Lita Villalon

Making the Most of Mealtimes (M3): protocol of a multi-centre cross-sectional study of food intake and its determinants in older adults living in long term care homes

BackgroundOlder adults living in long term care (LTC) homes are nutritionally vulnerable, often consuming insufficient energy, macro- and micronutrients to sustain their health and function. Multiple factors are proposed to influence food intake, yet our understanding of these diverse factors and their interactions are limited. The purpose of this paper is to fully describe the protocol used to examine determinants of food and fluid intake among older adults participating in the Making the Most of Mealtimes (M3) study.MethodsA conceptual framework that considers multi-level influences on mealtime experience, meal quality and meal access was used to design this multi-site cross-sectional study. Data were collected from 639 participants residing in 32 LTC homes in four Canadian provinces by trained researchers. Food intake was assessed with three-days of weighed food intake (main plate items), as well as estimations of side dishes, beverages and snacks and compared to the Dietary Reference Intake. Resident-level measures included: nutritional status, nutritional risk; disease conditions, medication, and diet prescriptions; oral health exam, signs of swallowing difficulty and olfactory ability; observed eating behaviours, type and number of staff assisting with eating; and food and foodservice satisfaction. Function, cognition, depression and pain were assessed using interRAI LTCF with selected items completed by researchers with care staff. Care staff completed a standardized person-directed care questionnaire. Researchers assessed dining rooms for physical and psychosocial aspects that could influence food intake. Management from each site completed a questionnaire that described the home, menu development, food production, out-sourcing of food, staffing levels, and staff training. Hierarchical regression models, accounting for clustering within province, home and dining room will be used to determine factors independently associated with energy and protein intake, as proxies for intake. Proportions of residents at risk of inadequate diets will also be determined.DiscussionThis rigorous and comprehensive data collection in a large and diverse sample will provide, for the first time, the opportunity to consider important modifiable factors associated with poor food intake of residents in LTC. Identification of factors that are independently associated with food intake will help to develop effective interventions that support food intake.Trial RegistrationClinicalTrials.gov ID: NCT02800291, retrospectively registered June 7, 2016.

Dépistage nutritionnel chez les aînés en établissements de soins de santé : comparaison entre les établissements francophones et anglophones

RésuméObjectifsLa malnutrition des aînés est un problème répandu dans les hôpitaux et les foyers de soins. Cependant, la pratique du dépistage nutritionnel dans ces milieux est peu connue, particulièrement dans les établissements francophones de soins de santé. Cette étude avait pour objectifs de comparer la situation du dépistage nutritionnel des aînés dans les établissements de soins de santé francophones et anglophones du Nouveau-Brunswick, ainsi que les perceptions et les pratiques des professionnels de la santé.MéthodesLes données sur les paramètres de dépistage ont été puisées directement dans les dossiers médicaux des patients/résidents âgés. Les perceptions et les pratiques de dépistage nutritionnel des professionnels de la santé (médecins, infirmiers, diététistes) ont été recueillies au moyen de questionnaires.RésultatsCinq hôpitaux et 31 foyers de soins de longue durée du Nouveau-Brunswick ainsi que 421 patients/résidents et 457 professionnels de la santé ont participé à l’étude. Des différences significatives quant à la disponibilité des paramètres de dépistage furent observées entre les patients/résidents francophones et anglophones; les francophones bénéficiant moins de certains paramètres de dépistage dont le poids à l’admission, la perte d’appétit et la fraction des repas consommés. Les perceptions des professionnels quant au dépistage nutritionnel varient selon la profession et la langue de l’établissement. Plusieurs obstacles au dépistage nutritionnel sont relevés.ConclusionLa disponibilité moindre de paramètres de dépistage dans les milieux francophones et la sous-évaluation de la malnutrition par les médecins et les infirmiers sont des barrières pouvant influencer le dépistage nutritionnel en établissements de soins de santé francophones.AbstractObjectivesMalnutrition among the elderly is a widespread problem in hospitals and nursing homes. However, data on the practice of nutritional screening in these facilities are limited, particularly in Francophone establishments. This study aimed to compare nutritional screening practices among the elderly in Anglophone and Francophone health care facilities in New Brunswick (NB), as well as perceptions and practices of health care professionals.MethodsInformation on screening parameters was taken directly from elderly patients’/residents’ medical records. Health care professionals’ (doctors, nurses, dietitians) perceptions and practices of nutritional screening were collected through questionnaires.ResultsA total of five hospitals and 31 nursing homes in NB took part in the study. Of these, 421 patients/residents and 457 health professionals participated. Significant differences in the availability of screening parameters were observed between Francophone and Anglophone patients/residents. Certain screening parameters, such as weight at admission, loss of appetite and meal fractions consumed were less available in Francophone patients’/residents’ records. In addition, health care professionals’ perceptions regarding nutritional screening varied by occupation and language of the establishment. Several barriers to screening were also identified.ConclusionReduced availability of screening parameters in Francophone establishments and the underestimation of malnutrition in elderly patients/residents by doctors and nurses are barriers that can influence nutritional screening in Francophone health care facilities.

Évaluation d’un programme de nutrition prénatale portant sur l’état nutritionnel des Béninoises enceintes et sur le poids de leurs enfants à la naissance

Une étude quasi-expérimentale a été effectuée dans la République du Bénin, en Afrique entre 2004 et 2007. La population étudiée était constituée de 47 béninoises enceintes. Cette étude avait pour but d’évaluer un programme de nutrition prénatale portant sur l’état nutritionnel des mères et sur le poids de leurs enfants à la naissance. La population étudiée a été répartie en deux groupes : un groupe expérimental qui a subi l’intervention et un groupe témoin qui servait de groupe contrôle. Les femmes du groupe expérimental ont bénéficié d’une intervention nutritionnelle de la 12ème semaine de gestation à l’accouchement. Les résultats de l’étude ont démontré que la fréquence de consommation des aliments provenant du groupe constructeur et énergétique était similaire avant et après l’intervention chez les femmes enceintes du groupe expérimental. En revanche, les femmes enceintes qui avaient reçu une éducation nutritionnelle prénatale avaient tendance à gagner le poids recommandé et avaient obtenu des enfants avec un meilleur indice d’Apgar à une minute après l’accouchement (p < 0,05). De plus, les nouveau-nés des mères ayant reçu l’intervention nutritionnelle avaient un poids de naissance de 88 g plus élevé que ceux du groupe témoin. Néanmoins, l’étude n’a pas démontré une relation statistiquement significative entre le programme d’intervention nutritionnelle et l’amélioration de l’état nutritionnel des femmes enceintes d’une part et la diminution du petit poids à la naissance d’autre part. Enfin, une nouvelle relation significative a toutefois été soulevée par cette étude entre l’intervention nutritionnelle et l’état de santé du nouveau-né.

La perception des aînés francophones en situation minoritaire face aux défis et aux enjeux liés au maintien à domicile en milieu urbain néo-brunswickois

RésuméObjectifExplorer les besoins et le degré de satisfaction des aînés francophones en situation sociolinguistique minoritaire au sein d’une communauté urbaine concernant la problématique du maintien à domicile.MéthodeUne étude de cas de type ethnographique fut réalisée dans une communauté urbaine du Nouveau-Brunswick entre octobre 2010 et juin 2011. Nous avons effectué des entrevues individuelles avec les responsables d’organismes communautaires (n=9) et des groupes de discussion avec des personnes âgées francophones demeurant en contexte sociolinguistique minoritaire (n=19).RésultatsLes aînés francophones rencontrés nous ont exprimé leur volonté de vieillir chez eux. En revanche, le manque de services et de soutien manifesté par les aînés francophones représente un obstacle au maintien à domicile. En dépit de ces lacunes, les responsables d’organismes communautaires ne prévoient pas modifier leurs services en vue de favoriser l’amélioration de la qualité de vie des aînés.ConclusionLe maintien à domicile pour les aînés francophones en milieu minoritaire requiert des actions concertées issues de la famille, de la communauté et de l’État. Selon la Charte d’Ottawa, le logement constitue une condition préalable à la santé. De plus, le logement et les réseaux sociaux sont des déterminants de la santé. Par conséquent, l’élaboration et la mise en œuvre d’une politique publique à destination des personnes âgées et, de surcroît, en situation minoritaire nous apparaissent un enjeu fondamental dans un contexte de vieillissement démographique.AbstractObjectiveExplore the needs and the degree of satisfaction of Francophone seniors living in a minority socio-linguistic urban community in regards to aging-in-place.MethodAn ethnographic case study was conducted in an urban community in the province of New Brunswick between October 2010 and June 2011. Individual interviews were completed with leaders of different community organizations (n=9) and focus groups were held with socio-linguistic minority French-speaking older adults (n=19).ResultsFrancophone seniors explained their willingness to age-in-place; however, the lack of services and support in the community makes aging-in-place difficult. Despite this identified absence of services, leaders of various community organizations have no plans to review current services in order to facilitate better quality of life for seniors.ConclusionAging-in-place for French-speaking seniors living in socio-linguistic minority communities requires concerted efforts from family members, the community and the government. The Ottawa Charter of Health clearly states housing as a prerequisite of health. Housing and social support are important determinants of health. Therefore, the development and implementation of a public policy with regard to seniors, and particularly those in a socio-linguistic minority, seems fundamental in the context of population aging.

Une approche participative pour la prévention du diabète de type 2 chez les jeunes francophones du Nouveau-Brunswick

A participatory approach for the prevention of type 2 diabetes for francophone youth of New Brunswick Diabetes, a serious public health problem, is on the rise, claiming millions of victims. A considerable body of research exists on diabetes, but the development of effective primary prevention strategies is just beginning. This article presents the results of a project, based on an innovative approach where health professionals and community groups have come together to address the issue. The purpose of the project is to develop an intervention strategy for the prevention of type 2 diabetes directed at young francophones living in a minority environment in New Brunswick and adapted to their needs. Qualitative data were gathered from two focus groups and submitted for a content analysis. The process was evaluated. The young francophones have identified the school environment as ideal for intervention. According to them, the intervention should be adapted to the age of the youths. For the 5-to-13-year-old group, the intervention should target healthy eating habits and physical activity whereas for the 14-to-18-year-old group, the emphasis should be on preventing diabetes. The youth and the professionals acquired a greater understanding of the problem of diabetes and its prevention. Youth can now proceed to action, with appropriate guidance. The experience and knowledge of the professionals contributed to the development of the strategy. A shortage of dietitians in public health to work in the area of the prevention of diabetes has been noted. (Can J Diet Prac Res 2004; 65:15-21)Diabetes, a serious public health problem, is on the rise, claiming millions of victims. A considerable body of research exists on diabetes, but the development of effective primary prevention strategies is just beginning. This article presents the results of a project, based on an innovative approach where health professionals and community groups have come together to address the issue. The purpose of the project is to develop an intervention strategy for the prevention of type 2 diabetes directed at young francophones living in a minority environment in New Brunswick and adapted to their needs. Qualitative data were gathered from two focus groups and submitted for a content analysis. The process was evaluated. The young francophones have identified the school environment as ideal for intervention. According to them, the intervention should be adapted to the age of the youths. For the 5-to-13-year-old group, the intervention should target healthy eating habits and physical activity whereas for the 14-to-18-year-old group, the emphasis should be on preventing diabetes. The youth and the professionals acquired a greater understanding of the problem of diabetes and its prevention. Youth can now proceed to action, with appropriate guidance. The experience and knowledge of the professionals contributed to the development of the strategy. A shortage of dietitians in public health to work in the area of the prevention of diabetes has been noted.A participatory approach for the prevention of type 2 diabetes for francophone youth of New Brunswick Diabetes, a serious public health problem, is on the rise, claiming millions of victims. A considerable body of research exists on diabetes, but the development of effective primary prevention strategies is just beginning. This article presents the results of a project, based on an innovative approach where health professionals and community groups have come together to address the issue. The purpose of the project is to develop an intervention strategy for the prevention of type 2 diabetes directed at young francophones living in a minority environment in New Brunswick and adapted to their needs. Qualitative data were gathered from two focus groups and submitted for a content analysis. The process was evaluated. The young francophones have identified the school environment as ideal for intervention. According to them, the intervention should be adapted to the age of the youths. For the 5-to-13-year-old g...

Exploring adolescents' awareness of diabetes using the free association technique.

Purpose: Healthy adolescents’ awareness of diabetes was explored, and gender and grade-level differences in understanding were determined. Methods: Adolescents without diabetes in grades five, eight, and 10 (n=128) at four New Brunswick schools wrote down all words/expressions that came to mind when they heard the word “diabetes” (i.e., they used the free association technique). Answers were classified into categories using content analysis. Results: Eighty-eight girls and 40 boys completed the activity (n=44, 52, and 32 in grades five, eight, and 10, respectively). Nine principal categories were identified: 66% of the adolescents cited sugar (e.g., eating too much sugar, not enough sugar), 48% treatment (e.g., needles, injections), 45% the nature of diabetes (e.g., a disease, types of diabetes, heredity), 41% nutrition (e.g., diet, sugar-containing foods, other foods), 38% blood (e.g., too much/not enough sugar in blood), 18% complications (e.g., death), 11% physiological manifestations/ symptoms (e.g., ...Purpose: Healthy adolescents’ awareness of diabetes was explored, and gender and grade-level differences in understanding were determined. Methods: Adolescents without diabetes in grades five, eight, and 10 (n=128) at four New Brunswick schools wrote down all words/expressions that came to mind when they heard the word “diabetes” (i.e., they used the free association technique). Answers were classified into categories using content analysis. Results: Eighty-eight girls and 40 boys completed the activity (n=44, 52, and 32 in grades five, eight, and 10, respectively). Nine principal categories were identified: 66% of the adolescents cited sugar (e.g., eating too much sugar, not enough sugar), 48% treatment (e.g., needles, injections), 45% the nature of diabetes (e.g., a disease, types of diabetes, heredity), 41% nutrition (e.g., diet, sugar-containing foods, other foods), 38% blood (e.g., too much/not enough sugar in blood), 18% complications (e.g., death), 11% physiological manifestations/ symptoms (e.g., ...

Hoping for the Best or Planning for the Future: Decision Making and Future Care Needs

Research has shown that relatively few older adults make plans for future care needs. In this study, we explore the thinking processes involved in planning or failing to plan for the future. Interviews were carried out with 39 older adults (M age = 81 years) who were experiencing disability and illness but who lived in their own home. Guiding questions for the interview focused on present living circumstances, but for the present qualitative analysis, all references to the future, and to future residence changes, were extracted. This approach allowed us to observe how older adults spontaneously address issues of future planning when not constrained to do so. Results supported the use of a positivity bias, as well as a risk-aversive decision-making style. These older adults seemed to be prioritizing present emotional well-being by avoiding thoughts of future risks and thereby eschewing proactive coping.

Food Related Challenges and Issues Faced by New Brunswick Seniors Livingin their Own Home

The number of seniors is projected to increase over the next decade and continue to rise in the following decades. The issues and challenges faced by New Brunswick seniors living in their own home were studied recently. Too many seniors are not able to afford healthy food or enough food to maintain their health as they age. Healthy eating is one of the main factors in ensuring healthy aging and should therefore be an important consideration when determining a senior’s capacity to remain in his or her own home. Little is known about how seniors, and particularly frail seniors, manage the challenges of maintaining healthy eating habits in their home. An exploratory qualitative study was conducted among seniors aged 65 and over living in New Brunswick.

Strategies for Aging in Place The Experience of Language-Minority Seniors With Loss of Independence

For healthy and independent older adults, aging in place can be seen as identical to any other adult living at home. Little is known about how frail seniors, particularly those who speak a minority language, manage the challenges of aging in place. The present qualitative descriptive study explores the strategies that Canadian French-speaking seniors have put in place to counter their loss of independence and promote their ability to stay in their home. Semistructured individual interviews were conducted with 39 older adults and transcribed, followed by content analysis to identify common themes related to study objectives. Six themes emerged in response to strategies described for aging in place. Findings reveal the limited extent to which language issues were perceived as a barrier by participants. In conclusion, the results of this study provide us with fruitful insights to guide community nursing practice, future research, and public policy.

L'influence du contexte sociolinguistique minoritaire sur le maintien à domicile des aînés en milieu rural dévitalisé: le cas d’Acadieville au Nouveau-Brunswick

New Brunswick is one of the provinces most affected by the aging of the population. Moreover, aging at home in Francophone minority communities is a major challenge in rural areas. The goal of this paper is to identify the main advantages and disadvantages of aging at home and to expose organizational strategies deployed by seniors and their families in order to promote aging in place. The case study is the method of analysis that we have recommended. Our methodology is based on content analysis of 13 semi-structured interviews with seniors and their children. The results show that family and community support, resourcefulness and resiliency, the practice of leisure activities as well as the living environment are among the principal means used by older adults to promote aging at home.