Heather H. Keller

Prevention of Weight loss in dementia with comprehensive nutritional treatment

OBJECTIVES: To determine whether body weight can be maintained or improved in dementia residents of special care units (SCUs) using a comprehensive intervention strategy.

Issues associated with the use of modified texture foods

Use of modified texture foods (MTF) is common in the geriatric population. There is a potential for increased prevalence of use of MTF due in part to longer survival of persons with dementia, those who have suffered from a stroke, as well as other degenerative diseases that affect chewing and swallowing. Unfortunately, little clinical, nutritional and sensory research has been conducted on MTF to inform practice. This review highlights issues identified in the literature to date that influence nutritional and sensory quality and acceptability of these foods. Use of MTF is highly associated with undernutrition, however causality is difficult to demonstrate due to confounding factors such as the requirement for feeding assistance. Knowledge gaps and considerations that need to be taken into account when conducting research are identified.

Nutrition Screening Tool for Every Preschooler (NutriSTEP): validation and test-retest reliability of a parent-administered questionnaire assessing nutrition risk of preschoolers.

Objectives:Study 1: To establish the validity of scores on Nutrition Screening Tool for Every Preschooler (NutriSTEP), a community-based parent-administered screening tool for assessing nutrition risk, by comparing scores to an expert rating. Study 2: To demonstrate test–retest reliability of NutriSTEP.Subjects/Methods:Study 1: Parents of 269 preschoolers (of 294 parents recruited from the community), completed the NutriSTEP questionnaire; a registered dietitian (RD) assessed the nutritional status (based on medical and nutritional history, 3 days of dietary recall and anthropometric measurements) of these preschoolers and rated their nutritional risk (1 (low) to 10 (high risk)). Receiver operating characteristic (ROC) curves were used to establish validity and determine appropriate cut points based on sensitivity and specificity. Study 2: Parents of 140 preschoolers (of 161 recruited) completed NutriSTEP on two occasions. Intraclass correlation (ICC) and κ were used to assess reliability.Results:Study 1: Scores on NutriSTEP and the RD rating were correlated (r=0.48, P=0.01). Area under the ROC curve for the high risk RD rating (score 8+) and the moderate risk rating (score 5+) were 81.5 and 73.8%, respectively. A moderate risk cut point of >20 and high risk cut point of >25 were identified for the NutriSTEP scores. Study 2: The NutriSTEP score was reliable between administrations (ICC=0.89, F=16.7, P<0.001). Most items on the questionnaire had adequate (κ>0.5) or excellent (κ>0.75) agreement.Conclusions:The NutriSTEP questionnaire is both valid and reliable for determining nutritional risk in preschoolers.

Social Influences and Eating Behavior in Later Life: A Review

Food intake is often poor within the older population and many are at nutritional risk. Food intake is complex, as there are multiple individual, social, and environmental determinants that may interact and change over time. Social isolation has long been recognized as a key factor predicting nutrition risk in this population. However, the mechanisms by which social relationships influence diet among older adults remain poorly understood. The purpose of this review is two-fold: (1) to identify and, where possible, clarify the social concepts used in older adult nutrition research over the past two decades, specifically, the concepts of social integration, social support, companionship and commensality; and (2) to provide a review and summary of the empirical literature on social factors and diet among cognitively well older adults living in the community. Finally, challenges to studying social concepts in older adult nutrition and areas of future research will be discussed.

Mealtimes in nursing homes: striving for person-centered care.

Malnutrition is a common and serious problem in nursing homes. Dietary strategies need to be augmented by person-centered mealtime care practices to address this complex issue. This review will focus on literature from the past two decades on mealtime experiences and feeding assistance in nursing homes. The purpose is to examine how mealtime care practices can be made more person-centered. It will first look at several issues that appear to underlie quality of care at mealtimes. Then four themes or elements related to person-centered care principles that emerge within the mealtime literature will be considered: providing choices and preferences, supporting independence, showing respect, and promoting social interactions. A few examples of multifaceted mealtime interventions that illustrate person-centered approaches will be described. Finally, ways to support nursing home staff to provide person-centered mealtime care will be discussed. Education and training interventions for direct care workers should be developed and evaluated to improve implementation of person-centered mealtime care practices. Appropriate staffing levels and supervision are also needed to support staff, and this may require creative solutions in the face of current constraints in health care.

Nutritional Risk Needs Assessment of Community-Living Seniors: Prevalence of Nutrition Problems and Priorities for Action.

A random mailed survey was sent to 425 members of a seniors recreation center in Guelph, Ontario for the purpose of identifying the prevalence of nutritional risk, specific nutrition problems, and educational format preferences of these seniors. This needs assessment was used to plan an education initiative called “Action Nutrition.” SCREEN, a 15-item nutritional risk screening instrument, demographic data, participation in current recreation programs, and frequency of visits to the center were included in this survey. The response rate was 62%, average age was 72 years and 59% were female. Respondents attended on average one activity per month, 60% visited the center at least once per month and 79% read the monthly newsletter. 56.7% of respondents were considered to be at nutritional risk using SCREEN and common problems were: significant weight change in 6 months; low intake of fruits and vegetables and milk products; and restriction of the diet due to health reasons. This survey determined that nutrition problems and risk are prevalent among community-living seniors, justifying the development and implementation of educational initiatives in this setting.

Mealtimes and being connected in the community-based dementia context

Mealtimes provide an opportunity for social activity and emotional connection. This grounded theory study focused on the meaning and experience of mealtimes in families living with dementia in the community; 28 partners in care and 27 persons with dementia were interviewed together and separately. Team analysis resulted in the development of a substantive theory which explains how eating together ‘mirrors the way we are’ and reveals the essence of what it is to be human while living with dementia. Mealtimes reflect how these families were being connected, honouring identity and adapting to an evolving life. This article focuses on three ways in which Being Connected occurs at mealtimes: being face to face, participating psychologically, and getting and giving support. Understanding the role that mealtimes play in promoting improved connections and thus relationships within the dementia context has important implications for both formal and family care partners.

Mealtime experiences of families with dementia.

Twenty-three family caregivers participated in interviews to provide their perspectives on mealtimes when caring for someone with dementia (probable Alzheimer’s disease, n = 14; senile dementia, n = 2; mixed dementia, n = 2; frontal temporal lobe dementia, n = 3; and Parkinson-related dementia, n = 1). Qualitative analyses described eating conduct changes and strategies to make mealtimes manageable. They also identified that mealtimes provided a social connection for families, although simplification of meals was required. Additionally, pleasure from food consumed was important, although tension existed around providing nutritious meals. Sometimes, caregivers compromised or “gave in”; at other times they needed to “step in” to promote a successful meal. The many changes noted around meals signaled the changing status of their family member. This study provides important insight into the challenges and benefits of mealtimes for those living with dementia in the community.

Nutrition education needs and resources for dementia care in the community.

Nutrition problems and specificly weight loss are common in older adults with dementia living in the community. Study 1 involved interviews with 14 formal providers to identify the range of nutrition concerns they had experienced. In study 2, 74 Canadian Alzheimer Society chapters were surveyed by e-mail (23% participation rate) to determine nutrition concerns and education resources provided to clients. In all, 26 of these nutrition pamphlets or handouts were rated on content and format by 2 independent researchers using a standardized rating system. Common nutrition concerns identified in older adults with dementia living in the community include safety, weight loss, forgetting or refusing to eat, appetite, dysphagia, and unfavorable eating behaviors. Most resources provided to clients were considered low quality and did not match the nutrition concerns expressed by formal providers. Currently, there is a considerable knowledge translation gap around nutrition and dementia, and this study provides a basis for the future development of nutrition education resources.

Reliance on Others for Food-Related Activities of Daily Living

Abstract Reliance on others for help with food related activities (grocery shopping and meal preparation) [FADL] can influence food intake and can be considered part of the concept of food security for older adults. Data collected from 193 community living seniors identified that 29.5% of these seniors required help with these activities. Covariates independently associated with FADL were: muscle strength/size, gender, avoidance of activities due to a fear of falling and occurrence of functionally limiting diagnoses. Mediation analysis identified variables that explain the „how and why” of the association between FADL and food intake. Mediators included informal supports, frequency of informal support, perceived health status, and number of medications. By specifically analyzing covariates and mediators of reliance for FADL, there is further understanding of the relationship between this reliance and food intake in older adults.