Kathryn Rose Young

Nutritional education for community dwelling older people: a systematic review of randomised controlled trials.

OBJECTIVES To evaluate the effectiveness of nutritional education or advice on physical function, emotional health, quality of life, nutritional indices, anthropometric indicators, mortality, service use and costs of care in people over 65 years of age living at home. DESIGN Systematic review of randomised controlled trials (RCTs). DATA SOURCES PUBMED, CINAHL, PSYCINFO, the Cochrane Central Register of Controlled Trials and the National Research Register. METHODS We included studies evaluating nutritional education or advice for people aged 65 and over living in their own homes that measured one or more of the following outcomes: physical function, emotional well being, service use, dietary change and other anthropometric indicators. Studies were assessed for risk of bias on six domains. Due to high heterogeneity, results were not pooled but are reported narratively. RESULTS Twenty-three studies met our inclusion criteria. All but one of the interventions were delivered by health care professionals; ten were delivered by nurses. The review found evidence to suggest that nutritional education or advice can be used to positively influence diet and improve physical function. There was also evidence that some biochemical markers can be positively affected, although these are surrogate outcomes and are generally disease specific. Several studies indicated that complex interventions, with nutritional education as a component, also reduce depression. The evidence from this review on the impact on weight change was inconclusive. There was no evidence of an improvement in anxiety, quality of life, service use, costs of care or mortality. However, many studies were at moderate or high risk of bias, and for some outcomes the data were insufficient to make judgments about effectiveness. CONCLUSIONS This review indicates that nutritional education or advice can positively affect physical function and diet, whilst complex interventions with nutritional education as a component, can reduce depression in people over 65 years who live at home. However, more research is needed to determine whether outcomes are influenced by types of intervention, morbidity, and socioeconomic circumstance of participants. RELEVANCE TO CLINICAL PRACTICE Nutritional education, alone or as part of a complex intervention, can improve diet and physical function and may reduce depression in the over 65 s living at home.

Assessing population needs in primary health care : the problem of GP attachment

Recent government policy has emphasised the benefits of assessing need at a local level, For Health Authorities operating a system of strict GP attachment, attempting to do this for localities within districts is not straightforward. Easily available quantitative data indicating need (such as that contained in the national census) can be useful in health service planning, but are mostly based on tightly fined geographical areas. This paper describes the problems which exist in defining need for local areas within Norwich Health Authority which is an example of a district where community nursing and paramedical staff are organised in a system of GP attachment with a commonly dispersed patient population. These problems would be reduced, and multidisciplinay teamwork enhanced, if teams could be organised to work within explicit geographical boundaries.