Abstract
ObjectiveTo estimate daily total energy expenditure (TEE) using a physical activity monitor, combined with dietary assessment of energy intake to assess the relationship between daily energy expenditure and patterns of activity with energy intake in people with dementia living in care homes.Design and settingA cross-sectional study in care homes in the UK.ParticipantsTwenty residents with confirmed dementia diagnosis were recruited from two care homes that specialised in dementia care.MeasurementsA physical activity monitor (Sensewear™ Armband, Body Media, Pittsburgh, PA) was employed to objectively determine total energy expenditure, sleep duration and physical activity. The armband was placed around the left upper triceps for up to 7 days. Energy intake was determined by weighing all food and drink items over 4 days (3 weekdays and 1 weekend day) including measurements of food wastage.ResultsThe mean age was 78.7 (SD ± 11.8) years, Body Mass Index (BMI) 23.0 (SD ± 4.2) kg/m2; 50% were women. Energy intake (mean 7.4; SD ± 2.6) MJ/d) was correlated with TEE (mean 7.6; SD ± 1.8 MJ/d; r=0.49, p<0.05). Duration of sleeping ranged from 0.4-12.5 (mean 6.1) hrs/d and time spent lying down was 1.3-16.0 (8.3) hrs/d. On average residents spent 17.9 (6.3-23.4) hrs/d undertaking sedentary activity. TEE was correlated with BMI (r=0.52, p<0.05) and body weight (r=0.81, p<0.001) but inversely related to sleep duration (r=-0.59, p<0.01) and time lying down (r=-0.62, p<0.01). Multiple linear regression analysis revealed that after taking BMI, sleep duration and time spent lying down into account, TEE was no longer correlated with energy intake.ConclusionsThe results show the extent to which body mass, variable activity and sleep patterns may be contributing to TEE and together with reduced energy intake, energy requirements were not satisfied. Thus wearable technology has the potential to offer realtime monitoring to provide appropriate nutrition management that is more person-centred to prevent weight loss in dementia.
Highlights
This is the first study that has reported objective measurements of total energy expenditure (TEE) using accelerometry combined with measurements of energy intake in people with dementia living in care homes
The results show that the relationship between TEE and energy intake is influenced by body mass, variable activity and sleep patterns that contributed to low energy intakes in some of the residents
The current study reports the value of real-time monitoring using wearable technology to measure TEE and the influence of body mass, variable activity and sleep patterns on energy intake in dementia
Summary
Design This cross-sectional study was performed between July 2014 and October 2014. Care home residents were recruited from two care homes in South West England that specialised in dementia care with confirmed clinical diagnosis of dementia (assessed by Mini Mental State Examination with scores less than 23; 22). Recruitment was restricted to two care homes owing to the intensive nature of the study that has taken a whole systems approach that involves everyone who has responsibility for delivering food and nutrition including managers, health care professionals, care and catering staff as well as relatives and family members. Residents with dementia were selected and recruited under the informed guidance of the care home managers. Exclusion criteria were residents with advanced dementia (advanced deterioration of language and cognition), those receiving palliative care treatment or artificial enteral or parenteral nutrition, dysphagia leading to aspiration, mood disorders and aggressive and volatile behaviour which would make it difficult to perform the measurements. Written consent was provided by the care home manager for access to the care home population. Residents provided informed verbal and/or written consent for their involvement in the study as well as a close family member and the care managers of both care homes. Confidentiality and anonymity was ensured by the use of numbers to code and represent data and all data was securely stored in locked environments
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