Associations Between Nutritional Status,Frailty and Health-Related Quality of Life Among Older Long-Term Care Residents in Helsinki

The aim of this study was to examine how nutritional status modifies the association between frailty and health-related quality of life (HRQoL) among older nursing home residents. We also investigated how residents’ energy intake is linked to frailty score. A total of 486 older (> 65 years of age) nursing home residents living in Helsinki, Finland were included to this cross-sectional study. We collected data on the residents’ background information, HRQoL by 15D, nutritional status by Mini Nutritional Assessment (MNA), frailty status (Fried’s phenotype criteria; pre-frail: 1–2 criteria and frail: 3–5) and energy intake (one- or two-day food records). The frail residents were more often malnourished and had lower HRQoL than those in the prefrail group. Energy and protein intakes were significantly lower among frail women than prefrail women. Energy intake was linearly associated with frailty points. When residents in the frail and prefrail groups were divided according to their nutritional status, both nutritional status and frailty were associated with HRQoL, but there was no interaction. Both nutritional status and frailty were associated with HRQoL, and lower energy intake indicated a higher frailty score. An adequate energy intake may promote residents’ HRQoL and prevent frailty in long-term care.     

Cognitively impaired residents' risk of malnutrition is influenced by foodservice factors in long-term care

BACKGROUND: Several long-term care studies have shown that residents with dementia-related disorders are more prone to weight loss and malnutrition. Very few studies have investigated institutional characteristics, such as foodservice factors, and their possible link to malnutrition in this population. The objective of this study was to identify whether foodservice factors influence risk of malnutrition in cognitively impaired elderly nursing home residents. METHODS: Cognitively impaired residents meeting inclusion criteria and living within each of 38 participating nursing homes were randomly sampled. The final sample of 263 residents was screened for risk of malnutrition, and a questionnaire on participants' dining experiences was completed by primary caregivers. Additional data came from participants' medical charts, and a written questionnaire was completed by each institution's foodservice manager. Logistic regressions were used to examine relationships between risk of malnutrition and foodservice characteristics. RESULTS: Close to 70% of participants were at risk of malnutrition. Foodservice factors, including tray food delivery systems, timing of menu selection, difficulty manipulating dishes, lids and food packages, as well as therapeutic diets were all significantly associated with risk of malnutrition. CONCLUSIONS: Our findings suggest that many nursing homes could modify certain aspects of foodservices that may affect risk of malnutrition among cognitively impaired residents.     

Cognitively Impaired Residents' Risk of Malnutrition Is Influenced by Foodservice Factors in Long-Term Care

Abstract

Background. Several long-term care studies have shown that residents with dementia-related disorders are more prone to weight loss and malnutrition. Very few studies have investigated institutional characteristics, such as foodservice factors, and their possible link to malnutrition in this population. The objective of this study was to identify whether foodservice factors influence risk of malnutrition in cognitively impaired elderly nursing home residents.

Methods. Cognitively impaired residents meeting inclusion criteria and living within each of 38 participating nursing homes were randomly sampled. The final sample of 263 residents was screened for risk of malnutrition, and a questionnaire on participants' dining experiences was completed by primary caregivers. Additional data came from participants' medical charts, and a written questionnaire was completed by each institution's foodservice manager. Logistic regressions were used to examine relationships between risk of malnutrition and foodservice characteristics.

Results. Close to 70% of participants were at risk of malnutrition. Foodservice factors, including tray food delivery systems, timing of menu selection, difficulty manipulating dishes, lids and food packages, as well as therapeutic diets were all significantly associated with risk of malnutrition.

Conclusions. Our findings suggest that many nursing homes could modify certain aspects of foodservices that may affect risk of malnutrition among cognitively impaired residents.     

Cost-effectiveness of nutrition interventions in nursing home residents: A pilot intervention

Objectives  

Unintentional weight loss is a prevalent and costly clinical problem among nursing home (NH) residents. One of the most common nutrition interventions for residents at risk for weight loss is oral liquid nutrition supplementation. The purpose of this study was to determine the cost effectiveness of supplements relative to offering residents’ snack foods and fluids between meals to increase caloric intake.     

The influence of context on residents' evaluations: effects of priming on clinical judgment and affect

Different lines of research have suggested that context is important in acting and learning in the clinical workplace. It is not clear how contextual information influences residents’ constructions of the situations in which they participate. The category accessibility paradigm from social psychology appears to offer an interesting perspective for studying this topic. We explored the effect of activating medically irrelevant mental concepts in one context, so-called ‘priming’, on residents’ interpretations as reflected in their judgments in another, work-related context. Obstetric-gynecologic residents participated in two unrelated-tasks experiments. In the first experiment residents were asked to indicate affect about a change in a routine procedure after performing an ostensibly unrelated ‘priming’ task which activated the concept of either ineffective coping or effective coping. The second experiment concerned residents’ patient management decisions in a menorrhagia case after ‘priming’ with either action or holding off. Contextually activated mental concepts lead to divergent affective and cognitive evaluations in a subsequent medical context. Residents are not aware of this effect. The strength of the effect varies with residents’ level of experience. Context influences residents’ constructions of a work-related situation by activating mental concepts which in turn affect how residents experience situations. Level of experience appears to play a mediating role in this process.     

Measurement of overall quality of life in nursing homes through self-report: the role of cognitive impairment

Measuring quality of life is a necessity for adequate interventions. This paper concerns the usefulness of six self-report measures for overall quality of life for nursing home residents with various levels of cognitive impairment. It was investigated which proportion of residents from four cognition groups could complete a scale, and internal consistency and construct validity of the scales were studied. Data collection took place in ten Dutch nursing homes (N = 227). The proportion of residents that could complete each scale varied. The Depression List could be administered most often to the cognitively most impaired group (43%; Mini Mental State Examination-scores 0–4). In the three cognition groups with MMSE-score >5, internal consistency of the Depression List, Geriatric Depression Scale and Negative Affect Scale was adequate in all three groups (alpha ≥.68). Intercorrelation was highest for the Philadelphia Geriatric Center Morale Scale, the Depression List, and the Geriatric Depression Scale (rho ≥.65). Nonetheless, self-report scales were not strongly correlated with two observational scales for depression, especially in cognitively severely impaired residents (rho ≤.30). In conclusion, it may not be possible to measure overall quality of life through self-report, and possibly also through observation, in many nursing home residents.     

Sunbeam Program Reduces Rate of Falls in Long-Term Care Residents With Mild to Moderate Cognitive Impairment or Dementia: Subgroup Analysis of a Cluster Randomized Controlled Trial

ObjectivesThe Sunbeam trial significantly reduced falls in long-term aged care (LTC) residents. The current study's primary objective was to undertake subgroup analysis of the Sunbeam trial, to determine whether the intervention was effective for reducing falls in LTC residents with mild-moderate cognitive impairment/dementia. Secondary objectives were to determine intervention effects on cognitive and physical function.DesignSubgroup analysis of a cluster randomized controlled trial (RCT).Setting and ParticipantsPermanent residents of LTC in Australia who participated in the Sunbeam trial with Addenbrooke's Cognitive Examination-Revised (ACE-R) scores <83 (Mini-Mental State Examination >14 = main trial inclusion criteria).MethodsOf 221 participants, 148 had an ACE-R <83 and were included in this study. Sixteen LTC residences (clusters) were randomized to receive either the Sunbeam program or usual care. The Sunbeam program involved two 1-hour sessions/week of tailored and progressive resistance and balance training for 25 weeks followed by a maintenance program (two 30-min sessions/week of nonprogressive exercise for 6 months). Assessments were conducted at baseline, 6 months, and 12 months. Falls were recorded using routinely collected data from the LTC incident management systems.ResultsRate of falls (50%) and risk of falls (31%), multiple falls (40%), and injurious falls (44%) were reduced in the intervention group. The intervention group had significantly better balance (static and dynamic) and sit-to-stand ability when compared with the control group at 6 months and significantly better dynamic balance at 12 months. There were no serious adverse events.Conclusions and ImplicationsThe Sunbeam Program significantly reduced falls and improved physical performance in cognitively impaired LTC residents. This is a novel and important finding, as many previous studies have excluded people with cognitive impairment/dementia and inconsistent findings have been reported when this population has been studied. Our findings suggest that progressive resistance and balance exercise is a safe and effective fall prevention intervention in LTC residents with mild-moderate cognitive impairment/dementia.     

A longitudinal evaluation of residents’ health outcomes in nursing homes and residential care homes in Taiwan

Purpose  

The role of nursing homes (NHs) and residential care homes (RHs) frequently overlaps in Taiwan, raising concerns about their level of care. This study aimed to investigate residents’ health outcomes in NHs and RHs 1 year after admission.     

Adapting “The Staff Attitudes to Nutritional Nursing Care scale” to geriatric nursing care

Objective  A positive attitude is assumed to be important in nursing staff’s help and support of elderly people during meals. As there is no specific tool for measuring staff’s attitudes regarding important issues within eating and nutrition, the SANN (Staff Attitudes to Nutritional Nursing Care) scale was developed. The scale was developed and tested in nursing staff working at resident homes, and the number of items was reduced from 63 to 19 with five underlying factors. The aim of this study was to describe how the SANN scale was adapted and tested in nursing staff working in different types of elderly care. Design: The raw 63-item version went through minor changes, and one unclear worded item was excluded. The changed raw 62-item version was answered by 188 nursing staff working at six hospital care clinics and 64 staff working at one resident home. Results  The analysis reduced the 62 items to 18, and the adapted scale was named the SANN-G scale, G standing for “geriatric care”. A rotated factor analysis gave a five-factor solution, explaining 54% of the variance. The scale achieved good internal reliability, with a Cronbach’s alpha of 0.83. Fourteen items fulfilled inclusion criteria in both the SANN and the SANN-G scales. Conclusion  The SANN-G scale is practicable for use in staff working in different types of elderly care. It can be used to explore existing attitudes and identify areas with a low degree of prevailing positive attitudes as well as to evaluate whether and how attitudes change after nutritional education and intervention.     

Stages of Consistent Condom Use,Partner Intimacy,Condom Use Attitude,and Self-Efficacy in African-American Crack Cocaine Users

This study examined how condom use attitude, self-efficacy, and partner intimacy related to five stages of consistent condom use. Interview data were collected from sexually active, heterosexual, African-American crack cocaine smokers (N = 366). Dependent measures assessed both the participants’ own responses and their perceptions about their last sex partner’s own personal condom use attitude and participants’ condom use self-efficacy expectations. Partner intimacy was assessed both as a continuous attitudinal and as a discrete relationship measure. Less than 10% were classified as consistent condom users. Two thirds of inconsistent users were in the Precontemplation (PC) stage. The contemplation (C) and preparation (P) stages were equal among the remainder of the inconsistent condom users. Higher partner intimacy reduced modestly readiness for consistent condom use. The stage but not the intimacy group was related to the condom use attitudes and self-efficacy measures. Last partners’ perceived own negative attitudes were significantly related to the stages of consistent condom use and was especially low in the action (A) and maintenance (M) stages. Participants’ own negative attitudes were unrelated to the stages. Of the self-efficacy measures, both participants’ performance and situational condom use self-efficacies increased significantly after the PC stage and were highest in the P, A, and M stages. However, situational self-efficacy accounted for most of performance self-efficacy variance. In sum, consistent condom use was rare. A partner’s attitudes and the participants’ own situational self-efficacy expectations, rather than intimacy, determined the readiness to adopt consistent condom use.     

Quality of life in long-term geriatric care: the dietitian's role

The dietitian plays a leadership role in improving the quality of life of nursing home residents. A better understanding of this role can strengthen practice in this area. This paper attempts to define the role of the dietitian in the nutritional care of the elderly in long-term care facilities. The impact of poor appetites, extended stays and nutrient requirements on menu planning and recipe development are discussed. Resident empowerment, improvement of the dining environment, evaluation of eating skills, and eating rehabilitation are proposed as new roles for the dietitian in the promotion of food consumption. The characteristics of nutritional assessment and therapeutic diets as they relate to long-term geriatric care are discussed.     

Association between residents’ perception of the neighborhood’s environments and walking time in objectively different regions

Objective The purpose of this study is to delineate the association between residents’ perception of the neighborhood’s environments and walking time in objectively different regions in Japan. Methods Two regions were selected as high and low walkable regions on the basis of differences in their residential density, mixed land use and street connectivity. The subjects in this study were participants in a health promotion program focused on walking sponsored by local governments. A questionnaire was sent to the participants asking about how their perception of the neighborhood’s environment related to walking, and the time spent walking per week. There were 237 residents from the high walkable region and 195 from the low walkable region who completed the study survey. Results The high walkable region had a larger residential density, a high mixed land use and a higher street connectivity than the low walkable region. Walking time, and the scores of the perception of the neighborhood’s environment for the high walkable region residents were significantly higher than those for the low walkable region residents. Thus, residents’ perception of the neighborhood’s environment generally reflected the actual physical environmental characteristics. Residents in the high walkable region whose scores for accessibility and aesthetics were high, spent significantly more walking time. Residents in the low walkable region whose scores for accessibility, safety, convenience and aesthetics were high, spent significantly more walking time. Conclusion The study results suggested that the neighborhood’s environment may influence daily walking time. The perceptions of the neighborhood’s environmental factors that correlate with walking times differ between the different regional physical environments. Therefore, to promote physical activity, the consideration of environmental factors unique to residents’ neighborhood’s environments is needed.     

Health effect of improved meal ambiance in a Dutch nursing home: a 1-year intervention study

BACKGROUND: The aim of this study was to determine the effect of an improved ambiance of food consumption on health and nutritional status of Dutch nursing home elderly residents (n = 38) in a 1-year intervention study. METHODS: A parallel group intervention study was performed. Improvement of ambiance focused on three points: (1) physical environment and atmosphere of the dining room, (2) food service, (3) organization of the nursing staff assistance. Dietary intake, biochemical indicators of nutritional and health status and quality of life (Sickness Impact Profile and Philadelphia Geriatric Center Moral Scale) were assessed at baseline and after 1 year of intervention. Body weight, used as an indicator of compliance and nutritional status, was assessed every 4 months. RESULTS: Twenty-two subjects completed the 1-year intervention trial. Mean body weight significantly increased (+3.3 kg, P < 0.05) in the experimental group (n = 12), not in the control group (-0.4 kg, P = 0.78; n = 10). Health status biochemical indicators and the SIP score remained stable in the experimental group, indicating relatively stable health conditions. On the contrary, negative changes in the control group suggested a decline in health status. Dietary intake, which was insufficient at baseline, increased in both groups. CONCLUSIONS: This study showed that improving the ambiance of food consumption is a non-negligible issue for improving nutritional status and stabilizing health of nursing home residents.     

Emotions generated by food in elderly French people

Eating behaviour depends partly on food preference, which may be determined by different types of emotions. Among the emotions generated by food, disgust and pleasure are common and can lead to increased and reduced food consumption. We tested the hypothesis that (1) elderly men and women felt different emotions towards food, and (2) low energy intake is related to negative emotions towards food. In February 2004, a convenience sample of elderly participants was recruited locally by telephone. Food intake of 52 elderly people, aged 63–80 years, was monitored throughout each day for one week and made it possible to assign the elderly people to two groups (low and high energy intake from food consumption data). One month later, each of them assessed their likes or dislikes towards 30 food pictures (vegetables, cheeses, fruits, starchy foods, sweets, meat, fish, offal and eggs) using 19 emotional words (eight words with a positive valence: ‘to like’, ‘thrilled’, ‘satisfaction’, ‘surprise’, ‘serene’, ‘amused’, ‘pride’, ‘interest’, and 11 other words with a negative valence: ‘disgust’, ‘indifference’, ‘guilt’, ‘uneasiness’, ‘nostalgia’, ‘impatience’, ‘doubt’, ‘frustration’, ‘embarrassment’, ‘disappointment’ and ‘lassitude’. The emotional intensities experienced with the different pictures were analysed by ANOVA for each group (men and women, small and big eaters). There were differences in likes and dislikes between men and women. Both guilty and liking scores towards food were generally higher in women than in men. Small eaters felt more doubt, unease, disappointment and indifference towards food than big eaters. In conclusion, the report of low food intake was related to more negative emotions towards foods that might be associated with the willingness to restrict food intake or to undernutrition.     

A questionnaire to examine food service satisfaction of elderly residents in long-term care facilities

The purpose of this study was to develop a survey tool for assessing the satisfaction of elderly long-term care (LTC) residents with the meals and food services they receive, as well as to assess quality of life issues related to eating. Food service delivery should be provided in an environment that fosters autonomy, interpersonal relations, and security. The questionnaire was administered as face-to-face interviews with 205 residents (> or = 65 years of age) of 13 LTC facilities in Saskatoon, Saskatchewan, Canada (participation rate = 67%). Residents expressed some concern with food variety, quality, taste, and appearance, and with the posting of menus. Quality of life issues were mostly positive; however, residents were less satisfied with areas related to their autonomy such as food choice and snack availability.     

Predictors of mortality in nursing home residents

A prospective cohort study was conducted to examine predictors of mortality in the nursing home. Participants were 399 long-term nursing home residents, who were followed up for 11 years at the end of which 380 had died, 16 were still alive, 2 were discharged with unknown status, and 1 was alive when discharged. The median duration from baseline to death was 2.75 years. For cognitively intact residents, male gender, larger number of medical diagnoses, and manifestations of physically nonaggressive agitated behaviors (e.g., restlessness, pacing) were significant predictors. For cognitively impaired residents, the significant predictors were older age, impaired activities of daily living, and screaming behavior at a high frequency. Cognitive impairment is important both in predicting death in this population and in understanding the impact of other predictors. The impact of agitated behaviors, quality of social relations, and appetite on mortality highlights issues of quality of life at the end of life.     

Defining Skilled Nursing Facility Residents’ Dining Style Preferences

The desire of skilled nursing facilities to increase quality of service to meet changes in residents’ expectations, improve marketability, and adhere to regulations warrant a new look at culture change and homelike dining as defined by residents in skilled nursing facilities (SNF). The objectives of this study were to determine residents’ home dining practices, to define residents’ desired dining style practices in the SNF, and to determine the relationship between home dining practices and dining preferences in SNF. One hundred and four residents in three SNF in the central Texas area who met the cognition criteria and consumed facility-provided food were engaged in a standardized interview using the Resident Dining Style Preferences Survey. Data were analyzed to determine the degree to which home practices determine SNF dining preferences. Our findings showed that the majority of the participants want hot, home cooked meals served in the dining room. They want to be seated at the table with friends and neighbors and served on every day plates in a quiet atmosphere, with food served restaurant or table service style. Length of stay and generational group were not significant predictors of dining style preferences. Study limitations included small sample size and lack of ethnic diversity. Our study results show that removing dining time restrictions may be the most valuable adaptation for a SNF looking to initiate culture change.     

Does Person-Centered Care Improve Residents' Satisfaction With Nursing Home Quality?

Objective

Person-centered care (PCC) is meant to enhance nursing home residents' quality of life (QOL). Including residents' perspectives is critical to determining whether PCC is meeting residents’ needs and desires. This study examines whether PCC practices promote satisfaction with QOL and quality of care and services (QOC and QOS) among nursing home residents.