The purpose of this study was with a multifaceted intervention model improve the nutritional status of elderly people living in residential homes to increase their energy intake and to maintain improvements over time. less thanbrgreater than less thanbrgreater thanThree different municipal residential homes in the south-east of Sweden. less thanbrgreater than less thanbrgreater thanThe study population consisted of 67 elderly people. A within-subjects design was used which means that the participants were their own controls. less thanbrgreater than less thanbrgreater thanA multifaceted intervention model was chosen, which included education on both theoretical and practical issues, training and support for staff, and individualized snacks to the residents. less thanbrgreater than less thanbrgreater thanNutritional status was measured by Mini Nutritional Assessment (MNA), the consumption of food was recorded by the staff using a food record method for 3 consecutive days. The length of night-time fasting has been calculated from the food records. less thanbrgreater than less thanbrgreater thanNutritional status improved after 3 months of intervention and was maintained after 9 months. Weight increased during the whole study period. Night-time fasting decreased but not to the recommended level. less thanbrgreater than less thanbrgreater thanThis study shows that it is possible by a multifaceted intervention model to increase energy intake including expanding snacks and thereby improve and maintain nutritional status over a longer period in the elderly living in residential homes. This result was possible to achieve because staff received education and training in nutritional issues and by provision of support during a period when new routines were introduced.

OBJECTIVE:

The aim was to study the effect of individualised meals on nutritional status among older people living in municipal residential homes and to compare the results with a control group. An additional aim was to estimate direct health care costs for both groups.

SETTING:

Six different municipal residential homes in the south-east of Sweden.

PARTICIPANTS:

Older people living in three residential homes constituted the intervention group n=42 and the rest constituted the control group n=67.

INTERVENTION:

A multifaceted intervention design was used. Based on an interview with staff a tailored education programme about nutritional care, including both theoretical and practical issues, was carried through to staff in the intervention group. Nutritional status among the elderly was measured by Mini Nutritional Assessment (MNA), individualised meals were offered to the residents based on the results of the MNA. Staff in the control group only received education on how to measure MNA and the residents followed the usual meal routines.

MEASUREMENTS:

Nutritional status was measured by MNA at baseline and after 3 months. Cost data on health care visits during 2007 were collected from the Cost Per Patient database.

RESULTS:

Nutritional status improved and body weight increased after 3 months in the intervention group. Thus, primary health care costs constituted about 80% of the total median cost in the intervention group and about 55% in the control group.

CONCLUSION:

With improved knowledge the staff could offer the elderly more individualised meals. One of their future challenges is to recognise and assess nutritional status among this group. If malnutrition could be prevented health care costs should be reduced.

in developing countries, malnutrition among children is a major public-health issue. The aim of the study was to describe perceptions of Malawian nurses about nursing interventions for malnourished children and their parents. A qualitative method was used. Data were collected and analyzed according to the phenomenographic research approach. Twelve interviews were performed with 12 nurses at a rural hospital in northern Malawi, Southeast Africa. Through the analysis, two major concepts, comprising four categories of description, emerged: managing malnutrition today and promotion of a favourable nutritional status. The categories of description involved identification and treatment of malnutrition, education during treatment, education during prevention, and assurance of food security. The participating nurses perceived education to be the most important intervention, incorporated in all areas of prevention and treatment of malnutrition. Identification and treatment of malnutrition, education during treatment, education to prevent malnutrition, and assurance of food security were regarded as the most important areas of intervention.

Weight loss is a common problem in Parkinsons disease (PD), but the causative mechanisms behind this weight loss are unclear. We compared 2( PD patients with sex and age matched healthy controls. Examinations were repeated at baseline, after one and after two years. Body fat mass was measured by Dual X-ray Absorptiometry (DXA). Seventy three per cent of the PD patients lost body weight. Loss of body fat mass constituted a considerable part of the loss of body weight. In the patients who lost weight, serum leptin levels were lower than in those who did not lose weight. The relationship between low body fat mass and low leptin levels seems to be relevant, at least for female PD patients. It is reasonable to believe that low leptin levels in these patients could be secondary to the decreased body fat mass.

Objective - The objective of the present study was to find risk factors for low bone mineral density (BMD) in patients with Parkinson's disease (PD). Material and methods - Twenty-six PD patients and 26 age-and sex-matched healthy controls were assessed twice within a 1-year period. PD symptoms, body weight, body fat mass, BMD, physical activity, smoking and serum concentrations of several laboratory analyses were investigated. Results - BMD in different locations was lower in PD patients compared with their controls and decreased during the investigated year. BMD was lower in PD patients with low body weight. BMD Z-score of trochanter in the PD group was directly correlated to the degree of physical activity and indirectly to the length of recumbent rest. Total body BMD Z-score in the PD group was directly correlated to the degree of rigidity. Serum 25-hydroxy-vitamin D was slightly lower in PD patients. Conclusion - Low body weight and low physical activity were risk factors for low BMD in PD, while rigidity seemed to be protective. © 2007 The Authors.

Aim.  The aim of this paper was to investigate to what extent parkinsonian symptoms, including mild dysphagia and other eating problems, could influence the choice of consistency and the amount of food intake and if this could be related to weight loss as an expression of the underlying neurodegenerative process.

Background.  Previous studies show that patients with Parkinson's disease tend to lose body weight even early during the disease.

Design.  The design was a longitudinal prospective study.

Methods.  Twenty-six free-living Parkinson's disease patients and 26 age- and sex-matched controls were investigated twice, with one-year apart, with focus on Parkinson's disease symptoms, as well as swallowing function. Intake of food items and food consistency were assessed by food records, completed over three consecutive days at each investigation.

Results.  In patients with weight loss, motor symptoms, problems with activities of daily living and problems with eating, related to motor symptoms, increased and they had more dysphagia compared with their controls. They consumed lower amounts of fluid and solid food on both investigated occasions, compared with their controls. Multiple regression analysis showed that weight loss was associated with female gender, eating difficulties related to activities of daily living and preference towards soft food, but negatively correlated with age.

Conclusion.  Parkinson's disease patients with weight loss seemed to avoid solid food, partly because of eating difficulties. Eating problems, as well as weight loss, could be because of the underlying disease, even when it is not at an advanced stage.

Relevance to clinical practice.  Caring for patients with Parkinson's disease should not only include medical treatment, but also support for adequate food intake to prevent weight loss.

Background: Weight loss is reported frequently in patients with Parkinson´s disease also early during the disease.

Objective: To investigate food habits and nutrient intake in elderly Parkinson´s disease patients compared with matched controls, as well as to compare PD patients with and without weight loss.

Methods: Twenty-six elderly free-living patients with PD, and 26 sex- and age-matched healthy controls, were assessed twice with one year interval between. All food consumed was recorded over 3 consecutive days. Food habits were assessed with the Food Based Concept for Classification of Eating Episodes and intakes of energy and nutrients were calculated. PD symptoms, olfaction, swallowing function, daily activities and serum concentration of different nutri ents were investigated.

Results: After 1 year, the PD patients decreased their intakes of daily high quality snacks from 0.5 ± 0.7 to 0.3 ± 0.3 (p < 0.05) and their prepared complete meals from 0.8 ± 0.3 to 0.6 ± 0.3 (p < 0.05), while their daily number of prepared incomplete meals increased from 0.2 ± 0.2 to 0.3 ± 0.3 (p < 0.01). PD patients with weight loss increased their daily intakes of fat by 12 ± 34 g and their energy intake per kg body weight increased by 21 ± 31 kJ (p < 0.05), respectively, and this was higher than in those without weight loss (p < 0.01). PD patients required more help with buying and cooking food compared with the controls.

Conclusions: PD patients’ food habits changed so that they consumed a lower number of prepared complete meals. PD patients with weight loss had a higher intake of fat and energy than those without weight loss, although this was obviously not sufficient to prevent weight loss. Impaired absorption of fat in PD should be discussed.

Objective –  Many patients with Parkinson's disease (PD) lose weight also early during the disease. The objective of the study was to investigate possible causative factors for this loss.

Materials and methods –  In this report, 28 PD patients and 28 age- and sex-matched controls were repeatedly assessed with the focus on body weight, body fat mass, dysphagia, olfaction, physical activity, PD symptomatology and drug treatment.

Results –  Weight loss was seen in PD patients both before and during l-dopa treatment.

Conclusion –  The underlying disease could play a role, but our results also suggest that l-dopa per se could contribute to the weight loss.

The purpose of the present study was to investigate if smaller but energy and protein enriched meals could improve energy and nutrient intakes in elderly geriatric patients. Ten patients, between 77 and 87 years of age were included in the study, performed at a Geriatric rehabilitation ward. The first week after inclusion, the patients were offered a three days' standard hospital menu and the second week, a three days' energy and protein-enriched menu. The consumption of food and the fluid intake were recorded using a pre-coded food record book during both the menus and analysed by the Swedish National Food Administration. The patients' energy requirements were calculated according to the Nordic Nutrition Recommendation for elderly subjects. When the standard hospital menu was offered, six patients had lower energy intake, -67 to -674 kcal/day, than the calculated energy requirements. The daily energy intake increased by 37 %, with the energy and protein-enriched menu compared with the standard hospital menu. Furthermore, the daily intake of protein, fat, carbohydrate, certain vitamins and minerals was significantly higher with the energy and protein-enriched menu compared with the standard hospital menu. Conclusion: This study showed that the intake of energy and nutrients increased with the energy and protein-enriched menu in elderly patients on a geriatric rehabilitation ward. © The Journal of Nutrition, Health & Aging 2005.

The aim of this thesis was to investigate possible factors concerning weight loss in elderly patients with untreated, as well as treated Parkinson's disease (PD) and to compare PD patients with age and sex matched controls. Twenty-eight PD patients (15 newly diagnosed and 13 previously treated) and 28 sex and age matched controls were included in the study.

Data on body weight, body fat mass, lean body mass, PD symptoms, cognitive function, dysphasia, oral and dental state, resting energy expenditure, food habits, olfactory ability and physical activities were collected prospectively, and all variables were assessed repeatedly three times with one year between investigations: Baseline, year 1 and year 2. The previously treated PD patients and their controls were assessed twice, at year 1 and year 2. After one year, when the de novo PD patients had been optimally treated with L-dopa, the two groups of PD patients were combined into one group for the purpose of analysis.

Twenty-six of the PD patients were able to participate to the end of the study, and the results were compared with those of their 26 controls. The PD patients had lower housework activity, a longer period of daily rest, fewer could do their own food shopping and cooking and more patients had impaired olfaction and presence of dysphagia, both at year 1 and at year 2. At year two, the PD patients also had lower body weight, body fat mass, lean body mass, physical activity and mobility. The PD patients had a higher number of eating events, compared with the controls at year one, but at year two the patients consumed fewer high quality snacks than their controls. There were no significant differences between PD patients and their controls with regard to daily intakes of energy, protein, fat and carbohydrates.

Nineteen of the PD patients lost body weight between year one and year two. In the weight losing patients, the PD symptoms, L-dopa dosage, and energy intake (kcal/kg body weight) increased as did their daily recumbent rest, while their cognitive function decreased. Multiple regression analysis showed that women with low cognitive function were predisposed to weight loss. The consumption of solid food decreased.

Conclusion: Weight loss was common in PD patients, in spite of increased energy intake. Food habits changed toward a lower number of adequate foods and their intake of solid food decreased. It has to be discussed whether weight loss in PD patients is part of this neurodegenerative process and L-dopa treatment could contribute to the weight loss.