Barriers and facilitators to screening and treating malnutrition in older adults living in the community: a mixed-methods synthesis

Abstract

Background Malnutrition (specifically undernutrition) in older, community-dwelling adults reduces well-being and predisposes to disease. Implementation of screen-and-treat policies could help to systematically detect and treat at-risk and malnourished patients. We aimed to identify barriers and facilitators to implementing malnutrition screen and treat policies in primary/community care, which barriers have been addressed and which facilitators have been successfully incorporated in existing interventions. Method A data-base search was conducted using MEDLINE, Embase, PsycINFO, DARE, CINAHL, Cochrane Central and Cochrane Database of Systematic Reviews from 2012 to June 2016 to identify relevant qualitative and quantitative literature from primary/community care. Studies were included if participants were older, community-dwelling adults (65+) or healthcare professionals who would screen and treat such patients. Barriers and facilitators were extracted and mapped onto intervention features to determine whether these had addressed barriers. Results Of a total of 2182 studies identified, 21 were included (6 qualitative, 12 quantitative and 3 mixed; 14 studies targeting patients and 7 targeting healthcare professionals). Facilitators addressing a wide range of barriers were identified, yet few interventions addressed psychosocial barriers to screen-and-treat policies for patients, such as loneliness and reluctance to be screened, or healthcare professionals’ reservations about prescribing oral nutritional supplements. Conclusion The studies reviewed identified several barriers and facilitators and addressed some of these in intervention design, although a prominent gap appeared to be psychosocial barriers. No single included study addressed all barriers or made use of all facilitators, although this appears to be possible. Interventions aiming to implement screen-and-treat approaches to malnutrition in primary care should consider barriers that both patients and healthcare professionals may face. Review registrations PROSPERO: CRD42017071398 . The review protocol was registered retrospectively. Electronic supplementary material The online version of this article (10.1186/s12875-019-0983-y) contains supplementary material, which is available to authorized users.

Beliefs about inevitable decline among home‐living older adults at risk of malnutrition: a qualitative study

“…The topic guide was based on evidence and evidence gaps, including findings from a mixed‐methods review ( 21 ) and previous qualitative research, as discussed in the Introduction. There were seven key questions, each with ‘probing’ questions that interviewers could use to prompt further detail about topics of interest, if needed.…”

“…A range of physical and psychosocial factors can undermine motivation to improve eating habits ( 20 ) by promoting unhelpful beliefs and fears. A mixed‐methods review identified that patients had reservations about screening and discussing diet ( 21 ) , and that difficulty chewing, swallowing, shopping or preparing food are barriers to nutritional self‐care ( 21 ) . Psychosocial barriers included not considering nutrition important, not recognising personal risk, avoiding ‘unhealthy’ energy‐dense food and loneliness ( 21 ) , being told to gain weight and not believing that recommendations will work ( 22 ) .…”

“…In previous intervention studies, barriers were addressed through eating pattern advice, such as recommending small portions, energy‐rich food, daily snacks and care pathways (e.g. dental referral for chewing problems) ( 21 ) , although participants did not always follow the advice given. Psychosocial barriers or beliefs about personal risk were rarely addressed ( 21 ) ; for example, patients can be surprised, offended or unconcerned when told they are ‘at risk’ ( 23 ) .…”

“…dental referral for chewing problems) ( 21 ) , although participants did not always follow the advice given. Psychosocial barriers or beliefs about personal risk were rarely addressed ( 21 ) ; for example, patients can be surprised, offended or unconcerned when told they are ‘at risk’ ( 23 ) . Previous studies were constrained by small sample size, variable quality and conflicting findings.…”

County-Level Characteristics Driving Malnutrition Death Rates among Older Adults in Texas

“…While the individual-level contributors to and consequences of malnutrition are known and important (as referenced above), less is known about the communitylevel influences on malnutrition death among older adults ( 22 ). An abundance of available studies about malnutrition examine school-aged youth ( 23 – 25 ); however, when older adults are specifically examined, studies typically target individual-level variables among mostly community-dwelling older adults ( 26 ). Unfortunately, such studies do not consider the totality of the aging population in a particular geographic area within the context of available resources young AND MIDDLE AGED ADULTS residents residing in the same geographic area.…”