Abstract
BackgroundMalnutrition is a risk factor for impaired functionality and independence. For optimal treatment of malnourished older adults (OA), close collaboration and communication between all stakeholders involved (OA, their caregivers and health‐care and welfare professionals) is important. This qualitative study assesses current collaboration and communication in nutritional care over the continuum of health‐care settings and provides recommendations for improvement.MethodsEleven structured focus group interviews and five individual interviews took place in three regions across the Netherlands from November 2017 until February 2018, including OA, caregivers and health‐care and welfare professionals. Various aspects of collaboration and communication between all stakeholders were discussed. Interviews were transcribed and analysed using a thematic approach.ResultsSix main themes emerged: causes of malnutrition, knowledge and awareness, recognition and diagnosis of malnutrition, communication, accountability and food preparation and supply. Physical and social aspects were recognized as important risk factors for malnutrition. Knowledge and awareness regarding malnutrition were acknowledged as being insufficient among all involved. This may impair timely recognition and diagnosis. Responsibility for nutritional care and its communication to other disciplines are low. Food preparation and supply in hospitals, rehabilitation centres and home care are below expected standards.ConclusionMany stakeholders are involved in nutritional care of OA, and lack of communication and collaboration hinders continuity of nutritional care over health‐care settings. Lack of knowledge is an important risk factor. Establishing one coordinator of nutritional care is suggested to improve collaboration and communication across health‐care settings.
Highlights
19% of the total Dutch population is aged 65 years and older, and this percentage is expected to rise to 26% in 2040.1,2 Longevity is not by definition associated with healthy ageing
A recent study based on SCREEN II found that over 80% (n = 2470) of Dutch community-dwelling OA (CDOA) has more than one nutritional risk factor,[6] such as eating alone, difficulties doing groceries, poor appetite and mobility limitations
The study was judged by the HAN Ethical Advisory Board, and they advised that no further ethical approval was necessary, as ‘The study does not fall within the remit of the Medical Research Involving Human Subjects Act (WMO)’
Summary
19% of the total Dutch population is aged 65 years and older, and this percentage is expected to rise to 26% in 2040.1,2 Longevity is not by definition associated with healthy ageing. A recent study based on SCREEN II found that over 80% (n = 2470) of Dutch CDOA has more than one nutritional risk factor,[6] such as eating alone, difficulties doing groceries, poor appetite and mobility limitations. These nutritional risk factors are common in older age and can lead to a decreased nutritional status and eventually malnutrition.[7]. General practice proves the opposite.[13] Ideally, nutritional care and malnutrition prevention and treatment should be a continuum across health-care settings.[14,15] So far, little research is available investigating nutritional care collaboration and communication between OA themselves, their caregivers and professionals across the continuum of health care. This qualitative study was to investigate how nutritional care collaboration and communication is organized in the Netherlands, by investigating possible barriers, facilitators, stakeholders’ experiences (OA, caregivers and professionals), wishes and needs in order to optimize collaboration and communication in nutritional care
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