Linköping University Medical Dissertations No. 951 Nutritional Intervention in Elderly People Admitted to Resident Homes

The aim was to investigate the effects of an intervention, based on education given to staff and implementation of an individualized nutritional programme given to the residents, to compare assessments on admission with a previous study, and to perform diagnostic test and inter-rater reliability of the Mini Nutritional Assessment (MNA). A further aim was to identify and describe factors with regard to appetite among the residents. Upon admission, and after a four month intervention period, residents were classified as being either protein energy malnourished (PEM), or not, based on anthropometry and biochemical measurements. On both occasions, the Activity Index and the Mini Mental State Examination were used. In order to identify individuals in need of nutritional care, the MNA was performed. Information about medical data was obtained. A total of 127 residents were consecutively admitted to eight resident homes in a municipality in Sweden. Three resident homes constituted the experimental unit (n = 68) and five the control unit (n = 59). Fifteen residents were interviewed using a qualitative method, to investigate what affects their appetite

Nutritional Intervention in Elderly People Admitted to Resident Homes

The aim was to investigate the effects of an intervention, based on education given to staff and implementation of an individualized nutritional programme given to the residents, to compare assessments on admission with a previous study, and to perform diagnostic test and inter-rater reliability of the Mini Nutritional Assessment (MNA). A further aim was to identify and describe factors with regard to appetite among the residents. Upon admission, and after a four month intervention period, residents were classified as being either protein energy malnourished (PEM), or not, based on anthropometry and biochemical measurements. On both occasions, the Activity Index and the Mini Mental State Examination were used. In order to identify individuals in need of nutritional care, the MNA was performed. Information about medical data was obtained. A total of 127 residents were consecutively admitted to eight resident homes in a municipality in Sweden. Three resident homes constituted the experimental unit (n = 68) and five the control unit (n = 59). Fifteen residents were interviewed using a qualitative method, to investigate what affects their appetite. On admission 32 % of the residents were classified as PEM, which was similar to in the previous study. A higher frequency of residents in the present study had severe medical diseases and cognitive impairment, compared with the previous study, indicating changed admission criteria in the present study. Between the experimental and the control groups, no differences were seen in any specific anthropometric or biochemical variable. Within the groups, statistically significant differences were seen, as the number of PEM residents in the experimental group decreased, and motor activity and overall cognitive function improved. In the control group, motor activity deteriorated. This indicates that the intervention improved nutritional status and functional capacity in the residents. Diagnostic sensitivity was 73 % regarding MNA versus PEM, and 89 % regarding MNA short form (MNA-SF) versus MNA, which indicates a rather high degree of sensitivity in both tests. Inter-rater reliability of MNA, carried out by simultaneous assessments by registered nurses and researcher showed a moderate agreement of 62 % (kappa 0.41). The interview study showed that the willingness to eat was what affected the residents´ appetite. The willingness to eat contains internal factors, dependent on mood and personal values, as well as external factors, dependent on wholesomeness, food, eating environment and meal fellowship. When planning and realizing residents´ nutritional care, factors affecting the residents´ appetite have to be taken into consideration. In conclusion, the results show that it is important to implement and develop strategies for individual nutritional care, in order to prevent and treat malnutrition in elderly people, which is in line with recommendations given by the European Society of Parenteral and Enteral Nutrition (ESPEN) and with the Swedish goal of nursing actions

Empowerment Intervention in Outpatient Care of Persons with Chronic Kidney Disease Pre-Dialysis

Empowering interventions can improve person-centered care. A pre- and post-evaluation using interactive research involving two years of empowering interventions was designed to improve quality of care in outpatients with chronic kidney disease who were pre-dialysis. The results showed significantly increased empowerment in the intervention group. Interactive research facilitated the implementation of the empowerment intervention, which may increase sustainability over time

The complexity in the implementation process of empowerment-based chronic kidney care: a case study

Background: This study is part of an interactive improvement intervention aimed to facilitate empowerment-based chronic kidney care using data from persons with CKD and their family members. There are many challenges to implementing empowerment-based care, and it is therefore necessary to study the implementation process. The aim of this study was to generate knowledge regarding the implementation process of an improvement intervention of empowerment for those who require chronic kidney care. Methods: A prospective single qualitative case study was chosen to follow the process of the implementation over a two year period. Twelve health care professionals were selected based on their various role(s) in the implementation of the improvement intervention. Data collection comprised of digitally recorded project group meetings, field notes of the meetings, and individual interviews before and after the improvement project. These multiple data were analyzed using qualitative latent content analysis. Results: Two facilitator themes emerged: Moving spirit and Encouragement. The healthcare professionals described a willingness to individualize care and to increase their professional development in the field of chronic kidney care. The implementation process was strongly reinforced by both the researchers working interactively with the staff, and the project group. One theme emerged as a barrier: the Limitations of the organization. Changes in the organization hindered the implementation of the intervention throughout the study period, and the lack of interplay in the organization most impeded the process. Conclusions: The findings indicated the complexity of maintaining a sustainable and lasting implementation over a period of two years. Implementing empowerment-based care was found to be facilitated by the cooperation between all involved healthcare professionals. Furthermore, long-term improvement interventions need strong encouragement from all levels of the organization to maintain engagement, even when it is initiated by the health care professionals themselves

Empowerment in outpatient care for patients with chronic kidney disease - from the family member's perspective

Background: Family members of persons with pre-dialysis chronic kidney disease may experience feelings of vulnerability and insecurity as the disease follows its course. Against this background, the aim of the present study was to explore empowerment in outpatient care as experienced by these family members. Methods: An inductive approach for qualitative data analysis was chosen. The study sample comprised 12 family members of pre-dialysis patients at an outpatient kidney clinic. Two interviews with each family member were subjected to content analysis to gain an understanding of empowerment from the family members' perspective. Results: Having strength to assume the responsibility was the main theme that emerged from the following five sub-themes: Being an involved participant, Having confirming encounters, Trusting in health-care staff, Comprehending through knowledge, and Feeling left out. Four of these five sub-themes were positive. The fifth subtheme illuminated negative experience, indicating the absence of empowerment. Conclusions: Family members' experience of empowerment is dependent on their ability to assume the responsibility for a relative with chronic kidney disease when needed. The findings emphasise the need for a family perspective and the significance of a supportive environment for family members of persons in outpatient care.Briding the Gap