Feeding Assistance Research Articles

Factors contributing to frailty in institutionalized older adults: a multi-institutional cross-sectional study

To reveal the characteristics and the oral function of institutionalized frail older adults and the factors contributing to frailty. This multicenter, cross-sectional study included 214 patients. A questionnaire was administered to registered dietitians from these institutions. Sex, age, height, weight, grip strength, calf circumference, level of care need, FRAIL-NH, MNA® -SF, dysphagia, food form and water thickening, number of medications, major diseases, comorbidities, independence in daily living of older people with dementia, use of medication with dry mouth, nutritional care issues (malnutrition-related problems) by multiple occupations in Nutrition and Eating Swallowing Screening, Assessment and Monitoring, and nine oral-related items were evaluated. One hundred six patients (49.5%) were classified as frail, 75% of the patients were women, and the mean BMI was 19.7 kg/m2. Older adults with frailty were characterized by high care needs, malnutrition, multiple comorbidities, multiple medications, eating and swallowing disorders, the requirement of feeding assistance, and the need to adjust the shape of meals and fluids. The multivariable OR (95%CI) for "choking and residue problems" was 1.81 (1.20-2.73), while that for "dietary concentration problems" was 4.28 (2.10-8.74). Caregivers must maintain posture and provide meal assistance. Professionals in various occupations must adjust the proper food form and medication content. Meal times must be examined in consideration of the times at which drugs will be most effective. Oral care must be provided, and an environment must be created to help the subject concentrate. Focusing on problems of choking, residue, and concentration on meals is expected to improve frailty, aspiration pneumonia, and the prognosis of institutionalized older adults.

Feeding Assistance Skill Score: development and verification of reliability and validity.

Feeding assistance should be safe and improve the assisted individual's ability to feed, yet objective tools for evaluating these skills are lacking. This study focuses on developing a tool for assessing feeding assistance skills. A group consisting of 25 experts employed the Delphi method to achieve a consensus on the essential items necessary for assessing feeding assistance skills. Subsequently, a draft score using a three-point scale was developed. To test the reliability of the draft scores, a group of 20 patients and 20 nurses was matched to record a meal assistance scene, which were independently evaluated by three raters. We computed the AC1 statistic to assess both intra- and inter-rater reliability, and further examined correlations between the Feeding Assistance Skill Score (FASS) scores and outcome items to verify validity. Initially, an 18-item draft score was generated using the Delphi method. Subsequently, seven items were omitted from the intra- or inter-rater reliability analysis. Furthermore, after discussion, researchers removed one item that assessed food cognition, because the agreement score between the two items was 91%. Finally, the 10-item FASS was developed, showing a correlation with dietary intake upon validation. We successfully developed a scoring system for peer evaluation of feeding assistance skills. Future studies should aim to validate the FASS. The implementation of the FASS aims to assess the effectiveness of feeding assistance training and care quality, potentially improving safety and satisfaction for those receiving feeding assistance.

Nutritional Care for Adults in Nursing Homes: A Scoping Review.

The need for improved nutrition in older adults requiring care has been acknowledged, but, to the best of our knowledge, there is a lack of systematic review and integration of nutritional care studies with older adults in nursing homes. This scoping review aimed to examine the scope and nature of nutritional care research for older adults in nursing homes and to identify research gaps, following the guidelines of the Joanna Briggs Institute. We found varied nutritional care for older adults living in nursing homes, including individualized sessions, such as nutrition counseling, the addition of foods and preparations for increased nutritional intake, and the maintenance of an eating environment, such as feeding assistance and calling. The nutritional care identified in this scoping review also included studies that have improved the nutritional status of older adults in nursing homes by implementing educational programs for care staff. For future research on effective nutritional care for older adults in nursing homes, we suggest evaluating both short- and long-term intervention effects with an adequate sample size.

Design and Evaluation of a Spoke-Based Double-Lumen Pediatric Gastrostomy Tube.

Gastrostomy tubes (G-tubes) are the gold standard for feeding assistance for children with feeding dysfunction. Current G-tubes pose complications that interrupt the delivery of feed, including tube displacement and difficulty of at-home use. This study details an alternative, spoke-based, double-lumen G-tube design and preliminary validation of its function and usability. Pull force testing was performed on spoke G-tube models across three sizes and two classifications (hard/soft). Preliminary models were evaluated against market standards. Though the pull force of the spoke model was found to be lower than that of both market standards, hard modifications to the spoke model improved retentive force. Ease of use was tested amongst users unfamiliar with G-tube placement. The spoke design required 12.3 ± 4.7 s to deploy, less than half the time required for market standards. However, balloon G-tubes were still perceived to be easiest to use by 70% of participants, with indications that a spoke design may be easier to use if sized similarly to current G-tubes, with auxiliary improvements to factors such as grip. While there is a need for improvements in the material properties and manufacturing of the proposed design, this study provides early validation of the potential to address complications of existing G-tubes.

The impact of using next-generation pulse oximetry on the outcomes of preterm babies admitted to the NICU: a randomized controlled trial

The purpose of this randomized controlled trial was to investigate the influence of state-of-the-art pulse oximetry technology on the health outcomes of preterm newborns in a Neonatal Intensive Care Unit (NICU). We included preterm infants born between 24 and 36 weeks of gestation in our analysis, excluding those with significant congenital anomalies, lung malformations, congenital heart defects, or early neonatal mortality. Our study involved 52 newborns, divided into two groups: one cohort was monitored using conventional oximetry, while the other was monitored with advanced pulse oximetry technology. The baseline characteristics of both cohorts, such as gender, gestational age, birth weight, prenatal care received, and infection risk, were comparable. Both groups received standardized care based on established clinical guidelines, including feeding assistance, infection prevention techniques, thermoregulation, respiratory distress management, and parental involvement through kangaroo care. We assessed the outcomes for common neonatal issues, such as chronic lung disease, sepsis, intraventricular hemorrhage, patent ductus arteriosus, and air leak syndromes. Our results indicate that there were no statistically significant differences in the primary outcomes between the two groups, suggesting that the randomization process was effective in creating balanced comparison groups. We utilized independent samples t-tests and chi-square tests as part of our statistical framework, with a p-value of less than 0.05 indicating statistical significance. Overall, our findings suggest that the implementation of next-generation pulse oximetry equipment in the NICU for monitoring preterm infants does not significantly affect clinical outcomes compared to conventional monitoring techniques. Further research is necessary to fully evaluate the benefits and feasibility of incorporating cutting-edge oximetry technologies into newborn care procedures.

The Feeding Habbits On Incidence Of Stunting

Stunting emerges as a consequential nutritional challenge among toddlers, resulting from prolonged exposure to malnutrition. Rooted in familial caregiving practices, particularly feeding habits, this study delves into the nexus between feeding behaviors and the prevalence of stunting among impoverished families in Palembang. Employing a quantitative approach through a Cross Sectional Study, the research encompasses 110 mothers with children aged 24-59 months from economically disadvantaged backgrounds in Palembang. The findings underscore a noteworthy correlation between feeding habits and the incidence of toddler stunting, yielding a significant p-value of 0.000 and an Odds Ratio of 14.389. Noteworthy feeding practices influencing stunting include the administration of colostrum at birth (p-value = 0.020), diversified feeding (p-value = 0.000), nutritionally balanced meals (p-value = 0.003), maternal food preparation (p-value = 0.005), consistent snack provision (p-value = 0.002), age-appropriate portion adjustments (p-value = 0.042), offering food choices during boredom (p-value = 0.001), active feeding assistance (p-value = 0.001), maternal efforts to encourage eating (p-value = 0.000), and fostering an interest in eating (p-value = 0.007). Comparatively, non-stunted toddlers exhibit superior feeding habits when juxtaposed with their stunted counterparts within similar economic circumstances. This research illuminates the pivotal role of feeding practices in mitigating or exacerbating toddler stunting, thereby advocating for targeted interventions to enhance nutritional well-being in vulnerable populations.

Development of feeding assistance skill score

Development of feeding assistance skill score

Congenital laryngo-tracheo-esophageal clefts: updates from a quaternary care pediatric airway unit

PurposeTo review the operative techniques, outcomes, and complications following surgery in pediatric patients with laryngo-tracheo-esophageal clefts (LTEC). We describe a new combined approach to treat long LTECs.MethodsTwenty-five patients underwent surgical repair for LTEC from March 2012 to July 2022 at our hospital. Every patient underwent a diagnostic endoscopy under general anesthesia and spontaneous ventilation to assess the LTEC and synchronous aero-digestive comorbidities/malformations. All patients underwent at least one surveillance endoscopy after the repair at our institution.ResultsThe patients had multiple other malformations, specifically gastro-intestinal, synchronous airway, and cardiac. The cleft distribution according to the modified Benjamin and Inglis classification was type I (n = 5, 20%), type II (n = 6, 24%), type IIIa (n = 8, 32%), type IIIb (n = 4, 16%), and type IVa (n = 2, 8%). The median follow-up was 44.6 months. Five patients (20%) had undergone previous cleft corrective surgery(s). Seven patients (28%) had partial to complete breakdown of the repair, needing additional intervention(s), and two required a combined—open plus endoscopic repair. Preoperatively, most patients (n = 18, 72%) needed a feeding assistance. At latest follow-up, feeding assistance was weaned off in 13 out of 18 patients, which was a 72% improvement. Ten patients (40%) needed ventilation assistance before the surgery. Post-operatively, ventilatory assistance was weaned off in 6 patients, meaning a 60% improvement.ConclusionLTEC are rare malformations, and their management needs precise diagnosis, appropriate surgical planning, and execution, and dedicated post-operative care. Primary and revision repair of long clefts with tracheal extension may require a combined approach.

Assistive feeding robot for upper limb impairment—Testing and validation

A personal care robotic system has been developed that can provide feeding assistance to those suffering from upper limb impairment. The system introduces a novel approach for feeding that prioritizes two ideas: generalized functionality to encompass multiple feeding tasks and seamless user interaction. Additionally, the system leveraged novel computer vision ideas to incorporate functionality that was not reported in the literature. For the functional prototype, the system was comprised of an off-the-shelf six degrees of freedom robotic manipulator, two depth cameras, and an electric gripper. Furthermore, various tools used during the operation were designed and constructed using a 3D printer. The system’s software has three main operation phases: food identification, acquisition, and delivery. One of the novel features of this system is that instead of attempting to identify the food, the robot identifies the method required for acquiring the food. During testing and validation, it was found that the system had minimal identification errors, high success rates for acquisition and delivery, and a fast safety response time.

Epidemiology and patient journey of Rett syndrome in the United States: a real-world evidence study

BackgroundRett syndrome (RTT) is a neurodevelopmental disorder that almost exclusively affects females and is associated with high clinical burden. However, literature characterizing the real-world journey of patients with RTT is limited. This study provided an overview of the epidemiology, patient characteristics, clinical manifestations, healthcare resource utilization (HRU), costs, and treatment patterns of patients with RTT in the US.MethodsIQVIA™ Medical Claims Data and Longitudinal Prescription Data (11/01/2016–10/31/2019) were used to identify female patients with RTT, with the first observed diagnosis defined as the index date. Annual incidence and prevalence of RTT were assessed over the entire study period; clinical manifestations, all-cause and RTT-related HRU and costs, and treatment patterns were evaluated during the observation period—from the index date to end of clinical activity or end of data availability, whichever occurred first. Results were further stratified into pediatric (< 18 years) and adult (≥ 18 years) subgroups.ResultsIn 2019, prevalence and incidence of RTT was 0.32 and 0.23 per 10,000 enrollees, respectively. Among 5,940 female patients (pediatric: 3,078; adult: 2,862) with mean observation period of 2.04 years, the most prevalent clinical manifestations were neurological disorders (72.8%), gastrointestinal/nutritional disorders (41.9%), and orthopedic disorders (34.6%). The incidence rate of all-cause HRU was 44.43 visits per-patient-per-year and RTT-related HRU comprised 47% of all-cause HRU. Mean all-cause healthcare costs were $40,326 per-patient-per-year, with medical costs driven by home/hospice care visits, therapeutic services, outpatient visits, and inpatient visits. RTT-related healthcare costs comprised 45% of all-cause healthcare costs. The most prevalent supportive therapy and pharmacologic agent were feeding assistance (37.9%) and antiepileptic drugs (54.8%), respectively. Trends were similar by subgroup; although, rates of HRU were generally higher among pediatric patients relative to adult patients (all-cause: 52.43 and 35.86, respectively), which translated into higher mean healthcare costs (all-cause: $45,718 and $34,548, respectively).ConclusionsPatients with RTT have substantial disease burden, including prevalent clinical manifestations, high rates of HRU and annual healthcare costs, and reliance on pharmacologic and supportive therapies. These findings underscore the unmet need for effective therapies to target the multifactorial manifestations of RTT.

Effectiveness of interventions on feeding difficulties among people with dementia: A systematic review and meta-analysis.

This systematic review and meta-analysis aimed to examine non-pharmacological interventions for helping people with dementia who experience feeding difficulties in order to improve their nutritional status. The articles were searched using PsycINFO, Medline, PubMed, CINAHL and Cochrane. Two independent investigators critically appraised eligible studies. The PRISMA guidelines and checklist were used. The possibility of risk of bias was assessed using a tool to assess the quality of randomised control trials (RCT) and non-RCT studies. A narrative synthesis was conducted as a method of synthesis. The Cochrane Review Manager (RevMan 5.4) was used for meta-analysis. The systematic review and meta-analysis included seven publications. Six interventions were identified and categorised as: eating ability training for people with dementia, staff training and feeding assistance and support. The meta-analysis found evidence of the effect of eating ability training on feeding difficulty, quantified by the Edinburgh Feeding Evaluation in Dementia scale (EdFED) with a weighted mean difference of -1.36 (95% confidence interval: -1.84 to -0.89, p < 0.001) and on self-feeding time. A spaced retrieval intervention showed a positive effect on EdFED. The systematic review discovered that while feeding assistance had a positive effect on feeding difficulty, staff training had no effect. According to the meta-analysis, these interventions had no effect on improving the nutritional status of people with dementia. None of the included RCTs met the Cochrane risk-of-bias criteria for randomised trials. This review found that direct training for people with dementia and indirect feeding support from care staff resulted in fewer mealtime difficulties. More RCT studies are needed to determine the efficacy of such interventions.

Optimalisasi Pemantauan Kesehatan Balita Stunting melalui Buku Monitoring Gizi Anak di Kabupaten Rote Ndao, NTT

Rote Ndao Regency, which is located on one of the outer islands in NTT Province, has a total stunting prevalence of 23.48%. The improvement of stunting with interventions in the health and non-health sectors has a considerable contribution. This activity aims to carry out a stunting control improvement program by utilizing child nutrition monitoring books as a medium in monitoring the health of stunting toddlers in Rote Ndao Regency. The target in this activity is families who have toddlers aged 13-48 months as many as 88 children. The method of this activity is that all targets are given a monitoring book and supplementary feeding and Zinc supplementation is carried out for 12 weeks. The results showed that the provision of additional feeding assistance and supplementation improved nutritional status with increased weight and even this activity increased the motivation of the family to improve the child's lifestyle and health status.

A Novel App for Assessing the Caregivers' Physical Activity: A Pilot/Feasibility Study.

This study sought to determine the feasibility and clinical value of using a novel mobile application (app) to record the muscle/physical activity (PA) of caregivers. In all, 23 caregivers were enrolled and they were trained to use the app and a wearable device that automatically recorded their care activities and PA/burden. Data were collected for 42 days. Muscle activity was measured for 3 weeks during maximum voluntary isometric contraction (MVIC) and PA. Approximately 80% of the caregivers agreed that they conveniently used the wearable device through the mobile app. The most active %MVIC was noted for the back muscles during feeding assistance. As regard subjective pain evaluation, back pain was the most prevalent and pain level in the left knee was the highest. Incorporating mobile apps with wearable devices to record every activity of the caregivers may be feasible and can provide valuable clinical data for optimizing their pain management.

Oropharyngeal Dysphagia in Hospitalized Older Adults With Dementia: A Mixed-Methods Study of Care Partners.

Oropharyngeal dysphagia (OD) affects nearly 90% of hospitalized persons with dementia. Yet, little is known about the care partner experience. The purpose of our study was to describe the experience of care partners related to OD management in patients with dementia as they transition from the hospital to the community setting. Using a mixed-methods approach, we conducted telephone interviews with care partners of recently hospitalized older adults with dementia and OD. Interviews consisted of quantitative/qualitative assessments: communication with health care team, perception about risks/benefits of dysphagia diet, and informational needs. Descriptive statistics were used for quantitative data. For the qualitative data, transcripts were independently coded by research team and categorized into themes. Of the care partners interviewed (N = 24), mean age was 63.5 (SD = 14.9), 62.5% were female, and 66.7% were White. Nearly 60% of patients had severe dementia, and 66.7% required feeding assistance. Care partners (n = 18) reported moderate burden of 14.11 (SD = 10.03). Most care partners (83.3%) first learned about OD during hospitalization. Only 29.2% of care partners reported that they discussed OD with a physician. Care partner perception of dysphagia diet risks/benefits ranged widely: 33.3% thought dysphagia diets would promote a more enjoyable existence. Over half (54.2%) of care partners indicated no choice regarding dysphagia diets was presented to them. Two thirds (n = 16) of care partners were nonadherent to diet recommendations; the top reason (n = 13%) was diet refusal by patients. Although 83.3% of care partners wanted additional information regarding dysphagia management, only 20.8% sought any. Our findings highlight that care partners of persons with dementia face significant OD-related communication and informational gaps, which may lead to elevated burden. Future studies are needed to address unmet OD-related care partner needs.

Food intake and prevalence of malnutrition in nursing homes. A multicenter observational study

Objective. The aim of this study was to investigate malnutrition prevalence and its associated factors in NHs including resident food and liquid intake. Methods. We conducted a multicenter observational study in Italian NHs. NHs were recruited using a convenience sample from regional register. To detect malnourished residents, we used Body Mass Index (BMI) &lt; 18.5 kg/m2 and another criterion based on unintentional weight loss combined with reduced BMI. We performed logistic regression to identify associated factors with malnutrition. Results. We recruited 1795 residents that lived in 29 NHs. 76% were female, with mean age 85.4 ± 8.5 years. 275 out of 1787 residents (15.4, 95% CI 13.8-17.2%) were malnourished . Moreover, when we combined BMI measures (&lt; 20 kg/m2 if residents &lt; 70 years or &lt; 22 kg/m2 if residents ≥ 70 years) with unintentional weight loss data in the previous 6 months (5-10% or greater than 10%) we found that 18.1% residents were malnourished. Malnourished residents drank less (median 702 ml per day) than well nourished ones (median 800 ml per day) and ate less, especially at dinner. Malnutrition was significantly associated to age, psychiatric disorders, disability in activity of daily life, feeding assistance, swallowing and chewing problems and poor fluid intake. Moreover, we found a higher number of malnourished residents amongst those who needed more feeding care during dinner, when there was a lower number of staff. This result confirms the strong relationship between the care feeding and malnutrition. Conclusions. In this study we found that malnourished residents were older with poor functional ability, chewing problems, dependence in feeding and poor fluid intake. Interventions to prevent malnutrition in nursing homes are a priority for the practice and for further studies.

Malrotation and Fibroblast Growth Factor Receptor-2-Associated Craniosynostosis: An Underrecognized Association and Management Pathway.

Feeding difficulties are common and multifactorial in children with Fibroblast Growth Factor Receptor-2 (FGFR-2) mutations. Intestinal rotation anomalies have been demonstrated to occur more frequently in animals with FGFR-2 mutations. This study aims to describe intestinal rotation anomalies, surgical management, and feeding assistance in children with FGFR-2 mutations who have undergone upper gastrointestinal (UGI) contrast studies. Retrospective data were collected of children born between 1988 and 2020 in a UK quaternary craniofacial unit with FGFR-2-associated craniosynostosis. A consultant survey of approach to malrotation was undertaken. Thirty-four children were included, 17 (50%) female. Six (18%) had UGI symptoms, which included bilious vomiting (n=2), nonbilious vomiting (n=5), retching (n=1), feed intolerance (n=3), and failure to thrive (n=3). Nine had a gastrostomy in situ. Intestinal rotation anomalies occurred in 4 (12%) children, 3 of whom underwent a Ladd procedure and two third required gastrojejunal feeding postoperatively. Consultants agreed that all children with FGFR-2 mutation and UGI symptoms should undergo UGI contrast study, as should children requiring a gastrostomy. Intestinal rotation anomalies in children with FGFR-2 mutations occur more frequently than the general population. Prompt consideration of UGI contrast in symptomatic children with FGFR-2 mutation is recommended to enable early surgical management of children with malrotation.

Caregiver's experiences in caring for the disabled and aging population using feeding assistance robots

Caregiver's experiences in caring for the disabled and aging population using feeding assistance robots

Pendampingan Kader dalam Pengolahan dan Pemberian Makanan Pendamping ASI berbasis Kearifan Lokal

Introduction: Childhood (up to two years old) is a golden period of growth and development that determines the quality of future health. Several factors play an important role for physical growth and development, including nutritional and non-nutritional factors. Nutritional problems, including stunting (dwarf), during childhood will hinder the process of growth and development and increase the risk of degenerative diseases or chronic noncommunicable diseases (NCDs) in later stages of life. Objective: This service activity aims to increase the knowledge of cadres about MP ASI and improve the ability of cadres in processing MP ASI Method: The methods used in this community service are lectures, discussions, and exercises to process MP ASI directly. Result: Based on the results of the training, it was found that there was an increase in the knowledge of cadres with an average increase in post test results of 17.2 with the highest score on the post test being 100. Conclusion: The implementation of this service activity has been carried out smoothly and according to plan, followed by 18 cadres from village representatives who are in the working area of the Bregbeg Health Center who are very enthusiastic and eager to participate in this activity to completion . There is a significant difference in the knowledge of cadres in the processing and provision of complementary feeding assistance compared to before participating in the mentoring (test score from 65.7 to 82.9).

Exploring Meal Provision and Mealtime Challenges for Aged Care Residents Consuming Texture-Modified Diets: A Mixed Methods Study.

Dysphagia has become more prevalent with age. Thus, the demand for texture-modified diets (TMDs) has increased. While the nutritional perspectives have been studied, the provision of TMDs and mealtime practice has received less attention. This study aimed to explore the TMD provision and mealtime challenges of residents requiring TMDs in aged care facilities. The study was conducted across five aged care facilities using a mixed methods design involving 14 TMD menu audits by a foodservice dietitian, 15 mealtime observations, and semi-structured interviews with residents and staff (n = 18). TMD menus failed to meet all nutrition requirements and foodservice and clinical standards based on the dietitian NZ foodservice and nutrition audit tool. A content analysis offered three main themes: (1) Foodservice production. Inconsistent quality and meal portions were observed. The variety, choice, and portion size of TMDs required improvement based on the residents’ preferences; (2) Serving procedures. There was a lack of standardisation of meal distribution and feeding assistance; and (3) Dining environment. The dining room set-up varied across facilities, and residents expressed different preferences towards the dining environment. There is a need to improve staff awareness of mealtime consistency and optimise feeding assistance. The dining environment should be individualised to accommodate residents’ psychosocial needs. Standardised policies and continuous training can facilitate quality mealtime implementation.

Relationship between Aspiration Pneumonia and Feeding Care among Home Care Patients with an In-Dwelling Nasogastric Tube in Taiwan: A Preliminary Study.

Home care patients have swallowing dysfunction and rely on an in-dwelling nasogastric tube (NGT) to complement oral food intake, supplement their diet, and maintain adequate nutritional status. This study explored the relationship between aspiration pneumonia (AP) and feeding care among home care patients with an in-dwelling NGT. This preliminary study employed a cross-sectional design. There were 35 patients who relied on an in-dwelling NGT to complement their oral intake of food (NGT-oral feeding) and their primary caregivers participated in this study. All of them developed AP in the past year. Factors involving food intake performance during mealtime of the home care patients and feeding care provided by the caregivers were simultaneously observed and recorded. Among the six risk factors univariately correlated with the incidence of AP, feeding in a noisy environment, using a large spoon to feed the participants, more than 5 mL of food per mouthful, food intake duration lasting > 30 min, swallowing twice for each mouthful of food, and coughing at least once every day remained significant in the logistic regression model (all p < 0.05). Four risk factors for AP were correlated with feeding care; the adjusted risk ratio ranged from 6.17 to 14.96 (all p < 0.05). In addition to each individual’s food intake ability, improper feeding assistance was related to the risk factors for AP among home care patients with NGT-oral feeding. Thus, home caregivers should receive safe oral feeding education and training.