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