Prospective, observational study of the impact of finger food on the quality of nutrition evaluated by the simple evaluation of food intake (SEFI) in nursing home residents.

INTRODUCTION: Finger food is a type of meal that can be eaten without cutlery, and may, therefore, be easier to consume for patients with cognitive disorders. The objective of this study was to assess whether finger food increased the quantity of food ingested among older nursing home residents. The secondary objectives were to evaluate satisfaction after meals and costs associated with the meals. METHODS: This was a single-center prospective study conducted on paired observations, comparing food intake observed during three finger food meals vs. three "control" meals (standard meals), for the same residents, in a public nursing home, from 21 April to 18 June 2021. RESULTS: A total of 266 meals were evaluated for 50 residents. The mean intake (simple evaluation of food intake) score was 40.7 ± 1.7 out of 50 with finger food, and 39.0 ± 1.5 for standard meals. Finger food was associated with a higher probability of an intake score ≥ 40 (odds ratio [OR] 1.91 (95% CI 1.15-3.18; p = 0.01). The difference in satisfaction scores following the meals did not reach statistical significance: 3.86 (SD 1.19) vs. 3.69 (SD 1.11) for the finger food and standard meals, respectively; p = 0.2. Finger foods had an excess cost of 49% compared to a standard meal. CONCLUSION: The occasional or seasonal (rather than systematic) use of these meals seems to be a valid option to reintroduce novelty and pleasure into the residents' diet. However, potential adopters should be aware that the finger food meals were 49% more expensive than standard meals.

[The proper use of oral nutritional supplements in a French Ehpad]. / Le bon usage des compléments nutritionnels oraux dans un Ehpad français.

Undernutrition in residents of residential care facilities for the dependent elderly can be managed by oral nutritional supplements (ONS). The objective of this study is to evaluate their proper use. A total of 41.9% of residents on NOCs were malnourished on the day of the audit, compared with 71.5% before the introduction of NOCs. NOCs were administered according to the dietician's prescription, which differed from the doctor's prescription in more than half of the cases. NOCs were fully consumed by 79.2% of residents.

[Healing the mind by healing the body in anorexia nervosa]. / Soigner le mental en soignant le corps dans l'anorexie mentale.

In anorexia nervosa, physical and psychological vulnerability confines the sufferer to the confines of his or her pathology. The physical body is the first victim of undernutrition, but also the first resource for restoring the psychic and emotional body. Reduced food intake has repercussions on cognition and affect, all of which affect relational capacities. Accompanying, understanding and caring for people means reaching out to them and their bodies, to re-establish the link between what has been broken, and to establish a relationship of trust with them.

[Undernutrition in the elderly, a syndrome with multiple deleterious consequences]. / La dénutrition du sujet âgé, un syndrome aux multiples conséquences délétères.

The prevalence of undernutrition is 4-10% in elderly people living at home, 15-38% in those living in institutions. Fifty percent of hospitalized elderly are undernourished and 40% are hospitalized for the consequences of undernutrition. This is a major problem in geriatrics.

[Context, issues and perspectives of nutrition in hospitals]. / Contexte, enjeux et perspectives de la nutrition à l'hôpital.

Undernutrition is common in hospitals, and it worsens the vital and functional prognosis of patients. The earlier it is treated, the more effective it is. The prevention, detection, treatment and monitoring of undernutrition or the risk of undernutrition are a public health priority, which directly involves all carers. Management can be improved by their daily collaboration with a transversal nutrition unit.

[Undernutrition in old age, nurses take action]. / Dénutrition et grand âge, des infirmiers mobilisés.

The diagnosis of protein-energy undernutrition in residential care facilities for the elderly is based on four criteria: weight, which is regularly assessed on admission and after hospitalisation, the body mass index, albumin and the Mini nutritional assessment, the complex analysis of which requires multidisciplinary reflection. Several challenges await professionals to improve the assessment of these criteria. Training is an important area for change.

[Nutrition and nursing]. / Nutrition et soins infirmiers.

Nutritional nursing care, whether prescribed or on its own role, is a fundamental aspect of the fight against undernutrition in hospital, which is a determinant of vital and functional prognosis. This care includes screening for undernutrition and its risk factors, assessment of intake and feeding difficulties, enrichment of oral nutrition, enteral and parenteral nutrition. Given the complexity and importance of these tasks, a multi-professional approach involving a transverse nutrition unit is beneficial.

Underweight and weight loss are predictors of poor outcome in patients with brain metastasis.

PURPOSE: Overweight may be associated with favorable outcome whereas tumor cachexia may be associated with worse outcome in patients with metastatic cancer. Here we evaluate the association of abnormal body mass index and weight change with outcome in patients with brain metastasis. METHODS: Patients with a diagnosis of brain metastasis treated at the University Hospital Zurich (n = 703) were assessed for associations of body mass index, weight change, comorbidities and survival. RESULTS: Compared with patients with normal body mass index of 18.5-24.9 kg/m2 and a median overall survival of 9 months (95% confidence interval 7.5-10.5), overall survival was inferior in patients with body mass index < 18.5 kg/m2 (overall survival 6 months, 95% confidence interval 1.6-10.3, p = 0.04), but superior in patients with body mass index > 25 kg/m2 (overall survival 13 months, 95% confidence interval 11.0-15.0; p = 0.033). We report a median relative weight loss of 5% within the first 6 months of diagnosis of brain metastasis (95% confidence interval 3.3-6.5), and reduction exceeding the median was associated with an unfavorable outcome (weight loss < 5% 22.0 months, 95% confidence interval 19.2-24.8; weight loss > 5% 14.0 months, 95% confidence interval 11.9-16.). CONCLUSION: High body mass index is associated with better, and underweight with worse outcome in patients with brain metastasis. Conversely, weight loss above median may predict poor outcome. Future studies need to address whether vigorous treatment of tumor cachexia, e.g. by specific nutrition management, might improve outcome of patients with brain metastasis. In contrast, regimens associated with weight loss such as ketogenic diet may be detrimental.

[ELDERLY UNDERNUTRITION IN HOSPITALS IN LOMÉ: EPIDEMIOLOGICAL, CLINICAL AND BIOLOGICAL ASPECTS]. / Dénutrition du sujet âgé en milieu hospitalier à Lomé: Aspects épidémiologique, clinique et biologique.

Introduction: La dénutrition protéino-énergétique est un déséquilibre entre les apports et les besoins protéino-énergétiques. L'objectif était d'étudier les aspects épidémiologiques, cliniques et biologiques de la dénutrition chez les personnes âgées. Méthodes: Etude transversale sur 200 patients d'au-moins 60 ans en consultation gériatrique en médecine interne aux CHU Sylvanus Olympio et Campus effectuée de Novembre 2017 au 31 janvier 2020. Nous avons évalué l'IMC, MNA, et l'albuminémie. Résultats: On notait une prédominance féminine avec 122 femmes (sex-ratio H/F= 0,64). L'âge moyen était de 75 ans ± 08,6 ans avec des extrêmes de 60 à 99 ans. Les personnes âgées (PA) étaient regroupées en 03 tranches d'âge : 60-74ans, 75-84ans et plus de 85 ans. Les tranches d'âge les plus représentés étaient 60 -74ans (49,0%) suivi de 75-84ans (35,5%). 98(49,0%) étaient mariés et vivaient en couple, 82(41,0%) étaient veuf(ve)s, 11(05,5%) étaient célibataire, et 09(04,5%) étaient divorcés. Cinquante (25%) avaient IMC<21kg/m². 160 (80%) avaient un score de dépistage individuel inférieur à 12selon MNA-SF. La prévalence de la dénutrition et de risque de dénutrition selon MNA complet était de 87% (36% de dénutris et 51,0% de risque de dénutrition). Quatre-vingt-deux (41%) avaient une albuminémie inférieure à 35g/l. L'état nutritionnel selon MNA variait de manière significative avec le statut matrimonial, l'IMC la consommation de lait et les régimes restrictifs alors que celui selon l'albumine variait avec le sexe, les régimes restrictifs, les pathologies neuropsychologiques, la polypathologie et la polymédication. Conclusion: La dénutrition est fréquente en gériatrie d'où la nécessité d'un dépistage et une prise en charge précoce.

[Nutritional status of residents of a nursing home and optimisation of the working time of caregivers]. / État nutritionnel des résidents en Ehpad et optimisation du temps de travail des soignants.

The lack of time to devote to care is a frequent complaint of nurses and nursing assistants. The results of a study show that an improvement in the nutritional status of nursing home residents could help to improve their quality of life and to optimise the working time of the nursing teams, thanks to the reduction of pressure ulcers, diarrhoea, falls, fractures and infections.

[Swallowing disorders and the elderly in a geriatric care facility]. / Fausses routes et sujet âgé dans un établissement gériatrique.

It is essential to fight against malnutrition and dehydration in elderly people in care facilities. They result in the deterioration of the general status, a risk of a fall, a risk of wounds, an increased risk of infection and mortality in geriatrics. In addition, swallowing disorders due to ageing increase the risk of food going down the wrong way. Those involved in the multidisciplinary care management pool their skills in support of the elderly person.

[Malnutrition in the elderly, screening and treatment]. / Malnutrition chez la personne âgée, dépister et prendre en charge.

Undernutrition is defined as an imbalance between the body's energy intake and requirements. It is present in 30 to 70% of hospitalised elderly people and its consequences are severe. Systematic screening and early treatment are an integral part of global geriatric care. The aetiological approach must be exhaustive (medico-psychosocial problems) and integrate difficulties related to the physiological ageing of the organism.

[Nutritional management of elderly people, everyone's concern]. / Prise en charge diététique du sujet âgé, l'affaire de tous.

In order to provide the appropriate care with regard to nutrition and the fight against frailty, it is important to know how to analyse the physical and physiological capacities of the ageing population. These are assessed in relation to the measurement of the patient's muscle strength, walking speed and balance.

[The diet of the elderly person undergoing dialysis]. / Quelle alimentation pour la personne âgée en hémodialyse ?

The elderly patient undergoing dialysis is often at risk of undernutrition. The condition may already be present at the pre-dialysis stage and can worsen once dialysis starts. Aside from the impact on the patient's quality of life and general health status, undernutrition exposes them to serious risk of complications and can be life-threatening. It is therefore essential that it is diagnosed early.

[Understanding the pathophysiology of malnutrition for better treatment]. / Comprendre la physiopathologie de la dénutrition pour mieux la traiter.

Malnutrition results from an imbalance between intake and protein-energy requirements resulting in tissue losses with adverse functional consequences. However, it would be better to speak of "states of malnutrition" rather than "malnutrition". Indeed, the mechanisms involved associate, with varying degrees, intake deficiency and increased needs with different clinical consequences. Adaptation to nutrient deficiency aims at establishing lasting saving conditions by promoting optimization of energy reserve utilization while preserving protein pool. This is achieved by reducing basal metabolism (low T3), by decreasing the secretion of anabolic factors and moderately increasing catabolic hormones. Unlike the previous process, the metabolic response to injury or stress, which will sometime induce major increase in requirements, will have as immediate purpose the defense of the organism. The body will draw sometime substantially in its protein pool to produce the glucose required for example by the immune cells. Stress response stems from both an endocrine response, and an immuno-inflammatory one with the important role of pro-inflammatory cytokines released in response to pathogens and more recently alarmins in response to endogenous stress in the inflammatory phenomena of the stress response and in the resulting malnutrition state. Treatment of these malnutrition conditions will thus differ: promoting anabolism in one case and fighting resistance to anabolism and hypercatabolism in the other.

[Anorexia, treating and caring for the mistreated body]. / Anorexie mentale, soigner et prendre soin du corps maltraité.

Anorexia is a complex, multifactorial disease, emerging during puberty and requiring cross-disciplinary care. The body, taken hostage, expresses psychological suffering and the patient's developmental impasse. Compassionate treatment and the care given to this mistreated and undernourished body facilitate the access to the psychological care and are an essential step towards recovery.

La préhabilitation, un nouveau parcours préopératoire pour améliorer la condition des patients.

The maintenance and optimization of functional capacities before, during, and after treatment are major challenges for frailty persons as cancer's patients. It is now known that physical activity in prehabilitation plays a crucial role in limiting, among other things, post-operative complications. The benefits have already been demonstrated in various studies, including a decrease in hospitalization duration, an increase in cardiorespiratory endurance, improvement in quality of life, and better fatigue management. It is observed that patients who undergo prehabilitation are those who recover their preoperative capacities the fastest. However, it is estimated that only one-third of patients with access to prehabilitation improve their physical capacities.

[Nutritional management of patients during surgical prehabilitation and rehabilitation programs]. / Prise en charge nutritionnelle des patients pendant les programmes de préhabilitation et de réhabilitation en chirurgie.

Undernutrition (UD) increases perioperative morbidity and mortality. Its prevention and treatment are therefore essential in surgical prehabilitation and rehabilitation programs. Nutritional treatment is individualized according to the patient's nutritional status, ingesta and protein-energy requirements. Oral nutrition is optimized to increase intakes through personalized dietary advice and oral nutritional supplements. Artificial nutrition support is indicated in cases of UD or high risk of UD before major surgery. Enteral nutrition is preferred to parenteral nutrition when the digestive tract is functional.

[The role of the coordinating nurse in a transverse clinical nutrition unit]. / Rôle de l'infirmier de coordination dans une unité transversale de nutrition clinique.

Malnutrition is a common pathology, often underdiagnosed, and is associated with numerous chronic diseases. Transversal clinical nutrition units (TCNU) are being implemented to improve the screening and management of malnutrition. The coordinating nurse plays a key role within a TCNU: organizing and coordinating personalized care pathways for malnourished patients, especially those with complex pathologies requiring multidisciplinary care. This article outlines the responsibilities of the coordinating nurse based on the experience of the TCNU established at the Pitié-Salpêtrière Hospital (Assistance Publique-Hôpitaux de Paris).

Role of RAPID score and surgery in the management of pleural infection: a single center retrospective study.

Background: The RAPID [Renal (urea level), Age, Pleural fluid purulence, source of Infection and Denutrition (albumin level)] score classifies patients with pleural infection according to mortality risk at 3 months. This study aims to assess the applicability of this score in a thoracic surgery department and to determine the impact of surgery in the management of pleural infection depending on the Rapid score. Methods: In this single center retrospective study, patients managed for pleural infection, from January 1st 2013 to June 30th 2019, were included. The primary endpoint was the probability of survival at 6 months and 12 months depending on the RAPID score. Secondary endpoint was the probability of survival at 6 and 12 months in patients who had surgeries (surgical treatment group) and patients who didn't have surgery (medical treatment group). Results: Seventy-four patients were included, with a median age of 54.5 years. According to the RAPID score, the low-, medium- and high-risk groups had 30, 30 and 14 patients respectively. The probability of survival at 6 and 12 months in the low- and medium-risk groups were both 0.967 [95% confidence index (CI95): 0.905-1] whereas, the probabilities of survival at 6 and 12 months in the high-risk group was significantly lower at 0.571 (CI95: 0.363-0.899) and 0.357 (CI95: 0.177-0.721) respectively (P<0.0001). The probabilities of survival at 6 months and 12 months in the medical treatment group was 0.875 (CI95: 0.786-0.974) and 0.812 (CI95: 0.704-0.931) respectively compared to the surgical treatment group where probabilities of survival at 6 and 12 months were both 0.923 (CI95: 0.826-1) (P=0.26). Conclusions: In our study, patients with pleural infection, classified as high-risk according to the RAPID score, had a lower survival rate compared to low- and medium-risk patients. No difference in survival rate was found between patients classified as low- and medium-risk. In selected patients, surgical management seems to decrease mortality compared to exclusive medical management: this result should be confirmed in larger prospective studies.