An investigation of community-dwelling older adults' opinions about their nutritional needs and risk of malnutrition; a scoping review

Castro, Patricia Domínguez; Reynolds, Ciara; Kennelly, S.; Geraghty, Aisling A.; Finnigan, K.; McCullagh, Laura; Gibney, Eileen R.; Perrotta, Carla; Corish, Clare

doi:10.1016/j.clnu.2020.12.024

Cited by 19 publications

(19 citation statements)

References 51 publications

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“…Recent reviews report that patients may not recognise signs of malnutrition as problematic. Furthermore, older adults may wish to persist with healthy eating guidelines and weight loss can be viewed as positive, hence there can be a reluctance to gain weight [30,31]. One opportunity highlighted here is when community pharmacists identify malnutrition risk.…”

Section: Comparison With Prior Workmentioning

confidence: 99%

Healthcare professionals’ perceptions of malnutrition management and oral nutritional supplement prescribing in the community: A qualitative study

Browne

Kelly

Geraghty

et al. 2021

Clinical Nutrition ESPEN

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Background & aim: Protein-energy malnutrition is under-recognised in the community despite being common in older adults due to physiological and social changes which are often compounded by chronic disease. This qualitative study aimed to explore the opinions of healthcare professionals (HCPs) working in the primary care and community settings about the management of malnutrition and the prescription of oral nutritional supplements (ONS), often included in the treatment of malnutrition. Methods: Twelve healthcare professional (HCP) focus groups with 75 participants were conducted: community dietitians (n ¼ 17), registered dietitians working in industry (n ¼ 5), community and residential care nurses (n ¼ 22), physiotherapists (n ¼ 12), pharmacists (n ¼ 9), occupational therapists (n ¼ 6) and speech and language therapists (n ¼ 4). Focus group discussions were audio-recorded and transcribed verbatim. The data were coded and analysed using thematic analysis and key themes with illustrative quotes extracted are presented. Results: Similar views on malnutrition management existed across professions. 'Gaps in Primary Care Management' was the first key theme wherein HCPs identified limitations in malnutrition management in the community. Barriers included limited or no dietetic services available in primary care and poor communication between general practitioners and wider primary care team members which resulted in inappropriate or delayed treatment. The second key theme, 'Challenges with ONS use in the Community', encapsulated several issues HCPs experienced with ONS usage including inappropriate prescribing and lack of monitoring of treatment goals. Conflicts of interest regarding dietitians working in industry assessing and treating older adults in residential care settings was highlighted by participants. Conclusions: This study highlights that more emphasis is needed to identify patients when they are at risk of malnutrition to avoid advanced or severe malnutrition presentations currently seen. Community

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Section: Comparison With Prior Workmentioning

confidence: 99%

Healthcare professionals’ perceptions of malnutrition management and oral nutritional supplement prescribing in the community: A qualitative study

Browne

Kelly

Geraghty

et al. 2021

Clinical Nutrition ESPEN

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Section: Barriers To Detecting Malnutrition Among Community-dwelling ...mentioning

confidence: 99%

“…There is certainly evidence to support this, and carers can be more concerned about weight loss as a sign of something wrong than patients themselves (40,41) . Recent reviews have highlighted that older adults do not always associate poor appetite or weight loss with poor health, and may dislike being screened for malnutrition or being asked about dietary behaviours (44,45) . One novel and important finding from the ONSPres study, which has not been widely reported in the literature previously, is the stigma associated with the term 'malnutrition' among older adults (40) .…”

Section: Lack Of Awareness and Knowledgementioning

confidence: 99%

Advances in knowledge of screening practices and their use in clinical practice to prevent malnutrition

2021

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Malnutrition is common among older adults and is associated with a progressive decline in overall health and increased mortality. With a rapidly ageing population, the detection, prevention and management of malnutrition require urgent attention within health service planning and delivery. Routine screening for malnutrition among older adults in community settings, which addresses aetiological as well as phenotypic factors, is considered an important step for prevention and early intervention. The aim of this review is to summarise current malnutrition screening literature and highlight research that seeks to understand and address community-based approaches to malnutrition screening and management. Key healthcare professionals (HCPs) that encounter community-dwelling older adults include general practitioners (GPs), community-based nurses, community pharmacists and a range of other health and social care professionals including dietitians, physiotherapists, speech and language therapists, and occupational therapists. The key barriers to implementing screening in primary care include lack of knowledge about malnutrition among non-dietetic HCPs, lack of resources allocated to managing malnutrition, lack of access to dietetic services, and poor GP knowledge about oral nutritional supplement prescribing. In addition, older adults have poor insight into the clinical condition and the associated negative health implications. Investment in education among HCPs and public awareness is required, as well as accompanying resources to successfully implement malnutrition screening programmes for community-dwelling older adults.

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“…[ 17 ] A scoping review identified anorexia as an obstacle to food intake among participants in the majority of the included studies. [ 18 ]…”

Section: Introductionmentioning

confidence: 99%

Polypharmacy is associated with malnutrition and activities of daily living disability among daycare facility users

Nakamura

Itoh²,

Yabe³

et al. 2021

Medicine

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Polypharmacy influences malnutrition and activities of daily living (ADL) in older individuals owing to side effects such as anorexia. This study aimed to examine whether polypharmacy (5 or more drugs) is associated with malnutrition and ADL disability among daycare facility users. This cross-sectional study was performed in a daycare facility specializing in rehabilitation. Malnutrition was defined according to the Global Leadership Initiative on Malnutrition criteria and ADL disability according to the “criteria for determination of the daily life independence level (bedridden level) of elderly with disabilities.” In total, 103 of the 134 included individuals were analyzed. Thirty-three (32.0%) participants were malnourished, 46 (44.7%) had ADL disability, 58 (56.3%) qualified as cases of polypharmacy, and 9 (8.7%) experienced loss of appetite. Multivariable logistic regression analysis showed that polypharmacy was independently associated with malnutrition and ADL disability. Separate analyses of each type of drug revealed that proton pump inhibitors (that impair protein absorption and assimilation), anticonstipation drugs, and antihypertensive drugs were associated with malnutrition, whereas proton pump inhibitors, anticonstipation drugs, antidyslipidemia drugs, and antidiabetic drugs were associated with ADL disability. The only factor related to anorexia was the loss of pleasure of eating, which in turn was related to psychological stress. The side effects of polypharmacy among individuals with malnutrition and ADL disability may include impaired protein absorption and assimilation caused by proton pump inhibitors, but not anorexia. Further multicenter prospective studies are required to confirm these findings.

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An investigation of community-dwelling older adults' opinions about their nutritional needs and risk of malnutrition; a scoping review

Cited by 19 publications

References 51 publications

Healthcare professionals’ perceptions of malnutrition management and oral nutritional supplement prescribing in the community: A qualitative study

Healthcare professionals’ perceptions of malnutrition management and oral nutritional supplement prescribing in the community: A qualitative study

Advances in knowledge of screening practices and their use in clinical practice to prevent malnutrition

Polypharmacy is associated with malnutrition and activities of daily living disability among daycare facility users

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