Background: Older adults living in long-term care (LTC) are nutritionally vulnerable. The purpose of this study was to determine diet quality of Canadian LTC residents and its association with malnutrition and low calf circumference. Methods: A cross-sectional study was undertaken in 32 LTC homes across four Canadian provinces. Nutrient adequacy ratios (NARs) were calculated for seventeen nutrients; mean adequacy ratio (MAR) was calculated to describe overall diet quality. Malnutrition risk was assessed with the Mini Nutritional Assessment-Short Form (MNA-SF) and diagnosis of protein/energy malnutrition with the Patient-Generated Subjective Global Assessment (PG-SGA). Calf circumference (CC) was also assessed. Linear and logistic regressions for these outcomes with diet quality as the predictor were conducted adjusting for covariates. Results: Average MNA-SF score was 10.7 ± 2.5. Residents (43.5%) had mild/moderate to severe malnutrition based on the PG-SGA and 32.6% had a CC of < 31 cm. Mean MAR score was 0.79 ± 0.09 with significant differences between those requiring eating assistance (0.77 ± 0.11) and those that did not require assistance (0.80 ± 0.07) (p < .05). MAR score was significantly associated with malnutrition in fully adjusted models: MNA-SF scores [β = 5.34, 95% Confidence interval (CI) (2.81, 7.85)] and PG-SGA [Odds ratio (OR) = 0.49, 95% CI (0.38, 0.64)]. Those who had better diet quality were more likely to be well nourished or not at risk. Although several individual nutrients were associated with low CC (< 31 cm), there was no association between overall diet quality (MAR) and low CC. Conclusions: Diet quality is associated with malnutrition and individual nutrients (NARs) with a low CC. In addition to calories and protein, nutrient dense diets that promote adequate micronutrient intake are required in LTC.
Objectives:
Given the increased risk of malnutrition in residential care homes, we studied how specific aspects of the mealtime environment are associated with residents’ eating challenges and energy intake in general and dementia care units of these homes.
Design:
Cross-sectional study.
Participants:
624 residents and 82 dining rooms.
Setting:
32 residential care homes across Canada.
Measurements:
Eating challenges were measured using the Edinburgh Feeding Evaluation in Dementia Questionnaire (Ed-FED-q). Energy intake was estimated over nine meals. Physical, social, person-centered, functional, and homelike aspects of the mealtime environment were scored using standardized, valid measures. Effects of interactions between dining environment scores and eating challenges on daily energy intake were assessed using linear regression.
Results:
More eating challenges were associated with decreased energy intake on the general (β = −36.5, 95% confidence interval [CI] = −47.8, −25.2) and dementia care units (β = −19.9, 95% CI = −34.6, −5.2). Among residents living on general care units, the functional (β = 48.5, 95% CI = 1.8, 95.2) and physical (β = 56.9, 95% CI = 7.2, 106.7) environment scores were positively and directly associated with energy intake; the social and person-centered aspects of the mealtime environment moderated the relationship between eating challenges and energy intake.
Conclusions:
Resident eating challenges were significantly associated with energy intake on both dementia care and general care units; however on general care units, when adjusting for eating challenges, the functional and physical aspects of the environment also had a direct effect on energy intake. Furthermore, the social and person-centered aspects of the dining environment on general care units moderated the relationship between eating challenges and energy intake. Dementia care unit environments had no measurable effect on the association between resident eating challenges and energy intake.
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