Assessment of Body Composition and Dietary Intake in Nursing-Home Residents: Could Lessons Learned from the COVID-19 Pandemic Be Used to Prevent Future Casualties in Older Individuals?

The population of older adults, especially those living in the nursing homes, is growing. The sedentary lifestyle and possible poor nutrition in nursing homes place residents (NHRs) at risk for body composition impairments, malnutrition, and, subsequently, numerous chronic diseases. The aim of this study was to assess body composition (including body fluids) and dietary intake in NHRs. The association between osteosarcopenic adiposity syndrome (OSA) and its components, osteopenic adiposity (OA), sarcopenic adiposity (SA), and adiposity-only (AD), and specific macro- and micro-nutrients was evaluated as well. The study included 84 participants (82.1% women), aged 65.3–95.2 years. Body composition was assessed with an advanced bioelectrical impedance device BIA-ACC® and dietary intake was assessed via 24-h recall and analyzed using “Nutrition” software. The majority (95%) of participants were overweight with a high body fat and low muscle and bone mass, leading to a high prevalence of OSA (>50%), OA (13%), and AD (26%). There were only a few participants with SA, and they were not analyzed. The highest extracellular water/total body water ratio was observed in the OSA participants, indicating a heightened inflammatory state. Participants in all three body composition categories had a similar nutrient intake, with protein, fiber, omega-3 fatty acids, and almost all micronutrients being far below recommendations. In conclusion, a high prevalence of OSA among NHRs accompanied by a poor dietary intake, could place these residents at a very high risk for COVID-19 infections. Therefore, optimization of body composition and nutritional status should be included along with standard medical care in order to provide better health maintenance, particularly in the COVID-19 era.

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Assessing Body Composition and Dietary Intake of Nursing Home Residents (NHR): A Case for Concern

Current Developments in Nutrition ◽

10.1093/cdn/nzab033_027 ◽

2021 ◽

Vol 5 (Supplement_2) ◽

pp. 27-27

Author(s):

Irena Keser ◽

Selma Cvijetić ◽

Martina Knezović ◽

Jasna Jurasović ◽

Irena Colić Barić ◽

...

Keyword(s):

Body Composition ◽

Nursing Home ◽

Dietary Intake ◽

Body Fat ◽

Saturated Fatty Acids ◽

Nursing Home Residents ◽

Volumetric Bone Mineral Density ◽

Mineral Density ◽

Funding Sources ◽

High Prevalence

Abstract Objectives Elderly are at the highest risk for COVID-19 infections. The risk is heightened among NHR for several reasons, including unhealthy body composition and poor nutrition. Previously, we showed high prevalence of osteosarcopenic adiposity (OSA; concomitant osteoporosis, sarcopenia and adiposity) in NRH. Objective of this study was to assess body composition and dietary intake of NHR in one Croatian nursing home. Methods Participants, n = 84 (81.2 ± 6.8 y), were 82.1% females. Body composition, assessed with bio-impedance, BIA-ACC (BioTekna®, Marcon, Italy), yielded fat, lean/muscle tissue and volumetric bone mineral density (BMD g/cm3). Dietary intake, estimated via 24-hour recall, was analyzed with “Nutrition” (Infosistem, d.d., Croatia). All NHR signed the informed consent. Results Both women and men were overweight with corresponding BMI of 29.6 ± 5.2 and 27.2 ± 3.2 kg/m2 (P = 0.027). Women, compared to men, had higher body fat (42.1 ± 5.9% vs. 36.6 ± 5.4%; ranking as obese), but lower skeletal muscle (11.3 ± 3.3 kg vs. 17.3 ± 3.1 kg). The respective BMD (1.006 ± 0.012 vs. 1.018 ± 0.012 g/cm3) was also low (all P ≤ 0.001) influencing high OSA prevalence (>50%). There was no difference in energy and macronutrient intake between women and men. Protein (0.71 and 0.68 g/kg for women and men) and fiber (∼16 g/day) were below recommendation. Fat intake was ∼35% of energy, with high saturated fatty acids (∼14%); cholesterol was within recommendations. Most of the minerals (calcium, magnesium, potassium, iron) were below, while sodium and phosphorus were above recommendations for both women and men. About 42% women were taking vitamin supplements which increased the average intake above recommendations except for vitamin A. Men were below recommendations for all vitamins. Conclusions High body fat and low muscle and bone mass leading to high prevalence of OSA, as well as poor dietary intake placed these NHR at higher risk for COVID-19. Their diet should be planned with higher nutrient-dense food, particularly protein and multiple minerals and vitamins, possibly through intake of fresh foods/vegetables and/or supplements. Personalized diets and exercise should be implemented to prevent further weight gain and improve muscle and bones, to render them less susceptible to COVID-19 infections. Funding Sources None

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The Impact of Egg Consumption on Visual Cognitive Performance in the Nutrition, Vision, and Cognition in Health: Egg (IONHealth-Egg) Study

Current Developments in Nutrition ◽

10.1093/cdn/nzab033_003 ◽

2021 ◽

Vol 5 (Supplement_2) ◽

pp. 3-3

Author(s):

Karen Beathard ◽

Nicos Georghiades ◽

Rosemary Walzem ◽

Susanne Talcott ◽

Stephen Smith ◽

...

Keyword(s):

Dietary Intake ◽

Cognitive Performance ◽

Repeated Measures ◽

Dietary Intervention ◽

Consumption Pattern ◽

Older Individuals ◽

Omega 3 ◽

Egg Consumption ◽

The Impact ◽

Visual Cognitive

Abstract Objectives The purpose of this study is to evaluate the impact of the nutrients in eggs, specifically in the yolk, on the visual cognitive performance (VCP) in generally healthy older individuals. Methods Ninety-nine generally healthy men (36) and women (63) aged 50 to 75 years were assigned randomly to one of five dietary treatment groups: four egg whites; two whole regular eggs; two whole omega-3-fortified eggs; four egg yolks; and a no-egg control. Subjects were asked to maintain their usual dietary intake including the treatment modifications daily for 30 d. VCP was measured using the NeuroTracker™ CORE (NT) 3-Dimensional (3-D) software program (15 training sessions) during the final 2 wk of the study. Extensive secondary information including body composition, cardiovascular measures, sleep and exercise patterns, and general readiness to perform were also collected. Participants recorded food intake during the first 2 wk of treatment and each day they trained on the NT. Food logs were analyzed using Nutribase software. Statistical analyses were performed in SPSS using repeated measures ANOVA including significant covariates when appropriate. Results The dietary intervention was successful at creating distinct dietary intake differences for choline, lutein, omega-3 fatty acids and cholesterol (P < 0.01) between groups and improving VSP in all groups (+37%, P < 0.01). Additionally, men had significantly higher VSP (NTmean = 1.02 ± 0.33) than women (0.88 ± 0.27, P = 0.02), however, no dietary intervention differences were significant (P > 0.05). Conclusions Dietary and cognitive interventions were successful at altering dietary intake and improving cognitive performance respectively but no egg consumption pattern was superior in improving cognitive response. Funding Sources Egg Nutrition Center

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Examining Caregiver-Resident Communication and Apathy in Dementia in Nursing Homes During the COVID-19 Pandemic

Innovation in Aging ◽

10.1093/geroni/igab046.1202 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 310-310

Author(s):

Diane Berish ◽

Yo-Jen Liao ◽

Marie Boltz ◽

Ying-Ling Jao

Keyword(s):

Nursing Homes ◽

Data Collection ◽

Facial Expressions ◽

Nursing Home Residents ◽

Lessons Learned ◽

Daily Routines ◽

Video Recordings ◽

Vital Component ◽

Communication Approach ◽

The Impact

Abstract This presentation shares lessons learned from conducting a study examining the impact of staff caregivers’ communication approach on apathy in residents with dementia in nursing homes. Due to COVID-19 restrictions, this study had to be paused and required major revisions to continue, which resulted in significant delays and increased expenses. Additionally, this study required in-person data collection and video recordings to capture staff caregivers’ communication with residents with dementia during caregiving activities. However, due to the pandemic, nursing home residents’ daily routines have been significantly changed, making it challenging to capture the nature of caregiver-resident interactions. Furthermore, using masks created unforeseen barriers for capturing communication between staff caregivers and residents including difficulties in identifying residents’ facial expressions, which are a vital component of assessing apathy. The presentation describes approaches to communication with founders, collaborators, and clinical sites and discusses strategies to recruit participants and conduct data collection.

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Body Composition, Strength, and Dietary Intake of Patients with Hip or Knee Osteoarthritis

Canadian Journal of Dietetic Practice and Research ◽

10.3148/cjdpr-2015-037 ◽

2016 ◽

Vol 77 (2) ◽

pp. 98-102 ◽

Cited By ~ 6

Author(s):

Sarah Purcell ◽

Robert Thornberry ◽

Sarah A. Elliott ◽

Lynn Panton ◽

Michael J. Ormsbee ◽

...

Keyword(s):

Body Composition ◽

Knee Osteoarthritis ◽

Dietary Intake ◽

Grip Strength ◽

Hip Osteoarthritis ◽

Fat Free Mass ◽

Omega 3 ◽

Body Composition Assessment ◽

Wide Range ◽

Lower Grip

Purpose: To describe body composition (fat mass (FM) and fat-free mass (FFM)), strength, and nutritional characteristics of patients with hip or knee osteoarthritis undergoing total joint arthroplasty. Methods: In this prospective pilot study, osteoarthritic patients underwent body composition assessment using bioelectrical impedance analysis, grip strength measurement, and completed a 24-h dietary recall during their pre-operative assessment. Results: Fifty-five patients were included (∼66% females, age 43–89 years). Mean ± SD body mass index (BMI) was 32.79 ± 6.48 kg/m2 and 62% were obese. Compared with hip osteoarthritis patients, knee osteoarthritis patients had a higher BMI (P = 0.018) and males with knee osteoarthritis had a lower grip strength (P = 0.028). There was a wide range in FM and FFM values across the BMI spectrum. Patients with a higher FM index (FMI, FM/height in m2) had higher levels of pain (P = 0.036) and females with higher FMI had a lower grip strength (P = 0.048). Dietary under-reporting was common and many patients did not meet recommendations for protein, vitamins C and E, or omega-3 fatty acids. Those who consumed less protein than the recommended dietary allowance were older (P = 0.018). Conclusions: A wide variability of body composition and dietary intake was observed which may impact strength and ultimately affect physical function. As such, patients with osteoarthritis may benefit from targeted nutrition and physical activity interventions before and after surgery.

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Association of chronic stress, inflammation, body composition and dietary intake in Croatian university students

Proceedings of The Nutrition Society ◽

10.1017/s0029665120001408 ◽

2020 ◽

Vol 79 (OCE2) ◽

Author(s):

Irena Keser ◽

Selma Cvijetić ◽

Jasna Jurasović ◽

Irena Colić Barić ◽

Maja Kauzlarić ◽

...

Keyword(s):

Body Composition ◽

University Students ◽

Dietary Intake ◽

Chronic Stress ◽

Reference Value ◽

Animal Protein ◽

Fat Free Mass ◽

Low Grade ◽

Omega 3 ◽

T Score

AbstractIntroductionChronic stress and low-grade chronic inflammation (LGCI) influence body composition and are key underlying factors in health and disease. New syndrome, osteosarcopenic obesity (OSO), signifies the simultaneous impairment of bone, muscle, and adipose tissues and has been associated with poor diet and metabolic derangements. Hyperactivation of the hypothalamic-pituitary-adrenal (HPA) axis associated with hypercortisolemia and LGCI disrupts the metabolism of bone, muscle and, adipose tissue and may cause changes in eating behavior. Some nutrients involved in preventing/alleviating OSO and LCGI include protein, calcium, magnesium, vitamin D, fiber and omega-3 fatty acids. The aim of this study was to examine the relations between chronic stress, LGCI, body composition and dietary intake in university students.Materials and MethodsParticipants were n = 50 graduate nutritional students (Age, 23.0 ± 1.4 years; BMI, 22.1 ± 2.7 kg/m2) [n = 45 females (90%)]. Advanced bio-impedance devices, BIA-ACC® and PPG-StressFlow® (BioTekna S.r.l., Marcon-Venice, Italy), were used to determine total bone mass (kg) and T-score; muscle mass (kg and % fat free mass) and S-score; and fat mass (kg and % of body weight), as well as extracellular water and HPA index (reference value > 3.5) as indicators of underlying LGCI and stress. Dietary intake was estimated by 24-hour recall and analyzed for all macro- and micro-nutrients.ResultsPositive correlation was found between HPA index and the intake of either total or animal protein, calcium and riboflavin, with r ranging from 0.3–0.35, all p < 0.05. HPA index also positively correlated with T-score (r = 0.39, p = 0.005) and S-score (r = 0.49, p = 0.0003). Total protein intake positively correlated with T-score (r = 0.32, p = 0.024) and animal protein with S-score (r = 0.34, p = 0.017).DiscussionOur results show that chronic stress, LGCI and body composition were interrelated in this young population and possibly augmented by higher protein and calcium intake. Screening for body composition dyshomeostasis, chronic stress and LGCI using innovative, non-invasive devices, along with assessing intake of some crucial nutrients, may provide quick and useful health information enabling prevention or early treatment of some linked disorders.

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Age Related Visual Pathologies among Nursing Home Residents: An Evaluation of Light Conditions and Recording in Client Files

World Journal of Social Science Research ◽

10.22158/wjssr.v1n2p136 ◽

2014 ◽

Vol 1 (2) ◽

pp. 136 ◽

Cited By ~ 1

Author(s):

Marianne M. Sinoo ◽

Mirjam Van Tilborg ◽

Jos M. G. A. Schols ◽

Helianthe S. M. Kort

Keyword(s):

Nursing Homes ◽

Nursing Home Residents ◽

Light Conditions ◽

Eye Care ◽

Lighting Conditions ◽

Age Related ◽

High Prevalence ◽

Visual Problems ◽

Poor Lighting

Objective: Reflection on visual problems in nursing homes. Data Sources: Eye examinations, documented visual problems and illuminance levels. Study design: The optometric examinations and recorded visual problems were combined with illuminance data. Data collection: In seven nursing homes, 259 residents underwent an optometric examination. Their client records were analyzed for information regarding visual functioning. The illuminance data were ranked to set the quality of the lighting conditions. Principal findings: 50% of the referred residents had problems with cataracts, retinal problems (21%), suspected glaucoma (13%), and other pathologies (16%). The information was not current in 56% of the records. The quality of lighting conditions was low or moderate. Conclusion: The finding of poor lighting conditions in nursing homes in combination with a high prevalence of visual problems (with cataract found to be the most common age related pathology), stretches the need of enhanced awareness of eye care by professional caregivers.

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Association of body composition with functional capacity and cognitive function in older adults living in nursing homes

Current Aging Science ◽

10.2174/1874609814666210831155002 ◽

2021 ◽

Vol 14 ◽

Author(s):

Pinelopi Stavrinou ◽

George Aphamis ◽

Eleni Andreou ◽

Marios Pantzaris ◽

Christoforos Giannaki

Keyword(s):

Older Adults ◽

Body Composition ◽

Nursing Home ◽

Cognitive Function ◽

Nursing Homes ◽

Body Fat ◽

Functional Capacity ◽

Handgrip Strength ◽

Nursing Home Residents ◽

Sit To Stand

Objective: Older adults living in nursing homes have an increased risk of adverse outcomes. However, the role of body composition in vital health and quality of life parameters such as functional capacity and cognitive function is less studied in this group of older adults compared to community-dwelling counterparts. Objective: The aim of the present study was to examine the association of body composition with functional capacity and cognitive function in nursing home residents. Methods: Fifty-three older adults (82.8±7.3 years) were enrolled in this study and they underwent body composition evaluation, functional capacity and cognitive function measurements. Results: The results showed a high prevalence of obesity accompanied by functional capacity limitations and cognitive impairment in older adults living in nursing homes. Partial correlations, controlling for age, showed that body fat percentage was positively correlated with sit-to-stand-5 (r=0.310, p=0.025) and timed-up-and-go (r=0.331, p=0.017), and negatively correlated with handgrip strength test results (r=-0.431, p<0.001), whereas greater lean body mass was associated with better sit-to-stand-5 (r=-0.410, p=0.003), handgrip strength (r=0.624, p<0.001) and cognitive function performance (r=0.302, p=0.037). Conclusions: These important associations reinforce the need to develop effective healthy lifestyle interventions targeting both lean mass and body fat to combat functional and cognitive decline in nursing home residents.

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LESSONS LEARNED FROM NURSING HOME CIVIL MONETARY PENALTY PROJECTS

Innovation in Aging ◽

10.1093/geroni/igz038.2832 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S770-S770

Author(s):

Diana L Sturdevant ◽

Kathleen C Buckwalter

Keyword(s):

Nursing Home ◽

Quality Of Care ◽

Nursing Homes ◽

Nursing Home Residents ◽

Lessons Learned ◽

Federal State ◽

Future Research ◽

Term Care ◽

Home Setting

Abstract Nursing homes must comply with numerous federal/state regulations to receive Medicare and Medicaid funding. Failure to comply with these regulations can result in deficiency citations, and depending on the severity of the deficiency, a resulting Civil Monetary Penalty (CMP). Through the Centers for Medicare and Medicaid Services (CMS) Civil Monetary Penalty Reinvestment Program, CMP funds are reinvested to support activities that benefit nursing home residents and that protect or improve their quality of life or quality of care. This symposium presents some of the unique challenges, successes, failures, and surprise findings from CMP-funded nursing home quality improvement projects in two, predominantly rural Midwestern states: Oklahoma and Kansas. Dr. Williams presents findings of a pilot-study testing an adaptation of a successful family caregiver telehealth support intervention in the nursing home setting and implications for future research. Dr. Sturdevant shares successes, challenges, and unanticipated results from the “It’s Not OK to Fall” project, a comprehensive, 3 year fall prevention project implemented in Oklahoma nursing homes. Lastly, Ms. Round’s paper describes the implementation and findings of a Long-term Care Leadership Academy aimed at improving leadership and team building skills of three levels of nursing home staff, including Administrators/Directors’ of Nursing, RN/LPN charge nurses and certified nursing assistants. Discussant, Dr. Kathleen Buckwalter Ph.D., FAAN, RN, will discuss how principles of nursing home culture change provides a common framework for these projects and conclude by offering suggestions on how promotion of these principles might improve the quality of care provided by nursing homes.

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“Teleswallowing”: a case study of remote swallowing assessment

Clinical Governance An International Journal ◽

10.1108/cgij-06-2015-0020 ◽

2015 ◽

Vol 20 (3) ◽

pp. 155-168 ◽

Cited By ~ 6

Author(s):

Elaine Bidmead ◽

Tilly Reid ◽

Alison Marshall ◽

Veronica Southern

Keyword(s):

Nursing Home ◽

Nursing Homes ◽

Nursing Home Residents ◽

Cost Savings ◽

Lessons Learned ◽

Teaching Hospitals ◽

Speech And Language ◽

Structured Interviews ◽

Content Type ◽

Adoption Study

Purpose – Telemedicine has enabled speech and language therapists (SLTs) to remotely assess swallowing difficulties (dysphagia) experienced by nursing home residents. The new technique, “teleswallowing”, was designed by the Speech and Language Therapy Service at Blackpool Teaching Hospitals NHS Foundation Trust. It allows prompt assessment, avoiding potential risks of aspiration pneumonia, malnutrition, poor rehabilitation, increased hospital stays and reduced quality of life (Hinchey et al., 2005; Langmore et al., 1998). The purpose of this paper is to report on a second pilot of teleswallowing and the concomitant adoption study. Design/methodology/approach – The adoption study employed qualitative methods, including consultations with senior managers, semi-structured interviews with nursing home matrons/managers and nurses, two focus groups and semi-structured interviews with SLTs. The project clinical lead kept an activity log, which was used to estimate resource savings. Findings – Over a three-month period, six SLTs and 17 patients in five nursing homes participated in teleswallowing assessments. Teleswallowing benefited both patients and participating nursing homes. Better use of therapist time and cost savings were demonstrated and evidence showed that the service could be successfully scaled up. Despite this, a number of barriers to service transformation were identified. Originality/value – This is the first implementation of teleswallowing in the UK, but it has been used in Australia (Ward et al., 2012). The approach to engaging stakeholders to understand and address barriers to adoption is novel. The value lies in the lessons learned for future innovations.

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‘All We Have to Decide Is What to Do with the Time That Is Given to Us’ A Photovoice Study on Physical Activity in Nursing Homes

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18105481 ◽

2021 ◽

Vol 18 (10) ◽

pp. 5481

Author(s):

Dorothée Altmeier ◽

Ansgar Thiel ◽

Annika Frahsa

Keyword(s):

Physical Activity ◽

Nursing Homes ◽

Thematic Analysis ◽

Physical Inactivity ◽

Nursing Home Residents ◽

Social Environments ◽

Daily Work ◽

Stakeholder Groups ◽

Social Incentives ◽

High Prevalence

(1) Background: Despite high prevalence of physical inactivity and sedentariness among nursing home residents, research on the influence of environments on this topic remains scarce. This Photovoice study explores how structural and social environments relate to residents’ everyday physical activity (PA). (2) Methods: 27 residents, staff, and significant others conducted Photovoice in eight nursing homes in Germany to document factors facilitating or hindering PA. Photographs were discussed with the participants in eight focus groups and analysed using thematic analysis. (3) Results: 169 photographs (between 8 and 42per home) were categorized into three thematic groups: (1) ‘architectural challenges for PA promotion in nursing homes’; (2) ‘opportunities and limitations of using daily work equipment for PA promotion’; (3) ‘social incentives for PA promotion’. Photographs’ foci in the homes differed considerably between participant groups. Staff primarily chose environmental constructions and aids that they perceived to enable residents’ PA. Residents were more likely to express affections and emotions that would encourage them to be active. (4) Conclusions: PA promotion research in this setting should be sensitive to diverse perceptions of different stakeholder groups and existing power imbalances. Interventions are needed that integrate residents’ needs and train staff on how to consider residents’ perspectives.

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