Malnutrition In Older Persons Research Articles

The refeeding-syndrome in older patients

The refeeding-syndrome is a potentially life-threatening metabolic complication that may occur after the initiation of a nutritional therapy in malnourished patients. The syndrome is not well known and probably frequently unrecognized and untreated. The pathophysiology is characterized by a progressive depletion in potassium, sodium and phosphate, despite mostly normal serum levels. This occult intracellular depletion is aggravated by the reintroduction of energy intake and thus compensated by a rapid transcellular shift from the extra- to the intracellular space. At that stage, suddenly decreasing serum levels occur and are responsible for the respective symptoms. Malnutrition, weight loss, chemotherapy, diuretics and alcoholism are the most important risk factors. Accordingly, due to the high prevalence of malnutrition in older persons, the refeeding-syndrome frequently occurs in this patient group. However, prevalence data are scarce. About 8 % of older hospitalized patients develop the refeeding syndrome if a nutritional therapy is introduced. The symptoms of the refeeding syndrome are various and unspecific. In geriatric patients, it frequently occurs in the form of a delirium. Particularly specific is the time course. The refeeding-syndrome typically develops within a few days after the start of a nutritional therapy. If serum-electrolytes, including magnesium and phosphate are monitored and supplemented tightly, the syndrome can be prevented or treated at an early stage. In addition, the measurement and supplementation of thiamine and the particularly slow increase of energy intake are fundamental for the prevention and treatment of the syndrome.

The relationship between malnutrition risk and inflammatory biomarkers in outpatient geriatric population

Key summary pointsAimIt is crucial to identify factors contributing to malnutrition risk in older persons in order to prevent malnutrition as far as possible.FindingsFactors that increased the risk of malnutrition were: increased levels of IL-8, osteoprotegerin (OPG), and Soluble-Receptor-For-TNF-alfa (sTNFRII; log transformed). In comparison with previous studies, in our study there was no significant difference in hsCRP and IL-6 in participants at risk of malnutrition and those who were well-nourished, nevertheless, those at risk of malnutrition had significantly higher IL-8, OPG and sTNFRII concentrations, but higher levels of IL-18.MessageThe etiopathogenesis of malnutrition in older persons is complex and our study indicated that chronic inflammation plays a probable role and should be considered in evaluating nutritional status in the geriatric population; however, it also exposes an avenue where further research is needed in order to enhance our understanding and guide comprehensive patient care.

Joint action malnutrition in the elderly (MaNuEL) knowledge hub: summary of project findings.

The Joint Action Malnutrition in the Elderly (MaNuEL) Knowledge Hub was established to extend scientific knowledge, strengthen evidence-based practice, build a sustainable, transnational network of experts and harmonize research and clinical practice in the field of protein-energy malnutrition in older persons. This paper aims to summarize the main scientific results achieved during the 2-year project and to outline the recommendations derived. 22 research groups from seven countries (Austria, France, Germany, Ireland, Spain, The Netherlands and New Zealand) worked together on 6 relevant domains of malnutrition-i.e. prevalence, screening, determinants, treatment, policy measures and education for health care professionals-making use of existing datasets, evidence and expert knowledge. Four systematic reviews, six secondary data analyses of existing cohort and intervention studies, two web-based surveys and one Delphi study were performed. In addition, a scoring system to rate malnutrition screening tools and a theoretical framework on the aetiology of malnutrition in older persons were developed. Based on these activities and taking existing evidence into consideration, 13 clinical practice, 9 research and 4 policy recommendations were developed. The MaNuEL Toolbox was created and made available to effectively distribute and disseminate the MaNuEL results and recommendations. The MaNuEL Knowledge Hub successfully achieved its aims. Results and recommendations will support researchers, healthcare professionals, policy-makers as well as educational institutes to advance their efforts in tackling the increasing problem of protein-energy malnutrition in the older population.

Nutrition education on malnutrition in older adults in European medical schools: need for improvement?

PurposeMalnutrition is a condition which is highly prevalent, especially in older persons. Physicians play an important role in multidisciplinary nutritional management, but often feel inadequately prepared to provide nutritional information/therapy to their patients. The aim of this study was to gather information on curricular content on malnutrition in older persons in basic study programs for medical doctors.MethodsWe selected a cross-sectional study design and used a Web-based online survey. We emailed the Web link to those persons responsible for curriculum development at 310 medical schools in 31 European countries.ResultsA total of 26 (8.4%) medical schools in 12 European countries completed the questionnaire. The topic of malnutrition in older adults was included as part of the medical students’ curricula at 50.0% (13 out of 26) of the participating institutions. Most commonly topics taught in the institutions were causes of malnutrition (13, 50%), assessment of malnutrition (13, 50%) and consequences of malnutrition (12, 46.2%). The topic of malnutrition screening was addressed in nine (35%) of the institutions.ConclusionsBased on our results, we strongly recommend including the topic of malnutrition in older adults in the undergraduate curricula of medical students in Europe. A special focus should be placed on multidisciplinary cooperation. Integrative teaching that targets all professional groups could be one option. Initiatives need to be carried out to create a higher level of awareness and promote improvements in nutrition education for medical doctors.

Existing european policies and guidelines related to malnutrition in older persons: A questionnaire based study

Existing european policies and guidelines related to malnutrition in older persons: A questionnaire based study

Nutritional screening in a case management program for community-living older individuals at high risk of hospital admission.

The prevalence of malnutrition in older persons depends on the healthcare setting. In recent years, hospital-based case management programs (CM Programs) targeting individuals in the community with chronic multimorbidity and high use of hospital resources (admissions or emergency visits) have been developed in many countries to reduce the need for complex health care. The objective of this study was to assess the prevalence of risk of malnutrition, using the Short Form of the Mini-Nutritional assessment, of community dwelling patients included in a chronic CM Program. Factors associated with malnutrition risk were also explored. Patients included in a hospital-based integrated CM Program for older persons at high risk for hospital readmission after an index admission were studied. MNA-SF was used at program inclusion to assess the risk of malnutrition. An array of factors potentially associated with malnutrition were explored (including feeding route, use of dental prosthesis, dysphagia, consistency of foods, specific therapeutic diets, use of oral nutritional supplements, polypharmacy, falls, and other diseases and geriatric syndromes). 791 participants were included, mean age 79.8years, 50.1% females. Risk of malnutrition was present in 44.9%. Participants at risk of malnutrition were more frequently female, had a lower BMI, were less likely to be fed orally and used more nutritional supplements. They also had a higher prevalence of dysphagia, needing changes in food consistency or using specific therapeutic diets, and had dementia or cancer more frequently. They also showed a higher need for palliative care. Risk of malnutrition in patients included in a CM Program is higher than in non-selected community dwelling older individuals. This information may help inform screening policies in similar populations at risk of hospital readmission.

Relevant outcomes for nutrition interventions to treat and prevent malnutrition in older people: a collaborative senator-ontop and manuel delphi study.

Research in malnutrition in older people is limited by the lack of consensus on relevant outcomes. Researchers of two European initiatives, the 'Malnutrition in the Elderly (MaNuEL) Knowledge Hub' (mostly experts in nutrition) and the Optimal Evidence-Based Non-drug Therapies in Older People (ONTOP) project (geriatricians) agreed to merge forces performing a systematic review of the effectiveness of nutritional interventions for the prevention and treatment of malnutrition in older persons. In a first step, we aimed to identify relevant outcomes for this review using a systematic approach and to explore if the rating of relevant outcomes differed depending on the researchers' professional background. Following the ONTOP protocol, we searched all outcomes used in research of nutritional interventions for the prevention and treatment of malnutrition in older people. We carried out a web-based Delphi survey using a standardized list of 13 potentially relevant outcomes among 41 experts in geriatrics and nutrition who were asked to rate each outcome from 1 to 9 points: low importance (score 1-3), important but non-critical (score 4-6), and critical (score 7-9). Participants were informed that only those outcomes rated as critical (7-9 points) would be used in the literature review. After two rounds consultation, we compared the results from each group of experts: the ONTOP group formed by 13 geriatricians and the MaNuEL group formed by 28 experts in nutrition. Mean values were used for overall rating and the Mann-Whitney U test was used to see the differences on ratings between both groups. Mortality, morbidity, functional status, nutritional status and quality of life were considered critical outcomes by the whole group of experts. However, by analysing the ratings by the experts' professional background, geriatricians only rated mortality, morbidity and functional status as critical, while experts in nutrition (MaNuEL group) rated nutritional status, changes in dietary intake, compliance with the intervention, quality of life, and frailty status outcomes as critical too. Two outcomes, changes in dietary intake and compliance with the intervention, were rated with a significant different between the two professional groups (p<0.05). Five outcomes were considered critical for research in nutritional interventions for the prevention and treatment of malnutrition in older persons: mortality, morbidity, functional status, nutritional status and quality of life by the whole panel of experts. However, more consensus is needed on the relevance of specific outcomes of nutritional interventions. Consensus processes within but also between relevant organizations are required to reach consensus and to contribute to this aim.

Tackling the increasing problem of malnutrition in older persons: The Malnutrition in the Elderly (MaNuEL) Knowledge Hub

AbstractIn order to tackle the increasing problem of malnutrition (i.e. protein‐energy malnutrition) in the older population, the Joint Action Malnutrition in the Elderly (MaNuEL) Knowledge Hub has been recently launched as part of the Strategic Research Agenda of the Joint Programming Initiative (JPI) A Healthy Diet for a Healthy Life (HDHL). This paper introduces this new European initiative and describes its objectives and design. The MaNuEL consortium consists of 22 research groups from seven countries (Austria, France, Germany, Ireland, Spain, The Netherlands and New Zealand). The Consortium aims to extend scientific knowledge; strengthen evidence‐based practice in the management of malnutrition in older persons; build a sustainable, transnational, competent network of malnutrition experts; and harmonise research and clinical practice. MaNuEL is built on five interconnected work packages that focus on (i) defining treatable malnutrition; (ii) screening of malnutrition in different settings; (iii) determinants of malnutrition; (iv) prevention and treatment of malnutrition; and (v) policies and education regarding malnutrition screening and treatment in older persons across Europe. Systematic literature reviews will be performed to assess current research on malnutrition and identify potential knowledge gaps. Secondary data analyses of nutritional intervention trials and observational studies will also be conducted. Using Web‐based questionnaires, MaNuEL will provide insight into current clinical practice, policies and health professionals’ education on malnutrition and will make recommendations for improvement. MaNuEL is being advised by a stakeholder board of five experts in geriatric nutrition who represent relevant European professional societies.

Assessment of malnutrition in older persons: a focus on the Mini Nutritional Assessment.

Assessment of malnutrition in older persons: a focus on the Mini Nutritional Assessment.

A mini-nutritional assessment of older Poles in relation to the food intake model and food intake variety

The aim of the research was to conduct a mini-nutritional assessment in relation to the food intake model and food intake variety for Polish older persons. The research included 420 people aged 65+. Using the food consumption frequency method (by a FIVeQ questionnaire), the weekly intake of 63 groups of products was assessed (yes, no). Food intake variety was assessed with the use of food intake variety index (FIVeI), which was calculated as the total number of products eaten per week in the amounts exceeding trace quantities. Four models of food intake were established: "ordinary" (S1), "rich varied" (S2), "ordinary with a tendency to vary" (S3) and "moderate connoisseur" (S4). The risk of malnutrition or the incidence of malnutrition was determined based on the questionnaire of the mini nutritional assessment (MNA). The good nutritional status of Polish older persons was affected by better results obtained in three parts of the questionnaire: "global evaluation" (MNA-2), "assessment of dietetic habits" (MNA-3) and "subjective assessment of self-perceived quality of health and nutrition" (MNA-4). It confirms the significance of those parts of the questionnaire in detecting malnutrition or the risk of malnutrition in older persons and suggests a lower share of the MNA-1 part which concerns anthropometric indicators. It was found that S2 and S3 persons were characterized by a greater food intake variety index (the median of 36 and 34 products eaten per week, respectively) and more often by a good nutritional status (88% and 79%, respectively) in comparison to S4 and S1 persons, who had a lower food intake variety index (the median of 4 and 30 products eaten per week, respectively) and more often occurring malnutrition (17% and 1% respectively) or a risk of malnutrition (17% and 30%, respectively). To conclude, a larger variety of food intake favoured better nutritional status of older persons, while a lower food intake variety increased the risk of malnutrition.

Who will become malnourished? A prospective study of factors associated with malnutrition in older persons living at home.

To describe the nutritional status of older persons living at home, to investigate factors of importance for nutritional status, and to describe possible relationships between nutritional status and health-related quality of life (HRQoL). A longitudinal study using data from older persons born between 1916 and 1925. Data were collected at three occasions separated by four-year intervals. Data collection was carried out in the participants' own homes. An experimenter administered all tests and conducted the interviews. A randomized selection from the Swedish Twin Register included 258 persons, all still living at home. Nutritional status was assessed using the Mini Nutritional Assessment (MNA), cognitive function using the Mini-Mental State Examination (MMSE) and HRQoL using the Nottingham Health Profile (NHP). Questions covering physical, psychological and social factors that may have an impact on nutritional status were also posed. Approximately 17% of participants were assessed as being at risk for malnutrition or as being malnourished. Cognitive impairment, reduced perceived health, recent hospital stay and receiving meals-on-wheels were factors associated with being at risk for malnutrition. Being at risk for malnutrition is common in older persons living at home, and many factors related to frailty increase this risk in later life. Making use of knowledge of these factors when giving care to older persons may be important in preventing nutritional problems.

Who will become malnourished? A prospective study of factors associated with malnutrition in older persons living at home

Who will become malnourished? A prospective study of factors associated with malnutrition in older persons living at home

Malnutrition and Mealtime Ambiance in Nursing Homes

Inadequate nutritional intake is the predominant cause of malnutrition in older persons. It is one of the most common and devastating conditions in nursing home residents. It is multifactorial and treatment or nutrition care plans should try to address the main causes. Such plans often include means to stimulate appetite to prevent or treat anorexia. One important stimulus, which can be modulated easily, is the meal ambiance. This article deals with the theory or mechanism behind this meal ambiance stimulus, discusses some study results, and makes practical recommendations.

Quality Indicators for the Care of Undernutrition in Vulnerable Elders

As a population, older adults are more likely than younger individuals to be afflicted with a variety of age-related diseases and functional impairments that may interfere with the maintenance of good nutritional status. This is particularly true of vulnerable elders (VEs). This population is also at greater risk of drug-induced nutritional deficiencies because of the number of prescription drugs they take. The term ‘‘malnutrition’’ can encompass a wide range of deficiencies (e.g., protein–energy, vitamins, fiber, water) and excesses (e.g., obesity, hypervitaminosis) that may or may not be clearly associated with adverse health outcomes. However, undernutrition has emerged as a priority area in caring for older persons. For example, an expert panel ranked undernutrition as the third leading condition in hospital and home care sites and the fourth leading condition in office practice and nursing home sites for which quality improvement efforts would enhance the functional health of older persons. Undernutrition in older persons is a particularly complex issue, because three populations must be considered: community dwelling, hospitalized, and institutionalized (nursing home). Although the overlap among these three populations is considerable, the burden of acute and chronic disease differs in the three groups. As a result, their nutritional requirements vary. This article will address quality indicators (QIs) for undernutrition only for communitydwelling and hospitalized VEs. The prevalence of energy undernutrition in VEs varies depending upon the definition used. In community-dwelling individuals in the United States, if energy undernutrition is defined as having a body weight of less than 45.4 kg (100 lbs), slightly more than 3% of those aged 60 and older may be affected. Similarly, low body mass index (BMI) is uncommon in community-dwelling older persons. Based on data from the 1999 to 2002 National Health and Nutrition Examination Survey, the prevalence of BMI levels less than 18.5 in persons aged 70 and older was 2.4%. If undernutrition is defined according to caloric or nutrient intake, 37% to 40% of older community-dwelling men and women ( 65) report energy intakes less than two-thirds of the recommended dietary allowance (RDA). Although other surveys have suggested that 30% of community-dwelling older persons have energy intakes below the RDA, the same surveys indicate that protein intake has generally been above the RDA. The prevalence of undernutrition is considerably higher in hospitalized patients, ranging from 55% to 61% in different populations using different definitions. Developing QIs for undernutrition in older persons is problematic, because there is no universally accepted clinical definition of undernutrition and because the research conducted on malnutrition in older persons, although voluminous, has not systemically focused on concerns of quality of care. As a result, there are substantial knowledge gaps in the literature, and many of the proposed QIs in this article are not supported by randomized clinical trials. When clinical trials have been available, many have studied patients who met narrow entry criteria. Moreover, most of the trials do not meet the highest quality of methodological rigor (e.g., concealed randomization and complete follow-up). Thus, even the clinical trial evidence cannot be regarded as conclusive when evaluating the proposed QIs in this monograph.

Assessment of protein energy malnutrition in older persons, part II: laboratory evaluation

A large proportion of chronic diseases affecting older persons can be either prevented or significantly improved by improving nutrition. This places an increased burden on health care professionals caring for older persons. Screening for malnutrition at an early stage allows the intervention to be most successful. History, physical examination, and anthropometric measurements are essential parts of any nutritional evaluation. However, these tools can be highly subjective and rely heavily on the knowledge and experience of the evaluator. Incorporating biochemical measurements in the routine nutritional assessment provides an often-needed objective dimension. Interpreting these measurements must take into consideration the normal biological changes seen with aging. In this article, we review many of the biochemical parameters used in nutritional assessment and their relation to morbidity and mortality, with a special focus on normal changes seen with aging.

An in-home nurse-administered geriatric assessment for hypoalbuminemic older persons: development and preliminary experience.

Although malnutrition in older persons is a common, potentially treatable condition, few data indicate that treatments for this disorder can be effective. To develop and preliminarily evaluate a two-component intervention that includes a nurse-administered, in-home assessment to identify potentially remediable causes of hypoalbuminemia and protocols to treat these problems. A pre-test post-test case-series. An academic geriatrics practice. Seventeen persons aged 65 and older with serum albumin levels < or = 3.8 g/dL; eight of the participants received pre-and post-test outcome measures. Nurse-administered standardized assessment and intervention protocols. Serum albumin, Medical Outcome Study (MOS) SF-36, serum IL-1a and b, TNF alpha, IL-6, and lymphocyte markers of immune function. The assessment took 87 minutes, on average, and generated a mean 4.2 recommendations. Among the eight subjects with pre- and post-test measures, serum albumin increased by 0.2 g/dL (P = .035). Compared with baseline, two T cell markers of immune function demonstrated changes consistent with better function. These preliminary data support the potential benefit of a nurse-administered assessment coupled with protocols to address remediable contributors to hypoalbuminemia.

Malnutrition in the institutionalized older adult

Most older adults in the United States live at home and are well nourished. Approximately 5% to 6% reside in nursing homes, and this segment of the older population typically suffers from multiple diseases that contribute to a high incidence of malnutrition. Forty percent of hospital beds are occupied by older persons. This article addresses the causes of malnutrition in older persons institutionalized in long-term and acute-care facilities. The causes include changes in nutrient requirements secondary to disease processes and drug modalities in combination with low or marginal dietary intake. Infections are common and result in anorexia, poor dietary intake, and malnutrition, which predispose the patient to another infection. Occurrence of decubitus ulcers is related to nutritional status and presents a serious risk for older persons with limited mobility. Depression and dementia are commonly seen in older persons and are major contributors to poor appetite and malnutrition. Cancer cachexia accounts for about half of the cases of malnutrition in older institutionalized persons. Physiologic changes that occur with age and multiple drug use place older persons at a high risk for adverse drug reactions. Less body water in the older individual influences and complicates many aspects of treatment. Standards, methods, and interpretation of nutritional assessment measurements in older persons differ from those in younger adults. The nutrition care provider must carefully consider many complex physical, medical, and psychosocial factors to deliver individualized nutrition care.