liu.seSearch for publications in DiVA
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • oxford
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Nutritional Intervention in Elderly People Admitted to Resident Homes
Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
2006 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The aim was to investigate the effects of an intervention, based on education given to staff and implementation of an individualized nutritional programme given to the residents, to compare assessments on admission with a previous study, and to perform diagnostic test and inter-rater reliability of the Mini Nutritional Assessment (MNA). A further aim was to identify and describe factors with regard to appetite among the residents.

Upon admission, and after a four month intervention period, residents were classified as being either protein energy malnourished (PEM), or not, based on anthropometry and biochemical measurements. On both occasions, the Activity Index and the Mini Mental State Examination were used. In order to identify individuals in need of nutritional care, the MNA was performed. Information about medical data was obtained. A total of 127 residents were consecutively admitted to eight resident homes in a municipality in Sweden. Three resident homes constituted the experimental unit (n = 68) and five the control unit (n = 59). Fifteen residents were interviewed using a qualitative method, to investigate what affects their appetite.

On admission 32 % of the residents were classified as PEM, which was similar to in the previous study. A higher frequency of residents in the present study had severe medical diseases and cognitive impairment, compared with the previous study, indicating changed admission criteria in the present study.

Between the experimental and the control groups, no differences were seen in any specific anthropometric or biochemical variable. Within the groups, statistically significant differences were seen, as the number of PEM residents in the experimental group decreased, and motor activity and overall cognitive function improved. In the control group, motor activity deteriorated. This indicates that the intervention improved nutritional status and functional capacity in the residents.

Diagnostic sensitivity was 73 % regarding MNA versus PEM, and 89 % regarding MNA short form (MNA-SF) versus MNA, which indicates a rather high degree of sensitivity in both tests. Inter-rater reliability of MNA, carried out by simultaneous assessments by registered nurses and researcher showed a moderate agreement of 62 % (kappa 0.41).

The interview study showed that the willingness to eat was what affected the residents´ appetite. The willingness to eat contains internal factors, dependent on mood and personal values, as well as external factors, dependent on wholesomeness, food, eating environment and meal fellowship. When planning and realizing residents´ nutritional care, factors affecting the residents´ appetite have to be taken into consideration.

In conclusion, the results show that it is important to implement and develop strategies for individual nutritional care, in order to prevent and treat malnutrition in elderly people, which is in line with recommendations given by the European Society of Parenteral and Enteral Nutrition (ESPEN) and with the Swedish goal of nursing actions.

Place, publisher, year, edition, pages
Institutionen för medicin och vård , 2006.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 951
Keyword [en]
Elderly people, resident homes, comparison, nutritional intervention, education, individualised care, inter-rater reliability, appetite, qualitative method
National Category
Nursing
Identifiers
URN: urn:nbn:se:liu:diva-7470ISBN: 91-85497-87-8 (print)OAI: oai:DiVA.org:liu-7470DiVA: diva2:22470
Public defence
2006-06-09, Berzeliussalen, Campus US, Linköpings Universitet, Linköping, 09:00 (English)
Opponent
Supervisors
Available from: 2006-09-28 Created: 2006-09-28 Last updated: 2009-08-23
List of papers
1. Nutritional Status in Elderly People Admitted to Community Residential Homes: Comparisons between two Cohorts
Open this publication in new window or tab >>Nutritional Status in Elderly People Admitted to Community Residential Homes: Comparisons between two Cohorts
2006 (English)In: Journal of Nutrition, Health and Aging, ISSN 1279-7707, Vol. 10, no 3, 232-238 p.Article in journal (Refereed) Published
Abstract [en]

The aim was to describe nutritional status and socio-demographic and medical data in people whowere newly admitted to community residential homes (cohort 2), and to compare the results with a previous studyperformed in the same municipality four years earlier (cohort 1). One hundred and twenty-seven people, 65 yearsof age, or older, newly admitted to residential homes in a municipality in the southern part of Sweden, wereconsecutively included. Nutritional status was assessed, using a combination of anthropometry and serum proteinmeasurements and by Mini Nutritional Assessment (MNA). The results showed that 32 % of the residents incohort 2 were assessed as protein-energy malnourished (PEM), compared with 38 % in cohort 1. Body massindex, psychological stress or acute disease, and reduced fluid intake were items in MNA which had power topredict PEM. Residents in cohort 2, diagnosed as having severe medical diseases, increased as well as residentswith neuropsychological problems. Simultaneously, the number living in residential homes decreased, ascompared to cohort 1. These differences indicate that the admission criteria have changed between cohorts 1 and 2.

Keyword
Elderly people, nutritional status, entering community care, comparison
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-14014 (URN)
Available from: 2006-09-28 Created: 2006-09-28 Last updated: 2009-06-08
2. Implementation of a Nutritional Programme in Elderly People Admitted to Resident Homes
Open this publication in new window or tab >>Implementation of a Nutritional Programme in Elderly People Admitted to Resident Homes
2009 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 23, no 3, 421-430 p.Article in journal (Refereed) Published
Abstract [en]

Aim: The aim was to test the hypothesis that education provided to staff regarding nutritional needs and individualizing nutritional care will improve the nutritional status and functional capacity of elderly people newly admitted to resident homes.

Design: Pre- and posttest, quasi experimental.

Setting: Resident homes.

Subjects: Sixty-two residents (20 men, 42 women) in the experimental group and 53 (14 men, 39 women) in the control group were consecutively included. Mean age was 85 years.

Methods: On admission and after 4 months, nutritional status was assessed using a combination of anthropometry (weight index, arm muscle circumference and triceps skinfold thickness) and biochemical measurements (serum albumin and transthyretin). Functional capacity and overall cognitive function were also assessed. In the experimental unit, the staff received education about nutritional needs and individualized nutritional care.

Results: After 4 months the number of residents assessed as protein energy malnourished decreased from 20 to seven in the experimental (p = 0.004), and from 17 to 10 in the control group (p = 0.1). In the experimental group, motor activity (p = 0.006) and cognitive function (p = 0.02) increased. In the control group, motor activity decreased (p = 0.02).

Conclusions: The results indicate that the intervention had effects, as the number of protein energy malnourished residents decreased in the experimental group and motor activity and cognitive function improved. No such improvements were seen in the control group.

Keyword
education, nutritional intervention, individualized care, elderly people, resident homes
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-14015 (URN)10.1111/j.1471-6712.2008.00632.x (DOI)
Available from: 2006-09-28 Created: 2006-09-28 Last updated: 2017-12-13
3. The two-step Mini Nutritional Assessment Procedure in Community Resident Homes
Open this publication in new window or tab >>The two-step Mini Nutritional Assessment Procedure in Community Resident Homes
2008 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 17, no 9, 1211-1218 p.Article in journal (Refereed) Published
Abstract [en]

Aims and objectivities: The aims were to test internal consistency and interrater reliability of Mini Nutritional Assessment during implementation of Mini Nutritional Assessment in community residential homes and to test sensitivity, specificity and diagnostic predictivity of Mini Nutritional Assessment-short form vs. Mini Nutritional Assessment.

Background: There is a need in clinical practice to assess nutritional status in older people and to identify those who could benefit from early intervention.

Methods: The two-step Mini Nutritional Assessment procedure (Mini Nutritional Assessment-short form and Mini Nutritional Assessment) was used in 127 older people admitted to eight residential homes. In three of those homes (A, B and C), registered nurses simultaneously performed the assessment procedure, after receiving education and training. The intention was to offer the registered nurses a tool for independent practice use.

Results: Internal consistency was 0·68 (Cronbach's alpha) (n = 127). In residential home A, B and C, the registered nurses carried out Mini Nutritional Assessment in 45 residents out of 68. The agreement level between the author's and the registered nurses' assessments was 62% (kappa 0·41). In residential home A, B and C, the agreement level was 89%, 89% and 44%, respectively. Sensitivity, specificity and diagnostic predictivity of Mini Nutritional Assessment-short form vs. Mini Nutritional Assessment were 89%, 82% and 92%, respectively.

Conclusions: The two-step Mini Nutritional Assessment procedure seems to be a useful tool to identify residents in need of nutritional interventions, despite the registered nurses not carrying out Mini Nutritional Assessment in all residents and the low agreement in residential home C. It indicates that to implement and use Mini Nutritional Assessment in nursing care demands the creating necessary staff resources, such as adequate staffing, sufficient education and continual supervision.

Relevance to clinical practice: Because of the high sensitivity of Mini Nutritional Assessment-short form and Mini Nutritional Assessment, Mini Nutritional Assessment-short form alone might be sufficient for practice use, as its simplicity might increase its usefulness.

Keyword
interrater reliability, nurses, nursing, nutritional status, resident homes, staff education
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-14016 (URN)10.1111/j.1365-2702.2007.02012.x (DOI)
Available from: 2006-09-28 Created: 2006-09-28 Last updated: 2017-12-13
4. The Willingness to eat: An investigation of appetite among elderly people
Open this publication in new window or tab >>The Willingness to eat: An investigation of appetite among elderly people
2004 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, Vol. 18, no 2, 120-127 p.Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to identify and describe factors of importance with regard to appetite among elderly people. A qualitative approach was used and the method was grounded theory. Fifteen elderly people were interviewed using a method with two overall questions. The results show that the willingness to eat plays a central role in appetite among elderly people. The appetite is a state on a sliding scale, from good to poor appetite. Factors affecting the appetite include six categories: mood, personal values, wholesomeness, food, eating environment and meal fellowship. When planning and realizing nursing actions concerning eating, the willingness to eat has to be observed. The desire within every individual has to be given consideration, including all factors as well as how they affect each other. The willingness to eat contains internal factors dependent on mood and personal values, as well as external factors dependent on wholesomeness, food, eating environment and meal fellowship. These factors contain qualitative dimensions, which affect elderly people's appetites as well as their quality of life to a varying extent. Through this, it can be seen that there is a connection between their desire or willingness to eat and their will to live.

Keyword
elderly people, nutritional status, appetite, qualitative method
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-14017 (URN)10.1111/j.1471-6712.2004.00259.x (DOI)
Available from: 2006-09-28 Created: 2006-09-28 Last updated: 2009-06-08

Open Access in DiVA

fulltext(335 kB)2640 downloads
File information
File name FULLTEXT01.pdfFile size 335 kBChecksum MD5
bcfce47522424d220710cbb928c95fe9e33fbea1a795a13256e30d6a83fa272abc6555af
Type fulltextMimetype application/pdf

Authority records BETA

Wikby, Kerstin

Search in DiVA

By author/editor
Wikby, Kerstin
By organisation
Nursing ScienceFaculty of Health Sciences
Nursing

Search outside of DiVA

GoogleGoogle Scholar
Total: 2640 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

isbn
urn-nbn

Altmetric score

isbn
urn-nbn
Total: 2567 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • oxford
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf