Reasons for and against Nutritional Interventions. An Exploration in the Nursing Home Setting

Malnutrition (MN) is widespread in nursing homes. Sometimes, but not always, nutritional interventions (NIs) are made, and the reasons for or against NIs are unknown. The aim of this cross-sectional study was to describe these reasons for residents with and without MN according to nurses’ subjective judgement and according to objective signs of MN. The nutritional status of 246 nursing home residents was subjectively judged by nurses (MN, at risk of MN, no MN) and objectively assessed by body mass index (BMI), weight loss (WL), and low food intake. NIs (enriched meals and/or oral nutritional supplements) were recorded using a standardized questionnaire, and nurses’ main reasons for (not) giving NIs were obtained in an open question. Of the residents, 11.0% were subjectively malnourished, and 25.6% were at risk of MN; 32.9% were malnourished according to objective criteria. Overall, 29.7% of the residents received NIs, 70.4% of those with MN as assessed by the nurses, 53.0% of those with objective MN, and 11.0% and 18.0% of non-malnourished residents, respectively. Reasons for NIs most often stated were low intake (47.9%), WL (23.3%), and low BMI (13.7%). Reasons against NIs mostly mentioned were adequate BMI (32.9%) and sufficient intake (24.3%). The lack of NIs for residents with MN was partially—but not always—explained by valid reasons. As residents without MN frequently received NIs, criteria for both MN rating and providing NIs, require closer scrutiny.

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Do malnutrition, sarcopenia and frailty overlap in nursing-home residents?

Journal of Frailty & Aging ◽

10.14283/jfa.2020.45 ◽

2020 ◽

pp. 1-5

Author(s):

G. Faxén-Irving ◽

Y. Luiking ◽

H. Grönstedt ◽

E. Franzén ◽

Å. Seiger ◽

...

Keyword(s):

At Risk ◽

Nursing Home ◽

Nursing Home Residents ◽

Nutritional Supplements ◽

Cross Sectional ◽

Increased Risk ◽

European Working ◽

Oral Nutritional Supplements ◽

Protein Rich ◽

Study Setting

Objectives: To study the prevalence and overlap between malnutrition, sarcopenia and frailty in a selected group of nursing home (NH) residents. Design: Cross-sectional descriptive study. Setting: Nursing homes (NH). Participants: 92 residents taking part in an exercise and oral nutritional supplementation study; >75 years old, able to rise from a seated position, body mass index ≤30 kg/m2 and not receiving protein-rich oral nutritional supplements. Measurements: The MNA-SF and Global Leadership Initiative on Malnutrition (GLIM) criteria were used for screening and diagnosis of malnutrition (moderate or severe), respectively. Sarcopenia risk was assessed by the SARC-F Questionnaire (0-10p; ≥4=increased risk), and for diagnosis the European Working Group of Sarcopenia in Older People (EWGSOP2) criteria was used. To screen for frailty the FRAIL Questionnaire (0-5p; 1-2p indicating pre-frailty, and >3p indicating frailty), was employed. Results: Average age was 86 years; 62% were women. MNA-SF showed that 30 (33%) people were at risk or malnourished. The GLIM criteria verified malnutrition in 16 (17%) subjects. One third (n=33) was at risk for sarcopenia by SARC-F. Twenty-seven (29%) subjects displayed confirmed sarcopenic according to EWGSOP2. Around 50% (n=47) was assessed as pre-frail or frail. Six people (7%) suffered from all three conditions. Another five (5%) of the residents were simultaneously malnourished and sarcopenic, but not frail, while frailty coexisted with sarcopenia in 10% (n=9) of non-malnourished residents. Twenty-nine (32%) residents were neither malnourished, sarcopenic nor frail. Conclusions: In a group of selected NH residents a majority was either (pre)frail (51%), sarcopenic (29%) or malnourished (17%). There were considerable overlaps between the three conditions.

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Indicators of oral nutritional supplements prescription in nursing home residents: A cross-sectional study

Clinical Nutrition ◽

10.1016/j.clnu.2015.07.015 ◽

2016 ◽

Vol 35 (5) ◽

pp. 1047-1052 ◽

Cited By ~ 4

Author(s):

Charlotte Dupuy ◽

Philipe de Souto Barreto ◽

Anne Ghisolfi ◽

Sophie Guyonnet ◽

Béatrice Dorigny ◽

...

Keyword(s):

Nursing Home ◽

Nursing Home Residents ◽

Nutritional Supplements ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Oral Nutritional Supplements

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Early Multidrug Outpatient Treatment of SARS-CoV-2 Infection (COVID-19) and Reduced Mortality Among Nursing Home Residents

10.1101/2021.01.28.21250706 ◽

2021 ◽

Author(s):

Paul E Alexander ◽

Robin Armstrong ◽

George Fareed ◽

Kulvinder K. Gill ◽

John Lotus ◽

...

Keyword(s):

At Risk ◽

Nursing Home ◽

Early Treatment ◽

Therapeutic Option ◽

Nursing Home Residents ◽

The Elderly ◽

Hospital Treatment ◽

Home Setting ◽

Inhaled Steroids ◽

Nursing Home Setting

AbstractThe outbreak of COVID-19 from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread all over the world with tremendous morbidity and mortality in the elderly. In-hospital treatment addresses the multifaceted nature of the illness including viral replication, cytokine storm, and endothelial injury with thrombosis. We identified nine reports of early treatment outcomes in COVID-19 nursing home patients. Multi-drug therapy including hydroxychloroquine with one or more anti-infectives, corticosteroids, and antithrombotic agents can be extended to seniors in the nursing home setting without hospitalization. Data from nine studies found multidrug regimens relying on the use of hydroxychloroquine as well as other agents including doxycycline were associated with a statistically significant and >60% reductions in mortality. Going forward, we theorize and based on the evidence, that early empiric treatment for the elderly with COVID-19 in the nursing home setting (or similar congregated settings with elderly residents/patients) has a genuine probability of success and acceptable safety. This group remains our highest at-risk group and warrants acute treatment focus that will prevent the development and/or worsening of problems associated with COVID-19, most particularly isolation, hospitalization, and death. In fact, with the rapidity and severity of SARS-CoV-2 outbreaks in nursing homes, in-center treatment of patients with acute COVID-19 is possibly the most rational and importantly feasible strategy to reduce the risks of hospitalization and death. If the approach remains ‘wait-and-see’ and elderly high-risk patients in such congregated nursing room type settings are allowed to worsen with no early treatment, they may be too sick and fragile to benefit from in-hospital therapeutics and are at risk for pulmonary failure, life-ending micro-thrombi of the lungs, kidneys etc. We put forth the notion that the most important factor in this regard, is making available early therapeutic intervention as described here. These drugs include and under supervision by skilled doctors, combination/sequenced ivermectin, hydroxychloroquine, colchicine, azithromycin, doxycycline, bromhexine hydrochloride, and favipiravir (outside the US), along with inhaled steroids such as budesonide and oral steroids including dexamethasone and prednisone, and anti-thrombotic anti-clotting drugs such as heparin). As the clinical trials data on treatments for COVID-19 mature, this early treatment therapeutic option deserves serious, urgent, and sober consideration by the medical establishment and respective decision-makers.

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74 GPs Knowledge of and Attitudes Towards the Management of Behavioural and Psychological Symptoms of Dementia: a Descriptive Cross Sectional Study

Age and Ageing ◽

10.1093/ageing/afz103.40 ◽

2019 ◽

Vol 48 (Supplement_3) ◽

pp. iii17-iii65

Author(s):

Aisling A Jennings ◽

Sheefah Bibi Fatimah Dhuny ◽

Tony Foley

Keyword(s):

General Practice ◽

Nursing Home ◽

Psychological Symptoms ◽

Cross Sectional Study ◽

Cross Sectional ◽

Home Setting ◽

People With Dementia ◽

Behavioural And Psychological Symptoms ◽

Nursing Home Setting ◽

Main Barrier

Abstract Background Evidence suggests that the current management of behavioural and psychological symptoms of dementia (BPSD) in general practice is sub-optimal. Non-pharmacological strategies are recommended first-line but uptake of these strategies is low. Despite their adverse effects and minimal effectiveness antipsychotics are frequently employed to manage BPSD. The aim of this study was to explore general practitioners (GPs) knowledge of and attitudes towards the management of BPSD with a view to informing future interventions. Methods A questionnaire was adapted from existing study. Additional questions were included, informed by the findings of a qualitative study previously conducted by the authors. The questionnaire was piloted with 3 GPs and was posted to a census sample of all GPs in county Cork and county Kerry in the south of Ireland. Statistical analysis was performed using SPSS. Results Of the 456 questionnaires sent 168 completed questionnaires were returned (36.8% response rate). The sample was representative of GPs nationally in terms of years of practice (p<0.0001). 62.5 % (105/168) of respondents had a nursing home commitment. The majority of GPs (60.7%) agreed that they required more training to improve their management of BPSD. ‘Lack of resources in the primary care team’ was cited as the main barrier to GPs recommending non-pharmacological strategies in the community. Nursing staff were identified as the group of people that most influenced the GPs prescribing of antipsychotic medications in a nursing home setting. The majority of respondents (84/168) did not monitor their prescribing of antipsychotics to people with dementia. 63.1% (106/168) of GPs were concerned that withdrawing these medications would negatively impact on the quality of life of the person with dementia. Conclusion This study identified several factors that influenced the management of BPSD in general practice. These findings will be used to guide future interventions in this area.

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Minerals Intake Distributions in a Large Sample of Iranian at-Risk Population Using the National Cancer Institute Method: Do They Meet Their Requirements?

International Journal for Vitamin and Nutrition Research ◽

10.1024/0300-9831/a000232 ◽

2015 ◽

Vol 85 (3-4) ◽

pp. 129-144 ◽

Cited By ~ 3

Author(s):

Zahra Heidari ◽

Awat Feizi ◽

Leila Azadbakht ◽

Nizal Sarrafzadegan

Keyword(s):

At Risk ◽

National Cancer Institute ◽

Population Based ◽

Cross Sectional Study ◽

Normal Function ◽

Dietary Intakes ◽

Middle Aged ◽

Cross Sectional ◽

Nutritional Interventions ◽

High Prevalence

Abstract. Background: Minerals are required for the body’s normal function. Aim: The current study assessed the intake distribution of minerals and estimated the prevalence of inadequacy and excess among a representative sample of healthy middle aged and elderly Iranian people. Methods: In this cross-sectional study, the second follow up to the Isfahan Cohort Study (ICS), 1922 generally healthy people aged 40 and older were investigated. Dietary intakes were collected using 24 hour recalls and two or more consecutive food records. Distribution of minerals intake was estimated using traditional (averaging dietary intake days) and National Cancer Institute (NCI) methods, and the results obtained from the two methods, were compared. The prevalence of minerals intake inadequacy or excess was estimated using the estimated average requirement (EAR) cut-point method, the probability approach and the tolerable upper intake levels (UL). Results: There were remarkable differences between values obtained using traditional and NCI methods, particularly in the lower and upper percentiles of the estimated intake distributions. A high prevalence of inadequacy of magnesium (50 - 100 %), calcium (21 - 93 %) and zinc (30 - 55 % for males > 50 years) was observed. Significant gender differences were found regarding inadequate intakes of calcium (21 - 76 % for males vs. 45 - 93 % for females), magnesium (92 % vs. 100 %), iron (0 vs. 15 % for age group 40 - 50 years) and zinc (29 - 55 % vs. 0 %) (all; p < 0.05). Conclusion: Severely imbalanced intakes of magnesium, calcium and zinc were observed among the middle-aged and elderly Iranian population. Nutritional interventions and population-based education to improve healthy diets among the studied population at risk are needed.

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Between Social Inclusion and Exclusion: Integration of Daycare Guests in the Nursing Home Setting

The Gerontologist ◽

10.1093/geront/gnaa157 ◽

2020 ◽

Author(s):

Kerstin Hämel ◽

Gundula Röhnsch

Keyword(s):

Nursing Home ◽

Social Inclusion ◽

Nursing Home Residents ◽

Community Dwelling ◽

Cognitive Capacity ◽

Home Setting ◽

Residential Care Facilities ◽

Care Approach ◽

Nursing Home Setting ◽

Close Relatives

Abstract Background and Objectives In integrated daycare, community-dwelling older people in need of care join existing groups in residential care facilities during the day. This study focuses on how nursing home residents experience the integrative care approach, exploring opportunities for social inclusion and mechanisms of exclusion. Research Design and Methods A purposive sample of residents differing in cognitive capacity and level of (non)conflictual interaction with daycare guests was selected. Episodic interviews with residents (N = 10) and close relatives (N = 2) were conducted in 3 pilot facilities in Germany and analyzed using thematic coding. Results The analysis revealed different orientation patterns towards the presence of daycare guests: respondents (a) demonstrated indifference to the daycare guests, (b) saw bonding with guests as a means to connect to the outside world, and (c) perceived incompatibility between in-group and out-group. Criticisms included disruption of daily routines and loss of privacy. Most interviewees came to terms with the care situation using rational and moral arguments. Discussion and Implications The study reveals the importance of residents’ participation when integrating daycare guests. Institutional procedures are required to prevent exclusion of daycare guests and avoid overtaxing residents.

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