Members of the elderly population experience a lot of negative changes in the body. The negative changes that they encounter are often related to aging and the degeneration-related physiologic changes associated with it, this was supported by a set of guidelines on malnutrition authored by Mauldin & Kelley. In this paper, the author discusses the different tenets of malnutrition, including the causes, of malnutrition among the elderly, drawing data and evidences from previously published studies.
It is not atypical for members of the allied medical fields, especially nurses, to encounter cases of elderlies experiencing malnourishment. In a study published in the Journal of Clinical Nursing, the researchers assessed how nurses employed in a skilled nursing facility prevent under-nourishment and why at some point, there are still cases of patients exhibiting signs of it despite the apparent presence of a standardized approach and or protocol to treat and prevent it. A total of 16 nurses were interviewed through focus group discussions and what the researchers discovered was that there are limits within the target university hospital’s (from which the respondents were extracted) structure and organization that prevent efficient nutritional care, thereby leading to the persistence of malnourishment among their elderly patients. The researchers theorized that the same problem may be part of the reason why malnourishment also exists in other larger scale medical facilities and health institutions.
Nutrition deficiency is one of the major causes of malnutrition; this was concluded in a study published in Perspectives in Practice about the causes of malnutrition among the elderly. Elderly people tend to have more specific and complex nutritional needs because of the various physiological changes undergoing in their body. This notion was examined further in a study published in Revue Canadienne de la pratique et de la recherché en dietetique where the researchers examined a full week’s menu from a large long term care facility. They hypothesized that one of the causes of malnutrition among elderlies is that their nutritional requirements based on Eating Well with Canada’s Food Guide (CFG) were not being met. After analyzing the week long menu being used to serve the patients in the long term care facility they examined, they concluded that it indeed did not fully meet the CFG and should therefore be revised so that there should be adequate vegetable, fruit, and grain, and foods with carbohydrates and protein servings.
It is important to note, however, that not all long term care and nursing facilities exhibit this lack of ability to adhere to certain nutritional standards in an effort to curb the rate of malnutrition among elderly patients. In another study published in the Journal of Clinical Nursing for example, the researchers hypothesized that there long term nursing care facilities treat their patients differently and so they compared the prevalence rates of malnutrition among Dutch and German nursing homes. Some 5,848 Dutch and 4,923 German participants more than 65 years old were examined in the said study. In the end, they concluded that overall malnutrition rates did not differ significantly between the two countries although there were structural differences observed. Specifically, they were able to rule in that the German respondents proved to have a somewhat better nutritional status—and therefore better means of combating and preventing elderly malnutrition, than Dutch respondents. Another effective tool to screen malnutrition would be the Malnutrition Screening Tool, presented by Ferguson et al. (1999). It outlines an objective form of evaluating a patient for malnutrition.
Food pickiness and or selectivity, a trait often exhibited by elderly nursing home residents has also been observed as one of the reasons why they fall prey to malnourishment. In one study published in Food Quality and Preference, the researchers examined the relationship between food pickiness and malnutrition among the elderly. They surveyed 559 French people aged over 65 years old, focusing on patterns that show food selectivity and malnutrition. The results of the said study showed that an increase in food selectivity can be statistically correlated with a higher prevalence rate of malnutrition and malnutrition risk. They also cited that the effects of food selectivity can be parallel to that of eating difficulties. This is one of the studies that focused more on the patients than the actual interventions used to prevent elderly malnutrition. This may be the case at some point because participation in a prescribed regimen can serve as an important success predictor. This was shown in a study published by De et al. (2010) when they assessed how patient characteristics and procedural interventions affect the likelihood that a hospital-acquired condition may occur. Macro trends such as the ones that lead to food insecurity have also been identified as one of the non-practitioner-related causes of malnutrition, based on what Simsek, Meseri, Sahin, & Ucku (2013) outlined in their study.
The Academy of Nutrition and Dietetics (2014) presented a report of the Dialogue Proceedings Launching the Malnutrition Quality Improvement Initiative. In the said report, the members of the dialogue shared their goals, objectives, best practices, and proposed methods to improve the outcomes on anti-malnutrition campaigns, especially among the elderly. The members of the dialogue identified the biggest hindrances to the success of anti-malnutrition campaigns as poor coordination of care among providers and settings of care, inadequate identification of malnourished patients and patients at risk for malnutrition, lack of standardization of definitions, ownership of patient malnutrition care needs in the hospital setting, and understanding or appreciation of the established link between appropriate nutritional interventions and cost savings, and limited nutrition information generally found in the said institutions.
The use of a holistic approach in assessing, treating, and monitoring the nutritional status of elderly patients diagnosed with malnourishment is what Demeny, Jukic, Dawson, and O’Leary proposed as more effective in their study. After reviewing 186 elderly individuals diagnosed with malnourishment, they were able to rule in that there currently exist no policies, standards, and protocols that are aimed at addressing and preventing malnourishment among the elderly that involve a complete set of assessment, treatment, and monitoring processes. Most dieticians conform to what is being practiced by the majority of other dieticians regardless whether such practices are truly evidence-based or otherwise. This can be a problem considering how widespread malnourishment among the elderly population is and how limiting its functional effects on the patients can be.
The use of nutritional supplements has long been raised as a strategy in addressing and preventing malnutrition among elderly nursing home residents. In a study published in Nutritional Therapy and Metabolism, the researchers assessed the nutritional status of 30 elderly nursing home patients and studied how they responded to a scheduled nutritional program based largely on the use of nutritional supplements. After doing their analyses, they were able to rule in that protein deficiency is one of the most commonly occurring causes of malnutrition among elderly nursing home residents. Considering the role that protein plays in the body, the researchers presumed that a protein-based supplement would be the most appropriate to address a problem of this nature . Their tests also showed that nutritional supplementation, not just in protein form, proved effective in improving the nutritional status of the patients.
In a systematic review and meta-analysis published in the Aging Research Reviews, the researchers argued that one of the effective ways to combat and prevent malnutrition among aging patients is to use high protein oral nutritional supplements (ONS). This was based on a review of some 36 randomized controlled trials involving 3,790 subjects with a mean age of 74 years old. One of the most evident manifestations of malnutrition is muscle wasting and this is what Cawood & Stratton aimed at in their review. Their results showed that the high protein approach they studied led to significant reduction in malnutrition complications, reduction in length of hospital stay and readmissions, improvements in handgrip strength, body weight, muscle mass, and reduction in overall food intake.
Conclusions
Overall, there is enough empirical evidence to confirm the considerable prevalence of malnutrition among the elderly in long-term care facilities. The researches reviewed were predominantly quantitative, which is a convenient format for planning a budget for long-term care facilities and for informing national policy on the overview of care facilities. The weaknesses of the literature are in terms of measurement. There is no standard rule for measuring actual food intake, studies use different measurements and use different definitions of malnutrition. These differences make cross study comparisons difficult.
The literature review indicated that educational programs are needed for nurses and other hospital staff involved with the nutrition of patients. Several studies reveal a lack of competence with regarding the identification and implementation of nutrition guidelines, a lack of nutrition policies and the non-implementation of facility policies. These findings suggest that dietitians can become involved in an examination of the institution’s structure with the aim to improving timely access to information and to review training needs. As research has indicated that malnutrition greatly increases when culinary activities are delegated, it could be useful for dieticians to implementing a program in a long-term care facility that would either involve picky eaters in the preparation of meals in long-term care facilities, or at least query residents as to their preferences.
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