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BACKGROUND/OBJECTIVES: Although malnutrition commonly affects stroke patients, there are no validated screening tools. We verified the usefulness of non-paralytic anthropometric measurements for the nutritional screening of stroke. SUBJECTS/METHODS: A cross-sectional study was conducted in consecutive stroke patients with hemiplegia aged [greater-than or slanted equal to]65 years, with Mini Nutritional Assessment Short Form score [[less-than or slanted equal to]11. Diagnostic malnutrition criteria from the European Society for Clinical Nutrition and Metabolism were the reference standards: body mass index (BMI) 10%+BMI RESULTS: We included 488 patients (224 men and 264 women) with a mean age of 78.8 years and mean BMI of 22.0 and 21.1 kg/m.sup.2, respectively. Eighty-one men and 124 women had malnutrition. The AUC for CC, AC, TSF, AMC and Alb was 0.859, 0.825, 0.764, 0.745 and 0.670 for men, and 0.881, 0.843, 0.796, 0.742 and 0.658 for women, respectively. In both sexes, CC had the highest kappa (0.533, 0.608; both P CONCLUSIONS: Non-paralytic CC indicated malnutrition with sufficient accuracy and good correlation with functional capacity; it may be a useful nutritional screening tool for stroke., Author(s): S Nishioka [sup.1] , H Wakabayashi [sup.2] , T Yoshida [sup.3] Author Affiliations: (1) Department of Clinical Nutrition and Food Services, Nagasaki Rehabilitation Hospital, Nagasaki, Japan (2) Department of [...]

Introduction 'Thousands of patients are annually starved in the midst of plenty, from the want of attention to the ways which alone make it possible for them to eat' (Nightingale [...]

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jada.2009.03.002 Byline: Shirley Y. Chao, Johanna T. Dwyer, Robert F. Houser, Sharon Tennstedt, Paul Jacques Abstract: The opinions of both national aging and health experts and practicing registered dietitians (RDs) were surveyed on which key quality indicators from the Food And Nutrition Care Indicators checklist should be regulated in assisted-living facilities (ALFs) for older adults. The extent to which the practices on which the indicators were based should be regulated, and which were in fact included in the current regulations of the 50 states was also studied. One hundred fifty-three national aging and health experts were surveyed in 2005 and 882 practicing RDs who were members of two American Dietetic Association dietetic practice groups employed in ALFs were surveyed in 2006. Both the experts and the RDs believed that the need for regulations in ALF food and nutrition services was vital for about a third of the indicators, (eg, 18 items on the 57 item checklist), particularly those involving facilities and staffing. For seven out of the 18 indicators, there was substantial consensus between experts and RDs. Only three of the seven indicators were addressed by regulations in more than half of the states. Consensus exists among experts and RDs that a small but significant number of food and nutrition service indicators need to be regulated. Article History: Accepted 24 October 2008

Background and objective: Malnutrition is a common and underrecognized clinical problem among aged institutionalized patients. The aim of this study was to investigate how well nurses recognize malnutrition in elderly patients in long-term care hospitals in Helsinki. Subjects and methods: In this descriptive, cross-sectional study, the nutritional status of 1043 elderly patients was assessed with the Mini Nutritional Assessment (MNA), their body mass indices (BMIS) (kg [m.sup.-2]) were counted, and factors related to their nutritional care were queried using a structured questionnaire. In addition, we asked the opinions of 53 nurses on whether they considered their patients to suffer from malnutrition. All the long-term care hospitals in Helsinki, Finland participated in this study. Results: The mean age of the patients was 81 years. The nurses considered only 15.2% of the patients to be malnourished, although the MNA showed that 56.7% were malnourished (MNA24 but MNA Conclusions: The nurses recognized malnutrition in their aged patients poorly. Nutrition education for nurses is urgently needed, as malnutrition and weight loss have been considered significant problems, and the benefits of nutritional care are well established. doi:10.1038/sj.ejcn.1602916; published online 19 September 2007 Keywords: malnutrition; Mini Nutritional Assessment test (MNA); aged patients; nurses' recognition, Introduction Malnutrition and low body mass index (BMI) are common and underrecognized problems among aged residents living in institutions (McWhirter and Pennington, 1994; Kelly et al., 2000; Saletti et al., [...]

An increasing body of evidence points to a role for vitamin K in brain physiology through its participation in sphingolipid metabolism and biological activation of the vitamin K--dependent protein Gas6. One hypothesis is that vitamin K may also play a role in the pathogenesis of Alzheimer's disease. A recent study found that patients with early-stage Alzheimer's disease consumed less vitamin K than did cognitively intact control subjects. To learn more about the dietary intakes and food sources of vitamin K in these patients, a detailed analysis was conducted. Dietary vitamin K intakes were assessed from 5 nonconsecutive days of food records collected from 31 community-dwelling patients with early-stage Alzheimer's disease and in 31 age- and sex-matched cognitively intact control subjects. Mean vitamin K intake on a person-day basis was 63 [+ or -] 90 [micro]g/day in patients and 139 [+ or -] 233 [micro]g/day in control subjects. Vitamin K intakes were significantly less in participants with Alzheimer's disease (P<0.0001), even after adjusting for energy intakes (P=0.0003). Vegetables, fats, and fruits contributed more than 70% of total vitamin K intake in both groups. The main source of vitamin K was green vegetables, which contributed 33% and 49% to total intakes in patients and control subjects, respectively. This lower consumption of green vegetables in participants with Alzheimer's disease explained their lower vitamin K intakes overall. Despite their limitations, results are in line with the most recent research in both vitamin K and Alzheimer's disease and suggest a need to consider vitamin K in future investigations on the role of diet in Alzheimer's disease.

Purpose: This study evaluated the social facilitation of elderly patients' food intake beyond the presence of mealtime companions by assessing various relationships. The study examined the relationships between patients' intake and (a) the number of interpersonal exchanges with mealtime fellows, (b) the nature of behaviors expressed by the patients themselves and their fellows, and (c) the degree of complementarity between these. Design and Methods: Interpersonal exchanges and intake were observed on repeated mealtime occasions (n = 1,477) nested within 32 geriatric patients (21 women, 11 men; age, M = 78.8 years). Participants' intake was estimated from plate leftovers. Interpersonal behaviors were examined for both participants and patients with whom they interacted in terms of agency and communion dimensions, following the interpersonal circumplex model of human interaction. With the use of multilevel regression analyses, the number, nature, and complementarity of behaviors that participants engaged in and were exposed to on a given meal were computed to test their impact on intake. Results: The total amount of interaction between patients was positively related to intake. The effect was significant for both participants' own behaviors and those to which they were exposed, and it varied with the nature of the interaction; effects were significant in terms of frequency and complementarity for communal behaviors, and complementarity only for agentic behaviors. Effects could only partly be explained by meal duration effects. Implications: The results provide support for the effect of the number, nature, and complementarity of mealtime interpersonal behaviors on the food intake of elderly patients, and they may inspire new approaches to ensure adequate intake in this malnutrition-prone population. Key Words: Interpersonal behavior, Interpersonal circumplex, Meal fellowship, Nutrition, Social facilitation

For the first time, a formula was specifically designed for the nutritional support of tube-fed elderly patients (Elderly-Specific Formula [ESF], Nestle, Switzerland). It was tested against a standard formula (Sondalis Iso [SI], Nestle Clinical Nutrition, Marne la Vallee, France) in sixteen 22-month-old Sprague Dawley rats fed by total continuous enteral infusion for 7 days. Body weight, stool weight, and nitrogen balance were measured daily. After death, muscle weight, plasma levels of amino acids, tissue protein, and amino acid content were measured. The ESF curbed weight loss, improved cumulative nitrogen balance, and increased jejunum protein content. Plasma levels of threonine, leucine, and isoleucine and the sum of total amino acids were higher in ESF-fed than in SF-fed rats. Threonine and isoleucine content in the soleus and gastrocnemius were higher in ESF-fed rats than SI-fed ones. ESF improved intestinal transit. Thus, in old rats, the ESF favored nutritional status more than a standard formula. Key Words: Enteral nutrition--Whey protein--Nitrogen balance--Amino acids--Aged rat.

Summary This information on best practice examines the evidence on effective interventions for use with undernourished older patients in hospital. It is based on an evidence synthesis of research published [...]

Objective Decreased food intakes, eating behavior disturbances, and loss of body weight are particularly significant problems among those with Alzheimer dementia. To follow the natural evolution of dietary and nutrition status among elderly community-dwelling adults with Alzheimer dementia. Methods With their caregivers, 36 community-dwelling patients in early stages of Alzheimer dementia, aged [greater than or equal to] 65 years, were recruited from memory clinics in Montreal, age-matched to cognitively intact community-based controls (n=58), and interviewed at four to five time points (TO to T4) across an 18-month period. Current diet and supplement use were assessed monthly by two food records and/or 24-hour diet recalls (666 records/recalls from patients and 1,678 records/recalls from controls), using adapted data collection techniques among patients, and analyzed using CANDAT with the 2001b Canadian Nutrient File. Results Nutrient intakes from diet and supplements were higher in control subjects, with significant differences in energy, the macronutrients, calcium, iron, zinc, vitamin K, vitamin A, and dietary fiber as well as n-3 and n-6 fatty acids. Repeated measures analysis of variance confirmed these observations among balanced groups of participants aged [greater than or equal to] 70 years with full nutrient data during 12 months' follow-up. Conclusions Dietary intakes by persons with Alzheimer dementia are poor compared to cognitively intact age-matched controls. Suboptimal diet is evident early in the onset of the disease. This vulnerable population would benefit from systematic dietary assessment and intervention to prevent further deterioration in food consumption and increased nutritional risk.

Background. Repeated administration of low-molecular-weight heparin (LMWH) to elderly patients with an impaired renal function may lead to an accumulation effect with an increased risk of bleeding. In this setting, Cockcroft-Gault (CG) is the most widely used formula for glomerular filtration rate (GFR) estimation. In hospitalized patients over the age of 70, the six-variable Modification of Diet in Renal Disease (MDRD) formula was compared with the CG formula to detect patients with renal impairment who are at higher risk of bleeding when treated with LMWH. Methods. We combined retrospective data from 366 patients aged 86.2 [+ or -] 6.6 years, treated with LMWHs. CG and MDRD GFR estimates were compared using the Bland-Altman method and the agreement between the two formulae by the [kappa] coefficient. Results. The mean CG and MDRD estimated GFR were 45.9 [+ or -] 21.9 mL/min and 75.6 [+ or -] 32.6 mL/min/1.73 [m.sup.2], respectively, with a mean bias of 29.6 mL/min. The concordance between the formulae to classify patients into stages of kidney disease was very poor (weighted [kappa] = 0.17): 21.8% patients had severe renal function impairment with the CG formula versus 1.3% with the MDRD formula. In our population, the MDRD thresholds that would correspond to CG estimates of 30 mL/min and 60 mL/min were found at 63 mL/min/1.73 [m.sup.2] and 80 mL/min/1.73 [m.sup.2], respectively. Conclusions. In elderly patients, GFR estimates using MDRD and CG formulae differ widely and identify different numbers of individuals with kidney disease. Prospective comparative studies are needed to validate these formulae and their different thresholds to better detect elderly patients at higher risk of bleeding when treated with LMWH.

Currently, there is no consensus about how to best treat malnutrition in elderly long-term care residents. A recent study found that the traditional treatment method of serving small, frequent meals was not effective at increasing energy intake. This review describes strategies to treat malnutrition in this vulnerable population. Key words: aged, deglutition disorders, elderly, fortified food, long-term care, malnutrition doi: 10.1301/nr.2007.mar.135-138

Objective The study was designed to identify how the beliefs and perceptions of registered dietitians (RDs) affect their decisions to propose artificial nutrition and hydration (ANH) for elderly patients as compared with nurses. Design A questionnaire consisting of demographic information, 13 belief statements, and eight patient scenarios requiring ANH was mailed to RDs (n=1,500) and nurses (n=1,500) throughout Florida. Thirteen statements, rated on a 5-point Likert scale, addressed beliefs that influence ANH decisions. Eight scenarios of patients, without an advance directive or surrogate decision maker, were created with variations in age, cognition, and emotion. For each scenario, participants selected a treatment, ANH or hydration, and responded: recommend; not recommend; undecided; or recommend a trial period; if no improvement, stop treatment. Statistical analyses performed To establish reliability and validity, the instruments were pilot-tested with a group of RDs and nurses. Cross tabulations with [chi square] tests compared the distribution of responses to the belief statements and scenarios. Statistical significance was P<0.05. Results Responses to the belief statement, "when in doubt, feed" differed significantly (P<0.001) between RDs and nurses, all other belief statements were not significantly different. In all eight scenarios, significantly more (P<0.001) RDs recommended ANH than did nurses. Conclusions RDs clearly endorsed feeding when in doubt; therefore, they recommended ANH more than nurses. Nurses, who hesitated to feed when in doubt, were more diverse with their recommendations, either recommending a trial or not recommending ANH. A philosophical difference related to feeding was apparent between RDs and nurses and may affect consistent and quality care in patients without an advance directive or surrogate decision maker.

Summary This article reviews the relationship between ageing and nutrition. The vulnerability of older adults to nutritional decline is explored and the importance of nutritional screening in this population is [...]

Abstract Nurses are responsible for identifying patients who are malnourished or at risk of malnutrition. They are also expected to follow-up patients' nutritional status and to initiate preventive and caring [...]

Purpose: Healthful eating is important for optimal diabetes self-care. However, the level of food sufficiency may influence the degree of adherence to dietary self-care behaviors through the affordability of nutritionally appropriate food. This study examines whether homebound older adults with diabetes were at greater risk for heightened food insufficiency over 1 year, despite regular receipt of home-delivered meals. Design and Methods: This was a longitudinal study of a randomly recruited sample of 268 homebound older adults in the Nutrition and Function Study (NAFS) who regularly received home-delivered meals and completed baseline and 1-year in-home assessments. Based on ah economic context model, self-reported data were collected on fundamental and proximate factors, food-sufficiency status, and intervening events. Determinants of heightened food insufficiency were examined with multivariate logistic regression models. Results: Not only did food-sufficiency status diminish over time in this sample, but it became or remained worse for older adults with diabetes. In addition to diabetes status, heightened food insufficiency was associated with perceived inadequacy of economic resources. Implications: Healthcare providers and nutrition programs should attempt to identify high-risk older adults--those who have diabetes and are at risk of food insufficiency--and develop community linkages and strategies that integrate nutrition with diabetes care plans, thus supporting a multidisciplinary, chronic care model to improve diabetes management and outcomes. Key Words: Chronic care, Diabetes management, Dietary adherence, Food insufficiency, Home-delivered meals, Nutrition

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jada.2005.01.006 Byline: Etty B. Baker, Nancy S. Wellman Abstract: This survey of 84 case managers (CMs) (88% response rate) in 11 south Florida hospitals, in one for-profit health care system, sought to identify their discharge planning concerns regarding the food and nutrition needs of older patients, how they addressed these concerns, and the degree to which registered dietitians (RDs) were involved. Most CMs were female (82 of 84, 98%), older than age 40 (59 of 84, 70%), and were registered nurses (51 of 84, 61%). Almost all (82 of 84, 98%) reported job barriers, including excessive patient loads and responsibilities and limited community services. Almost all said that nutrition-related diseases and factors (eg, chewing/swallowing problems, poor appetite, modified diets, poor dentition) strongly influenced discharge planning. Many perceived community nutrition resources (eg, congregate meals, food stamps, shopping assistance, outpatient dietitians) as not readily available. While physicians, nurses, social workers, and physical therapists were identified as very important in discharge planning, RDs were not; almost half of CMs consulted them infrequently, if at all. Strategies for the six nutrition-related case scenarios were inconsistent. Home-health agencies were chosen most often and outpatient RDs least often. Comprehensive discharge planning must include more attention to nutrition with greater input from clinical, outpatient, home health, and community RDs through, for example, attendance at hospital discharge planning rounds, inservices for CMs, and better marketing of RD services. More RDs can and should become CMs to help serve the number of older adults with nutrition-related chronic conditions.

Background. Recommendations have been made to increase the number of nursing home (NH) staff available to provide feeding assistance during meals and to individualize care for residents. However, there are few data reflecting the number of residents responsive to feeding assistance during meals and what alternative interventions might be appropriate for other residents. The purpose of this study was to evaluate the effects and staffing requirements of two individualized feeding assistance interventions to improve oral food and fluid intake in NH residents. Methods. Skilled nursing participants (n = 134) in 3 NHs received a 2-day trial of one on-one feeding assistance daring 6 meals. 68 participants who did not increase their oral intake in response to feeding assistance during meals received a 2-day intervention trial during which snacks were offered between meals 3 times daily. As part of both interventions. research staff provided adequate feeding assistance that enhanced the resident's self-feeding ability, social stimulation throughout the meal or snack period, and availability of choices for foods and fluids. Results. 46% significantly increased their oral intake in response to one-on-one mealtime feeding assistance, and the staff time required to implement this intervention was 35 ([plus or minus] 8) minutes/meal per resident compared with usual NH care, which averaged 6 ([plus or minus] 9) minutes. 44% of the participants significantly increased their oral intake in response to the between-meal snack intervention, which required 12 ([plus or minus] 6) minutes of staff time per snack/resident compared with usual NH care (1 [plus or minus] 4 minutes). Conclusions. Most participants (90%) significantly increased their daily oral food and fluid intake in response to one of two individualized interventions. The staff time necessary to implement each intervention was significantly greater than the staff time currently being spent on feeding assistance care delivery. Suggestions are made to increase the efficiency of staff time when delivering feeding assistance.

Objectives: We studied the nutritional status and the effects of nutritional intervention on body weight, cognition and activities of daily life (ADL)-function in demented individuals. Design: Controlled non-randomised study. Setting: Group-living for demented elderly (GILD), ie community assisted housing. Subjects and interventions: Twenty-two residents living in one of two units (GILD-1), received oral liquid supplements (1720 kJ/410 kcal/day) and the personnel of the GLD-I were given nutritional education. Fourteen residents in the other unit (GLD-C) served as controls. After 6 months 21 (83 (4) y, 81% women) and 12 (85 (4) y, 100% women) of the participants, respectively, were re-examined according to body mass index (BMI, kg/[m.sup.2]), cognitive function (Mini Mental State Examination (MMSE, 0-30 p) and Clinical Dementia Rating Scale (CDR) and the Katz&apos; ADL index. Results: Body mass index (BMI) < 20 was found in 19% of the participants and 44% had BMI [less than or equal to] 23. BMI correlated with MMSE (r=0.43, P Conclusions: Being underweight was common among demented elderly in group-living and was related to low cognitive capacity. Five months of oral supplementation, along with education of personnel, was followed by a weight gain. In this study the nutritional treatment did not affect the rate of decline in cognitive function or Katz&apos; ADL index. Sponsorship: Supported by grants from the Swedish National Board of Health and Social Welfare. Semper Foods AB provided the liquid supplements. DOI: 10.1038/sj/ejcn/1601304 Keywords: aged; dementia; housing for the elderly; nutritional status; oral supplements, Introduction The mean life expectancy and the proportion of elderly in the population will continue to increase during coming decades. As a consequence, the occurence of age-related diseases, eg dementia [...]

Objective: To validate a 7-day estimated dietary record routine with standardized portion sizes and household measuring in a clinical setting with the doubly labelled water (DLW) method as the reference method. Design: Energy expenditure was measured with deuterium ([sup.2]H) and oxygen-18 ([sup.18]O), and water loss was estimated by [sup.2]H dilution as part of the DLW measurements. Energy and water intake was measured with a 7 day dietary record. Setting: Five nursing home wards in Sweden. Subjects: Thirty-one geriatric patients with a mean age of 86y. Inclusion criteria were stable body weight, defined as a maximum change of [+ or -] 4% during the last 4 months of [+ or -] 2% during the last 2 months and without any acute illness. Results: The mean daily energy intake was 7.2 MJ (1727 kcal) and the mean daily energy expenditure was 6.7 MJ (1595 kcal). The mean daily water intake was 1787 ml and mean daily water loss assessed by labelled water was 1774 ml. Using the dietary record routine, the staff overestimated the patients&apos; energy intake by 8% and water intake from food and beverages by < 1% compared to DLW. Conclusion: The 7 day dietary record routine based on standardized portion sizes and household measuring seems to be a valid method for assessing the intake of energy and fluids by geriatric patients. Descriptors: malnutrition; aged; validity; diet records; doubly labelled water; body water, Introduction Malnutrition in nursing home residents is an important clinical and public health problem. One important factor contributing to its prevalence appears to be the failure of health care professionals [...]

Objective: To assess the use of the Mini-Nutritional Assessment (MNA) in elderly orthopaedic patients. Design: An observation study assessing the nutritional status of female orthopaedic patients. Setting: The orthopaedic wards of the Royal Surrey County Hospital. Subjects: Forty-nine female patients aged 60-103y; dietary records were obtained for 41 subjects and 36 subjects gave a blood sample for biochemical analysis. Major outcome methods: MNA questionnaire, anthropometry, plasma albumin, transferrin, C-reactive protein (CRP) levels and dietary analyses. Results: The group as a whole had low mean values for body weight, albumin and transferrin and high CRP levels. In addition, the group had mean energy intakes well below the estimated average requirement (EAR) and mean intakes of vitamin D, magnesium, potassium, selenium and non-starch polysaccharides (NSP) were below the lower reference nutrient intakes (LRNI). The MNA screening section categorized 69% of the patients as requiring a full assessment (scored 11 or below), but for the purposes of the study the MNA was completed on all patients. The MNA assessment categorized 16% of the group as &apos;malnourished&apos; (scored < 17 points), 47% as &apos;at risk&apos; (scored 17.5-23.5) and 37% as &apos;well nourished&apos; (scored >23.5). Significant differences were found between the malnourished and well nourished groups for body weight (P This was compared with the sensitivity and specificity of using a score of less than 23.5 on the MNA to predict malnourished individuals. Using this cut-off the sensitivity ranged from 75 to 100%, but the specificity declined to between 37 and 50%. Conclusions: The results suggest that the MNA is a useful diagnostic tool in the identification of elderly patients at risk from malnutrition and those who are malnourished in this hospital setting. Sponsorship: Nestle Clinical Nutrition, Croydon, Surrey. Descriptors: elderly; nutritional assessment; orthopaedic patients, Recent findings suggest that the prevalence of undernutrition in the free living elderly population is relatively low, with the recently published National Diet and Nutrition Survey (NDNS) of people aged [...]

Keywords: Elderly patients, Nutritional supplementation, Vitamins, Glucose. Introduction Many elderly people admitted to hospital are undernourished [1, 2] and this adversely affects their prognosis, in terms of mortality, morbidity and [...]