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A scoping review of best practice guidelines for the dietary management of diabetes in older adults in residential aged care.
Farrer, O, Yaxley, A, Walton, K, Miller, M
Primary care diabetes. 2019;(4):293-300
Abstract
Over the last two decades guidelines have been published on the subject of the care and liberalised nutrition management of older adults with diabetes in residential aged care, recognising that they may have different needs to those older adults in their own home. This study aimed to scope and appraise these guidelines using the AGREE II tool. Overall physician developed guidelines were more robust, but there was discordance in their recommendations compared to guidelines developed by dietitians; particularly regarding the use of therapeutic diets. A lack of standardised approach has implications for optimal dietary management of diabetes in aged care.
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Texture-modified food and fluids in dementia and residential aged care facilities.
Painter, V, Le Couteur, DG, Waite, LM
Clinical interventions in aging. 2017;:1193-1203
Abstract
INTRODUCTION Dysphagia is common in people living with dementia and associated with increased risk of aspiration pneumonia, dehydration, malnutrition, and death. Treatment options are limited and the use of texture-modified food and fluids (TMF) is a widespread clinical practice. This review aimed to evaluate the evidence for TMF in dementia. METHODS A literature search using terms "dysphagia," "texture-modified food and fluids," "dementia," and "aged care" was performed by using three electronic databases from 1990 to March 2017. Studies were assessed for suitability, then reviewed with data extracted, and grouped by categories of outcome measures. RESULTS A total of 3,722 publications were identified, and 22 studies met the inclusion criteria. Studies were heterogeneous in design and methodology. There were no publications examining dementia exclusively; however, many subjects with dementia were included in studies of residential aged care facilities. TMF reduced the risk of aspiration seen on videofluoroscopy but not clinical aspiration and pneumonia. TMF was associated with lower daily energy and fluid intake and variable adherence. CONCLUSION There is a lack of evidence for people living with dementia and in residential care facilities that TMF improves clinical outcomes such as aspiration pneumonia, nutrition, hydration, morbidity, and mortality. Adverse effects including poorer energy and fluid intake were identified.
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Defining characteristics and risk indicators for diagnosing nursing home-acquired pneumonia and aspiration pneumonia in nursing home residents, using the electronically-modified Delphi Method.
Hollaar, V, van der Maarel-Wierink, C, van der Putten, GJ, van der Sanden, W, de Swart, B, de Baat, C
BMC geriatrics. 2016;:60
Abstract
BACKGROUND In nursing home residents, it is not possible to distinguish pneumonia and aspiration pneumonia clinically. International literature reveals no consensus on which and how many characteristics and risk indicators must be present to diagnose (nursing home-acquired) pneumonia and aspiration pneumonia. The aim of this survey was to reach consensus among a panel of clinical medical experts in geriatrics and pulmonology about the characteristics required for diagnosing pneumonia, and about the risk indicators needed to consider the diagnosis aspiration pneumonia in nursing home residents with pneumonia. METHODS Literature review and three expert-rating iterations using the electronically-modified Delphi Method were carried out. After each expert rating iteration, data analysis was performed. Qualitative responses and additional (nursing home-acquired) pneumonia characteristics which were mentioned in reply to structured open-ended questions were summarised, whilst similar responses were combined and these combinations were ordered by frequency in order to use them in the next iteration. Characteristics which failed to reach consensus were considered as inconclusive and eliminated. Consensus was reached when at least 70 % of the participants agreed. RESULTS Literature review revealed 16 currently used common characteristics for diagnosing (nursing home-acquired) pneumonia. No consensus was reached about characteristics and the number of characteristics required for diagnosing (nursing home-acquired) pneumonia. However, 57 % agreed that dyspnea, fever, deterioration of general functioning, tachypnea and crepitation with auscultation are the most important characteristics and the responses by the participants suggested that two or three characteristics should be present. Subsequently, 80 % of the participants agreed on the risk indicators dysphagia, choking incident, (history of) tube feeding, neurological disease and cognitive impairment for considering the diagnosis aspiration pneumonia in nursing home residents with pneumonia. CONCLUSIONS No final consensus could be reached about which and how many characteristics are required for diagnosing pneumonia in nursing home residents. However, the results indicated that dyspnea, fever, deterioration of general functioning, tachypnea and crepitation with auscultation are characteristics of some importance and that at least two or three characteristics should be present. With regard to considering aspiration pneumonia in nursing home residents with pneumonia, final consensus was reached about the risk indicators dysphagia, choking incident, (history of) tube feeding, neurological disease and cognitive impairment.
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Inverse relationship between body mass index and mortality in older nursing home residents: a meta-analysis of 19,538 elderly subjects.
Veronese, N, Cereda, E, Solmi, M, Fowler, SA, Manzato, E, Maggi, S, Manu, P, Abe, E, Hayashi, K, Allard, JP, et al
Obesity reviews : an official journal of the International Association for the Study of Obesity. 2015;(11):1001-15
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Abstract
Body mass index (BMI) and mortality in old adults from the general population have been related in a U-shaped or J-shaped curve. However, limited information is available for elderly nursing home populations, particularly about specific cause of death. A systematic PubMed/EMBASE/CINAHL/SCOPUS search until 31 May 2014 without language restrictions was conducted. As no published study reported mortality in standard BMI groups (<18.5, 18.5-24.9, 25-29.9, ≥30 kg/m(2)), the most adjusted hazard ratios (HRs) according to a pre-defined list of covariates were obtained from authors and pooled by random-effect model across each BMI category. Out of 342 hits, 20 studies including 19,538 older nursing home residents with 5,223 deaths during a median of 2 years of follow-up were meta-analysed. Compared with normal weight, all-cause mortality HRs were 1.41 (95% CI = 1.26-1.58) for underweight, 0.85 (95% CI = 0.73-0.99) for overweight and 0.74 (95% CI = 0.57-0.96) for obesity. Underweight was a risk factor for higher mortality caused by infections (HR = 1.65 [95% CI = 1.13-2.40]). RR results corroborated primary HR results, with additionally lower infection-related mortality in overweight and obese than in normal-weight individuals. Like in the general population, underweight is a risk factor for mortality in old nursing home residents. However, uniquely, not only overweight but also obesity is protective, which has relevant nutritional goal implications in this population/setting.
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Systematic review: Health-related characteristics of elderly hospitalized adults and nursing home residents associated with short-term mortality.
Thomas, JM, Cooney, LM, Fried, TR
Journal of the American Geriatrics Society. 2013;(6):902-911
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Abstract
OBJECTIVES To identify the domains of health-related characteristics of older hospitalized adults and nursing home residents most strongly associated with short-term mortality. DESIGN Systematic review. SETTING Studies published in English in MEDLINE, Scopus, or Web of Science before August 1, 2010. PARTICIPANTS Prospective studies consisting of persons aged 65 and older that evaluated the association between at least one health-related participant characteristic and mortality within a year in multivariable analysis. MEASUREMENTS All health-related characteristics associated with mortality in multivariable analysis were extracted and categorized into domains. The frequency, with all studies combined, with which particular domains were associated with mortality in multivariable analysis was determined. RESULTS Thirty-three studies (28 in hospitalized individuals, five in nursing home residents) reported a large number of characteristics associated with mortality that could be categorized in seven domains: cognitive function, disease diagnosis, laboratory values, nutrition, physical function, pressure ulcers, and shortness of breath. Measures of physical function and nutrition were the domains most frequently associated with mortality up to 1 year from the time of evaluation for hospitalized individuals and nursing home residents; measures of physical function, cognitive function, and nutrition were the domains most frequently associated with in-hospital mortality for hospitalized individuals. CONCLUSION Of a large number of health-related characteristics of older persons shown to be associated with short-term mortality, measures of nutrition, physical function, and cognitive function were the domains of health most frequently associated with mortality. These domains provide easily measurable factors that may serve as helpful markers for individuals at high mortality risk.
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Falls in the nursing home: a collaborative approach.
Messinger-Rapport, B, Dumas, LG
The Nursing clinics of North America. 2009;(2):187-95
Abstract
Problem solving using a collaborative approach may reduce the risk of falls in the nursing home. Interventions need to be tailored to the individual's cognitive and physical impairments as well as be feasible in the particular long-term care setting. Polypharmacy, Vitamin D deficiency, delirium, and urinary incontinence are among several risks for falls that are discussed in this article.
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Managing under-nutrition in a nursing home setting.
Ali, PA
Nursing older people. 2007;(3):33-6; quiz 37
Abstract
This article considers interventions and strategies used to manage the problems of an undernourished older adult residing in a nursing home. A brief introduction to the patient is followed by a discussion of the process of identifying care needs, and the planning and provision of care based on current evidence and outcome evaluation. The crucial role of nurses in meeting the nutritional needs of older patients is also emphasised.
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Alzheimer's treatment in nursing homes: room for improvement.
Bright-Long, L
Journal of the American Medical Directors Association. 2006;(2):90-5
Abstract
Managing Alzheimer's disease (AD) continues to challenge long-term care physicians and administrators. Although pharmacologic treatment can substantially benefit AD patients in the nursing home setting, common misconceptions and skepticism about its value are barriers to treatment use. Aggressive treatment for AD maximizes patient function and independence and is cost-effective. Herein we discuss state-of-the-art treatment of AD with a view to providing nursing home physicians a framework from which to make treatment decisions.
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Nutrition in advanced Alzheimer's disease.
White, HK
North Carolina medical journal. 2005;(4):307-12
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Can we prevent aspiration pneumonia in the nursing home?
Oh, E, Weintraub, N, Dhanani, S
Journal of the American Medical Directors Association. 2004;(3):174-9
Abstract
Aspiration pneumonia is a significant cause of morbidity, hospitalization, and mortality in the nursing home population. Patients who aspirate have three times higher mortality than patients who do not aspirate. We discuss the factors known to increase the risk of aspiration and its consequences, and recognize some of the preventive measures for aspiration pneumonia. We suggest approaches to decrease the risk of this very prevalent syndrome.