Social Factors Associated With Nutrition Risk in Community-Dwelling Older Adults in High-Income Countries: Protocol for a Scoping Review.

BACKGROUND: In high-income countries (HICs), between 65% and 70% of community-dwelling adults aged 65 and older are at high nutrition risk. Nutrition risk is the risk of poor dietary intake and nutritional status. Consequences of high nutrition risk include frailty, hospitalization, death, and reduced quality of life. Social factors (such as social support and commensality) are known to influence eating behavior in later life; however, to the authors' knowledge, no reviews have been conducted examining how these social factors are associated with nutrition risk specifically. OBJECTIVE: The objective of this scoping review is to understand the extent and type of evidence concerning the relationship between social factors and nutrition risk among community-dwelling older adults in HICs and to identify social interventions that address nutrition risk in community-dwelling older adults in HICs. METHODS: This review will follow the scoping review methodology as outlined by the JBI Manual for Evidence Synthesis and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. The search will include MEDLINE (Ovid), CINAHL, PsycINFO, and Web of Science. There will be no date limits placed on the search. However, only resources available in English will be included. EndNote (Clarivate Analytics) and Covidence (Veritas Health Innovation Ltd) will be used for reference management and removal of duplicate studies. Articles will be screened, and data will be extracted by at least 2 independent reviewers using Covidence. Data to be extracted will include study characteristics (country, methods, aims, design, and dates), participant characteristics (population description, inclusion and exclusion criteria, recruitment method, total number of participants, and demographics), how nutrition risk was measured (including the tool used to measure nutrition risk), social factors or interventions examined (including how these were measured or determined), the relationship between nutrition risk and the social factors examined, and the details of social interventions designed to address nutrition risk. RESULTS: The scoping review was started in October 2023 and will be finalized by August 2024. The findings will describe the social factors commonly examined in the nutrition risk literature, the relationship between these social factors and nutrition risk, the social factors that have an impact on nutrition risk, and social interventions designed to address nutrition risk. The results of the extracted data will be presented in the form of a narrative summary with accompanying tables. CONCLUSIONS: Given the high prevalence of nutrition risk in community-dwelling older adults in HICs and the negative consequences of nutrition risk, it is essential to understand the social factors associated with nutrition risk. The results of the review are anticipated to aid in identifying individuals who should be screened proactively for nutrition risk and inform programs, policies, and interventions designed to reduce the prevalence of nutrition risk. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/56714.

"Nobody But a Family Member Can Do It Quite the Same Way": Understanding the Meaning of Mealtimes to Residents and Families in Long-Term Care Homes During the Pandemic.

BACKGROUND AND OBJECTIVES: Meals in long-term care (LTC) are essential to residents not only for nutrition and their physical well-being but also for their social interactions supporting resident quality of life. This study aims to understand the mealtime experiences of residents and family care partners during the coronavirus 2019 disease (COVID-19) pandemic when restrictions were put in place in LTC and retirement homes. RESEARCH DESIGN AND METHODS: Interpretive description analysis of qualitative interviews in LTC and retirement homes, with 17 family care partners and 4 residents. Convenience and snowball sampling was used to recruit participants for telephone interviews. RESULTS: Three themes were generated. Compromised mealtimes mean compromising community-meals were seen by participants as a key social and community-building event of the home; they reported this loss of community with pandemic restrictions. Participants noted that family care partners are indispensable at meals for social, psychological, and physical support. The dangers of eating alone spoke to the social isolation reported by participants that occurred during the pandemic and the risks they described of eating alone. DISCUSSION AND IMPLICATIONS: This study confirms the importance of mealtimes in LTC and retirement homes to community building and extends our understanding of the importance of family inclusion at meals and why eating alone, as happened during COVID-19, was so detrimental to residents. Effort needs to be made to value this communal activity for the well-being of residents.

Factors Associated with the Development of High Nutrition Risk: Data from the Canadian Longitudinal Study on Aging.

This study aimed to determine which social network, demographic, and health-indicator variables were able to predict the development of high nutrition risk in Canadian adults at midlife and beyond, using data from the Canadian Longitudinal Study on Aging. Multivariable binomial logistic regression was used to examine the predictors of the development of high nutrition risk at follow-up, 3 years after baseline. At baseline, 35.0 per cent of participants were at high nutrition risk and 42.2 per cent were at high risk at follow-up. Lower levels of social support, lower social participation, depression, and poor self-rated healthy aging were associated with the development of high nutrition risk at follow-up. Individuals showing these factors should be screened proactively for nutrition risk.

Finding the Optimal Resistance Training Intensity for Your Bones: Protocol for a Randomized Controlled Trial.

OBJECTIVE: The purpose of this trial is to evaluate the effect of twice-weekly, moderate-to-high intensity progressive resistance training (PRT) for 1 year on lumbar spine bone mineral density (BMD) in individuals with low BMD, compared to attention control. Secondary analyses will examine if resistance training improves other health outcomes; if high intensity is more effective than moderate intensity resistance training for all outcomes; the cost of intervention versus benefit; the willingness to pay; and harms. METHODS: For this study, 324 men or postmenopausal women aged ≥50 years with a femoral neck, total hip, or lumbar spine BMD T-score of ≤-1, or a Fracture Risk Assessment Tool probability of ≥20% for major osteoporotic fracture or ≥ 3% for hip fracture are being recruited to participate in a randomized controlled trial with 1:1:1 randomization. Participants will be stratified by site (3 centers) to twice-weekly, supervised PRT at moderate intensity (about 10 repetitions maximum), to high intensity PRT (≤6 repetitions maximum), or to a home posture and balance exercise program (attention control) for 1 year (resistance training to comparator allocation ratio of 2:1). The primary outcome is lumbar spine BMD via dual-energy X-ray absorptiometry. Secondary outcomes include trabecular bone score, proximal femur and total hip BMD and structure, bone-free and appendicular lean mass, physical functioning, falls, fractures, glucose metabolism, cost per life-year gained, adverse events, and quality of life. Between-group differences will be tested in intention-to-treat and per-protocol analyses using analysis of covariance, chi-square tests, or negative binomial or logistic regression, adjusting for site and baseline values. IMPACT: The Finding the Optimal Resistance Training Intensity For Your Bones trial will support decision making on resistance training for people at risk of fracture.

Nutrition risk and cognitive performance in community-living older adults without cognitive impairment: a cross-sectional analysis of the Canadian Longitudinal Study on Aging.

Malnutrition is correlated with poor cognition; however, an understanding of the association between nutrition risk, which precedes malnutrition, and cognition is lacking. This study aimed to determine if nutrition risk measured with the SCREEN-8 tool is associated with cognitive performance among cognitively healthy adults aged 55+, after adjusting for demographic and lifestyle covariates. Sex- and age-stratified analyses were also explored. Baseline data from the Canadian Longitudinal Study on Aging was used. Cognition was determined using a 6-measure composite score based on four executive functions and two memory tasks, taking into account age, sex, and education. Multivariable linear regression was performed while adjusting for body mass index (BMI), lifestyle, and health covariates in the entire sample (n = 11 378) and then stratified by sex and age. Approximately half of participants were female (54.5%) aged 65+ (54.1%). Greater nutrition risk was associated with poorer cognitive performance in the entire sample (F[1, 11 368] = 5.36, p = 0.021) and among participants aged 55-64 (n = 5227; F[1, 5217] = 5.45, p = 0.020). Sex differences in lifestyle and health factors associated with cognition were apparent, but nutrition risk was not associated with cognition in sex-stratified models. Based on this analysis, there may be an association between nutrition risk and cognitive performance in older adults. When screening for either cognitive impairment or nutrition risk, complementary assessments for these conditions is warranted, as early intervention may provide benefit.

Non-pharmacological management of osteoporotic vertebral fractures: health-care professional perspectives and experiences.

PURPOSE: To understand experiences and perceptions on non-pharmacological treatment of vertebral fractures and virtual-care from the perspective of care professionals' (HCPs). DESIGN AND SETTING: We conducted semi-structured interviews with 13 HCPs within Canada (7 F, 6 M, aged 46 ± 12 years) and performed a thematic and content analysis from a post-positivism perspective. RESULTS: Two themes were identified: acuity matters when selecting appropriate interventions; and roadblocks to receiving non-pharmacological interventions. We found that treatment options were dependent on the acuity/stability of fracture and were individualized accordingly. Pain medication was perceived as important, but non-pharmacological strategies were also considered helpful in supporting recovery. Participants discussed barriers related to the timely identification of fracture, referral to physiotherapy, and lack of knowledge among HCPs on how to manage osteoporosis and vertebral fractures. HCPs reported positive use of virtual-care, but had concerns related to patient access, cost, and comprehensive assessments. CONCLUSION: HCPs used and perceived non-pharmacological interventions as helpful and selected specific treatments based on the recency of fracture and patient symptoms. HCPs' also believed that virtual-care that included an educational component, an assessment by a physiotherapist, and an exercise group was a feasible alternative, but concerns exist and may require further evaluation.Implications for RehabilitationNon-pharmacological strategies in combination with pain medication may be a more effective strategy to support recovery than pain medication alone but should be informed by fracture acuity and patient symptoms.To improve access to physiotherapy and other non-pharmacological treatment options during the acute or chronic management of vertebral fractures, it may be worthwhile to explore the effectiveness and feasibility of virtual-care.

Multi-Level Factors Associated with Relationship-Centred and Task-Focused Mealtime Practices in Long-Term Care: A Secondary Data Analysis of the Making the Most of Mealtimes Study.

Mealtimes in long-term care (LTC) can reinforce relationships between staff and residents through relationship-centred care (RCC) practices; however, meals are often task-focused (TF). This cross-sectional study explores multi-level contextual factors that contribute to RCC and TF mealtime practices. Secondary data from residents in 32 Canadian LTC homes were analyzed (n = 634; mean age 86.7 ± 7.8; 31.1% male). Data included resident health record review, standardized mealtime observation tools, and valid questionnaires. A higher average number of RCC (9.6 ± 1.4) than TF (5.6 ± 2.1) practices per meal were observed. Multi-level regression revealed that a significant proportion of variation in the RCC and TF scores was explained at the resident- (intraclass correlation coefficient [ICC]RCC = 0.736; ICCTF = 0.482), dining room- (ICCRCC = 0.210; ICCTF = 0.162), and home- (ICCRCC = 0.054; ICCTF = 0.356) levels. For-profit status and home size modified the associations between functional dependency and practices. Addressing multi-level factors can reinforce RCC practices and reduce TF practices.

Determinants of a decline in a nutrition risk measure differ by baseline high nutrition risk status: targeting nutrition risk screening for frailty prevention in the Canadian Longitudinal Study on Aging (CLSA).

OBJECTIVES: Nutrition risk is a key component of frailty and screening, and treatment of nutrition risk is part of frailty management. This study identified the determinants of a 3-year decline in nutrition risk (measured by SCREEN-8) for older adults stratified by risk status at baseline. METHODS: Secondary data analysis of the comprehensive cohort sample of the Canadian Longitudinal Study on Aging (CLSA) (n = 5031) with complete data for covariates at baseline and 3-year follow-up. Using a conceptual model to define covariates, determinants of a change in nutrition risk score as measured by SCREEN-8 (lower score indicates greater risk) were identified for those not at risk at baseline and those at high risk at baseline using multivariable regression. RESULTS: Models stratified by baseline nutrition risk were significant. Notable factors associated with a decrease in SCREEN-8 for those not at risk at baseline were mental health diagnoses (- 0.83; CI [- 1.44, -0.22]), living alone at follow-up (- 1.98; CI [- 3.40, -0.56]), and lack of dental care at both timepoints (- 0.91; CI [- 1.62, -0.20]) and at follow-up only (- 1.32; CI [- 2.45, -0.19]). For those at high nutrition risk at baseline, decline in activities of daily living (- 2.56; CI [- 4.36, -0.77]) and low chair-rise scores (- 1.98; CI [- 3.33, - 0.63]) were associated with lower SCREEN-8 scores at follow-up. CONCLUSION: Determinants of change in SCREEN-8 scores are different for those with no risk and those who are already at high risk, suggesting targeted approaches are needed for screening and treatment of nutrition risk in primary care.

RéSUMé: OBJECTIFS: Le risque nutritionnel est l'un des principaux éléments de la fragilité et le dépistage, et le traitement du risque nutritionnel font partie de la prise en charge de la fragilité. Dans cette étude, nous avons cerné les déterminants du risque de déclin nutritionnel sur 3 ans chez les personnes âgées (mesuré par l'instrument SCREEN-8 ­ Seniors in the Community Risk Evaluation for Eating and Nutrition), stratifiés selon l'état de risque au départ. MéTHODE: Nous avons analysé les données secondaires d'un échantillon de la cohorte globale de l'Étude longitudinale canadienne sur le vieillissement (ELCV) (n = 5 031) avec des données complètes pour les covariables au départ et au suivi après 3 ans. En utilisant un modèle théorique pour définir les covariables, nous avons cerné les déterminants d'un changement du score de risque nutritionnel tel que mesuré par l'instrument SCREEN-8 (un faible score indiquant un risque élevé) pour les personnes qui n'étaient pas à risque au départ et pour celles qui étaient à risque élevé au départ, en faisant appel à la régression multivariée. RéSULTATS: Les modèles stratifiés selon le risque nutritionnel au départ étaient significatifs. Les facteurs notables associés à la baisse du score SCREEN-8 chez les personnes qui n'étaient pas à risque au départ étaient les diagnostics de santé mentale (-0,83; IC[-1,44, -0,22]), le fait de vivre seul au suivi (-1,98; IC[-3,40, -0,56]) et l'absence de soins dentaires au départ et au suivi (-0,91; IC[-1,62, -0,20]) ou seulement au suivi (-1,32; IC[-2,45, -0,19]). Chez les personnes ayant un risque nutritionnel élevé au départ, la baisse des activités dans la vie quotidienne (-2,56; IC[-4,36, -0,77]) et un faible score pour se lever d'une chaise (-1,98; IC[-3,33, -0,63]) étaient associés à la baisse du score SCREEN-8 au suivi. CONCLUSION: Les déterminants d'un changement du score SCREEN-8 sont différents chez les personnes qui ne sont pas à risque au départ et chez celles qui sont déjà à risque élevé, ce qui indique que des approches ciblées sont nécessaires pour le dépistage et le traitement du risque nutritionnel dans les soins primaires.

Characterizing Canadian long-term care home consumed foods and their inflammatory potential: a secondary analysis.

BACKGROUND: Nutrient dense food that supports health is a goal of food service in long-term care (LTC). The objective of this work was to characterize the "healthfulness" of foods in Canadian LTC and inflammatory potential of the LTC diet and how this varied by key covariates. Here, we define foods to have higher "healthfulness" if the are in accordance with the evidence-based 2019 Canada's Food Guide, or with comparatively lower inflammatory potential. METHODS: We conducted a secondary analysis of the Making the Most of Mealtimes dataset (32 LTC homes; four provinces). A novel computational algorithm categorized food items from 3-day weighed food records into 68 expert-informed categories and Canada's Food Guide (CFG) food groups. The dietary inflammatory potential of these food sources was assessed using the Dietary Inflammatory Index (DII). Comparisons were made by sex, diet texture, and nutritional status. RESULTS: Consumption patterns using expert-informed categories indicated no single protein or vegetable source was among the top 5 most commonly consumed foods. In terms of CFG's groups, protein food sources (i.e., foods with a high protein content) represented the highest proportion of daily calorie intake (33.4%; animal-based: 31.6%, plant-based: 1.8%), followed by other foods (31.3%) including juice (9.8%), grains (25.0%; refined: 15.0%, whole: 10.0%), and vegetables/fruits (10.3%; plain: 4.9%, with additions: 5.4%). The overall DII score (mean, IQR) was positive (0.93, 0.23 to 1.75) indicating foods consumed tend towards a pro-inflammatory response. DII was significantly associated with sex (female higher; p<0.0001), and diet (minced higher; p=0.036). CONCLUSIONS: "Healthfulness" of Canadian LTC menus may be enhanced by lowering inflammatory potential to support chronic disease management through further shifts from refined to whole grains, incorporating more plant-based proteins, and moving towards serving plain vegetables and fruits. However, there are multiple layers of complexities to consider when optimising foods aligned with the CFG, and shifting to foods with anti-inflammatory potential for enhanced health benefits, while balancing nutrition and ensuring sufficient food and fluid intake to prevent or treat malnutrition.

Nutrition risk varies according to social network type: data from the Canadian Longitudinal Study on Aging.

OBJECTIVE: There were two primary objectives, namely: (1) to determine the social network types that Canadian adults aged 45 and older belong to and (2) to discover if social network type is associated with nutrition risk scores and the prevalence of high nutrition risk. DESIGN: A retrospective cross-sectional study. SETTING: Data from the Canadian Longitudinal Study on Aging (CLSA). PARTICIPANTS: 17 051 Canadians aged 45 years and older with data from baseline and first follow-up of the CLSA. RESULTS: CLSA participants could be classified into one of seven different social network types that varied from restricted to diverse. We found a statistically significant association between social network type and nutrition risk scores and percentage of individuals at high nutrition risk at both time points. Individuals with restricted social networks had lower nutrition risk scores and are more likely to be at nutrition risk, whereas individuals with diverse social networks had higher nutrition risk scores and are less likely to be at nutrition risk. CONCLUSIONS: Social network type was associated with nutrition risk in this representative sample of Canadian middle-aged and older adults. Providing adults with opportunities to deepen and diversify their social networks may decrease the prevalence of nutrition risk. Individuals with more restricted networks should be proactively screened for nutrition risk.

Loneliness and resilience are associated with nutrition risk after the first wave of COVID-19 in community-dwelling older Canadians.

Nutrition risk is linked to hospitalization, frailty, depression, and death. Loneliness during the coronavirus disease 2019 (COVID-19) pandemic may have heightened nutrition risk. We sought to determine prevalence of high nutrition risk and whether loneliness, mental health, and assistance with meal preparation/delivery were associated with risk in community-dwelling older adults (65+ years) after the first wave of COVID-19 in association analyses and when adjusting for meaningful covariates. Data were collected from 12 May 2020 to 19 August 2020. Descriptive statistics, association analyses, and linear regression analyses were conducted. For our total sample of 272 participants (78 ± 7.3 years old, 70% female), the median Seniors in the Community: Risk evaluation for Eating and Nutrition (SCREEN-8) score (nutrition risk) was 35 [1st quartile, 3rd quartile: 29, 40], and 64% were at high risk (SCREEN-8 < 38). Fifteen percent felt lonely two or more days a week. Loneliness and meal assistance were associated with high nutrition risk in association analyses. In multivariable analyses adjusting for other lifestyle factors, loneliness was negatively associated with SCREEN-8 scores (-2.92, 95% confidence interval [-5.51, -0.34]), as was smoking (-3.63, [-7.07, -0.19]). Higher SCREEN-8 scores were associated with higher education (2.71, [0.76, 4.66]), living with others (3.17, [1.35, 4.99]), higher self-reported health (0.11, [0.05, 0.16]), and resilience (1.28, [0.04, 2.52]). Loneliness, but not mental health and meal assistance, was associated with nutrition risk in older adults after the first wave of COVID-19. Future research should consider longitudinal associations among loneliness, resilience, and nutrition.

Reimagining Nutrition Care and Mealtimes in Long-Term Care.

Poor food and fluid intake and subsequent malnutrition and dehydration of residents are common, longstanding challenges in long-term care (LTC; eg, nursing homes, care homes, skilled nursing facilities). Institutional factors like inadequate nutrition care processes, food quality, eating assistance, and mealtime experiences, such as staff and resident interactions (ie, relationship-centered care) are partially responsible and are all modifiable. Evidence-based guidelines on nutrition and hydration for older adults, including those living with dementia, outline best practices. However, these guidelines are not sector-specific, and implementation in LTC requires consideration of feasibility in this setting, including the impact of government, LTC home characteristics, and other systems and structures that affect how care is delivered. It is increasingly acknowledged that interconnected relationships among residents, family members, and staff influence care activities and can offer opportunities for improving resident nutrition. In this special article, we reimagine LTC nutrition by reframing the evidence-based recommendations into relationship-centered care practices for nutrition care processes, food and menus, eating assistance, and mealtime experience. We then expand this evidence into actions for implementation, rating these on their feasibility and identifying the entities that are accountable. A few of the recommended activities were rated as highly feasible (6 of 27), whereas almost half were rated moderate (12/27) and the remainder low (9/27) owing to the need for additional staff and/or expert staff (including funding), or infrastructure or material (eg, food ingredients) investment. Government funding, policy, and standards are needed to improve nutrition care. LTC home leadership needs to designate roles, initiate training, and support best practices. Accountability will result from enforcement of policies through auditing of practice. Further evidence on these desirable nutrition care and mealtime actions and their benefit to residents' nutrition and well-being is required.

Automated food intake tracking requires depth-refined semantic segmentation to rectify visual-volume discordance in long-term care homes.

Malnutrition is a multidomain problem affecting 54% of older adults in long-term care (LTC). Monitoring nutritional intake in LTC is laborious and subjective, limiting clinical inference capabilities. Recent advances in automatic image-based food estimation have not yet been evaluated in LTC settings. Here, we describe a fully automatic imaging system for quantifying food intake. We propose a novel deep convolutional encoder-decoder food network with depth-refinement (EDFN-D) using an RGB-D camera for quantifying a plate's remaining food volume relative to reference portions in whole and modified texture foods. We trained and validated the network on the pre-labelled UNIMIB2016 food dataset and tested on our two novel LTC-inspired plate datasets (689 plate images, 36 unique foods). EDFN-D performed comparably to depth-refined graph cut on IOU (0.879 vs. 0.887), with intake errors well below typical 50% (mean percent intake error: [Formula: see text]%). We identify how standard segmentation metrics are insufficient due to visual-volume discordance, and include volume disparity analysis to facilitate system trust. This system provides improved transparency, approximates human assessors with enhanced objectivity, accuracy, and precision while avoiding hefty semi-automatic method time requirements. This may help address short-comings currently limiting utility of automated early malnutrition detection in resource-constrained LTC and hospital settings.

Nutrition risk prevalence and associated health and social risk factors in Maori and non-Maori: Results from the New Zealand Health, Work and Retirement Study.

OBJECTIVE: To determine the nutrition risk prevalence and associated health and social risk factors amongst community-living Maori and non-Maori older adults in New Zealand. METHODS: As part of the 2014 Health, Work and Retirement postal survey, 2914 community-living older adults (749 Maori) aged 49-87 years completed the Seniors in the Community: Risk Evaluation for Eating and Nutrition (SCREEN II-AB) to determine nutrition risk status and sociodemographic and health measures. RESULTS: Half (50.2%) of Maori and 32.7% of non-Maori were at nutrition risk. Independent risk factors were as follows: for Maori, being unpartnered and rating general health as fair, and for non-Maori, being unpartnered and rating general health as fair or poor, lower life satisfaction, higher number of health conditions and emotional loneliness. CONCLUSIONS: Findings highlight the need for culturally appropriate intervention strategies, which provide opportunity for older adults to eat with others, especially for those who are unpartnered and lonely.

Nutrition risk, physical activity and fibre intake are associated with body composition in OA: analysis of the Canadian Longitudinal Study on Aging.

Objective: Sarcopenic obesity is a key feature in osteoarthritis (OA). While ideal OA treatment involves physical activity and diet, how diet influences OA pathophysiology is unclear. We explored the associations between diet, nutrition risk and physical activity with body composition in older adults with OA. Methods: Baseline data from the Canadian Longitudinal Study on Aging data set were analysed. Participants with hip, knee, hand or multiple forms of OA were included in this cross-sectional analysis. Body composition measures (lean, fat and total masses (kg) and body fat percentage) were separate dependent variables. Regression analyses were conducted to explore associations between body composition with dietary intake (high calorie snack, fibre), nutrition risk (SCREEN II) and physical activity (Physical Activity Scale for the Elderly). Results: 1596 participants were 66.5 (9.0) years old with a body mass index of 28.2 (5.3) kg/m2. Higher fibre cereal intake was associated with higher lean mass (unstandardised beta coefficient 0.5 (0.1, 0.9), p=0.02) and lower body fat percentage (-0.3 (-0.6, 0.0), p=0.046). Lower nutrition risk was associated with higher lean mass (0.1 (0.0, 0.1), p=0.03), lower fat mass (-0.05 (-0.1, 0.0), p=0.009) and lower body fat percentage (-0.1 (-0.1, 0.0), p<0.001). Higher physical activity was associated with higher lean mass (0.01 (0.01, 0.02), p<0.001), lower fat mass (-0.01 (0.0, 0.0), p=0.005) and lower body fat percentage (-0.01 (0.0, 0.0), p<0.001). Conclusion: Greater physical activity and lower nutrition risk were associated with better body composition. While fibre intake was also associated body composition, the CIs were wide suggesting weak associations.

Systematised, Interdisciplinary Malnutrition Program for impLementation and Evaluation delivers improved hospital nutrition care processes and patient reported experiences - An implementation study.

AIM: Models of hospital malnutrition care reliant on dietitians can be inefficient and of limited effectiveness. This study evaluated whether implementing the Systematised, Interdisciplinary Malnutrition Program for impLementation and Evaluation (SIMPLE) improved hospital nutrition care processes and patientreported experiences compared with traditional practice. METHODS: A multi-site (five hospitals) prospective, pre-post study evaluated the facilitated implementation of SIMPLE, a malnutrition care pathway promoting proactive nutrition support delivered from time of malnutrition screening by the interdisciplinary team, without need for prior dietetic assessment. Implementation was tailored to local site needs and resources. Nutrition care processes delivered to inpatients who were malnourished or at-risk of malnutrition were identified across diagnosis, intervention, and monitoring domains using standardised audits from medical records, foodservice systems and patient-reported nutrition experience measures. RESULTS: Pre-implementation (n = 365) and post-implementation (n = 397) cohorts were similar for age (74 vs 73 years), gender (47.1% vs 48.6% female), and nutrition risk status (46.6% vs 45.3% at-risk). Post-implementation, at-risk participants were more likely to receive enhanced food and fluids (68.5% vs 83.9%; P < .01), nutrition information (30.9% vs 47.2%; P < .01), mealtime assistance where required (61.4% vs 77.9% P = .04), nutrition monitoring (25.2% vs 46.3%; P < .01) and care planning (17.8% vs 27.7%; P = .01). Patient-reported nutrition experience measures confirmed improved nutrition care. There was no difference in dietetic occasions of service per patient (1.51 vs 1.25; P = .83). CONCLUSIONS: Tailored SIMPLE implementation improves nutrition care processes and patient reported nutrition experience measures for at-risk inpatients within existing dietetic resources.

Relationship-Centered Mealtime Training Program Demonstrates Efficacy to Improve the Dining Environment in Long-Term Care.

OBJECTIVES: Mealtimes in residential care tend to be task-focused rather than relationship-centered, impacting resident quality of life. CHOICE+ uses participatory approaches to make mealtimes more relationship-centered. The aim of this study was to demonstrate the efficacy of the 12-month external-facilitated implementation of CHOICE+ to improve the mealtime environment. DESIGN: Modified stepped-wedge time series design. SETTING AND PARTICIPANTS: Dining rooms in 3 homes were entered into the intervention every 4 months; total study length was 20 months. Pre- and postintervention evaluations were attained from residents (n = 27, n = 19) and staff (n = 39, n = 29) respectively. METHODS: Five meals in each home were observed by a blinded trained assessor every 4 months using the Mealtime Scan+ to assess physical, social, and relationship-centered practices and overall quality of the dining environment. Repeated measures analysis determined change in mealtime environment scores. The Team member Mealtime Experience Questionnaire and 5 questions from the InterRAI Quality of Life Questionnaire for residents and family were administered at pre- and postintervention. RESULTS: There were significant increases in physical and social environments, relationship-centered care practices, and overall quality of the mealtime environment during the intervention period at all sites (all P < .001) and significant site by intervention interactions for physical (P = .01) and relationship-centered care (P = .03). Statistically significant site differences were noted for relationship-centered care practices (P < .001) and overall quality of the dining environment (P < .002). There was no significant difference in staff and resident/family pre-/postintervention questionnaire results. CONCLUSIONS AND IMPLICATIONS: The external facilitated model of CHOICE+ resulted in significant improvements in the mealtime environment. Although site context impacted implementation, this study demonstrates that mealtimes can be improved even in homes that have challenges. Future work should determine impact of these improvements on other outcomes such as resident quality of life, using more specific measures.

Hungry for more: Low resident social engagement is indirectly associated with poor energy intake and mealtime experience in long-term care homes.

Mealtimes in long-term care (LTC) homes provide social engagement and nutritional intake to residents. Psychosocial challenges may detract from the mealtime experience, resulting in low food intake and increased risk of malnutrition. This study explores the independent effects of psychosocial factors on energy intake among LTC residents. Secondary data (Making the Most of Mealtimes [M3]) from residents in 32 Canadian LTC homes were analyzed. Data included 3-day weighed food intake, mealtime care actions taken by staff, loss of appetite, eating challenges, and other resident characteristics. Psychosocial factors (i.e., social engagement, depression, and aggressive behaviours) were measured using standardized scales. The independent effects of psychosocial factors on energy intake were tested using bivariate and linear regression analyses adjusted for loss of appetite, eating challenges, and demographic characteristics. The final sample included 604 residents (mean age = 86.8 ± 7.8 years; 31.8% male). Of the three psychosocial factors, only social engagement was associated with energy intake. Low social engagement was associated with cognitive and functional challenges, malnutrition risk, more task-focused mealtime actions by staff, and lower energy intake. Simple regression analysis revealed that individuals with low social engagement ate 59.6 kcal less per day (95% CI = -111.2, -8.0). This significant association remained when adjusting for loss of appetite, but was no longer significant when adjusting for eating challenges. Low social engagement occurs concurrently with physical and functional challenges among LTC residents, affecting both the nutritional and social aspects of mealtimes. Emphasis on socializing during mealtimes, especially for those with eating challenges (e.g., requiring assistance), may contribute to improved resident appetite and quality of life.

Trends and Novel Research in Hospital Nutrition Care: A Narrative Review of Leading Clinical Nutrition Journals.

Hospital malnutrition is a longstanding problem that continues to be underrecognized and undertreated. The aim of this narrative review is to summarize novel, solution-focused, recent research or commentary to update providers on the prevention of iatrogenic malnutrition as well as the detection and treatment of hospital malnutrition. A narrative review was completed using the top 11 clinically relevant nutrition journals. Of the 13,850 articles and editorials published in these journals between 2013 and 2019, 511 were related to hospital malnutrition. A duplicate review was used to select (n = 108) and extract key findings from articles and editorials. Key criteria for selection were population of interest (adult hospital patients, no specific diagnostic group), solution-focused, and novel perspectives. Articles were categorized (6 classified in >1 category) as Screening and Assessment (n = 17), Standard (n = 25), Advanced (n = 12) and Specialized Nutrition Care (n = 8), Transitions (n = 15), Multicomponent (n = 21), Education and Empowerment (n = 9), Economic Impact (n = 3), and Guidelines (n = 4) for summarizing. Research advances in screening implementation, standard nutrition care, transitions, and multicomponent interventions provide new strategies to consider for malnutrition prevention (iatrogenic), detection, and care. However, several areas requiring further research were identified. Specifically, larger and more rigorous studies that examine health outcomes and economic analyses are urgently needed.