Carol Porter

Factors Contributing to Dehydration in Nursing Homes: Inadequate Staffing and Lack of Professional Supervision

OBJECTIVE: To investigate the factors that influenced fluid intake among nursing home residents who were not eating well.

A Prospective Study of the Use of Liquid Oral Dietary Supplements in Nursing Homes1

OBJECTIVE: To investigate the use of liquid oral dietary supplements among nursing home residents who were eating poorly and losing weight.

Why patients in critical care do not receive adequate enteral nutrition? A review of the literature

Enteral nutrition is frequently used to provide nutrients for critically ill patients. However, only about half of critically ill enterally fed patients receive their energy requirements. Underfeeding is associated with detrimental clinical outcomes including infection, pressure ulcers, impaired wound healing, prolonged hospital stays, and increased morbidity and mortality. This literature review was conducted to identify major barriers to adequate enteral nutrition intake in critically ill adults and to identify gaps in the research literature. Studies (n = 30) reviewed addressed adult patients in critical care, published since 1999, and written in English. Findings showed that factors that explain inadequate enteral nutritional intake include delayed initiation of enteral nutrition and slow advancement of infusion rate, underprescription, incomplete delivery of prescribed nutrition, and frequent interruption of enteral nutrition. Frequent interruption was caused by diagnostic tests, surgical procedures, gastrointestinal intolerance, feeding tube problems, and routine nursing procedures. There are no standardized protocols that address these barriers to receiving adequate enteral intake. Such protocols must be developed, implemented, and tested to address undernutrition and mitigate the negative consequences of inadequate enteral intake.

Indirect calorimetry in critically ill patients : role of the clinical dietitian in interpreting results

Evaluation and interpretation of energy needs of critically ill patients require the expertise of clinical dietitians: Dietitians must be knowledgeable about the methods available to quantify energy needs and able to communicate effectively with physicians and nurses regarding nutritional requirements. Several prediction equations are available for calculating energy needs of critically ill patients. Indirect calorimetry is also used frequently to measure energy requirements in this patient population. This article defines when energy expenditure measured by indirect calorimetry may provide clinically useful information. Data obtained by indirect calorimetry must be interpreted carefully. Indirect calorimetry is based on the equations for oxidation of carbohydrate, protein, and fat. Errors in interpretation can be made when metabolic pathways other than oxidation dominate or when clinical conditions exist that affect carbon dioxide excretion from the lungs. Before incorporating data obtained from indirect calorimetry into a nutrition care plan, the clinical dietitian should carefully evaluate the following factors for a patient: clinical conditions when the measurement was made, desired weight loss or gain, tolerance to food or nutrition support, relationship between protein intake and energy need, and need for anabolism or growth. This article provides clinical examples illustrating how measured values compare with calculated values and recommendations for how to incorporate measured values into nutrition care plans.

Risk for low weight in community-dwelling, older adults.

Purpose: The purpose of this study was to describe nutritional risk and low weight in community-dwelling elderly. Method: This cross-sectional exploratory study used in-depth interviews conducted on older adults with a body mass index <24 kg/m2. Depression, mental state, nutrition, and demographic data were measured. Results: These elders (n = 130) were mostly female (55%, n = 71), married, white (84%, n = 109), and had a greater than a high school education. In a multivariate logistic regression analysis, 3 variables were statistically significantly associated with being severely underweight: those who self-reported having an illness or condition that changed the kind and/or amount of food eaten, unintentional weight loss of 10 lb in the last 6 months, and needing assistance with traveling outside the home. Conclusion: Awareness of the high nutritional risk should prompt consideration of early, appropriate assessment and therapy to prevent malnutrition and a declining quality of life.

Factors contributing to low weight in community-living older adults.

Purpose To investigate the factors that influence the dietary practices and eating patterns of low‐weight, community‐living older adults (aged 65 and older) and to examine the nutritional advice given to them by healthcare providers (HCPs) (e.g., nurse practitioner, medical doctor). Data sources A qualitative approach was used to study a convenience sample of older women. Semistructured interviews were conducted. Thematic analysis and open coding were used to analyze data. Conclusions Eating alone, social isolation, and stressors are the main reasons reported by participants for low weight. Data gathered in this study provide important insights into possible reasons for low weight in community‐living older adults. Implication for practice As HCPs, it is important to bring low weight to the attention of older adults and educate them regarding appropriate weight for their age (body mass index [BMI] range >21 to <27 kg/m2 for age 65 and older), to understand that older adults with a BMI of <24 may be at increased risk for poor nutritional status, and to weigh older adults at each office visit to assess change in BMI. Small changes in eating patterns and food intake can potentially play an important role in stabilizing weight. Strategies that address eating alone, social isolation, and stressors need to be pursued.

Enteral nutritional intake in adult korean intensive care patients.

BACKGROUND Nutritional support is important for maximizing clinical outcomes in critically ill patients, but enteral nutritional intake is often inadequate. OBJECTIVE To assess the nutritional intake of energy and protein during the first 4 days after initiation of enteral feeding and to examine the relationship between intake and interruptions of enteral feeding in Korean patients in intensive care. METHODS A cohort of 34 critically ill adults who had a primary medical diagnosis and received bolus enteral feeding were studied prospectively. Energy and protein requirements were determined by using the Harris-Benedict equation and the American Dietetic Association equation. Energy and protein intake prescribed and received and the reasons for and lengths of feeding interruptions were recorded for 4 consecutive days immediately after enteral feeding began. RESULTS Although the differences between requirements and intakes of energy and protein decreased significantly, patients did not receive required energy and protein intake during the 4 days of the study. Energy intake prescribed was consistently less than required on each of the 4 days. Enteral nutrition was withheld for a mean of 6 hours per patient for the 4 days. Prolonged feeding interruptions due to gastrointestinal intolerance (r= -0.874; P < .001) and procedures (r= -0.839; P = .005) were negatively associated with the percentage of prescribed energy received. CONCLUSIONS Enteral nutritional intake was insufficient in bolus-fed Korean intensive care patients because of prolonged feeding interruptions and underprescription of enteral nutrition. Feeding interruptions due to gastrointestinal intolerance and procedures were the main contributors to inadequate energy intake.

Adequacy of early enteral nutrition in adult patients in the intensive care unit

AIMS AND OBJECTIVES To evaluate the adequacy of energy and protein intake of patients in a Korean intensive care unit in the first four days after initiation of enteral feeding and to investigate the factors that had impact on adequate intake. BACKGROUND Underfeeding is a common problem for patients hospitalised in the intensive care unit and is associated with severe negative consequences, including increased morbidity and mortality. DESIGN A prospective, cohort study was conducted in a medical intensive care unit of a university hospital in Korea. METHODS A total of 34 adult patients who had a primary medical diagnosis and who had received bolus enteral nutrition for the first four days after initiation of enteral nutrition were enrolled in this study. The data on prescription and intake of energy and protein, feeding method and feeding interruption were recorded during the first four days after enteral feeding initiation. Underfeeding was defined as the intake <90% of required energy and protein. RESULTS Most patients (62%) received insufficient energy, although some (29%) received adequate energy. More than half of patients (56%) had insufficient protein intake during the first four days after enteral feeding was initiated. Logistic regression analysis showed that the factors associated with underfeeding of energy were early initiation of enteral nutrition, under-prescription of energy and prolonged interruption of prescribed enteral nutrition. CONCLUSION Underfeeding is frequent in Korean critically ill patients owing to early initiation, under-prescription and prolonged interruption of enteral feeding. RELEVANCE TO CLINICAL PRACTICE   Interventions need to be developed and tested that address early initiation, under-prescription and prolonged interruption of enteral nutrition. Findings from this study are important as they form the foundation for the development of evidence-based care that is badly needed to eliminate underfeeding in this large vulnerable Korean intensive care unit population.