Alice A. Spangler

Fluid intake in the Institutionalized Elderly

OBJECTIVE Actual fluid intake in the institutionalized elderly was compared with three established standards to determine adequacy of fluid intake. DESIGN Consecutive 3-day food and fluid intake was observed directly and analyzed by computer for water content. Number and frequency of medications and Minimum Data Set (MDS) information about cognitive skills, physical locomotion, and ability to understand were obtained from medical records. Recommended fluid intake was determined using three established standards for two age groups: 65 through 85 years and 86 through 100 years. The standards were 30 mL/kg body weight (standard 1); 1 mL/kcal energy consumed (standard 2); and 100 mL/kg for first 10 kg, 50 mL/kg for next 10 kg, and 15 mL for remaining kg (standard 3). SUBJECTS/SETTING Data were collected in one nursing home. Subjects were 40 residents who were free from acute illness and infection and/or were not receiving enteral feedings. MAIN OUTCOME MEASURES Fluid intake and MDS data were collected. Data about medications were obtained after preliminary data collection observations. STATISTICAL ANALYSIS PERFORMED A two-tailed t test was used to compare actual fluid intake with recommended fluid intake. Interaction effect of age on fluid intake was analyzed using multiple analysis of variance. Correlations were used to evaluate relationships among fluid intake, number and frequency of medications, age, weight, and MDS data. RESULTS This population received adequate or more than adequate fluid according to the standards of 30 mL/kg body weight or 1 mL/kcal energy consumed, but inadequate fluid according to standard 3, which adjusted for extremes of underweight or overweight. Age was not a factor in adequacy of fluid intake. Positive correlations existed between fluid obtained from nonmeal feedings and number and frequency of medications. APPLICATIONS When the standard of 30 mL/kg body weight is used, underweight residents have unrealistically low fluid recommendations. Standard 3, which adjusts for extremes in body weight, is more reasonable for patients whether they are of normal weight, underweight, or overweight. This standard more closely supports other recommendations of 1,500 to 2,000 mL fluid intake per day. Number and frequency of medications influences the amount of fluid residents obtain during nonmeal feedings.

Maternal Stress in Caring for Children with Feeding Disabilities: Implications for Health Care Providers

The purposes of this study were to compare the stress experienced by mothers of children with feeding disorders to the stress experienced by mothers of children with other childhood disabilities, to compare the stress experienced by mothers of children who are tube-fed with that of mothers of children with disabilities who do not require tube feeding, to ascertain the types of stressors that mothers in both groups experience, and to determine their coping resources. Subjects were mothers of children with disabilities who had recently been discharged or were receiving outpatient care from a private rehabilitation facility in a Midwestern city. The Short Form of the Questionnaire on Resources and Stress instrument and open-ended questions developed by the researchers were used. Results were analyzed using analysis of variance. Results indicate that mothers of children requiring tube feeding experienced significantly greater stress than mothers of children with disabilities who do not require tube feedings. Mothers of children requiring tube feeding also receive less support from family and friends. To assist dietitians, other health care professionals, and university instructors in developing family-centered treatment programs, we recommend including fathers, friends, or relatives in the care and feeding process; discovering ways to include the tube-fed child in family mealtime activities; increasing public awareness of tube-feeding issues; organizing support groups; and educating dietetics students about the unique stresses experienced by mothers of children who are tube-fed.

Differences in preferences of entrees by elderly congregate meal participants according to age, gender, ethnicity and education and a factor analysis approach to group entrée preferences.

Abstract Congregate meal participants (n = 381), ages 60-100, provided preference ratings of 43 entrees utilizing a modified Food Rating Scale (FACT). Differences in preferences of entrees associated with age, gender, ethnicity and educational level were analyzed using X2 analysis. Factor analysis was used to group entrees which were associated according to preferences. Both males and females agreed with the top five preferred entrees. For other entrees, females had a higher acceptance level. Both age groups preferred the same top five entrees; for other entrees, the younger group was more accepting of these. Few differences were noted among the various ethnic groups (91% white and 7% African-American). Education level of respondents had a varying association with entree preference, depending upon the specific entree.

Comparison of Nutritional Risk Indicators and Levels Among a Continuum of Independent-dependent Elderly in Northeast Indiana

Abstract LEARNING OUTCOME: To compare nutrition risk and indicators of risk in elderly participants of regional health fairs, congregate meal sites, and home delivered meal programs. Identifying various factors that compromise nutritional status of the elderly can aid in decreasing risk of disease and improve overall health. The Nutrition Screening Initiative DETERMINE Checklist can be used to identify groups of elderly who may benefit from appropriate nutrition intervention. Although the Checklist has been used extensively in congregate and home delivered meal programs, its use among independent-living elderly has been limited. Thus, the purpose of the study is to compare indicators of nutritional risk and risk levels within a continuum of independent-dependent elderly. The DETERMINE Checklist and accompanying questionnaire were completed by participants in three community settings in northeast Indiana: 848 people at regional Focus on Health Fairs (HF); 531 at congregate meal (CM) sites; and 354 in home delivered meal (HD) programs. Additional data were collected on age, gender, education, marital status, and use of formal and informal community resources. The age range of the respondents was 60-101 years. HF participants were the youngest in age and HB the oldest. Subjects were classified into nutrition risk categories. The percent of high risk HF participants was 4.7%; 20.8% were at moderate and 74.5% at low risk. The respective percentages for CM were 20.3%, 30.5% and 49.2% and for HB were 44.4%, 35.2% and 20.4%. Among the groups, HF were more educated and less likely to live alone. The questions screening for an illness or condition, eating alone, and multiple medications were among the top problems for all groups. The DETERMINE Checklist provides guidance in regard to the need for further nutrition assessment of various groups of elderly, particularly homebound. Based on the results, congregate meal participants and older people attending health fairs could benefit from nutrition education focusing on nutrition risk prevention.

Nutrition Risk Potential and Needs of Older African-American and White Congregate and Home Delivered Meal Participants

Abstract Identifying problems that potentially compromise the nutritional status of the elderly can aid in decreasing risk of disease and improve overall health. Few studies have been conducted which examine malnutrition in older minorities. The purpose of this study was to compare potential of nutrition risk and needs between African-American elderly and white elderly participants of congregate and home delivered meal programs. Working with the 16 planning and service areas in a midwest state, a survey was completed by over 12,000 participants, using the Nutrition Screening Initiative DETERMINE Checklist. Study participants who were African American (n=985) and white (n= 10244) were selected for the comparative analysis. Using Chi-square analysis, significant differences (p This study documents more potential of high nutrition risk among older African-Americans than older whites. At the same time, older African-Americans had lesser education and income resources, and different living arrangements. The information is essential for service providers developing appropriate plans for older persons.

Comparison between Homebound and Independent-Living Elderly:: Nutrition Risk and Appropriate Intervention Identified by Level I Screen

Abstract LEARNING OUTCOME: To demonstrate use and outcomes of the Level I Screen of the Nutrition Screening Initiative among two elderly groups representing widely different levels of independence in a community setting. The Level I Screen of the Nutrition Screening Initiative is used to identify malnutrition risk of among elderly and suggest appropriate intervention based on various factors which may impair the ability to obtain a nutritious diet. Two groups of elderly, representing widely different levels of independence, were studied to compare responses to the Level I Screen, nutrient intake, and intervention appropriate for each group. The two groups consisted of 35 homebound participants of a home delivered meal (HDM) program and 33 independent-living residents (IL) identified through a variety of contacts from three randomly selected non-urban communities. Participants were interviewed in their homes, during which information was gathered to complete the Level I Screen and three 24 hour food recalls. Level I Screen revealed several significant differences (P The Level I Screen was effective in identifying various areas of intervention for both groups and can be useful for home health care planners as well as for those planning programs such as nutrition education for independent living elderly. The study supports the important contribution of the home delivered meal, the need for monitoring various factors which may impair nutritional status for various groups of elderly, and the need for further nutrition assessment of homebound elderly established by results of the Screen.