Feasibility of implementing routine nutritional screening for older adults in Australian general practices: a mixed-methods study

Hamirudin, Aliza Haslinda; Charlton, Karen E; Walton, Karen; Bonney, Andrew D; Potter, Jan; Milosavljevic, Marianna; Hodgkins, Adam; Albert, George; Ghosh, Abhijeet; Dalley, Andrew

doi:10.1186/s12875-014-0186-5

Cited by 21 publications

(35 citation statements)

References 35 publications

(44 reference statements)

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“…There is a need to conduct prospective longitudinal studies along with appropriate nutritional interventions as emphasized by Roberts et al (2007). Green and Watson (2006) Implementation of routine nutrition screening in general practice is an ideal strategy for timely malnutrition risk identification and provision of appropriate nutrition interventions and follow up (Flanagan et al, 2012;Hamirudin et al, 2014). However, reports of nutrition screening initiatives conducted in general practice are uncommon, as confirmed in this review.…”

Section: Discussionmentioning

confidence: 75%

Outcomes related to nutrition screening in community living older adults: A systematic literature review

Hamirudin

Charlton

Walton

2016

Archives of Gerontology and Geriatrics

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Introduction Nutrition screening is an initial procedure in which the risk of malnutrition is identified. The aims of this review were to identify malnutrition risk from nutrition screening studies that have used validated nutrition screening tools in community living older adults; and to identify types of nutrition interventions, pathways of care and patient outcomes following screening. Methods A systematic literature search was performed for the period from January 1994 until December 2013 using SCOPUS, CINAHL Plus with Full Text, PubMed and COCHRANE databases as well as a manual search. Inclusion and exclusion criteria were determined for the literature searches and the methodology followed the PRISMA guidelines. Results Fiftyfour articles were eligible to be included in the review and malnutrition risk varied from 0% to 83%. This large range was influenced by the different tools used and heterogeneity of study samples. Most of the studies were cross sectional and without a subsequent nutrition intervention component. Types of nutrition intervention that were identified included dietetics care, nutrition education, and referral to Meals on Wheels services and community services. These interventions helped to improve the' nutritional status of older adults. Conclusions Timely nutrition screening of older adults living in the community, if followed up with appropriate intervention and monitoring improves the nutritional status of older adults. This indicates that nutrition intervention should be considered a priority following nutrition screening for malnourished and at risk older adults. Further evaluation of outcomes of nutrition screening and associated interventions, using structured pathways of care, is warranted. Abstract IntroductionNutrition screening is an initial procedure in which the risk of malnutrition is identified. The aims of this review were to identify malnutrition risk from nutrition screening studies that have used validated nutrition screening tools in community living older adults; and to identify types of nutrition interventions, pathways of care and patient outcomes following screening. MethodsA systematic literature search was performed for the period from January 1994 until December 2013 using SCOPUS, CINAHL Plus with Full Text, PubMed and COCHRANE databases as well as a manual search. Inclusion and exclusion criteria were determined for the literature searches and the methodology followed the PRISMA guidelines. ResultsFifty-four articles were eligible to be included in the review and malnutrition risk varied from 0 % to 83%. This large range was influenced by the different tools used and heterogeneity of study samples. Most of the studies were cross sectional and without a subsequent nutrition intervention component. Types of nutrition intervention that were identified included dietetics care, nutrition education, and referral to Meals on Wheels services and community services. These interventions helped to improve the' nutritional status of older adults. ConclusionsTimely ...

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Section: Discussionmentioning

confidence: 75%

Outcomes related to nutrition screening in community living older adults: A systematic literature review

Hamirudin

Charlton

Walton

2016

Archives of Gerontology and Geriatrics

Self Cite

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“…We currently have little data on how older adults perceive screening or why they are reluctant to be screened [48, 49]. Notably, findings relating to patients’ barriers to screening emerged largely from HCPs’ experiences [48, 49, 55]. Moreover, we noted some conflicting findings, such as that some patients are willing to be screened when the purpose of screening is explained to them [55], whilst others seem to prefer not to know [55].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2019

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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.

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“…A review by McInnes et al [11] and a study by Merrick et al [12] provided worthwhile understandings of challenges to teamwork, collaboration and decision-making in the general practice environment without specifically tackling issues surrounding advanced practice nursing. Other studies focused on nurses performing certain roles [13, 14], working in specific contexts [10, 15], or managing particular illnesses [16–18]. …”

Section: Introductionmentioning

confidence: 99%

A systematic review of experiences of advanced practice nursing in general practice

2017

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BackgroundDespite efforts to achieve conceptual clarity, advanced practice nursing continues to reside in a liminal space, unable to secure ongoing recognition as a viable means of healthcare delivery. This is particularly evident in general practice where advanced practice role development is more fluid and generally less supported by the hierarchical structures evident in the hospital system. This review synthesises published qualitative studies reporting experiences of advanced practice nursing in general practice. The panoramic view provided by patients, nurses and doctors within this novel context, offers a fresh perspective on why advanced practice nurses have struggled to gain acceptance within the healthcare milieu.MethodsWe conducted a systematic review of qualitative studies that explored the experiences of patients, nurses and doctors who had contact with advanced practice nurses working in general practice. Published work from 1990 to June 2016 was located using CINAHL and PubMed. The full text of relevant studies was retrieved after reading the title and abstract. Critical appraisal was undertaken and the findings of included studies were analysed using the constant comparative method. Emergent codes were collapsed into sub-themes and themes.ResultsTwenty articles reporting the experiences of 486 participants were included. We identified one major theme: legitimacy; and three sub-themes: (1) establishing and maintaining confidence in the advanced practice nurse, (2) strengthening and weakening boundaries between general practitioners and advanced practice nurses and (3) establishing and maintaining the value of advanced practice nursing.ConclusionsWe set out to describe experiences of advanced practice nursing in general practice. We discovered that general practitioners and patients continue to have concerns around responsibility, trust and accountability. Additionally, advanced practice nurses struggle to negotiate and clarify scopes of practice while general practitioners have trouble justifying the costs associated with advanced practice nursing roles. Therefore, much work remains to establish and maintain the legitimacy of advanced practice nursing in general practice.Electronic supplementary materialThe online version of this article (doi:10.1186/s12912-016-0198-7) contains supplementary material, which is available to authorized users.

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Feasibility of implementing routine nutritional screening for older adults in Australian general practices: a mixed-methods study

Cited by 21 publications

References 35 publications

Outcomes related to nutrition screening in community living older adults: A systematic literature review

Outcomes related to nutrition screening in community living older adults: A systematic literature review

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

A systematic review of experiences of advanced practice nursing in general practice

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