Content uploaded by Zvonimir Satalic
Author content
All content in this area was uploaded by Zvonimir Satalic on Apr 24, 2014
Content may be subject to copyright.
Nutritional Quality of Meals in Nursing Homes and Meals on Wheels for Elderly Persons in Croatia
Abstract
The aim of the study was to evaluate the adequacy of meals provided for elderly residents and non-residents of nursing homes in Croatia.
Menus of 44 all-day meals provided for residents from 4 nursing homes and 34 meals on wheels provided for non-residents of low socioeconomic status were selected by random sampling. A questionnaire was used to determine socioeconomic status and attitude of residents (n = 89) and non-residents (n = 80) regarding meals offered.
An average energy value of all-day meals and meals on wheels was 96.7 and 39.8% RDA respectively. All-day meals provide adequate amounts of the micronutrients examined (phosphorus, iron, thiamine, riboflavin, niacin and vitamin C) with exception of calcium. Fat provided 35% and 36% of energy for all-day meals and meals on wheels respectively. The body mass index (BMI) under 18.5 kg/m ² had 1.7% residents and 4.0% non-residents. BMI higher than 24.9 kg/m ² were observed in 50% and 47% of residents and non-residents respectively. Gender differences were observed for meal preferences offered to both residents and non-residents.
The meals provided adequate amounts of energy and the micronutrients examined. However, a decrease in the energy fraction of fat and decrease in protein content would be advisable.
... Other screening instruments were previously developed, but as far as we know, the checklist was not validated in one of them (21), or they were assessing only one of the meals in another one (22). Nevertheless, other researchers have analyzed the quality of meals in LTC homes using their own methodology (23)(24)(25). ...
... Regarding micronutrients, the regular menus failed to meet the dietary recommendations (Fig. 1). The results are consistent with previous studies (28)(29)(30)(31), but differ from others which indicated an appropriate nutritional value (24,32,33). Some of the discrepancies between studies may be caused by differences in the characteristics of the LTC homes, differences in the recommendations used as reference, or the study's methodology. ...
Background: Institutionalization is a risk factor for malnutrition. Low energy intake and/or nutrient defi ciencies are considered to be the main causes.
Objective: To evaluate the quality of meals and meal service as well as the nutritional value of the main menus (regular menu, menu for diabetics, and pureed menu) offered in three long-term care (LTC) homes located in the metropolitan area of Granada (Spain).
Methods: Cross-sectional study. A validated “quality of meals and meal service” set of indicators was applied. The menus were assessed by weighed food records on 14 consecutive days. The results were compared with the dietary reference intakes (DRIs) and the recommended number of servings.
Results: Important defi ciencies in the quality of meals and meal service have been reported. Average energy varies from 1,788 to 2,124 kcal/
day in the regular menus, from 1,687 to 1,924 kcal/day in the menus for diabetics, and from 1,518 to 1,639 kcal/day in the pureed menus. Average protein varied from 71.4 to 75.4 g/day, from 72.6 to 76.1 g/day, and from 50.5 to 54.7 g/day, respectively. None of the menus complied with the recommendations for fi ber, potassium, magnesium, iodine, vitamin D, vitamin E, folate, nor for vegetables, fruit, milk products, olive oil,
legumes, or nuts.
Conclusions: It is necessary to ensure the implementation of regular routines for controlling the quality of meals and meal service as well as the nutritional value of the menus offered in LTC homes.
... Our results on calcium intake in elderly people are similar to previous research on the diet quality in nursing home residents in Zagreb, which showed that approximately 53 % of residents had a calcium intake below 50 % of recommended value and that only 3.2 % of participants had an adequate calcium intake (Rumbak, 2010). In the study on adequacy of nutrition in elderly residents and non-residents of nursing homes in Croatia, Colić Barić (2006) found that all meals provided adequate amount of micronutrients, with exception of calcium, which was 63 % of DRI. In the study group of 120 adults from eastern Croatia, aged 33.8 years, the average daily dietary intake of calcium was 661 mg/day (Mandić-Puljek 2005). ...
Elderly people, especially those who live in nursing homes, are at high risk for getting osteoporosis and bone fractures. Knowing that an adequate calcium intake is important for prevention and therapy of osteoporosis, we aimed to estimate calcium intake in old people living in nursing homes in Zagreb. In a cross-sectional study, calcium intake was estimated using previously validated food frequency questionnaire especially designed for calcium intake, among 292 nursing homes residents (232 women and 60 men), mean age 82.4±6.5 years. Mean dietary calcium intake in men was 653±297 mg/day and in women 528±279 mg/day (p=0.004). Only 10 % of women and no men were taking calcium supplements. Calcium intake below the 750 mg/day was present in 67.3 % of men and 77.5 % of women. Very low calcium intake, below the half of the recommended value, was present in 18.3 % of men and 31.0 % of women. Milk and dairy products were the main source of calcium intake in our study and contributed more than 80% of total daily calcium intake. No significant correlation was found between the body mass index and calcium intake in both genders. We conclude that the mean calcium intake in nursing home residents was below the recommended values.
... The remaining 33 articles were further evaluated in full text against the study selection criteria. Among them, eight articles evaluated the nutrition status of home-delivered meal program participants but without pre-post or cross-sectional comparisons (Coulston et al., 1996;Herndon, 1995;Lipschitz et al., 1985;Lo et al., 1989;Sharkey, 2002Sharkey, , 2004Sharkey and Schoenberg, 2002;Vailas et al., 1998), seven articles evaluated the nutritional value of home-delivered meals but without measuring participants' food or nutrient intakes (Barić et al., 2006;Beck et al., 2010;Bunker et al., 1986;Galea et al., 2013;Gatherer, 1971;Maclellan, 1997;O'Dwyer et al., 2009), five articles compared the effectiveness of different modes of homedelivered meal programs in increasing nutrient intakes and satisfaction among participants (the study designs were mode-to-mode rather than treated-to-untreated comparison) Gollub and Weddle 2004;Kretser et al., 2003;Osteraas et al., 1983;Silver et al., 2008), one article identified the nutritional needs (rather than food or nutrient intakes) of home-delivered meal program participants (Krassie et al., 2000), one article evaluated the impact of nutrition education and counseling (rather than the meals) on nutritional risk among home-delivered meal program participants (Wunderlich et al., 2011), and three articles examined home-delivered meal programs in other countries including Canada (Keller, 2006;Roy and Payette, 2006) and Belgium (Goeminne et al., 2012). Excluding the above articles yielded a final pool of eight studies (Edwards et al., 1993;Frongillo and Wolfe, 2010;Gleason et al., 2002;Marceaux, 2012;Ponza et al., 1996;Racine et al., 2012;Steele and Bryan, 1985;Troyer et al., 2010). ...
Background:
Poor diet quality and insufficient nutrient intake is of particular concern among older adults. The Older Americans Act of 1965 authorizes home-delivered meal services to homebound individuals aged 60 years and older.
Objective:
The purpose of this study was to review scientific evidence on the impact of home-delivered meal services on diet and nutrition among recipients.
Methods:
Keyword and reference searches were conducted in Cochrane Library, Google Scholar, PubMed and Web of Science. Inclusion criteria included: study design (randomized controlled trials, cohort studies, pre-post studies, or cross-sectional studies); main outcome (food and nutrient intakes); population (home-delivered meal program participants); country (US); language (articles written in English); and article type (peer-reviewed publications or theses).
Results:
Eight studies met the inclusion criteria, including two randomized controlled trial studies (from the same intervention), one cohort study, two pre-post studies, and three cross-sectional studies. All but two studies found home-delivered meal programs to significantly improve diet quality, increase nutrient intakes, and reduce food insecurity and nutritional risk among participants. Other beneficial outcomes include increased socialization opportunities, improvement in dietary adherence, and higher quality of life.
Conclusions:
Home-delivered meal programs improve diet quality and increase nutrient intakes among participants. These programs are also aligned with the federal cost-containment policy to rebalance long-term care away from nursing homes to home- and community-based services by helping older adults maintain independence and remain in their homes and communities as their health and functioning decline.
The global population is both expanding and aging, resulting in a rise in the burden of fragility fractures. The highest fracture rates occur in the oldest old, or those greater than 80 years of age. The majority of institutionalised elderly are women aged 80 years and older, so a substantial fracture burden arises from the aged-care sector. Malnutrition, and more specifically deficiencies of protein, calcium and vitamin D contribute to fracture risk, and are common in elderly in aged-care. While drug therapy is not an option to reduce the public health burden of fractures, correction of these deficiencies may be a safe, accessible and cost saving approach to fracture prevention.
The nutritional benefits of oral nutritional supplements in relation to weight gain and fewer health complications have been demonstrated in the short term, but limited compliance and efficacy have been observed for interventions greater than 6 months. Significant improvements in bone metabolism in elderly aged-care residents have been observed with fortification of foods, especially dairy foods fortified with calcium and vitamin D. However, fortified products may not be available to all elderly. A food-based approach that warrants attention is improving the dairy content of the food supply in aged-care, as dairy is a good source of protein, calcium (and vitamin D) and this approach satisfies the requirements of safe, low cost and accessible. Feasibility studies of added dairy foods indicate significant improvements in nutritional status in elderly aged-care residents using this method. To advocate for a dairy-based approach to fracture prevention, quality studies demonstrating anti-fracture efficacy are required.
Objectives: This study aimed to develop a proposal of reference criteria for the qualitative evaluation of menus based on national and international recommendations. Methods: There were selected 36 items of detailed menus qualitative assessment (AQE-d method) of Varos et al. (2007) for establishment of the menu evaluation criteria. According to the importance of several items to the nutritional and sensorial balance of the menu, we have taken into account each of them for the final classification. The score of a menu is obtained by adding the values of the weighting of criteria met. To allow the qualitative classification of menus percentual intervals were defined corresponding to "verygood", "good", "acceptable" and "not acceptable". Results: A reference criteria is proposed for each analysis group, on the basis of healthy eating principles, to which menus must answer to be considered a balanced menu. Conclusions: The tool proposed may be applied associated to the method of AQE by Veiros et al and allows standardization in the quality evaluation of menus by various professionals involved on their elaboration. Catering, Meal, Menu, Qualitative assessment.
Introduction: A study carried out in 2000 showed effects on the nutritional status in older adults in the city of Havana. The same experimental design has been repeated in a municipality in the center of the country to increase information on this issue. Materials and methods: Body weight and waist and hip circumferences were obtained from 216 subjects aged over 60 years (Men: 50%) with an apparent absence of diseases interfering with nutritional status, randomly selected from among the residents. in the Quemado de Güines municipality (Villa Clara, Cuba). The subject's height was reconstructed from the shoulder-elbow and knee-heel distances. The Body Mass Index (BMI) and the waist-hip index (ICC) were calculated. The lipid profile of the serum and the content of niacin in the urine were also determined. Nutritional income was estimated from a 3-day food record in a subsample of 19 subjects. Results: More than a third of the subjects studied showed overweight and obesity. About 38% of the sample had body fat distributed in the upper part of the body. The mean values of BMI, urinary niacin, total serum cholesterol, and LDL-cholesterol fraction were higher in women (all differences: p <0.05). Energy and macronutrient intakes were lower than recommended. Normal levels of total cholesterol, LDL-cholesterol and triglycerides were found in 90% of the subjects studied; while 82% of them exhibited high urinary excretion of niacin. Conclusions: The population group studied did not show an optimal nutritional state, so they were recommended to consume a varied diet, as well as changes in lifestyle. Rev Cubana Aliment Nutr 2011; 21 (1): 59-70
To determine incidence of malnutrition among patients on admission to hospital, to monitor their changes in nutritional status during stay, and to determine awareness of nutrition in different clinical units.
Prospective study of consecutive admissions.
Acute teaching hospital.
500 patients admitted to hospital: 100 each from general surgery, general medicine, respiratory medicine, orthopaedic surgery, and medicine for the elderly.
Nutritional status of patients on admission and reassessment on discharge, review of case notes for information about nutritional status.
On admission, 200 of the 500 patients were undernourished (body mass index less than 20) and 34% were overweight (body mass index > 25). The 112 patients reassessed on discharge had mean weight loss of 5.4%, with greatest weight loss in those initially most undernourished. But the 10 patients referred for nutritional support showed mean weight gain of 7.9%. Review of case notes revealed that, of the 200 undernourished patients, only 96 had any nutritional information documented.
Malnutrition remains a largely unrecognised problem in hospital and highlights the need for education on clinical nutrition.
As an increasing proportion of the population is living into 7th, 8th, and 9th decades, it is increasingly important that recommended dietary intakes be established experimentally rather than by extrapolation from data on a younger population. This is especially important for protein, because failure to maintain nitrogen balance is associated with wasting of body tissues and declines in mobility and immune function.
The accuracy of self-reported weights was assessed by comparing reported weights with measured weights of 1302 subjects at eight different medical and nonmedical sites across two countries (United States and Denmark), across ages, sexes, and different purposes for the weight measurements. Self-reported weights were remarkably accurate across all these variables in the American sample, even among obese people, and may obviate the need for measured weights in epidemiological investigations. Danish reports were somewhat less accurate, particularly among women over 40 yr of age.
Undernutrition of long-stay hospital patients and those in surgical units is well documented. This study was designed to determine the extent of the problem in elderly people admitted to hospital with acute medical problems and to assess therelationship between nutritional status and course of hospital stay.
Sixty-nine patients underwent a nutritional assessment on admission and at intervals throughout their hospital stay andepisodes of sepsis were documented. Severely malnourished patients were identified using body mass index, BMI (22%)and corrected arm muscle area, CAMA (26%). Episodes of sepsis occurred significantly more often in the severely undernourished group (p < 0.04). The median length of stay of the group was 16 days (range 2–113): during this time there was no significant change in markers of nutritional status apart from actual muscle circumference (AMC), which showed a reduction in measurement between admission and discharge which was statistically significant (p < 0.0003).
This study indicated that severe malnutrition is common in elderly medical admissions, and that it is associated with an increased risk of sepsis. Additional nutritional depletion may occur during hospital stay, and is not easily recognized unless anthropometry is undertaken.
Current knowledge of the relation between nutrition and bone health in the elderly is sufficient, if applied, to lead to a reduction in fractures in the aged of from 30-60%. The critical nutrients are calcium and vitamin D, and possibly phosphate as well. Additionally, nutritional measures, especially protein repletion, dramatically improve outcomes from hip fracture. Fortunately the indicated interventions have a favorable cost-benefit relationship, especially when skim milk is used as the source of the needed nutrients.
The oldest age category in the 1989 edition of the Recommended Dietary Allowances (RDAs) is 51 years and above. Future committees on dietary reference intakes will likely define recommendations for age categories older than this. Instead of extrapolations from data derived from experiments on younger people, future RDAs should be derived directly from experiments on older people. Further, scientists are now interested in the amount of the nutrient that it takes to prevent chronic diseases from occurring rather than to prevent deficiencies, and this will likely influence RDA numbers. A review of past and current data suggests that the current RDAs for the elderly are too low for riboflavin, vitamin B-6, folic acid, vitamin B-12, vitamin D, and calcium, and are probably too high for vitamin A.
The importance of dietary calcium for bone health is unclear, partly since most investigations have dealt only with a fairly narrow range of calcium intake. In the present population-based observational study with longitudinal dietary assessment, we investigated women with a mean age of 60 years and with a consistently high (range 1417-2417, mean 1645 mg, n = 40), intermediate (800-1200, mean 1006 mg, n = 35) or low (400-550, mean 465 mg, n = 40) estimated daily consumption of calcium. Measurements of bone mineral density (BMD) of the lumbar spine, femoral neck and total body were performed by dual-energy X-ray absorptiometry, as well as ultrasound of the heel. In a multivariate analysis, with adjustment for energy intake the risk factors for osteoporosis (age, body mass index, physical activity, menopausal age, use of estrogens, smoking and former athletic activity), the group with the highest calcium intake had higher values for BMD than the others at all measured sites. The average mean difference compared with the low and the intermediate calcium group was 11% for the femoral neck, 8-11% for the lumbar spine and 5-6% for total body BMDs. In univariate analyses and multivariate models which did not include energy intake, the differences between the groups were less pronounced. The women in the intermediate calcium group had approximately the same mean BMD values as those in the low calcium group. These findings support the view that only a high calcium intake (3% highest percentiles in the studied population) protects against osteoporosis in Swedish postmenopausal women.
This study was intended to characterize a rural population of older persons through nutrition screening and relate screening items to functional limitations and health care charges. There were 5373 participants (2522 males and 2851 females, mean age 71 y) screened over a 22-mo period by using a self-administered questionnaire adapted from the Nutrition Screening Initiative. Height and weight and cholesterol and albumin concentrations were measured, and health care claims data were obtained. The most frequent screening items reported were use of > or = 3 medications (41%) and food group intakes below recommended frequencies (> 50%). There were significant (P < 0.05) sex differences in affirmative responses to screening items and in likelihood of exceeding proposed threshold values for risk status assigned for body mass index (BMI; in kg/m2), albumin, or cholesterol. Overweight status was notable, with one-half of all subjects having BMIs > 27. Stepwise modeling procedures were used to identify screening items with the ability to predict self-reported functional limitation (logistic regression) and monthly average recorded health care charges (linear regression on logged charges). Age > or = 75 y, use of > or = 3 medications, and an albumin concentration < 35.0 g/L were significant predictors of both functional limitation and health care charges. Poor appetite, eating problems, income < $6000/y, eating alone, and depression were significant predictors of functional limitation but not health care charges. Being male, loss of 10 lb (4.5 kg), BMI > 27, cholesterol concentration < 4.14 or > 6.21 mmol/L, and functional limitation were significant predictors of health care charges only. These findings suggest that selected screening items may have be useful in the identification of subjects at potential risk for these outcomes.
The prevalence of obesity among older persons is growing. This trend has adverse medical, functional, psychosocial, and health care resource consequences. Many obese older persons were obese middle-aged adults. A sedentary lifestyle may be the dominant contributing factor. Intervention should focus on moderate weight reduction through the modification of diet, exercise, and behavior. Improvements in health and quality of life can be achieved with moderate weight reduction. Strategies tailored to the older population will facilitate successful interventions. Dietitians must be key participants in the effort to raise awareness of obesity as a serious health concern for older persons. The focus must be on achieving a more healthful weight.