Nutritional status and mealtime experiences in elderly care recipients
Author: Saletti, Anja
Date: 2007-03-30
Location: Föreläsningssalen Birke Aulan, F-huset, plan 5, Karolinska Universitessjukhuset, Huddinge
Time: 09.00
Department: Institutionen för neurobiologi, vårdvetenskap och samhälle / Department of Neurobiology, Care Sciences and Society
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thesis.pdf (1.170Mb)
Abstract
Elderly people receiving municipal services and care are at risk for
malnutrition due to frailty and chronic diseases. In this work, the
nutritional status of elderly patients (>65 y) was evaluated in three
different populations. One population lived in various care settings,
i.e. service flats (SF), old peoples home (OPH), group living for
demented (GLD) and nursing homes (NH) (Study I). The other two
populations were free-living elderly receiving home nursing care (HNC)
(Study II) or home help services (HHS) (Study III). In the HHS population
we evaluated nutritional status and its relation to long-term mortality
and performed a reexamination in a sub-sample after three years. In study
IV qualitative interviews were performed in elderly people in SF and
NH/OPH about their experiences of food, mealtimes and appetite. Also a
repeated 24-hoursdietaryrecall was assessed and biochemical nutrition
markers analyzed. Altogether 1,305 elderly subjects (85 y, 73 % female)
were examined (I,II,III). Nutritional status was assessed by the Mini
Nutritional Assessment (MNA, 0-30 points), which consists of 18
point-weighted questions, including anthropometrics, e.g. body mass index
(BMI, kg/m2). After three years it was possible to register mortality in
224 of 353 subjects by examining Swedish population records (III). Of 64
subjects, 31 were possible to re-examine using the initial protocol
(III). In study IV 14 elderly were interviewed. It was possible to
collect data on food intake and blood tests of 11 persons.
According to the MNA, between 3% (HHS) and 71% (NH), with a mean of 26%
in the whole population were assessed as malnourished (MNA <17 points),
whereas none (NH) up to 51% (HHS), with a mean of 27% in the whole
population, were assessed as well nourished (MNA >24 points). The rest
were considered as at risk for malnutrition (MNA 17-23.5 points). A BMI <23
kg/m2 was found in 51% of the subjects, 25% had a BMI 24-26 and 24% had a
BMI >=27 (I, II, III). Chewing and swallowing problems, reduced appetite
as well as illness and feelings of depression were more often reported in
those at risk for malnutrition as compared to the well nourished
(p=0.001) (III). Fifty-four percent (28/58) of those who were assessed as
being malnourished or were suspected of being malnourished did not have
meals-on-wheels or other meal support (II). One-third received
meals-on-wheels service and two of three used one portion for several
meals (III). The three year mortality rate was 50% for the malnourished,
40% for those at risk for malnutrition and 28% for the well nourished
(p<0.05). Corresponding mortality figures were 45% for those with a BMI
of <23, 36% with a BMI of 23-28 and 22% with a BMI of >28, respectively
(p<0.05) (III). In study IV the six SF respondents expressed that they
were still able to have influence of their food intake and mealtimes.
They used various strategies to maintain independency and experienced
some degree of appetite. In contrast, the eight respondents living in
NH/OPH experienced lack of influence over their food and mealtimes and
lack of appetite. The dietary recalls indicated low intakes of energy and
nutrients which was not confirmed by biochemical analyses.
In conclusion, one-fourth of the subjects were assessed to be
malnourished, and almost half were at risk for malnutrition. The subjects
with MNA <23.5 points, i.e. malnourished and at risk of malnutrition
combined, reported a higher prevalence of eating problems during mealtime
than the well nourished. Malnutrition as assessed by the MNA and
underweight, i.e. a BMI <23 were associated with increased mortality.
Elderly people s opportunity to influence food and mealtimes needs to be
considered. Nutritional routines in the services and care for the elderly
still need more attention.
List of papers:
I. Saletti A, Lindgren EY, Johansson L, Cederholm T (2000). "Nutritional status according to mini nutritional assessment in an institutionalized elderly population in Sweden." Gerontology 46(3): 139-45
Pubmed
II. Saletti A, Johansson L, Cederholm T (1999). "Mini nutritional assessment in elderly subjects receiving home nursing care." J Hum Nutr Diet 12: 381-87
III. Saletti A, Johansson L, Yifter-Lindgren E, Wissing U, Osterberg K, Cederholm T (2005). "Nutritional status and a 3-year follow-up in elderly receiving support at home." Gerontology 51(3): 192-8
Pubmed
IV. Saletti A, Emami A, Cederholm T, Mattsson-Sydner Y (2007). "Old peoples experiences of food, mealtimes and appetite in various care settings." (Submitted)
I. Saletti A, Lindgren EY, Johansson L, Cederholm T (2000). "Nutritional status according to mini nutritional assessment in an institutionalized elderly population in Sweden." Gerontology 46(3): 139-45
Pubmed
II. Saletti A, Johansson L, Cederholm T (1999). "Mini nutritional assessment in elderly subjects receiving home nursing care." J Hum Nutr Diet 12: 381-87
III. Saletti A, Johansson L, Yifter-Lindgren E, Wissing U, Osterberg K, Cederholm T (2005). "Nutritional status and a 3-year follow-up in elderly receiving support at home." Gerontology 51(3): 192-8
Pubmed
IV. Saletti A, Emami A, Cederholm T, Mattsson-Sydner Y (2007). "Old peoples experiences of food, mealtimes and appetite in various care settings." (Submitted)
Issue date: 2007-03-09
Rights:
Publication year: 2007
ISBN: 978-91-7357-121-0
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