2) Importance of food choices to nutritional status; (3) Impact of food choices on autonomy and quality of life. The importance of increasing staff awareness and a need to develop aged care regulation to ensure adequate food choices provided.
Discussion
The importance of increasing staff awareness regarding the interrelatedness of respecting older people’s food choices, autonomy and quality of life is identified. The needs of determining aged care regulation and accreditation standards were also highlighted.
Conclusion
Failure to provide satisfying food choices impacts older people’s quality of life. However, the strength of the relationships between food choices, autonomy and quality of life requires further study.
Background:
Food regulations exist to protect older people in residential aged care, leading to the restriction of potentially hazardous foods. The impacts of malnutrition, resident centred care and the importance of maintaining individual autonomy for older people are well documented. By contrast, there is scant literature describing residents' perceptions of food regulations and food risks in the residential aged care setting.
Aims:
The aim of this study is to explore resident perceptions of food choice and food restrictions in residential aged care.
Methods:
Using a qualitative, hermeneutic phenomenological design, semi-structured interviews were conducted with six participants recruited from two residential aged care facilities. Interviews were audio-taped, transcribed verbatim and thematically analysed.
Results:
The following key themes emerged in this study: participants were largely unaware of food regulations and risks, yet expressed the desire to make their own choices. Participants provided contradictory accounts of their experiences with food in residential aged care, which emphasises the ongoing challenge of meeting individual preferences.
Conclusion:
These themes warrant further investigation, particularly in relation to the impact of food regulations on food choice and the meaning of risk to older people in residential aged care. This research provides new insight into the perceptions of residents regarding their individual autonomy and independence against legislated risk minimization strategies.
Presented and described in detail is a clinical technique called subjective global assessment (SGA), which assesses nutritional status based on features of the history and physical examination. Illustrative cases are presented. To clarify further the nature of the SGA, the method was applied before gastrointestinal surgery to 202 hospitalized patients. The primary aim of the study was to determine the extent to which our clinician's SGA ratings were influenced by the individual clinical variables on which the clinicians were taught to base their assessments. Virtually all of these variables were significantly related to SGA class. Multivariate analysis showed that ratings were most affected by loss of subcutaneous tissue, muscle wasting, and weight loss. A high degree of interobserver agreement was found (kappa = 0.78, 95% confidence interval 0.624 to 0.944, p less than 0.001). We conclude that SGA can easily be taught to a variety of clinicians (residents, nurses), and that this technique is reproducible.
To validate a nutritional intervention programme for elderly people living in nursing homes.
In a prospective, randomized, controlled study of 88 residents, we determined nutritional status at day 0 and day 60 using a record of dietary intake, anthropometry, hand-grip strength and mini-nutritional assessment. Dietary intake, grip strength and body weight were also recorded at day 30. We divided subjects into four groups according to their mini-nutritional assessment score. Those with a score 24 received no oral supplementation. Those at risk of malnutrition (with a score of 17-23.5) were randomized to oral supplementation. Those with a score <17 received oral supplementation. We recorded the amount of oral supplements consumed daily.
Compliance with oral supplementation was good, and daily intake averaged about 400 kcal. The total energy intake on day 60 was significantly higher in both of the groups that received supplements. Following supplementation, most subjects at risk of malnutrition improved their mini-nutritional assessment score and increased their weight (by 1.4 +/- 0.5 kg). Neither the mini-nutritional assessment score nor weight improved in subjects at risk of malnutrition who did not receive supplements. Supplementation in the malnourished group resulted in a mean mini-nutritional assessment score increase (from 13.9 +/- 2.6 to 17.1 +/- 3.9) and a mean weight gain of 1.5 +/- 0.4 kg.
Oral nutritional supplements are well accepted and result in increased daily protein and energy intake, body weight and nutritional status in most malnourished patients and in those at risk of malnutrition.
Good nutrition promotes health-related quality of life (HRQOL) by averting malnutrition, preventing dietary deficiency disease
and promoting optimal functioning. However, definitions of quality of life also encompass life satisfaction and both physical
and mental well-being. Nutrition and diet have not been a part of mainstream research on quality of life and are not included
among key quality of life domains. This article explores connections between diet and nutritional status in relation to HRQOL
measures and overall well-being among older adults.
To evaluate the Subjective Global Assessment (SGA) and the Mini Nutritional Assessment (MNA) with regard to validity using a combination of anthropometric and serum-protein measurements as standard criteria to assess protein-energy malnutrition (PEM).
Cross-sectional study with consecutive selection of residents aged >or=65 y.
A municipality in the south of Sweden.
During a year, starting in October 1996, 148 females and 113 males, aged >or=65-104 y of age, newly admitted to special types of housing for the elderly, were included in the study.
According to SGA, 53% were assessed as malnourished or moderately malnourished on admission. The corresponding figure from MNA was 79% malnourished or at risk of malnutrition. Both tools indicated that anthropometric values and serum proteins were significantly lower in residents classified as being malnourished (P<0.05). Sensitivity in detecting PEM was in SGA 0.93 and in MNA 0.96 and specificity was 0.61 and 0.26, respectively. Using regression analysis, weight index and serum albumin were the best objective nutritional parameters in predicting the SGA- and MNA classifications. Item 'muscle wasting' in SGA and 'self-experienced health status' in MNA showed most predictive power concerning the odds of being assessed as malnourished.
SGA was shown to be the more useful tool in detecting residents with established malnutrition and MNA in detecting residents who need preventive nutritional measures.
Up to 85% of the older adults living in our nation's nursing homes suffer from protein-calorie malnutrition (PCM). Early identification and treatment of PCM can reduce or prevent hospital stays, reduce complications, and decrease mortality. We describe the influence of PCM on quality of life in nursing homes, using archived data from the Minimum Data Set.
The study was guided by the Quality Nutrition Outcomes-Long Term Care Model, which posits a pathway whereby organizational issues influence nutritional status, consisting of body mass index (BMI), serum albumin levels, and prealbumin levels, and subsequent quality of life, morbidity, and health care utilization. A cross-sectional design was used to analyze Minimum Data Set assessment data already collected from a previous study. The sample for this analysis was 311 nursing home residents, aged 65 years or older, who lived in three nursing homes in eastern Washington.
Of the participants, 38.6% were malnourished. PCM (measured by BMI) influenced quality of life for these residents in that there was a significant relationship between BMI and functional status (eating, personal hygiene, and toilet use) and BMI and psychosocial well-being (initiative or involvement, unsettled relationships, and past roles). Depression was not a significant indicator of low BMI in these nursing home residents.
Low BMI, indicating PCM, was found to negatively influence quality of life in this study. Understanding the relationship between quality of life and PCM could lead to improved quality of life for older adults in nursing homes and guide future innovative intervention studies aimed at preventing PCM.
To investigate the prevalence and risk factors of malnutrition in geriatric patients admitted to a convalescent and rehabilitation hospital.
Cross-sectional study.
Regional hospital, Hong Kong.
A total of 120 patients (aged 60 years or older) referred to Tung Wah Eastern Hospital.
Anthropometric, biochemical, and haematological parameters were measured for nutritional assessment. Malnutrition was defined as a body mass index of lower than 18.5 kg/m(2) and serum albumin level of lower than 35 g/L. The clinical outcomes of patients were also recorded. The predictive value of the Chinese Mini Nutritional Assessment as a nutritional screening tool was assessed. Potential risk factors associated with malnutrition were evaluated according to established protocols.
The mean age of patients was 80.3 years (standard deviation, 7.4 years), and the mean body mass index was 21.9 kg/m(2) (standard deviation, 4.4 kg/m(2)). The prevalence of malnutrition was 16.7%. The age distribution of malnourished patients (mean, 86.2 years; standard deviation, 7.0 years; n=20) was significantly different to those nourished (mean, 79.1 years; standard deviation, 6.9 years; n=100) [P=0.0001]. Mortality was also higher in malnourished patients (25%) than nourished patients (4%) [P=0.001]. Based on the Chinese Mini Nutritional Assessment, 16.9% of patients were classified as malnourished (cut-off value, 18.5). The Chinese Mini Nutritional Assessment was useful as a screening tool to exclude patients who were not malnourished, ie it had a high negative predictive value (95%). Being totally dependent for the performance of activities of daily living, living in a home for the elderly, and being chair- or bed-bound posed a significantly increased risk of malnutrition. The presence of mental depression (geriatric depression scale score of 8 or higher), moderately or severely impaired cognitive function (abbreviated mental test score of lower than 7), or polypharmacy (five medications or more) did not significantly affect risk of malnutrition.
Malnutrition was common in the geriatric patients studied and was associated with an increased mortality. The Chinese Mini Nutritional Assessment was a useful screening tool to exclude malnutrition. Significant risk factors of malnutrition were total dependence, living in a home for the elderly, and being chair- or bed-bound.
Malnutrition is a common and often unrecognized problem in elderly persons. Every health evaluation in this population should include an assessment of nutritional status. The Mini Nutritional Assessment (MNA) is a thoroughly validated and easily used assessment tool that can detect malnourishment or the risk of malnourishment before clinical signs and allow early intervention before symptoms manifest.
Dietary, biochemical and anthropometric data indicate good nutritional status, in general, in community-dwelling, healthy elderly people, at least in the USA. In a sample of 209 men over 65 years of age without acute disease-related nutritional risk factors, mean intake of nutrients generally met or exceeded the recommended dietary values, with the exception of calories, although 7% of subjects consumed inadequate amounts of thiamine, vitamin A, vitamin C and calcium. Few subjects were extremely underweight or obese, although body fat, as assessed by skinfold thickness, fell over the two years of evaluation. The prevalence of malnutrition in patients with chronic disease living in the community in the UK is estimated to be around 8%, however. In this study of more than 11 000 men and women aged 18 years or over, consultation rates in general practice and prescription rates were lowest amongst patients with a body-mass index between 20 and 25. Hospital outpatient referral rates were not related to nutritional status, but both hospital admission rates and mortality were greatest in people with a body-mass index(BMI) (kg/m ² ) below 20, and declined as BMI increased.
Background: Protein‐energy malnutrition delays wound healing, extends length of stay, and increases complication rates. Identification of patients at risk of malnutrition, together with early intervention, may prevent further deterioration of nutritional status.
Objectives: Through the use of nutrition screening and assessment, prioritise nutrition intervention to those at greatest nutritional risk. To improve the consumption rate of nutritional supplements, using a ‘nutrition as medication’ program.
Methods: We assessed 200 acute aged care patients for malnutrition risk using the Mini Nutritional Assessment (MNA) tool (Nestle SA, Vevey, Switzerland) within 72 h of hospital admission. Patients ‘at risk’ or malnourished, received either mid meal supplements (control group) or 60 mL of a 2 kcal per ml supplement, given four times daily (trial group). Outcome measures included comparison of supplement consumption changes in MNA scores on fortnightly reassessment or discharge.
Results: Thirty per cent of patients were malnourished on admission, with a further 42%‘at risk’. Patient compliance with the ‘nutrition as medication’ program was excellent (95%) compared with current practice (48%). On reassessment patients in the trial group showed a trend towards a greater improvement in score for appetite ( P = 0.065), number of meals consumed ( P = 0.01) and protein intake ( P = 0.007). Improvement in score for weight was significant in the trial group ( P = 0.027). Length of stay was shorter in the trial group ( P = 0.044).
Conclusion: Routine use of a validated assessment tool is essential for early identification of malnutrition risk. A ‘nutrition as medication’ program is effective in attenuating deterioration in nutritional status.
Aim: To determine the prevalence of malnutrition in Queensland public acute and residential aged care facilities, and explore effects of variables associated with malnutrition in these populations.
Methods: A multicentre, cross‐sectional audit of a convenience sample of subjects was carried out as part of a larger audit of pressure ulcers in Queensland public acute and residential aged care facilities in 2002 and again in 2003. Dietitians in 20 hospitals and six aged care facilities conducted single‐day nutritional status audits of 2208 acute and 839 aged care subjects using the Subjective Global Assessment, in either or both audits. Subjects excluded were obstetric, same‐day, paediatric and mental health patients. Weighted average proportions of nutritional status categories for acute and residential aged care facilities across the two audits were determined and compared. The effects of gender, age, facility location and medical specialty on malnutrition were determined via logistic regression.
Results: A mean of 34.7 ± 4.0% and 31.4 ± 9.5% of acute subjects and a median of 50.0% and 49.2% of residents of aged care facilities were found to be malnourished in Audits 1 and 2, respectively. Variables found to be significantly associated with an increased odds risk of malnutrition included: older age groups, male (in residential aged care facilities), metropolitan location of facility and medical specialty, in particular, oncology and critical care.
Conclusion: Malnutrition is significant in public acute and residential aged care facilities in Queensland. Action must be taken to increase the recognition, prevention and treatment of malnutrition especially in high‐risk groups.
Evidence for the effectiveness of nutritional supplements containing protein and energy, often prescribed for older people, is limited. Malnutrition is more common in this age group and deterioration of nutritional status can occur during illness. It is important to establish whether supplementing the diet is an effective way of improving outcomes for older people at risk from malnutrition.
This review examined trials for improvement in nutritional status and clinical outcomes when extra protein and energy were provided, usually as commercial 'sip-feeds'.
We searched The Cochrane Library, MEDLINE, EMBASE, Healthstar, CINAHL, BIOSIS, CAB abstracts. We also hand searched nutrition journals and reference lists and contacted 'sip-feed' manufacturers.
Randomised and quasi-randomised controlled trials of oral protein and energy supplementation in older people, with the exception of groups recovering from cancer treatment or in critical care.
Two reviewers independently assessed trials prior to inclusion and independently extracted data and assessed trial quality. Authors of trials were contacted for further information as necessary.
Sixty-two trials with 10,187 randomised participants have been included in the review. Maximum duration of intervention was 18 months. Most included trials had poor study quality. The pooled weighted mean difference (WMD) for percentage weight change showed a benefit of supplementation of 2.2% (95% confidence interval (CI) 1.8 to 2.5) from 42 trials. There was no significant reduction in mortality in the supplemented compared with control groups (relative risk (RR) 0.92, CI 0.81 to 1.04) from 42 trials. Mortality results were statistically significant when limited to trials in which participants (N = 2461) were defined as undernourished (RR 0.79, 95% CI 0.64 to 0.97).The risk of complications was reduced in 24 trials (RR 0.86, 95% CI 0.75 to 0.99). Few trials were able to suggest any functional benefit from supplementation. The WMD for length of stay from 12 trials also showed no statistically significant effect (-0.8 days, 95% CI -2.8 to 1.3). Adverse effects included nausea or diarrhoea.
Supplementation produces a small but consistent weight gain in older people. Mortality may be reduced in older people who are undernourished. There may also be a beneficial effect on complications which needs to be confirmed. However, this updated review found no evidence of improvement in functional benefit or reduction in length of hospital stay with supplements. Additional data from large-scale multi-centre trials are still required.
Nutrition screening identifies individuals who are malnourished or at risk of becoming malnourished and who may benefit from nutrition support. The aim of this study was to develop a simple, reliable and valid malnutrition screening tool that could be used at hospital admission to identify adult acute patients at risk of malnutrition. The sample population included 408 patients admitted to an Australian hospital, excluding pediatric, maternity, and psychiatric patients. The ability of various nutrition screening questions to predict subjective global assessment (SGA) were examined in contingency tables. The combination of nutrition screening questions with the highest sensitivity and specificity at predicting SGA was termed the malnutrition screening tool (MST), and consisted of two questions regarding appetite and recent unintentional weight loss. Subjects who were at risk of malnutrition according to the MST had significantly lower mean values for the objective nutrition parameters (except immunologic parameters) and longer length of stays than subjects who were not at risk of malnutrition. Therefore convergent and predictive validity of the MST was established. The interrater reliability of the malnutrition screening tool was high (93-97%). The MST is a simple, quick, valid, and reliable tool which can be used to identify patients at risk of malnutrition.
Malnutrition is an important predictor of morbidity and mortality. In the non-elderly, a subjective global assessment (SGA) has been developed. It has a high inter-rater agreement, correlates with other measures of nutritional status, and predicts subsequent morbidity. The purpose of this study was to determine the validity and reproducibility of the SGA in a group of patients older than 70 y of age. Consecutive patients from four geriatric/rehabilitation units were considered for the study. Each patient underwent independent nutritional assessments by a geriatrician and senior medical resident. At the completion of the assessment, skinfold caliper measurements were obtained and the patient reclassified according to the results, which were then compared with objective measures of nutritional status. Six-month follow-up was obtained on all patients. The agreement between the two clinicians was 0.48 +/- 0.17 (unweighted kappa), which represents moderate agreement and is less than the reported agreement in nonelderly subjects. Skin calipers improved the agreement between clinicians but did not improve the correlation with other nutritional markers or prediction of morbidity and mortality. There was a correlation between a patient's severely malnourished state and mortality. In addition, patients with a body mass index (BMI) of <75% or >150% age/sex standardized norms had an increased mortality. The SGA is a reproducible and valid tool for determining nutritional status in the elderly. The reproducibility is less than in the nonelderly, which may relate to changes in body composition or ability to obtain an accurate nutritional history.
To assess how the dental status of older people affected their stated ability to eat common foods, their nutrient intake and some nutrition-related blood analytes.
Cross-sectional survey part of nation-wide British National Diet and Nutrition Survey: people aged 65 years and older. Data from a questionnaire were linked to clinical data and data from four-day weighed dietary records. Two separate representative samples: a free-living and an institutional sample. Seven-hundred-and-fifty-three free-living and 196 institution subjects had a dental exam and interview.
About one in five dentate (with natural teeth) free-living people had difficulty eating raw carrots, apples, well-done steak or nuts. Foods such as nuts, apples and raw carrots could not be eaten easily by over half edentate (without natural teeth but with dentures) people in institutions. In free-living, intakes of most nutrients and fruit and vegetables were significantly lower in edentate than dentate. Perceived chewing ability increased with increasing number of teeth. Daily intake of non-starch polysaccharides, protein, calcium, non-haem iron, niacin, vitamin C and intrinsic and milk sugars were significantly lower in edentate. Plasma ascorbate and retinol were significantly lower in the edentate than dentate. Plasma ascorbate was significantly related to the number of teeth and posterior contacting pairs of teeth.
The presence, number and distribution of natural teeth are related to the ability to eat certain foods, affecting nutrient intakes and two biochemical measures of nutritional status.
Purpose:
Malnutrition is a frequent and serious problem in the elderly. Today there is no doubt that malnutrition contributes significantly to morbidity and mortality in the elderly. Unfortunately, the concept of malnutrition in the elderly is poorly defined. The purpose of this paper is to clarify the meaning of malnutrition in the elderly and to develop the theoretical underpinnings, thereby facilitating communication regarding the phenomenon and enhancing research efforts.
Scope, sources used:
Critical review of literature is the approach used to systematically build and develop the theoretical propositions. Conventional search engines such as Medline, PsyINFO, and CINAHL were used. The bibliography of obtained articles was also reviewed and additional articles identified. Key wards used for searching included malnutrition, geriatric nutrition, nutritional status, nutrition assessment, elderly, ageing, and weight loss.
Conclusions:
The definition of malnutrition in the elderly is defined as following: faulty or inadequate nutritional status; undernourishment characterized by insufficient dietary intake, poor appetite, muscle wasting and weight loss. In the elderly, malnutrition is an ominous sign. Without intervention, it presents as a downward trajectory leading to poor health and decreased quality of life. Malnutrition in the elderly is a multidimensional concept encompassing physical and psychological elements. It is precipitated by loss, dependency, loneliness and chronic illness and potentially impacts morbidity, mortality and quality of life.
This study tested an evidence-based nutrition education program for licensed nurses working in nursing homes who scored an average of 56% on a pretest. Posttest scores averaged 66%, demonstrating a continuing deficit of basic nutritional knowledge despite the educational intervention. Statistical analysis revealed that less experienced nurses scored better on posttests than more experienced nurses; more experienced nurses performed nutritional assessment more often than less experienced nurses; and more experienced nurses were usually charge nurses or nurses completing Minimum Data Sets. Although the education did not eliminate all deficits in nutrition knowledge, a decrease in the percentage of residents with significant weight loss was noted.
Improvements in delivery systems for enteral feeding, in formulas, and in the understanding of complications have made the technology for enteral feeding easy to apply. Adequate nutrients can be delivered, and individual tolerance for feeding is acceptable. The remaining question is when to apply the technology. Formula selection should be as simple as possible. Aspiration and other early complications are a serious risk and are not diminished by route of feeding. Long-term enteral feeding is associated with a high complication rate, with high mortality, and may not be effective.
Anorexia and weight loss represent a major cause of morbidity and mortality. At present in the United States two effective anorectic agents are commonly used, namely, megestrol acetate and dronabinol. These two agents are compared in Table 1. In persons with a large excess cytokine production. megestrol acetate should be tried at a does of 800 mg per day for no longer than 3 months. Megestrol acetate should be administered with testosterone in men. It should be avoided in persons who are bed-bound because of the risk of deep vein thrombosis. Dronabinol should be used for most anorectic patients. Dronabinol should initially be given in a low dose (2.5 mg) in the evening. The dose should be increased to 5 mg per day if no improvement in appetite is seen after 2 to 4 weeks. Dronabinol can be continued indefinitely. It seems to have a particularly good profile for persons with anorexia who are at the end of life. In persons with depression and anorexia. mirtazapine seems to be the antidepressant of choice. In addition, the use of taste enhancers can be considered in persons who complain that the food does not taste good. The appropriate use of anabolic agents in older persons with weight loss is controversial. Certainly all older men who are losing weight should have bioavailable testosterone measured and, if the testosterone level is low, should receive testosterone replacement therapy. Women who are losing weight may benefit from the use of low-dose testosterone (eg, Estratest). Anabolic agents, such as oxandrolone, should be reserved for those who have profound cachexia. An approach to the management of anorexia and weight loss in older persons is given in Fig. 1. Thomas et al have provided a more complex algorithm the management of weight loss in nursing home residents.
In more than 10,000 elderly persons, the mean prevalence of malnutrition is 1% in community-healthy elderly persons, 4% in outpatients receiving home care, 5% in patients with Alzheimer's disease living at home, 20% in hospitalized patients, and 37% in institutionalized elderly persons. In community-dwelling elderly persons, the MNA detects risk of malnutrition and life-style characteristics associated with nutritional risk while albumin levels and the BMI are still in the normal range. In outpatients and in hospitalized patients, the MNA is predictive of outcome and cost of care. In home care patients and nursing home residents, the MNA is related to living conditions, meal patterns, and chronic medical conditions and allows targeted intervention. The MNA has been used successfully in follow-up evaluation of outcome, nutritional intervention, nutritional education programs, and physical intervention programs in elderly persons. The MNA-SF allows quick screening to determine a person's risk of malnutrition. Early detection of malnutrition is important to allow targeted nutritional intervention and should be a key component of the geriatric assessment. The MNA test is a simple, noninvasive, well-validated screening tool for malnutrition in elderly persons and is recommended for early detection of risk of malnutrition. The MNA, as a two-step procedure (screening with the MNA-SF followed by assessment, if needed, by the full MNA), is reliable and can be easily administered by general practitioners and by health professionals at hospital or nursing home admission for early detection of risks of malnutrition. The MNA has the following characteristics: * The MNA is a two step procedure: (1) the MNA-SF to screen for malnutrition and risk of mainutrition; (2) assessment of nutritional status with the full MNA. * The MNA is an 18-item questionnaire comprising anthropometric measurements (BMI, mid-arm and calf circumference, and weight loss) combined with a questionnaire regarding dietary intake (number of meals consumed, food and fluid intake, and feeding autonomy), a global assessment (lifestyle, medication, mobility, presence of acute stress, and presence of dementia or depression), and a self-assessment (self-perception of health and nutrition). The MNA-SF comprises 6 items from the 18. * The MNA is well validated. It correlates highly with clinical assessment and objective indicators of nutritional status (albumin level, BMI, energy intake, and vitamin status). * A low MNA score can predict hospital-say outcomes in older patients and can be used to follow up changes in nutritional status. * Because of its validity in screening and assessing the risk of malnutrition, the MNA should be integrated in the comprehensive geriatric assessment. * In more than 10,000 elderly persons, the prevalence of undernutrition assessed by the MNA is 1% to 5% in community-dwelling elderly persons and outpatients, 20% in hospitalized older patients, and 37% in institutionalized elderly patients.
It is reported that undernutrition in older hospitalized patients is commonly found, but estimates of its prevalence vary. It is also not clear which treatment approaches are best because poor methodology prevents comparison of outcomes between different studies.
The rationale of this observational study was to look at typical elder care wards in order to determine what food supplements were being prescribed. We wished to determine whether serum albumin and/or body mass index (BMI) were appropriately related to the prescription of sip feeds and also to determine the palatability of supplements provided.
We monitored the wastage of sip feeds over a 24-hour period and extrapolated an estimated cost. Ninety-six patients were studied, including 23 patients with a BMI of less than 20, of whom 30% were on supplementary feeds.
Seventy percentage of prescribed sip feeds were being given to people with a BMI of 20 or more. The mean wastage in this 24-hour period was 63% ( pound 79.56) in four wards containing 96 older patients.
We concluded that there was no relationship between the numbers of patients with a low albumin and BMI and the prescription of sip feeds. We found compliance to be low (37%) because of poor palatability, with a large number of patients who appeared to require sip feeds not being prescribed them and those who received them wasting more than they drank.
Undernutrition has significant implications for patients' clinical condition and economical consequences for the NHS. However, due to continually increasing prescribing costs for sip feeds, treating undernutrition is often seen as very costly. An audit project in Lothian was undertaken to look at the appropriateness of sip feeds being prescribed. The project found there was a significant level of inappropriate prescribing with 30% of patients having their prescriptions for supplements stopped as they were deemed unnecessary. In view of this, the community dietitians involved developed and introduced a nutritional care pathway to allow a systematic and evidence-based approach to the identification and treatment of undernutrition.
Malnutrition represents an underestimated danger in the elderly population. It is found frequently and casually during admissions to our subacute care nursing homes (abbreviated from the Italian name: "Residenza Socio-Assistenziale" = RSA) when patients are treated for other types of disorders. During a period of 24 months, in our RSA, we found that 93% of patients were malnourished or at risk of malnourishment at admission. Specific interventions allowed us to substantially improve the nutritional status of these patients.
Protein and energy supplementation in elderly people at risk from malnutrition admitted to hospital or in long-term care appears to be useful. The reviewers suggest that supplementation appears to produce a small but consistent weight gain. There may also be a beneficial effect on mortality and a shorter length of hospital stay. The reported acceptance of supplements was variable between trials, but overall appeared to be quite good. Relatively few adverse effects such as nausea or diarrhoea were reported. However there were problems of study design and quality and more evidence is required to confirm these findings, particularly as the data were too limited to suggest an improved quality of life, reduced morbidity or improved functional status.
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