Abstract
BackgroundPrevious studies have investigated process and structure indicators of nutritional care as well as their use in nursing homes (NHs), but the relative weight of these indicators in predicting the risk of malnutrition remains unclear.Aims of the present study are to describe the quality indicators of nutritional care in older residents in a sample of NHs in Tuscany, Italy, and to evaluate the predictors of protein-energy malnutrition risk.MethodsA cross-sectional survey was conducted in 67 NHs. Information was collected to evaluate quality indicators of nutritional care and the individual risk factors for malnutrition, which was assessed using the Malnutrition Universal Screening Tool. A multilevel model was used to analyse the association between risk and predictors.ResultsOut of 2395 participants, 23.7 % were at high, 11 % at medium, and 65.3 % at low risk for malnutrition. Forty-two percent of the NHs had only a personal scale to weigh residents; 88 % did not routinely use a screening test/tool for malnutrition; 60 % used some standardized approach for weight measurement; 43 % did not assess the severity of dysphagia; 12 % were not staffed with dietitians.Patients living in NHs where a chair or platform scale was available had a significantly lower risk of malnutrition (OR = 0.73; 95 % CI = 0.56–0.94). None of the other structural or process quality indicators showed a statistically significant association with malnutrition risk.ConclusionsOf all the process and structural indicators considered, only the absence of an adequate scale to weigh residents predicted the risk of malnutrition, after adjusting for case mix. These findings prompt the conduction of further investigations on the effectiveness of structural and process indicators that are used to describe quality of nutritional care in NHs.
Highlights
Previous studies have investigated process and structure indicators of nutritional care as well as their use in nursing homes (NHs), but the relative weight of these indicators in predicting the risk of malnutrition remains unclear
Assessment of malnutrition risk remains largely unapplied in NHs, despite the high prevalence, up to 85 %, of malnutrition among older persons living in this setting [9]
The risk of malnutrition was significantly associated with the following variables (Table 2): presence of severe dementia, being bedridden, poor language understanding and expression, impaired visual and hearing abilities, nervousness, physical impairment, cognitive impairment, feeding mode, place where meals were consumed on the day of the survey, age and functional ability related to eating
Summary
Previous studies have investigated process and structure indicators of nutritional care as well as their use in nursing homes (NHs), but the relative weight of these indicators in predicting the risk of malnutrition remains unclear. A few recent studies have been conducted to describe and better understand the kind of services provided, at national and regional levels, to residents of Italian NHs with different levels and types of disabilities, and to assess the quality of these services [3,4,5]. Both the central government and regional authorities are taking actions and developing specific legislations to ensure quality of care and equity of access to older persons with disabilities and NHs residents across the whole nation [6,7,8]. Assessment of malnutrition risk remains largely unapplied in NHs, despite the high prevalence, up to 85 %, of malnutrition among older persons living in this setting [9]
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