Undernutrition in the Nursing Home: Prevalence, Consequences, Causes and Prevention

Abbasi, Adil A.; Rudman, Daniel

doi:10.1111/j.1753-4887.1994.tb01403.x

Cited by 145 publications

(52 citation statements)

References 61 publications

(5 reference statements)

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“…Despite the quality improvement, substantial problems remain with the quality of care in nursing homes [4,22]. The literature documented quality problems ranging from malnutrition [23][24], and dehydration [25], to medication errors [26], pressure ulcers [27], and pain [28]. Hospitalizations of nursing home residents are common.…”

Section: Evidence Of Low Quality In Nursing Homes and Changes In Qualmentioning

confidence: 99%

Medicaid Reimbursement and the Quality of Nursing Home Care: A Case Study of Medi-Cal Long-Term Care Reimbursement Act of 2004 in California

Xing¹,

Mukamel²,

Glance³

et al. 2016

WHM

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2013ii Biographical SketchThe author was born in Shanghai, China. She attended Shanghai Second Medical This dissertation provides evidence that linking Medicaid reimbursement rate to each NH's own expenditures and incentivizing NHs to invest in direct care were effective ways in achieving quality improvement. Refinements of current Medi-Cal reimbursement policy might be needed to encourage NHs to make larger investments. However, maximizing NHs' spending on direct care cannot be relied on as the only policy strategy to improve quality of care. vii Contributors and Funding SourcesThis work was supervised by a dissertation committee consisting of Professors

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Section: Evidence Of Low Quality In Nursing Homes and Changes In Qualmentioning

confidence: 99%

Medicaid Reimbursement and the Quality of Nursing Home Care: A Case Study of Medi-Cal Long-Term Care Reimbursement Act of 2004 in California

Xing¹,

Mukamel²,

Glance³

et al. 2016

WHM

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“…The results of the BAPEN nutrition screening week found that 28-32 % of residents in care homes were malnourished (2) . However, in everyday practice malnutrition is not always identified and therefore not treated (3) . The National Institute for Health and Clinical Excellence recommends that all hospital patients and carehome residents should be weighed and measured on admission (4) and advises that this screening should include BMI and unplanned weight loss.…”

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confidence: 99%

Symposium 9: Competent to care A train-the-trainer method of teaching as a way of implementing the correct use of the ‘Malnutrition Universal Screening Tool’ in Norfolk: is it effective?

Lee

Scott

2009

Proc. Nutr. Soc.

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Malnutrition is frequently undetected in care homes. It is recommended that residents are screened on admission and at suitable intervals thereafter. It is aimed to implement the 'Malnutrition Universal Screening Tool' ('MUST') in all care homes in Norfolk in order to fulfil this recommendation. Following a pilot of successful (but time-consuming) 'MUST' training a train-the-trainer package was developed as a practical way of achieving this goal. Courses were held in 2007, each comprising a study day and an assessment of each trainer delivering training. Trainers were provided with a dossier of training support materials. Data were collected at the study day and 3 months after the course to evaluate its effectiveness. Sixty-seven trainers were trained, all of whom rated the course as effective in preparing them to deliver training. At their assessments 96 % were able to explain 'MUST' accurately. Of the new trainers 44 % returned follow-up questionnaires and copies of sample care plans. The majority of care plans showed 'MUST' scores had been calculated accurately and appropriate nutrition care plans had been set up and evaluated. The train-the-trainer model is an effective method of training large numbers of care-home staff to use 'MUST'. One of the unexpected benefits observed was the ownership taken by the trainers, which was demonstrated by the enthusiasm and confidence with which they subsequently trained their colleagues. Malnutrition: Nutritional screening: 'MUST' training

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“…MUST is based on BMI and weight loss (2) . It is a validated, objective, screening tool that identifies adults who are underweight and at risk of malnutrition and provides guidelines for management.Malnutrition is not always identified, therefore not treated (3) . The cost of malnutrition in the UK has been estimated to be £7.3 billion (4) : more than twice the cost of obesity.…”

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confidence: 99%

Evaluation of a training package for the Malnutrition Universal Screening Tool (MUST)

et al. 2008

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Excellence (NICE) guidelines on nutrition support in adults (1) recommend that all people in hospitals and Care Homes should be weighed and measured on admission. NICE advise screening should include BMI and unplanned weight loss. MUST is based on BMI and weight loss (2) . It is a validated, objective, screening tool that identifies adults who are underweight and at risk of malnutrition and provides guidelines for management.Malnutrition is not always identified, therefore not treated (3) . The cost of malnutrition in the UK has been estimated to be £7.3 billion (4) : more than twice the cost of obesity.Our aim is that MUST is used in all settings in Norfolk. As a preliminary step we developed, delivered, and evaluated a pilot training package for six Social Services Care Homes. A 3-h training session that included formal teaching, practical work and group discussion was delivered twice to each Home. Post-training support was provided by email. Three months after completion of training Home Managers distributed questionnaires to all carers and caterers. Completed questionnaires and photocopies of all care plans and food charts were returned to the authors for audit and were cross-checked to ensure inter-rater reliability. All data was collated by an external auditor. The evaluation showed that staff considered they had received adequate training and that MUST was easy to use. Audit of care plans showed MUST was used accurately, and that appropriate actions were selected, implemented and monitored. The results of the care plan audit and comments made by staff have been used to develop a workbook for trainees.Overall, 90 % of carers were satisfied with their MUST training and found MUST easy to use. There was a high rate of accuracy (84 %) in calculation of MUST scores and appropriate care plans were developed from the guidelines (82 %). In general, providing snacks and fortified foods did not add to the workload but appropriate foods were reported to be available in only about half of the Homes.Achieving our aim of MUST being used in all settings in Norfolk will involve training thousands of staff. This is not possible within our current workload. We are therefore developing a 'train the trainers' package. Social Services is generously funding a half-time post, for one year, to develop, deliver and evaluate this. They are also funding a researcher from the University of East Anglia to investigate anecdotal findings of a 30 % reduction in the number of falls at Homes where MUST is used. The first tranche of 'train the trainer' has been completed and is being audited. Future developments will include developing e-learning and distance-learning packages.

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Undernutrition in the Nursing Home: Prevalence, Consequences, Causes and Prevention

Cited by 145 publications

References 61 publications

Medicaid Reimbursement and the Quality of Nursing Home Care: A Case Study of Medi-Cal Long-Term Care Reimbursement Act of 2004 in California

Medicaid Reimbursement and the Quality of Nursing Home Care: A Case Study of Medi-Cal Long-Term Care Reimbursement Act of 2004 in California

Symposium 9: Competent to care A train-the-trainer method of teaching as a way of implementing the correct use of the ‘Malnutrition Universal Screening Tool’ in Norfolk: is it effective?

Evaluation of a training package for the Malnutrition Universal Screening Tool (MUST)

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