Low staffing level is associated with malnutrition in long-term residential care homes

Abstract

Objective: To determine if staffing level is associated with poor nutrition in the long-term residential care setting, adjusting for other confounding factors. Design: Cross-sectional survey. Setting: In total, 14 residential care facilities in Hong Kong, stratified by nature (government subvention or for-profit) to reflect the overall proportion in Hong Kong. Subjects: A total of 1914 subjects were assessed, using the Resident Assessment Instrument (RAI) 2.0. The response rate was 95% (1820 subjects), of which 1699 subjects had complete nutritional information. Intervention: Body mass index (BMI) was calculated by weighing and height measurement, and arm span was used if the subject could not stand. Subjects who were receiving parenteral or enteral nutrition via nasogastric of enterostomy tubes were excluded. A history of weight loss of 5% in the past month or 10% in the past 6 months, leaving 25% of food uneaten, and BMI o18.5 kg/m 2 were examined as nutritional indicators. Association with age, gender, functional disability, oral problems, taste problems, presence of physical diseases and psychological well-being was examined using w 2 -test, and multiple logistic regression. Results: In all, 26% of residents had a BMI o18.5 kg/m 2 , with a higher prevalence in the for-profit homes. History of weight loss and the record that 25% of food was left uneaten were poor indicators of low BMI. Multivariate analysis showed that having chronic obstructive airways disease, requiring help with feeding, being female, older age, were factors associated with an increased risk of poor nutrition, while being independent in activities of daily living and higher staff levels were associated with a reduced risk. Conclusion: Poor nutrition is a persistent problem in the long-term care setting, and inadequate staffing levels may be a reversible cause. However, resource limitations may render efforts at improvement difficult. Sponsorship: SK Yee Memorial Fund.

The SNAQRC, an easy traffic light system as a first step in the recognition of undernutrition in residential care

“…The development of a traffic light dial disk for the BMI calculation will improve the feasibility (figure 1). Woo et al (2005) describes that lower staff education levels were associated with an increased risk of undernutrition (32). Education of the care workers in the weighing and screening is essential.…”

The importance of combating malnutrition in care

“…The use of food enhancers and oral nutritional supplements (ONS) as part of nutritional interventions may promote food intake, reduce the risk of malnutrition and decrease the rates of falls (Woo et al, 2005;Neyens et al, 2010). These nutritional interventions may also be in the form of energy and protein rich diets and energy-enriched snacks, which are often provided between meals (Dunne, 2009;Neyens et al, 2010).…”

“…Other measures that could be employed to tackle malnutrition in care may involve: the use of nutritional interventions, good oral health, training and sustenance of national standards for food provisions, a good meal environment, availability of meal choices and provision of support with eating-especially for residents with a disability (Woo et al, 2005;Brown and Copeman, 2008). The use of food enhancers and oral nutritional supplements (ONS) as part of nutritional interventions may promote food intake, reduce the risk of malnutrition and decrease the rates of falls (Woo et al, 2005;Neyens et al, 2010).…”

Utilizing predictive resident-focused problems to improve nutritional outcomes in nursing homes

“…In fact, up to 85% of residents suffer from malnutrition (Crogan and Pasvogel, 2003;Suominen et al, 2005), implying that many residents have inadequate food intake. Malnutrition can result in a compromised quality of life (Crogan and Pasvogel, 2003;American Dietetic Association, 2005), and can lead to chronic disability, functional decline, increased health care utilization, increased health care costs and death (Reed et al, 2005;Woo et al, 2005). The causes of malnutrition are multidimensional, including dental caries, impaired chewing capacity, impaired ability to eat certain foods and even environmental factors such as poor food quality or lack of assistance while eating (Isaksson et al, 2003;Carrier et al, 2007).…”