Insights from a retrospective chart audit of oral nutrition supplement use in long-term care

The validity was determined for Minimum Data Set (MDS) 2.0 oral/nutrition status (Section K) items, used to identify long-term care residents at nutritional risk. A registered dietitian assessed 128 long-term care residents using standardized procedures, and used clinical judgment to provide a nutritional risk rating. Registered nursing staff completed the MDS assessments. Bivariate tests of association were used to assess the relationship between the dietitian rating and each Section K item. The sensitivity (Se) and specificity (Sp) of specific and combinations of variables were also determined. The MDS variables of dietary prescription (diet rx), supplement use, and swallowing problems were significantly associated with nutritional risk rating. Body mass index (BMI), calculated from MDS data, also was significantly associated with nutritional risk rating. The MDS trigger system, however, had poor Se and Sp. The best combination of variables included the presence of one or more of diet rx, supplement use, swallowing problem, or BMI <24 kg/m2 (Se=0.81, Sp=0.50). Although Section K items are associated with nutritional risk, Se and Sp analyses suggest that these items and this section require further refinement and validation before use as part of a referral mechanism.

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Calculating the True Costs of Food Service in Long-Term Care: Development of a Costing Methodology

Innovation in Aging ◽

10.1093/geroni/igaa057.291 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 88-88

Author(s):

Mikaela Wheeler ◽

Karen Abbey ◽

Sandra Capra

Keyword(s):

Long Term Care ◽

Systems Approach ◽

Food Service ◽

Term Care ◽

Oral Nutrition ◽

Total Cost ◽

Real Cost ◽

Future System ◽

Care Development

Abstract As population’s age and the need for long term care (LTC) increases, so too does the focus on the costs to provide that care. Providing food, oral nutrition supplements and meals, can be a considerable expense to a home. The objective of this research was to develop a valid foodservice costing tool (FCT), to calculate the real cost of providing foods and meals in LTC. Current costing methodologies are not specific to LTC and do not account for all costs of a foodservice, including staff, procurement and nutrition supplements. An initial tool was developed using the systems approach in conjunction with literature and professional knowledge. This was piloted in real world contexts, using volunteer LTC homes. Four iterations of the tool were completed to assess its feasibility in calculating costs and useability. Managers were interviewed after completing the tool to gather an understanding of how the tool was interpreted and to refine completion. Following feedback, the resulting tool consists of nine sections, measuring both costs incurred in meal production and service as well as analysis of staff workloads. Preliminary results show consistency between homes within Australia, indicating that the true cost is much higher than that reported in the literature to date. The development of a comprehensive, usable tool which captures the total cost of foodservice allows homes to accurately report and understand costs from a systems level. This information can be used to demonstrate cost effectiveness of a foodservice and the potential to justify and plan future system changes.

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Use of vitamin and mineral supplements in long-term care home residents

Applied Physiology Nutrition and Metabolism ◽

10.1139/h11-141 ◽

2012 ◽

Vol 37 (1) ◽

pp. 100-105 ◽

Cited By ~ 12

Author(s):

Navita Viveky ◽

Lynda Toffelmire ◽

Lilian Thorpe ◽

Jennifer Billinsky ◽

Jane Alcorn ◽

...

Keyword(s):

Older Adults ◽

Vitamin D ◽

Long Term Care ◽

Care Home ◽

Care Facility ◽

Dementia Diagnosis ◽

Term Care ◽

Supplement Use ◽

Supplement Usage

Vitamin–mineral supplementation may offer older adults health and cognition-related benefits but overuse may contribute to polypharmacy. We examined the prevalence of supplement usage in long-term care facility (LTC) residents (≥65 years of age). As cognition may be affected by nutrition, we also examined use in those with diagnosis of dementia and those with no dementia diagnosis. The prevalence of supplement usage and overall “pill count” from pharmaceutical use was assessed in 189 LTC residents and a subsample of 56 older adults with dementia diagnosis, respectively. Participants were residing in an LTC facility of a mid-size metropolitan area during 2009. The average use of supplements was 1.0 per day for all residents, with 35% taking vitamin D supplements, 20% multivitamins, and 26% calcium. Supplement use was similar (p ≥ 0.05) for those with dementia diagnosis (53%, average 2.0 per day) and for those without such diagnosis (45%, average 2.2 per day). Usage ranged between 1–6 supplements per day. In both of these groups, ∼73% of users were taking vitamin D. The number of prescribed medications ranged from 4 to 24 (average 10.2) in a subsample of residents whose supplement intake was 0 to 6 (average 2). These findings suggest an overall low rate of supplement use, with no significant differences (p ≥ 0.05) in use between residents with and without dementia diagnosis. However, some residents were at risk for supplement overuse.

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PTSD Symptoms and Dementia in Older Veterans Who are Living in Long-Term Care

Qualitative Health Research ◽

10.1177/10497323211061345 ◽

2021 ◽

pp. 104973232110613

Author(s):

Kim Ritchie ◽

Heidi Cramm ◽

Alice Aiken ◽

Catherine Donnelly ◽

Catherine Goldie

Keyword(s):

Posttraumatic Stress Disorder ◽

Posttraumatic Stress ◽

Health Care Providers ◽

Long Term Care ◽

Stress Disorder ◽

Care Providers ◽

Chart Audit ◽

Term Care ◽

Posttraumatic Stress Disorder Symptoms

Co-occurring posttraumatic stress disorder symptoms and dementia can result in increased symptoms, such as suspicion, aggression, and nightmares in Veterans that can be difficult to manage in long-term care environments. The objective of the study was to explore how the co-occurrence of posttraumatic stress disorder symptoms and dementia are understood in Canadian Veterans who are living in long-term care. A descriptive multiple case study was conducted in two Veteran long-term care facilities in Canada. Data collection consisted of semi-structured interviews with Veterans, their family caregivers, and health care providers, non-participant observation, and a chart audit. Three major themes emerged relating to symptom expression and care approach: a) symptoms are the same but different; b) differences in the complexity of care; and c) added dimensions involved in care. The results of this study contribute foundational information about co-occurring posttraumatic and dementia symptoms that can inform policy, care approaches, and potential interventions.

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The Last 48 Hours of Life in Long-Term Care: A Focused Chart Audit

Journal of the American Geriatrics Society ◽

10.1046/j.1532-5415.2002.50117.x ◽

2002 ◽

Vol 50 (3) ◽

pp. 501-506 ◽

Cited By ~ 102

Author(s):

Pippa Hall ◽

Cori Schroder ◽

Lynda Weaver

Keyword(s):

Long Term Care ◽

Chart Audit ◽

Term Care

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Institutional Issues

Voluntarily Stopping Eating and Drinking ◽

10.1093/med/9780190080730.003.0012 ◽

2021 ◽

pp. 229-240

Author(s):

David A. Gruenewald

Keyword(s):

Best Practice ◽

Long Term Care ◽

Shared Understanding ◽

Advanced Dementia ◽

Term Care ◽

Oral Nutrition ◽

Basic Care ◽

Institutional Issues ◽

Nutrition And Hydration

Increasingly, older adults wishing to avoid prolonged dying with dementia are completing advance directives to limit oral nutrition and hydration (ONH) in advanced dementia, but resistance to implementing these directives has arisen within the professional long-term care (LTC) community. Some “dementia directives” call for withholding or withdrawing assisted hand-feeding when specific thresholds are met during dementia’s progression. “Comfort feeding only” (CFO) has been suggested as a best practice in advanced dementia, but CFO may not be sufficient for those wishing to hasten death when advanced dementia develops. Of concern, some LTC facility residents desiring comfort-focused care may be harassed or coaxed to eat and drink by staff as part of “basic care.” It may be possible to identify areas of shared understanding between older people who fear living in advanced dementia and staff who find meaning in caring for demented people who appear to accept or even enjoy ONH.

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Working With Resistance and Encouraging Buy-In to New Programs

Perspectives on Gerontology ◽

10.1044/gero16.1.18 ◽

2011 ◽

Vol 16 (1) ◽

pp. 18-21

Author(s):

Sara Joffe

Keyword(s):

Long Term Care ◽

Term Care ◽

Optimal Outcomes ◽

Speech Language Pathologist

In order to best meet the needs of older residents in long-term care settings, clinicians often develop programs designed to streamline and improve care. However, many individuals are reluctant to embrace change. This article will discuss strategies that the speech-language pathologist (SLP) can use to assess and address the source of resistance to new programs and thereby facilitate optimal outcomes.

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Feeding Dependency Issues in the Long-Term Care Environment

Perspectives on Swallowing and Swallowing Disorders (Dysphagia) ◽

10.1044/sasd10.1.19 ◽

2001 ◽

Vol 10 (1) ◽

pp. 19-24

Author(s):

Carol Winchester ◽

Cathy Pelletier ◽

Pete Johnson

Keyword(s):

Long Term Care ◽

Term Care ◽

Care Environment

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