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Home-Living Elderly People's Views on Food and Meals  [PDF]
Ellinor Edfors,Albert Westergren
Journal of Aging Research , 2012, DOI: 10.1155/2012/761291
Abstract: Background. The aim of the study was to describe home-living elderly people's views on the importance of food and meals. Methods. Semistructured interviews with twelve elderly people. The interviews were analysed using qualitative content analysis. Results. Respondents described how their past influenced their present experiences and views on food and meals. Increased reliance on and need of support with food and meals frequently arose in connection with major changes in their life situations. Sudden events meant a breaking point with a transition from independence to dependence and a need for assistance from relatives and/or the community. With the perspective from the past and in the context of dependency, respondents described meals during the day, quality of food, buying, transporting, cooking, and eating food. Conclusions. Meeting the need for optimal nutritional status for older people living at home requires knowledge of individual preferences and habits, from both their earlier and current lives. It is important to pay attention to risk factors that could compromise an individual's ability to independently manage their diet, such as major life events and hospitalisation. Individual needs for self-determination and involvement should be considered in planning and development efforts for elderly people related to food and meals. 1. Introduction Malnutrition, which includes undernutrition as well as overweight/obesity, is a common problem among the elderly. The prevalence of undernutrition among home-living elderly people was found to be 14.5% according to the Mini Nutritional Assessment (MNA) [1]. Among elderly people who had recently moved to a residential home, 33–37% were malnourished according to the MNA [2]. The higher prevalence of undernutrition among elderly people admitted to residential homes highlights the importance of identifying elderly people who live at home and are at risk of malnutrition, to prevent the development and aggravation of undernutrition, followed by increased dependency on and need for institutional care [1]. In addition, among 70-year-old Swedes, 20% of the men and 24% of the women were obese ( B M I > 3 0 ) [3]. In Swedish nursing homes the prevalence of overweight was 22% and another 8% were obese [4]. Thus, obesity is also a frequent problem among the elderly. The consequences of undernutrition in elderly people include functional decline or frailty [5–7], decreased quality of life [8], increased health care utilisation and costs [9, 10], higher rates of adverse complications from other health conditions [11], and
Falls in nursing home residents receiving pharmacotherapy for anemia
Reardon G, Pandya N, Bailey RA
Clinical Interventions in Aging , 2012, DOI: http://dx.doi.org/10.2147/CIA.S34789
Abstract: lls in nursing home residents receiving pharmacotherapy for anemia Original Research (1741) Total Article Views Authors: Reardon G, Pandya N, Bailey RA Published Date October 2012 Volume 2012:7 Pages 397 - 407 DOI: http://dx.doi.org/10.2147/CIA.S34789 Received: 08 June 2012 Accepted: 24 July 2012 Published: 05 October 2012 Gregory Reardon,1 Naushira Pandya,2 Robert A Bailey3 1Informagenics, LLC and The Ohio State University College of Pharmacy, Columbus, OH, USA; 2Department of Geriatrics, Nova Southeastern University College of Osteopathic Medicine, Ft Lauderdale, FL, USA; 3Janssen Scientific Affairs, LLC, Horsham, PA, USA Purpose: Falls are common among nursing home residents and have potentially severe consequences, including fracture and other trauma. Recent evidence suggests anemia may be independently related to these falls. This study explores the relationship between the use of anemia-related pharmacotherapies and falls among nursing home residents. Methods: Forty nursing homes in the United States provided data for analysis. All incidents of falls over the 6-month post-index follow-up period were used to identify the outcomes of falls (≥1 fall) and recurrent falls (>1 fall). Logistic regression was used to analyze the relationship between falls and recurrent falls with each of the anemia pharmacotherapies after adjusting for potential confounders. Results: A total of 632 residents were eligible for analysis. More than half (57%) of residents were identified as anemic (hemoglobin < 12 g/dL females, or <13 g/dL males). Of anemic residents, 50% had been treated with one or more therapies (14% used vitamin B12, 10% folic acid, 38% iron, 0.3% darbepoetin alfa [DARB], and 1.3% epoetin alfa [EPO]). Rates of falls/recurrent falls were 33%/18% for those receiving vitamin B12, 40%/16% for folic acid, 27%/14% for iron, 38%/8% for DARB, 18%/2% for EPO, and 22%/11% for those receiving no therapy. In the adjusted models, use of EPO or DARB was associated with significantly lower odds of recurrent falls (odds ratio = 0.06; P = 0.001). Other significant covariates included psychoactive medication use, age 75–84 years, age 85+ years, worsened balance score, and chronic kidney disease (P < 0.05 for all). Conclusion: Only half of the anemic residents were found to be using anemia therapy (vitamin B12, folic acid, or iron). There is little evidence to support an association between the use of vitamin B12, folic acid, or iron in reducing the rates of falls and recurrent falls in nursing homes. Reduced odds of recurrent falls were observed for DARB or EPO users.
Falls in nursing home residents receiving pharmacotherapy for anemia  [cached]
Reardon G,Pandya N,Bailey RA
Clinical Interventions in Aging , 2012,
Abstract: Gregory Reardon,1 Naushira Pandya,2 Robert A Bailey31Informagenics, LLC and The Ohio State University College of Pharmacy, Columbus, OH, USA; 2Department of Geriatrics, Nova Southeastern University College of Osteopathic Medicine, Ft Lauderdale, FL, USA; 3Janssen Scientific Affairs, LLC, Horsham, PA, USAPurpose: Falls are common among nursing home residents and have potentially severe consequences, including fracture and other trauma. Recent evidence suggests anemia may be independently related to these falls. This study explores the relationship between the use of anemia-related pharmacotherapies and falls among nursing home residents.Methods: Forty nursing homes in the United States provided data for analysis. All incidents of falls over the 6-month post-index follow-up period were used to identify the outcomes of falls (≥1 fall) and recurrent falls (>1 fall). Logistic regression was used to analyze the relationship between falls and recurrent falls with each of the anemia pharmacotherapies after adjusting for potential confounders.Results: A total of 632 residents were eligible for analysis. More than half (57%) of residents were identified as anemic (hemoglobin < 12 g/dL females, or <13 g/dL males). Of anemic residents, 50% had been treated with one or more therapies (14% used vitamin B12, 10% folic acid, 38% iron, 0.3% darbepoetin alfa [DARB], and 1.3% epoetin alfa [EPO]). Rates of falls/recurrent falls were 33%/18% for those receiving vitamin B12, 40%/16% for folic acid, 27%/14% for iron, 38%/8% for DARB, 18%/2% for EPO, and 22%/11% for those receiving no therapy. In the adjusted models, use of EPO or DARB was associated with significantly lower odds of recurrent falls (odds ratio = 0.06; P = 0.001). Other significant covariates included psychoactive medication use, age 75–84 years, age 85+ years, worsened balance score, and chronic kidney disease (P < 0.05 for all).Conclusion: Only half of the anemic residents were found to be using anemia therapy (vitamin B12, folic acid, or iron). There is little evidence to support an association between the use of vitamin B12, folic acid, or iron in reducing the rates of falls and recurrent falls in nursing homes. Reduced odds of recurrent falls were observed for DARB or EPO users.Keywords: anemia, fall, hemoglobin, long-term care, nursing home, pharmacotherapy
Public home care professionals’ experiences of being involved in food distribution to home-living elderly people in Sweden – a qualitative study with an action research approach  [cached]
Zada Pajalic,Lena Persson,Albert Westergren,Kirsti Skovdahl
Journal of Nursing Education and Practice , 2012, DOI: 10.5430/jnep.v2n2p41
Abstract: Background: Research focusing on Food Distribution (FD) from various professionals’ and organisational perspectivesare lacking. The aim of this study was therefore to explore various professionals’ experiences of involvement in FD inorder to get comprehensive understanding of the organisation, responsibilities and roles. Methods: This qualitative study is a part of a larger project with an action research approach focusing on FD in themunicipal home service and care for home-living elderly persons in a municipality in southern Sweden. The data wascollected through participatory observations (n=90 occasions and in total 480 hours), repeated focus group interviews (n =4) with different professionals (n =10) involved in the FD process and one individual interview. The material was analysedby qualitative manifest and latent content analysis. Results: The study indicates that Food Distribution is a fragmentary intervention where a comprehensive perspective andclear roles of responsibility are lacking. The FD organisation seemed to be strictly divided and limited by constraintsregarding time and money. The fragmented organisation led partly to staff only taking responsibility for their part of thechain and no one having the full picture of and responsibility for the FD process, but also to some professionals takingmore responsibility than they were supposed to. Conclusions: The aim of the study was met by using an action research approach. The study was however limited by thatno home help officers were represented. The FD appeared as an extremely complex chain of different but connectedactivities. It is not merely the distribution of a product, i.e. the meal box. The fragmentation of FD means that staff onlytakes responsibility for their part of the chain, and that no one has the full picture of or responsibility for the FD process.Consequently, there is a need for an outline of responsibilities. The findings have implications for nursing, gerontology,and in the care for the elderly.
Socioeconomic Status, Youth’s Eating Patterns and Meals Consumed away from Home  [PDF]
N. Hejazi,Z. Mazloom
Pakistan Journal of Biological Sciences , 2009,
Abstract: This study was design to determine whether there is a difference in the number of meals consumed away from home (restaurant or fast food) between low socioeconomic status (SES) and high SES adolescents. Additionally, this study sought to determine if the nutrients and food group chosen differs among children who consume meals away from home versus those who do not. Eighty four adolescences (51 boys and 33 girls) ages 12-16 years and their parents from Shiraz, Iran completed the three 24 h diet recalls (one weekend and two week days). The demographics questionnaire was also completed from each participant. Data analyzed using SPSS and hypothesis tested using one way ANOVA. There was no significant difference in the number of meals consumed away from home in low SES adolescents compared to high SES (p = 0.464). However, those who consumed meals away from home reported a higher percentage of calories from fat (p = 0.007) and serving of fried vegetables (p = 0.010) compared to those who consumed no meals away from home. These findings suggest that intervention for adolescents eating patterns should provide information on choosing healthy meals away from home.
Relationships between frequency of family meals, BMI and nutritional aspects of the home food environment among New Zealand adolescents
Jennifer Utter, Robert Scragg, David Schaaf, Cliona Ni Mhurchu
International Journal of Behavioral Nutrition and Physical Activity , 2008, DOI: 10.1186/1479-5868-5-50
Abstract: Data were collected during baseline measurements of the Pacific Obesity Prevention In Communities study. In total, 3245 ethnically diverse students completed a questionnaire about their nutrition behaviors and were weighed and measured for height.In total, 42% of adolescents ate a family meal on all of the previous five school nights. Frequency of family meals was modestly associated with BMI in bivariate analysis (p = 0.045), but lost significance when demographic characteristics were included in the model. Frequency of family meals was associated with many positive aspects of home food environment and positive nutrition behaviors, including parental support for healthy eating, limits on television use, having fruit available at home, consuming five fruits and vegetables a day, eating breakfast, and bringing lunch from home. Surprisingly, no relationships were observed between frequency of family meals and accessibility and consumption of many high fat/high sugar foods.Our findings suggest that the positive effect of family meals may reflect an overall positive home food environment. Families who have meals together have more healthful foods available at home and support their child in eating healthfully. There were no relationships between family meals and high fat/high sugar foods; this suggest that while families may prioritize eating together, messages about limiting the availability and consumption of these snack foods are not getting through.The family and home environment plays an important role in adolescent nutrition as it has been estimated that adolescents consume about 60% of their daily energy from foods sourced at home [1]. Accessibility of healthy and unhealthy foods at home, parental modelling of healthy eating, family eating patterns and work demands all influence the eating practices of children and families [2,3]. Family meals are one aspect of the home environment associated with the overall well-being of adolescents. Frequency of family meals h
Development and validation of a screening instrument to assess the types and quality of foods served at home meals
Jayne A Fulkerson, Leslie Lytle, Mary Story, Stacey Moe, Anne Samuelson, Audrey Weymiller
International Journal of Behavioral Nutrition and Physical Activity , 2012, DOI: 10.1186/1479-5868-9-10
Abstract: Primary food preparing adults (n = 51) participated in a validation study in their own homes. Staff and participants independently completed a screener as participants cooked dinner. The screener assessed the types of foods offered, method(s) of preparation, and use of added fats. Two scale scores were created: 1) to assess offerings of foods in five food groups (meat and other protein, milk, vegetables, fruit, grains), 2) to assess the relative healthfulness of foods based on types offered, preparation method, and added fats. Criterion validity was assessed comparing staff and participant reports of individual foods (kappa (k)) and scale scores (Spearman correlations).Criterion validity was high between participants' and staffs' record of whether major food categories (meat and other protein, bread and cereal, salad, vegetables, fruits, dessert) were served (k = 0.79-1.0), moderate for reports of other starches (e.g., rice) being served (k = 0.52), and high for the Five Food Group and Healthfulness scale scores (r = 0.75-0.85, p < .001).This new meal screening tool has high validity and can be used to assess the types of foods served at home meals allowing a more comprehensive assessment of the home food environment.Studies have shown that compared to foods consumed at home, away-from-home foods are higher in fat and calories [1] and contribute to poorer dietary quality and overweight status [2-6]. Thus, health and nutrition experts recommend limiting eating out and encourage more frequent home meal preparation [7]. The importance of the home environment in influencing food intake and weight status has prompted the development of new valid instruments to assess food availability within the home food environment [8,9]. Although these instruments assess foods available in the home, no validated instruments exist to assess what types of foods are served specifically at meals within the home. Foods served at meals may include a subset of those available within the home
The role country of birth plays in receiving disability pensions in relation to patterns of health care utilisation and socioeconomic differences: a multilevel analysis of Malmo, Sweden
Anders Beckman, Anders Hakansson, Lennart Rastam, Thor Lithman, Juan Merlo
BMC Public Health , 2006, DOI: 10.1186/1471-2458-6-71
Abstract: We used multilevel logistic regression analysis with individuals (first level) nested within countries of birth (second level). We analysed the entire population between the ages of 40 and 64 years (n = 80 212) in the city of Malmo, Sweden, in 2003, and identified 73% of that population who had visited a physician at least once during that year. We studied the associations between individuals and country of birth socioeconomic characteristics, as well as individual utilisation of different kinds of physicians in relation to having been granted a disability pension.Living alone (ORwomen = 1.72, 95% CI: 1.62–1.82; ORmen = 2.64, 95% CI: 2.46–2.83) and having limited educational achievement (ORwomen = 2.14, 95% CI: 2.00–2.29; ORmen = 2.12, 95% CI: 1.98–2.28) were positively associated with having a disability pension. Utilisation of public specialists was associated with a higher probability (ORwomen = 2.11, 95% CI: 1.98–2.25; ORmen = 2.16, 95% CI: 2.01–2.32) and utilisation of private GPs with a lower probability (ORmen = 0.76, 95% CI: 0.69–0.83) of having a disability pension. However, these associations differed by countries of birth. Over and above individual socioeconomic status, men from middle income countries had a higher probability of having a disability pension (ORmen = 1.61, 95% CI: 1.06–2.44).The country of one's birth appears to play a significant role in understanding how individual socioeconomic differences bear on the likelihood of receiving a disability pension and on associated patterns of health care utilisation.Sweden has a general welfare policy that guarantees financial security and social rights to all citizens [1]. Included in this system is the provision of a disability pension for those between the ages of 30 and 64 who, for medical reasons, are incapable of working or supporting themselves financially [2].A number of studies have investigated the association between different measures of health status [3,4], medical conditions [5], and receiv
Prevalence and Clinical Features of Pressure Ulcers in Patients Receiving Home Health Care Services in the City of Kocaeli  [PDF]
Aysun ?ikar Aktürk,Erkan Atmaca,Sezai Zengin,Dilek Bayramgürler
Turkderm , 2010,
Abstract: Background and Design: In this study, we aimed to determine the prevalence of pressure ulcers and to investigate the clinical features of ulcers and associated factors in patients receiving home health care in the City of Kocaeli. Material and Method: A total of 420 patients, who received home health care by Kocaeli Metropolitan Municipality between August and October 2007, were included in this study. Each patient who had pressure ulcers during this period was assessed from the standpoint of accompanying diseases, nutritional and socioeconomic status, personal cleanliness, existence of incontinence and other factors. In addition, localization, number and clinical stage according to the depth of pressure ulcers were recorded. Results: The prevalence of pressure ulcers was 23.8%. The mean age of the patients was 68 (range: 11- 100) years. Of the patients with pressure ulcers, 49% had cerebrovascular accident and 14% had past history of trauma. Pressure ulcers were found mainly in the sacral region (mean, 72%) and were most commonly in stage 2 (mean, 33%). Conclusion: We determined that the prevalence of pressure ulcers was 23.8%. In our study, similar to other studies, it was observed that decubitus ulcers are still a frequently seen health problem in bedfast and needy patients, even though their occurrence can be prevented by some simple measures.
How the professionals can identify needs for improvement and improve Food Distribution service for the home-living elderly people in Sweden - an action research project  [cached]
Zada Pajalic,Kirsti Skovdahl,Albert Westergren,Lena Persson
Journal of Nursing Education and Practice , 2013, DOI: 10.5430/jnep.v3n8p29
Abstract: Background: Making changes to municipal social care and service has been found to be challenging to realise and highly multifaceted. The aim of this study was to describe how the professionals can identify needs for improvement and improve Food Distribution (FD) service for the home-living elderly people in Sweden. Methods: This study is part of a larger project with an action research approach focusing on to municipal FD to older people living in their own home in Sweden. The professionals involved in FD invited the first author to assist them in this process. The study participants were comprised of the following groups: “The Identification focus group” that identified need for improvement of FD (n= 5); “The Action focus group” that planned and choose suitable ‘action’ for improvement (n=5); “The First Evaluation group” (n=4) that evaluated the content of planned improvement and finally “The Second Evaluation group” (n=29) that evaluated the changes following improvement. The data was gathered and analysed by Story Dialogue Method. Results: The need to update and increase the FD recipient’s knowledge in nutrition by sending them informative letters was found to be an important area to focus on. The information letters (n=1700) were distributed to the all FD recipients in six municipalities in southern Sweden during April 2011. The results were evaluated during May 2011. The overall general estimation was that the content of the letters indicated that this was a suitable method for gaining information to make a nutrition competence update. Following this, “The Action focus group” decided: firstly, to continue preparing and distributing information letters to all FD recipients to be sent out twice a year, and secondly: to make the information letters accessible on the websites of the six municipalities and county councils involved. Conclusions: This study showed that systematic work inspired by an action research approach with motivated and involved participants can be beneficial and a starting point for the process of change in municipal service and care practice. The major conclusion of the study was that systematic reflection over everyday practice can be the vehicle for the future change of practice. The research process and the findings have implications for nursing, care of the elderly and gerontology.
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