REDUCING MALNUTRITION IN ELDERLY HOMES...CONSEQUENCES: PATIENTS 4 • Increased duration of...

Prof. dr. Dimitri Beeckman University Centre for Nursing and MidwiferyGhent University, Belgium

Nele Van Dammedr. Bianca BuijckEdwig Goossens

Project in cooperation withCentre for GastrologyLeuven, Belgium

REDUCING MALNUTRITION IN ELDERLY HOMES:THE GASTROLOGICAL APPROACH

BACKGROUND

• Undernutrition, often featured by underweight and/or involuntaryweight loss, is a frequent problem in institutionalized elderly, which can lead to increased risk of morbidity and mortality

• A gastrological approach, with focuses on people’s food preferences and needs may help to improve food intake and prevent undernutrition in institutionalized elderly

STILL A PROBLEM?

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Kaiser MJ, et al. Frequency of malnutrition in older adults: a multinational perspective using the mini nutritional assessment. J Am Geriatr Soc. 2010 Sep;58(9):1734-8.

N = 4507 (+65 years)Multinational

1.Belgium2.Switzerland3.Germany4.Italy5.Sweden6.Spain7.France8.the Netherlands9.the United States, 10.South Africa11.Japan12.Australia

CONSEQUENCES: PATIENTS

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• Increased duration of hospitalisation (6.9 ± 7.3 days vs. 4.6 ± 5.6 days, p<0.001)

• Increased risk of re- hospitalisation after 15 days of discharge (RR=1.9, 95% CI 1.1–3.2, p=0.025)

• Significant higher costs (p=0.014)• Significant higher mortality:

o 1 year (34% vs. 4.1 %)o 2 year (42.6% vs. 6.7%)o 3 year (48.5% vs. 9.9%)

• Significant predictor for death (OR= 4.4, 95% CI 3.3–6.0, p<0.001)

Lim SL, et al. Malnutrition and its impact on cost of hospitalization, length of stay, readmission and 3-year mortality. Clin Nutr. 2012 Jun;31(3):345-50.

Study:•N= 818 adults, 29% malnourished•Results adjusted for gender, age, ethnicity, and matched for disease-related group

CONSEQUENCES: BUDGETS

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Economic impact for Belgium and the Netherlands

• The Netherlands (nursing homes):

o 279 milion EURO extra/yearo At risk: 8.000 EURO/residento Malnourished: 10.000

EURO/resident

• Belgium (hospitals):

o Cost increase upto + 1.152 EURO/patient

CONSEQUENCES: QOL

Kvamme JM, Olsen JA, Florholmen J, Jacobsen BK. Risk of malnutrition and health-related quality of life in community-living elderly men and women: the Tromsø study. Qual Life Res. 2011 May;20(4):575-82.

Study:•N= 1,632 men; 1,654 women aged 65 to 87 years (Norway)•Cross- sectional design•Risk assessment using MUST tool

AIM

• The aim of this study was to evaluate food satisfaction and intake after managing food quality in a gastrological approach among elderly living in nursing homes

METHODS

• A gastroteam was established to implement, evaluate and adjust agastrological approach throughout the six month of intervention

• Individual preferences and needs of the residents were assessed

• Chefs were trained to apply the principles of a gastrological approach in preparing tasty and nutritious meals

• Communication procedures of caregivers and kitchen staff were improved to facilitate direct feedback

METHODS

• Two residential facilities in the Netherlands and Belgium participated in the study (November 2013 - October 2014)

• The Food and Food Service Questionnaire (FoodEx-LTC) was used twice (pretest-posttest design) to measure residents’ satisfaction with food and food service

• During the intervention period, food intake and satisfaction were assessed monthly using a four-point Likert scale during five days

• Residents were screened on (risk of) under-nutrition using the Malnutrition Universal Screening Tool (MUST)

RESULTS

• A total of 154 residents, with a mean age of 85 (± 7) years participated in the study

• Pre and post measurements with FoodEx-LCT indicated that enjoyment of food, satisfaction with meal service and cooking significantly increased after the intervention (p<0,05)

RESULTS

• At baseline 69 residents were scored for malnutrition, of whom 13% were at risk of malnutrition. Among residents with both pre-and post measurements available (n=34), the risk for malnutrition decreased significantly (p=0.033)

RESULTS

• There was also a significant increase in food intake of the main dish (p= 0.021) and dessert (P=0.001)

• Post-test data showed a significant positive correlation between food intake and:

o Enjoying the soup (r= 0.408 p= 0.001)

o Mean dish (r= 0.349 p= 0.001)

o Dessert (r= 0.166 p= 0.001)

CONCLUSION

• This study showed that improving meal quality in elderly homes based on individual food preferences and needs of the residents can increase food satisfaction and food intake

• The gastrological approach helps to prevent undernutrition amonginstitutionalized elderly

• A tailored approach is need at different levels:

• Individual resident/patient: selective taste steering • Organization• Regions (differences in eating cultures)

Dimitri.Beeckman@UGent.be

REDUCING MALNUTRITION IN ELDERLY HOMES:THE GASTROLOGICAL APPROACH