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Malnutrition in elderly people in need of municipal care
Linköping University, Department of Medicine and Care, Nursing Science. Linköping University, Faculty of Health Sciences.
2002 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The aim of this thesis was to describe nutritional status in elderly people at the time of entering municipal care, to evaluate nutritional assessment techniques and to investigate the effect of a nutritional care plan. Furthermore the aim was to investigate the staffs' attitudes towards nutritional nursing care. A total of 261 residents, mean age 84 years (range 65-103 years), admitted to a community resident home in a municipality in the south of Sweden were included. At the same municipalities, 151 nursing staff responded to an attitude scale on two occasions with one year between.

During the first or second week after admission nutritional status was assessed using a combination of anthropometry and serum protein measurements as the criterion to define protein- energy malnutrition (PEM). This combination constituted the standard criterion when validity of the Subjective Global Assessment (SGA) and the Mini Nutritional Assessment (MNA) were evaluated. In 40 residents assessed as non-PEM on admission health problems were measured by the Nottingham Health Profile (NHP). To investigate the effect of a nutritional programme energy intake, anthropometry, serum protein measurements and functional capacity were assessed continuously during a five months period in 11 residents assessed as being PEM on admission. The nutritional programme consisted of meals based on individual energy requirements. An attitude scale was developed and used in order to measure whether the attitudes of nursing staff towards important issues within eating and nutrition changed after implementation of an educational programme.

On admission, 33% of 261 elderly people were assessed as being PEM. The frequency of pressure sores or leg ulcers, psychological stress or acute disease in the previous 3 months, reduced fluid intake, deteriorated appetite, reduced mobility, need of help during meals and gastrointestinal symptoms were significant higher in residents assessed as PEM compared with residents assessed as non-PEM. Both SGA and MNA proved to be useful in detecting residents objectively assessed as PEM. NHP, measuring health problems, showed power to predict residents at risk of malnutrition. Anthropometric measurements, serum protein concentration and functional capacity increased significantly in 11 residents assessed as PEM after 3 months on the individualised care programme. Nutritional education and implementation of a nutritional programme did not change the attitudes of nursing staff towards important nutritional issues.

In conclusion, at the time of entering municipal care a high frequency of residents assessed as PEM or at risk of PEM was found. The SGA and MNA were shown to be useful tools in detecting resident in need of nutritional attention. For early detection of residents at risk of malnutrition, measurement of health problems added important information. An individualised nutritional care programme was one useful approach to the improvement of nutritional status and functional capacity in residents assessed as PEM on admission. On the whole, nursing staff responded with positive attitudes towards nutritional nursing care. Nutritional education and implementation of a nutritional programme did not significantly change their attitudes.

Place, publisher, year, edition, pages
Linköping: Linköpings universitet , 2002. , 63 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 755
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-27471Local ID: 12124ISBN: 91-7373-197-8 (print)OAI: oai:DiVA.org:liu-27471DiVA: diva2:248023
Public defence
2002-11-22, Berzeliussalen, Hälsouniversitetet, Linköping, 09:00 (Swedish)
Opponent
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2012-09-18Bibliographically approved
List of papers
1. Malnutrition in elderly people newly admitted to a community resident home
Open this publication in new window or tab >>Malnutrition in elderly people newly admitted to a community resident home
1999 (English)In: The Journal of Nutrition, Health & Aging, ISSN 1279-7707, E-ISSN 1760-4788, Vol. 3, no 3, 133-139 p.Article in journal (Refereed) Published
Abstract [en]

The purpose of this study was to assess nutritional status in elderly people, newly admitted to a community resident home, and to describe the characteristics of residents with protein-energy malnutrition (PEM). The participants were 261 people, 65 to 103 years of age (M= 84.8+/-7.1 in women, 82.5+/-6.4 in men) who during one year entered special types of housing for the elderly in a municipality in the south of Sweden. During the first two weeks after admission nutritional status was assessed using weight index, triceps skinfold thickness, arm muscle circumference, serum albumin and transthyretin. Demographic and sociomedical data and eating-related factors were collected by using structured interviews and studying residents records. PEM was found in 29% of the residents who entered municipal care from their own homes, 33% among those moving within municipal care and 43% of the residents who entered from hospital care. Pressure sores or leg ulcers, psychological stress or acute disease in the previous 3 months, reduced fluid intake, deteriorated appetite, reduced mobility, need of help during meals and gastrointestinal symptoms were factors associated with PEM.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-81529 (URN)10823979 (PubMedID)
Available from: 2012-09-18 Created: 2012-09-18 Last updated: 2017-12-07Bibliographically approved
2. Evaluation of nutritional assessment techniques in elderly people newly admitted to municipal care
Open this publication in new window or tab >>Evaluation of nutritional assessment techniques in elderly people newly admitted to municipal care
2002 (English)In: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 56, no 9, 810-818 p.Article in journal (Refereed) Published
Abstract [en]

Objectives: 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).

Design: Cross-sectional study with consecutive selection of residents aged 65 y.

Setting: A municipality in the south of Sweden.

Subjects: During a year, starting in October 1996, 148 females and 113 males, aged 65-104 y of age, newly admitted to special types of housing for the elderly, were included in the study.

Results: 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.

Conclusions: 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.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-26841 (URN)10.1038/sj.ejcn.1601394 (DOI)11459 (Local ID)11459 (Archive number)11459 (OAI)
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13Bibliographically approved
3. Measurement of perceived health problems as a means of detecting elderly people at risk of malnutrition
Open this publication in new window or tab >>Measurement of perceived health problems as a means of detecting elderly people at risk of malnutrition
2003 (English)In: The Journal of Nutrition, Health & Aging, ISSN 1279-7707, E-ISSN 1760-4788, Vol. 7, no 4, 257-262 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND:

As nutritional preventative measures are more effective in elderly people assessed as non protein-energy malnourished (non-PEM) than such interventions are in those who are malnourished, early detection of those at risk of malnutrition is important.

OBJECTIVE:

This study tests the hypothesis that health problems measured by the Nottingham Health Profile (NHP) can predict residents at risk of malnutrition.

DESIGN:

Nutritional status was assessed in 261 residents newly admitted to municipal care using a combination of anthropometry and serum protein measurements. From this sample, 20 non-PEM residents, simultaneously assessed as moderately malnourished according to a subjective method, were consecutively included. Using a paired matched design, 20 other non-PEM residents, who were simultaneously subjectively assessed as well nourished, completed the pairs.

RESULTS:

Univariate logistic regression analyses showed that the dimensions of emotional reactions, energy, pain, physical mobility and sleep had significant power to predict residents at risk of malnutrition. In the multiple logistic regression analysis, energy had the highest explanatory power.

CONCLUSION:

Non-PEM residents, assessed as moderately malnourished according to the Subjective Global Assessment, perceived significantly greater health problems than non-PEM residents subjectively assessed as well nourished. Measurement of health problems adds important information to that used in early detection of residents at risk of malnutrition.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-26840 (URN)12917751 (PubMedID)11458 (Local ID)11458 (Archive number)11458 (OAI)
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13Bibliographically approved
4. Individually adjusted meals for older people with protein-energy malnutrition: a single-case study
Open this publication in new window or tab >>Individually adjusted meals for older people with protein-energy malnutrition: a single-case study
2001 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 10, no 4, 491-502 p.Article in journal (Refereed) Published
Abstract [en]

• The objective of this study was to investigate the effect of a 3-month intervention programme consisting of meals based on individual nutritional requirements in residents assessed as protein-energy malnourished on admission to a municipal care Institution.

• Using a single-case design, 11 malnourished residents were given individual care aimed at fulfilling their personal requirements for energy intake during a period of 12 weeks. The residents were selected from a sample of 261 newly admitted older adults of whom 87 were assessed to be malnourished on admission. Nutritional status, including anthropometric and biochemical variables and functional capacities were assessed before, during, and after the intervention. Energy intake was recorded every day. Body weight, and serum concentration of albumin and transthyretin were measured every other week.

•  During a 3-month period, the mean value of energy intake reached the calculated energy requirement in 10 residents. Eight residents increased in weight, triceps skin-fold thickness, and transthyretin concentration. Nine residents increased in arm muscle circumference, and 10 showed increased serum albumin concentration and functional capacity.

• We conclude that nursing care based on individual nutritional requirements, resources, and desires improves nutritional status and functional capacity in a group of malnourished residents.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-26838 (URN)10.1046/j.1365-2702.2001.00508.x (DOI)11456 (Local ID)11456 (Archive number)11456 (OAI)
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13Bibliographically approved
5. Attitudes of nursing staff towards nutritional nursing care
Open this publication in new window or tab >>Attitudes of nursing staff towards nutritional nursing care
2003 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 17, no 3, 223-231 p.Article in journal (Refereed) Published
Abstract [en]

Fulfilling nutritional requirements in residents with eating problems can be a challenge for both the person in need of help and for the caregiver. In helping and supporting these residents, a positive attitude is assumed to be as important as practical skill. The aim of this study was to test the hypothesis that nutritional education and implementation of a nutritional programme would change the attitudes towards nutritional nursing care among nursing staff with daily experience of serving food and helping residents in municipal care. The study was carried out as a before and after experimental design. An attitude scale, staff attitudes to nutritional nursing care (SANN scale), was developed and used. The response on the scale gives a total SANN-score and scores in five underlying dimensions: self ability, individualization, importance of food, assessment and secured food intake. Nursing staff at eight different residential units (n = 176) responded to the attitude scale and, of these, staff at three of the units entered the study as the experimental group. After responding to the attitude scale, nutritional education was introduced and a nutritional programme was implemented in the experimental units. One year later, attitudes were measured a second time (n = 192). Of these, 151 had also responded on the first occasion. Education and implementation of a nutritional programme did not significantly change attitudes. Overall, nursing staff responded with positive attitudes towards nutritional nursing care. Most of the positive attitudes concerned items within the dimension importance of food. In contrast, items within self ability showed the lowest number of staff with positive attitudes.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-24815 (URN)10.1046/j.1471-6712.2003.00226.x (DOI)7101 (Local ID)7101 (Archive number)7101 (OAI)
Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2017-12-13Bibliographically approved

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