Need for quantifying malnutrition awareness among community-dwelling older adults and identifying factors associated with malnutrition awareness.
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Objectives: The aim of this study was to determine how diagnosing and coding of malnutrition in an internal medicine ward setting influences potential hospital reimbursement. Methods: Patients admitted to the internal medicine ward of Centro Hospitalar do Médio Ave between April 24 and May 22, 2018 were screened by Nutritional Risk Screening 2002, and patients classified as at “risk for malnutrition” were assessed by the Patient-Generated Subjective Global Assessment (PG-SGA). For each patient, medical coders simulated coding, taking into account the malnutrition diagnosis by PG-SGA, and compared it with the real coding as retrieved from the medical records. For the coding, the Diagnosis-Related Group and Severity of Illness were determined, allowing the calculation of hospitalization cost (HC) according to Portuguese Ministerial Directive number 207/2017. The increase of HC in this subsample was extrapolated to the number of patients admitted during 2018, to obtain the estimated unreported annual HC. Results: Of the 71% (92/129) participants having malnutrition risk according to Nutritional Risk Screening 2002, 86% were malnourished. Including malnutrition diagnosis in the coding of malnourished patients increased the level of Severity of Illness in 39% of cases and increased HC for this subsample, resulting in €52 000. Extrapolating for the annual HC, total HC reached €1.3 million. Conclusions: Identifying malnourished patients and including this highly prevalent diagnosis in medical records allows malnutrition coding and consequent increase of HC. This can improve the potential hospital reimbursement, which could contribute to the quality of patient care and economic sustainability of hospitals.
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Background: As our global population ages, malnutrition and sarcopenia are increasingly prevalent. Given the multifactorial nature of these conditions, effective management of (risk of) malnutrition and sarcopenia necessitates interprofessional collaboration (IPC). This study aimed to understand primary and social care professionals’ barriers, facilitators, preferences, and needs regarding interprofessional management of (risk of) malnutrition and sarcopenia in community-dwelling older adults. Methods: We conducted a qualitative, Straussian, grounded theory study. We collected data using online semi-structured focus group interviews. A grounded theory data analysis was performed using open, axial, and selective coding, followed by developing a conceptual model. Results: We conducted five online focus groups with 28 professionals from the primary and social care setting. We identified five selective codes: 1) Information exchange between professionals must be smooth, 2) Regular consultation on the tasks, responsibilities, and extent of IPC is needed; 3) Thorough involvement of older adults in IPC is preferred; 4) Coordination of interprofessional care around the older adult is needed; and 5) IPC must move beyond healthcare systems. Our conceptual model illustrates three interconnected dimensions in interprofessional collaboration: professionals, infrastructure, and older adults. Conclusion: Based on insights from professionals, interprofessional collaboration requires synergy between professionals, infra-structure, and older adults. Professionals need both infrastructure elements and the engagement of older adults for successful interprofessional collaboration.
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The aim of this systematic review was to examine the association between malnutrition and oral health in older people (≥ 60 years of age). A comprehensive systematic literature search was performed in four databases (PubMed, CINAHL, Dentistry and Oral Sciences Source, and Embase) for literature from January 2000 to May 2020. Both observational and intervention studies were screened for eligibility. Two reviewers independently screened the search results to identify potential eligible studies, and assessed the methodological quality of the full-text studies. A total of 3240 potential studies were identified. After judgement for relevance, 10 studies (cross-sectional (n = 9), prospective cohort (n = 1)) met the inclusion criteria. Three studies described malnourished participants as having fewer teeth, or functional (tooth) units (FTUs), compared to well-nourished participants. Four studies reported soft tissue problems in malnourished participants, including red tongue with blisters, and dry or cracked lips. Subjective oral health was the topic in six studies, with poorer oral health and negative self-perception of oral health in malnourished elderly participants. There are associations between (at risk of) malnutrition and oral health in older people, categorized in hard and soft tissue conditions of the mouth, and subjective oral health. Future research should be focused on longitudinal cohort studies with proper determination of malnutrition and oral health assessments, in order to evaluate the actual association between malnutrition and oral health in older people.
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ObjectivesBody weight and muscle mass loss following an acute hospitalization in older patients may be influenced by malnutrition and sarcopenia among other factors. This study aimed to assess the changes in body weight and composition from admission to discharge and the geriatric variables associated with the changes in geriatric rehabilitation inpatients.DesignRESORT is an observational, longitudinal cohort.Setting and ParticipantsGeriatric rehabilitation inpatients admitted to geriatric rehabilitation wards at the Royal Melbourne Hospital, Melbourne, Australia (N = 1006).MethodsChanges in body weight and body composition [fat mass (FM), appendicular lean mass (ALM)] from admission to discharge were analyzed using linear mixed models. Body mass index (BMI) categories, (risk of) malnutrition (Global Leadership Initiative on Malnutrition), sarcopenia (European Working Group on Sarcopenia in Older People), dependence in activities of daily living (ADL), multimorbidity, and cognitive impairment were tested as geriatric variables by which the changes in body weight and composition may differ.ResultsA total of 1006 patients [median age: 83.2 (77.7–88.8) years, 58.5% female] were included. Body weight, FM (kg), and FM% decreased (0.30 kg, 0.43 kg, and 0.46%, respectively) and ALM (kg) and ALM% increased (0.17 kg and 0.33%, respectively) during geriatric rehabilitation. Body weight increased in patients with underweight; decreased in patients with normal/overweight, obesity, ADL dependence and in those without malnutrition and sarcopenia. ALM% and FM% decreased in patients with normal/overweight. ALM increased in patients without multimorbidity and in those with malnutrition and sarcopenia; ALM% increased in patients without multimorbidity and with sarcopenia.Conclusions and ImplicationsIn geriatric rehabilitation, body weight increased in patients with underweight but decreased in patients with normal/overweight and obesity. ALM increased in patients with malnutrition and sarcopenia but not in patients without. This suggests the need for improved standard of care independent of patients’ nutritional risk.
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Aim: The prevalence of age‐related malnutrition is increasing in almost all Western countries. Because of their expertise, dietitians should have a central role in the management of malnutrition. This review aimed to synthesise the literature on the role of the dietitian in the management of malnutrition in the elderly in comparison with other health professionals. Methods: In November 2018, a search of Embase, Medline Ovid, Cinahl Ebscohost, Cochrane Central, Web of Science and Google Scholar was undertaken using ‘dietitian’, ‘elderly’ and ‘malnutrition’ as the main search terms. Qualitative and quantitative empirical research studies that focussed on the role of dietitians as the (main) subject of the study were included. Data extraction and data synthesis were performed by the three authors using a thematic synthesis approach. Results: Three themes emerged from the coding and synthesis of the 21 included studies. The first theme demonstrates that other health professionals' time for, and knowledge of, screening policies negatively affects the role of the dietitian. The second theme demonstrates that the importance of nutritional care is acknowledged. However, this does not always imply familiarity with dietetics nor does it always mean that other health professionals think involving dietitians is worth the effort. The third theme demonstrates that issues of workload appeared to be especially important in crossing or guarding role boundaries. Conclusions: The role of dietitians in managing age‐related malnutrition is not always clear and coherent. Therefore, how dietitians shape their role to provide optimal management of malnutrition in the elderly is open to debate. https://doi.org/10.1111/1747-0080.12546 LinkedIn: https://www.linkedin.com/in/matthijs-fleurke-66279110/ https://www.linkedin.com/in/dorien-voskuil-9b27b115/
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BACKGROUND & AIMS: Diagnosed prevalence of malnutrition and dietary intake are currently unknown in patients with severe aortic stenosis planned to undergo Transcatheter Aortic Valve Implantation (TAVI). This study describes the preprocedural nutritional status, protein intake and diet quality.METHODS: Consecutive preprocedural TAVI patients were asked to participate in this explorative study. Nutritional status was diagnosed with the global leadership initiative on malnutrition (GLIM) criteria. Preprocedural protein intake and diet quality were assessed with a three-day dietary record. To increase the record's validity, a researcher visited the participants at their homes to confirm the record. Protein intake was reported as an average intake of three days and diet quality was assessed using the Dutch dietary guidelines (score range 0-14, 1 point for adherence to each guideline).RESULTS: Of the included patients (n = 50, median age 80 ± 5, 56% male) 32% (n = 16) were diagnosed with malnutrition. Patients diagnosed with malnutrition had a lower protein intake (1.02 ± 0.28 g/kg/day vs 0.87 ± 0.21 g/kg/day, p = 0.04). The difference in protein intake mainly took place during lunch (20 ± 13 g/kg vs 13 ± 7 g/kg, p = 0.03). Patients adhered to 6.4 ± 2.2 out of 14 dietary guidelines. Adherence to the guideline of whole grains and ratio of whole grains was lower in the group of patients with malnutrition than in patients with normal nutritional status (both 62% vs 19%, p = 0.01). In a multivariate analysis diabetes mellitus was found as an independent predictor of malnutrition.CONCLUSION: Prevalence of malnutrition among TAVI patients is very high up to 32%. Patients with malnutrition had lower protein and whole grain intake than patients with normal nutritional status. Furthermore, we found diabetes mellitus as independent predictor of malnutrition. Nutrition interventions in this older patient group are highly warranted.
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This study evaluates the concurrent validity of five malnutrition screening tools to identify older hospitalized patients against the Global Leadership Initiative on Malnutrition (GLIM) diagnostic criteria as limited evidence is available. The screening tools Short Nutritional Assessment Questionnaire (SNAQ), Malnutrition Universal Screening Tool (MUST), Malnutrition Screening Tool (MST), Mini Nutritional Assessment—Short Form (MNA-SF), and the Patient-Generated Subjective Global Assessment—Short Form (PG-SGA-SF) with cut-offs for both malnutrition (conservative) and moderate malnutrition or risk of malnutrition (liberal) were used. The concurrent validity was determined by the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and the level of agreement by Cohen’s kappa. In total, 356 patients were included in the analyses (median age 70 y (IQR 63–77); 54% male). The prevalence of malnutrition according to the GLIM criteria without prior screening was 42%. The conservative cut-offs showed a low-to-moderate sensitivity (32–68%) and moderate-to-high specificity (61–98%). The PPV and NPV ranged from 59 to 94% and 67–86%, respectively. The Cohen’s kappa showed poor agreement (k = 0.21–0.59). The liberal cut-offs displayed a moderate-to-high sensitivity (66–89%) and a low-to-high specificity (46–95%). The agreement was fair to good (k = 0.33–0.75). The currently used screening tools vary in their capacity to identify hospitalized older patients with malnutrition. The screening process in the GLIM framework requires further consideration.
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Background: Disease-related malnutrition is a significant problem in hospitalized patients, with high prevalence rates depending on the studied population. Internal Medicine wards are the backbone of the hospital setting. However, prevalence and determinants of malnutrition in these patients remain unclear. We aimed to determine the prevalence of malnutrition in Internal Medicine wards and to identify and characterize malnourished patients. Methods: A cross-sectional observational multicentre study was performed in Internal Medicine wards of 24 Portuguese hospitals during 2017. Demographics, hospital admissions during the previous year, type of admission, primary diagnosis, Charlson comorbidity index, and education level were registered. Malnutrition at admission was assessed using Patient-Generated Subjective Global Assessment (PG-SGA). Demographic characteristics were compared between well-nourished and malnourished patients. Logistic regression analysis was used to identify determinants of malnutrition. Results: 729 participants were included (mean age 74 years, 51% male). Main reason for admission was respiratory disease (32%). Mean Charlson comorbidity index was 5.8 ± 2.8. Prevalence of malnutrition was 73% (56% moderate/suspected malnutrition and 17% severe malnutrition), and 54% had a critical need for multidisciplinary intervention (PG-SGA score ≥9). No education (odds ratio [OR] 1.88, 95% confidence interval [CI]: 1.16–3.04), hospital admissions during previous year (OR 1.53, 95%CI: 1.05–2.26), and multiple comorbidities (OR 1.22, 95%CI: 1.14–1.32) significantly increased the odds of being malnourished. Conclusions: Prevalence of malnutrition in the Internal Medicine population is very high, with the majority of patients having critical need for multidisciplinary intervention. Low education level, admissions during previous year, and multiple comorbidities increase the odds of being malnourished.
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The Global Leadership Initiative on Malnutrition (GLIM) created a consensus‐based framework consisting of phenotypic and etiologic criteria to record the occurrence of malnutrition in adults. This is a minimum set of practicable indicators for use in characterizing a patient/client as malnourished, considering the global variations in screening and nutrition assessment, and to be used across different healthcare settings. As with other consensus‐based frameworks for diagnosing disease states, these operational criteria require validation and reliability testing, as they are currently based solely on expert opinion.
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