Evaluation of Malnutrition Knowledge among Nursing Staff in the Czech Republic: A Cross-Sectional Psychometric Study.

Construct: The Knowledge of Malnutrition - Geriatric 2.0' (KoM-G 2.0) instrument was designed to quantify nursing staff malnutrition knowledge in inpatient medical and rehabilitation care facilities, as well as home health care. It has been used to assess grasp of current clinical practice guidelines and proficiency in addressing issues related to malnutrition. It provides insight into familiarity with and capacity to tackle issues pertaining to malnutrition in clinical practice. Furthermore, it has been used assess the effectiveness of educational interventions aimed at improving nursing professionals knowledge and awareness of malnutrition. Background: The quality of nursing education affects malnutrition risk assessment, monitoring of food intake, and effectiveness of nutrition care. Improvements in malnutrition education require determining the current level of knowledge and benchmarking with other countries. In the Czech Republic, no nationwide assessment of nursing staff malnutrition knowledge has ever been conducted. Approach: The purpose of the study was to translate the KoM-G 2.0 instrument, gather initial validity evidence, and evaluate nursing staff knowledge of malnutrition in inpatient medical, rehabilitation care facilities, and home care in the Czech Republic. All inpatient healthcare facilities and home healthcare facilities in the Czech Republic were invited to participate. The Czech version of the internationally standardized KoM-G 2.0 (KoM-G 2.0 CZ) was used to assess nursing staff malnutrition knowledge between 3 February 2021 and 31 May 2021. A total of 728 nurses began the questionnaire, and 465 (63.9%) of respondents completed it and were included in the study. Data analyses examined instrument difficulty, discriminability, and reliability, as well as sources of variation in knowledge scores. Findings: The psychometric characteristics of the KoM-G 2.0 CZ instrument included the difficulty index Q (0.61), the discriminant index (ULI 0.29, RIT 0.38, upper-lower 30% 0.67), and Cronbach alpha (0.619). The overall mean of correct answers was 6.24 (SD 2.8). There was a significant impact of educational attainment and nutrition training on KoM-G 2.0 CZ scores. Conclusions: Our findings provide initial validity evidence that KoM-G 2.0 CZ is useful and appropriate for assessing malnutrition knowledge among Czech nursing staff. Our research identified gaps in knowledge and examples of good practice in understanding malnutrition that can be applied internationally. The knowledge of academic nurses was greater; therefore, we suggest they play a key role in nutritional care. We recommend continuous education to improve understanding of malnutrition in this setting.

Which factors influence the prevalence of institution-acquired falls? Results from an international, multi-center, cross-sectional survey.

PURPOSE: Falls are a highly prevalent problem in hospitals and nursing homes with serious negative consequences such as injuries, increased care dependency, or even death. The aim of this study was to provide a comprehensive insight into institution-acquired fall (IAF) prevalence and risk factors for IAF in a large sample of hospital patients and nursing home residents among five different countries. DESIGN: This study reports the outcome of a secondary data analysis of cross-sectional data collected in Austria, Switzerland, the Netherlands, Turkey, and the United Kingdom in 2017 and 2018. These data include 58,319 datapoints from hospital patients and nursing home residents. METHODS: Descriptive statistics, statistical tests, logistic regression, and generalized estimating equation (GEE) models were used to analyze the data. FINDINGS: IAF prevalence in hospitals and nursing homes differed significantly between the countries. Turkey (7.7%) had the highest IAF prevalence rate for hospitals, and Switzerland (15.8%) had the highest IAF prevalence rate for nursing homes. In hospitals, our model revealed that IAF prevalence was associated with country, age, care dependency, number of medical diagnoses, surgery in the last two weeks, and fall history factors. In nursing homes, care dependency, diseases of the nervous system, and fall history were identified as significant risk factors for IAF prevalence. CONCLUSIONS: This large-scale study reveals that the most important IAF risk factor is an existing history of falls, independent of the setting. Whether a previous fall has occurred within the last 12 months is a simple question that should be included on every (nursing) assessment at the time of patient or resident admission. Our results guide the development of tailored prevention programs for persons at risk of falling in hospitals and nursing homes.

Malnutrition as predictor of poor outcome after total hip arthroplasty.

INTRODUCTION: The aim of this study was to assess the prevalence of protein energy malnutrition (PEM) and correlation with poor post-operative outcome in the elderly undergoing primary total hip arthroplasty (THA). HYPOTHESIS: Patients with PEM would have inferior post-operative outcome after THA. MATERIALS AND METHOD: We retrospectively evaluated the nutritional status of 220 hospitalized patients undergoing THA, 65 years and older. PEM was assessed using serum albumin and total lymphocyte count (TLC). Studied outcome parameters were length of pre-operative and post-operative stay, complications up to six months after surgery and 12-month mortality. Clinical and demographic data were retrieved from medical records from the hospital database. RESULTS: The prevalence of PEM among patients undergoing THA was 12.3% (27/220). Patients with PEM were significantly older (mean age 81.3 ± 7.0, p < 0.001), had a lower BMI (24.7 ± 4.1 kg/m 2, p = 0.022), and showed more comorbid conditions (mean CCI 2.8 ± 2.0, p = 0.002) compared with well-nourished patients (age 75.6 ± 6.2, BMI 26.8 ± 4.3 kg/m 2, CCI: 1.7 ± 1.7). Length of pre-operative stay differed significantly (p < 0.001) between PEM (median 7, range 1-36 days) and non PEM (median 1, range 1-22 days). In the PEM group, 12 (44.4%) patients had post-operative complications within six months after OP and 15 (7.8%) patients in the non PEM group (HR = 6.3, 95% CI 1.7-23.1). CONCLUSION: We observed a higher post-operative complication rate for malnourished patients undergoing elective THA. These results underline the importance of pre-operative nutritional assessment in the elderly. Therefore, serum albumin and TLC are valuable clinical markers of PEM and the post-operative outcome.

Association between malnutrition risk and pain in older hospital patients.

OBJECTIVE: To describe the prevalence of malnutrition risk and pain in older hospital patients and characterise the association between these two problems. RESEARCH METHODS AND PROCEDURES: The study includes a secondary data analysis of data collected in two cross-sectional studies. Data collection was performed in 2017 and 2018 using a standardised and tested questionnaire. The study protocol was approved by an ethical committee. RESULTS: Data from 3406 patients were analysed. Among the participants, 24.6% of the patients were at risk of malnutrition, and 59.6% of the patients reported feeling pain. A significantly higher number of patients with pain (26.4%) were at risk of malnutrition than patients without pain (22.1%). The multivariate logistic regression analysis showed that patients with severe/very severe or unbearable pain were 1.439 times more likely to develop a risk of malnutrition than patients without pain. Patients with cancer or diseases of the digestive system were twice as likely to develop malnutrition than those without these diseases. CONCLUSIONS: The results of this study show that older patients with severe pain are at higher risk of developing a risk of malnutrition than those without pain, although the study design (cross-sectional) does not imply causality. Therefore, special efforts should be made to assess pain in these patients to reduce the negative consequences of this pain, such as malnutrition.

Which Characteristics of Fecal Incontinence Predispose Incontinence-Associated Dermatitis? A Classification and Regression Tree Analysis.

OBJECTIVE: To investigate which characteristics of fecal incontinence (FI) are predictors for incontinence-associated dermatitis (IAD) using the Classification and Regression Tree method. DESIGN AND SETTING: Data collected from 2014 to 2016 during the Austrian Nursing Quality Measurement 2.0, an annually conducted, cross-sectional, multicenter prevalence study, were merged and analyzed. MAIN OUTCOME MEASURE: The duration, frequency, and amount of FI were used as predictors for IAD. Nurses were asked if the participants suffered from IAD based on their clinical judgment (yes/no). MAIN RESULTS: In total, 1,513 participants with FI were included in this analysis. More than 75% of the participants with FI were to a great extent or completely care dependent. Of all FI participants, nearly 6% suffered from IAD, and more than 70% received special skin care for IAD prevention. Participants with FI had the highest risk of developing IAD if they experienced FI every day, had FI for less than 3 months, and had developed the FI in their current institution. CONCLUSIONS: Nurses face many challenges while helping patients with FI maintain healthy skin. Knowledge of the results of this study and accumulated knowledge about the specific characteristics of FI that are associated with the development of IAD can help healthcare personnel prevent IAD. Based on these results, improving patient education for persons with newly diagnosed FI to prevent IAD is recommended. Research studies should use the definition of FI established by the International Continence Society.

Associations between personal protective equipment and nursing staff stress during the COVID-19 pandemic.

AIM: This study gives insights into the association between the use of personal protective equipment (PPE), wearing time of masks and stress among frontline nursing staff during the COVID-19 pandemic. BACKGROUND: PPE can have physical consequences like headache and pain, which could result in increased nurse stress levels. METHODS: A total of 2600 nurses participated in this online survey. The questionnaire is based on literature and includes the perceived level of stress scale. RESULTS: We found no significant association between the use of PPE and stress. Nurses who wore masks for more than 8 h had significant higher stress levels than those who used the masks for a shorter period. CONCLUSIONS: The duration of wearing masks is associated with nurse's stress level. Our findings can help nurses to argue a higher frequency of breaks and a maximum duration of mask usage in their organisations. IMPLICATIONS FOR NURSING MANAGEMENT: We recommend that nursing managers implement practical strategies such as a mask break task force. This task force could promote awareness for mask breaks and recommend and allocate rooms or locations such as balconies for mask breaks.

Improving the quality of nursing care in Austria: 10 years of success.

AIMS: We provide more updated and comprehensive insights, including descriptions of changes that have taken place in the quality of pressure injury care provided in hospitals over a 10-year period. BACKGROUND: Various nursing quality measurements do not present a comprehensive view on nursing-sensitive quality indicators or place a focus on one specific care problem. METHODS: It is a repeated cross-sectional multicentre study conducted annually on 1 day including comprehensive data regarding nursing-sensitive care problems and quality indicators on the structure, process and outcome levels. RESULTS: The prevalence of pressure injuries decreased over the years from 4.4% to 2.9%, and the frequency of interventions increased. CONCLUSION: The Nursing Quality Measurement 2.0 initiative shows considerable improvements over a 10-year period. Therefore, the maintenance of such nursing databases should be treated as a prerequisite to providing high-quality nursing care and safe nursing practice. One main benefit of creating and maintaining such databases is that allow users to screen for improvements, for example in pressure injury care. These observations can be used to develop marketing strategies and/or to empower and engage nursing staff. IMPLICATIONS FOR NURSING MANAGEMENT: Participation in such quality measurements allows the comparison of data collected in wards and institutions in many different countries, enabling them to set appropriate benchmarks. Furthermore, the results can be compared over a period of time, highlighting systematic changes, trends or improvements (e.g., due to implemented innovations).

[Make nursing practice visible through nursing science in times of COVID-19]. / Pflegepraxis durch Pflegewissenschaft in Zeiten von COVID-19 sichtbar machen.

Due to coronavirus disease 2019 (COVID-19) nursing practice is facing enormous challenges. Nevertheless, nursing science was hardly actively represented as a mouthpiece for the practice in the public discussions on the COVID-19 pandemic. Therefore, the question arises which projects with a focus on nursing and COVID-19 have been carried out at Austrian universities. Overall, six projects were identified using the snowball method. Of the studies one showed that an increased wearing time of masks is associated with an increased stress level for nursing personnel. An additional study result showed that almost 50% of lay people used masks incorrectly. Individual experiences, interventions undertaken and solution approaches from the perspective of the nursing staff with respect to ethical challenges in nursing homes were collected in a further project. This and other projects show that nursing science, with its knowledge and as a voice for nursing practice, has taken the initiative and contributes to the COVID-19 discourse. Additionally, the findings of the projects can be used as a basis for making future political decisions.

Nutritional problems and their non-pharmacological treatment in adults undergoing haematopoietic stem cell transplantation-A systematic review.

OBJECTIVE: This systematic review aimed to identify the most relevant problems related to malnutrition in adult patients undergoing haematopoietic stem cell transplantation (HSCT) and to identify non-pharmacological interventions to treat these problems. METHODS: A systematic search for each research question was performed in MEDLINE, CINAHL, Embase, the Cochrane Library, Google Scholar and reference lists in the period 2009-2019. RESULTS: Six and nine studies were included respectively. Quantitative pooling of data was not possible due to the heterogeneity of the studies. Oral mucositis (OM), nausea/vomiting, diarrhoea and dysgeusia were the most frequently reported nutritional problems. Cryotherapy and laser therapy seem to be effective in the prevention and treatment of OM. Recommendations for or against the use of mouth rinses and light therapy in the treatment of OM cannot be made, as too few studies have been conducted in this area. The evidence for non-pharmacological treatment options in the case of nausea/vomiting and diarrhoea is rather limited. No study was identified with regard to treatment of dysgeusia. CONCLUSION: Nutrition in HSCT patients has not yet been studied to a satisfactory extent. There is an urgent need for high-quality studies to be conducted in this area to optimise the care of patients undergoing haematopoietic stem cell transplantation.

Development of a nutritional documentation tool: a Delphi study.

In daily clinical practice, the smooth, timely and comprehensive transfer of information between care settings is important and reflects a cornerstone of high-quality patient care. The integration of nutritional information in the medical information transfer is currently not included in an evidence-based approach. It was, therefore, the aim of this study to develop a nutritional documentation tool (NDoc) on the basis of evidence and test it for its usability in daily clinical practice. Based on the results of a literature review, the authors collected core content using a modified Delphi survey from experts across Europe and included the information collected in a structured, NDoc. The subsequently developed tool included thirty items and was tested for its usability on a daily basis among primary care physicians and clinical physicians. The new NDoc can be introduced for use in any computer-based hospital information system regionally and adapted for worldwide use.

Dysphagia and factors associated with malnutrition risk: A 5-year multicentre study.

AIMS: To describe the associations between dysphagia and malnutrition risk and to identify predictors for dysphagia in a group of persons at risk of malnutrition in hospitals and nursing homes. DESIGN: A secondary analysis of cross-sectional data from the years 2012-2016. METHODS: The risk of malnutrition was assessed using the Malnutrition Universal Screening Tool for Adults (MUST). The data were compared regarding malnutrition risk and dysphagia. Regression analyses were conducted to identify variables that were associated with the risk of malnutrition and dysphagia. RESULTS: Patients (N = 17,580) were included in the study sample. The prevalence of dysphagia was 6.6% and the prevalence of malnutrition risk was 18.9%. A multivariable logistic regression analysis resulted in the identification of dysphagia and cancer as variables with the highest odds ratios with regard to malnutrition risk. Patients with cancer, stroke or respiratory diseases represent a high-risk group for the co-occurrence of dysphagia and risk of malnutrition. CONCLUSIONS: Screening for dysphagia should be carried out on patients at risk of malnutrition as an integral part of their admission to a healthcare institution and especially on the higher risk group of patients with cancer, a stroke or a respiratory disease. IMPACT: What problem did the study address? This study identified the relationship between dysphagia and malnutrition risk and associated factors. What were the main findings? Dysphagia among patients in the research sample was associated with more than two times higher prevalence of the malnutrition risk. Where and on whom will the research have an impact? Thorough malnutrition risk and dysphagia screening lead to better nursing care.

Does Conducting a Risk Assessment Facilitate Better Care for Patients at Risk of Pressure Injuries?

OBJECTIVE: To evaluate if the use of a pressure injury (PI) risk assessment is associated with the more frequent use of international evidence-based guideline interventions in patients at risk of PI. METHODS: Data were collected through a multicenter cross-sectional prevalence study conducted on November 14, 2017. Study authors analyzed data from 532 patients 65 years at risk of PI or older in Austrian hospitals. MAIN OUTCOME MEASURES: Repositioning, mobilization, floating heels/heel devices, moisture/barrier cream, patient education, malnutrition screening, referral to a dietitian, and hydration/nutrition management. MAIN RESULTS: The risk assessment was documented on admission for 80% (n = 435) of the at-risk patients. Patients for whom a PI risk assessment was conducted were older and more care dependent, and nearly 20% had a PI compared with patients for whom no risk assessment was conducted upon admission. Conducting a risk assessment led to a statistically significantly higher number of internationally recommended PI preventive interventions being performed for at-risk patients, such as provision of moisture/barrier cream, mobilization specific for PI, malnutrition screening, and floating heels or heel suspension devices. CONCLUSIONS: These results showed that conducting and documenting a risk assessment led to more recommended interventions being performed. Although such interventions are recommended for all patients, these findings are especially relevant for patients at mild or moderate risk of PI who might be otherwise overlooked, which in turn could reduce hospital-acquired PI rates.

Six Nursing Care Problems in Hospitals: A Cross-Sectional Study of Quality of Care.

BACKGROUND: Investigations on the quality of nursing care relating to various care problems are rare. PURPOSE: This study assessed the (1) fulfillment of structural indicators, (2) application of nursing interventions as process indicators, and (3) prevalence rate as outcome indicators with regard to various care problems. METHODS: A cross-sectional multicenter study was conducted in 30 Austrian hospitals with 2878 patients. RESULTS: The highest number of structural quality indicators was fulfilled for pressure ulcers, falls, restraints, and pain. In malnutrition and urinary incontinence, a lack of structural indicators was observed. Most interventions were offered to patients with pressure ulcers or those who had experienced a fall. The lowest frequency of nursing interventions was seen in malnourished and incontinent persons. CONCLUSION: There is a need for the national adaptation of guidelines for malnutrition and urinary incontinence. This may increase the frequency of evidence-based nursing interventions.

Structure, Process, and Quality Indicators for Pressure Injury Prevention and Care in Austrian Hospitals: A Quality Improvement Project.

The purpose of this quality improvement point-prevalence project conducted in 2017 was to describe the structure, process, and outcome indicators for pressure injury (PI) prevention and care in 37 Austrian hospitals with 208 wards and 2955 patients, with an average age of 66 years. Structural indicators such as PI guideline availability were measured on hospital and ward levels. On the process level, patients were assessed to determine whether PI interventions such as mobilization or use of moisturizer/barrier cream were implemented. On the outcome level, data on the presence of hospital-acquired PIs based on skin inspection were collected. These data were collected using the Austrian version of the National Prevalence Measurement of Care Problems, a standardized survey. Structural level results showed PI protocols or guidelines were available in 75.7% of the participating institutions. Staff education such as refresher courses was seldom available on the ward level (46.6%). Process-level results indicated the most commonly applied intervention in both patients at risk of or had a PI was the use of skin-protectant moisture barrier creams (63.1% and 85.2%, respectively). Patients with PIs also frequently received interventions focusing on the heels (72.9%) and mobilization (69.2%). With regard to the outcome level, the overall and hospital-acquired PI prevalence rates were 3.6% and 1.3%, respectively. We recommend focusing on staff, patient and family education including the prevention and treatment of hydration and nutritional deficits, an uncommonly used intervention in Austria based on these data, to improve the quality of PI prevention and care in the hospital setting.

Nutritional management of older hospitalised patients with pressure injuries.

This cross-sectional, multicentre study was conducted in hospitals to investigate nutritional interventions conducted in patients aged 70 years or older with (risk of) pressure injuries. A total of 1412 patients from 33 hospitals with 208 wards participated in the study. A standardised questionnaire was used to collect demographic data and data on care dependency, malnutrition risk, risk for/prevalence of pressure injuries, and nutritional interventions. Data analyses were conducted by using descriptive statistics, chi-square tests, or independent t-tests. According to the Braden Scale, 678 (48.0%) of the patients were at risk of developing pressure injuries, and 71 patients (5.0%) had at least one pressure injury (assessed by skin inspection). The most frequently conducted nutritional interventions in patients with pressure injuries were providing support during mealtimes (50.7%), food specifically desired by the patient (40.8%), and conducting a malnutrition screening (39.4%). One quarter of the patients with pressure injuries were referred to a dietitian. The provision of an energy-enriched/protein-enriched diet (18.3%), energy-enriched/protein-enriched snacks (12.7%), or oral nutritional supplements (8.5%) was rare. Nutritional care in older patients with risk of pressure injuries is suboptimal. Health care professionals need to raise awareness regarding the importance of nutrition in the management of patients with pressure injuries.

Use of an electronic malnutrition screening tool in a hospital setting: effects on knowledge, attitudes and perceived practices of healthcare staff.

Malnutrition risk screening is essential for the adequate identification and treatment of malnourished hospitalised patients. The aim of this study was to determine the effect of the use of an electronic malnutrition screening tool on the knowledge, attitudes and perceived practices (KAP) of a pool of nurses, nurses' aides and physicians. A controlled study using a pre-test-post-test design was carried out in two Austrian hospitals. The hospital that was assigned to the intervention group used the Graz malnutrition screening tool. The hospital that was assigned to the control group received no intervention. To collect data, a questionnaire was filled out by the study participants at baseline (T0) and 1 month after the implementation (T1) to assess KAP. All data were analysed using descriptive statistics, χ 2 tests, Wilcoxon signed-rank tests and Student's t tests. A total of 269 nurses, nurses' aides and physicians participated in the study and completed the questionnaires at T0, and 190 people at T1. The sum score for the KAP questionnaire changed significantly after the implementation of the malnutrition screening tool in the intervention group (P<0·001), but not in the control group. The use of a valid and reliable malnutrition screening tool effectively improved the KAP of healthcare staff. The KAP described here are essential for providing successful nutritional care in malnourished patients, and improving these factors may result in improved patient outcomes. To attain these outcomes, stakeholders, as well as members of all professions involved in multidisciplinary nutritional care, must invest significant efforts.

The Graz Malnutrition Screening (GMS): a new hospital screening tool for malnutrition.

Despite the significant impact of malnutrition in hospitalised patients, it is often not identified by clinical staff in daily practice. To improve nutritional support in hospitals, standardised routine nutritional screening is essential. The Graz Malnutrition Screening (GMS) tool was developed for the purpose of malnutrition risk screening in a large hospital setting involving different departments. It was the aim of the present study to validate the GMS against Nutritional Risk Screening (NRS) and Mini Nutritional Assessment-short form (MNA-sf) in a randomised blinded manner. A total of 404 randomly selected patients admitted to the internal, surgical and orthopaedic wards of the University Hospital Graz were screened in a blinded manner by different raters. Concurrent validity was determined by comparing the GMS with the NRS and in older patients (70+ years) with the MNA-sf additionally. According to GMS, 31·9 or 28·5% of the admitted patients were categorised as at 'risk of malnutrition' (depending on the rater). According to the reference standard of NRS, 24·5% of the patients suffered from malnutrition. Pearson's r values of 0·78 compared with the NRS and 0·84 compared with the MNA showed strong positive correlations. Results of accuracy (0·85), sensitivity (0·94), specificity (0·77), positive predictive value (0·76) and negative predictive value (0·95) of GMS were also very high. Cohen's κ for internal consistency of the GMS was 0·82. GMS proves to be a valid and reliable instrument for the detection of malnutrition in adult patients in acute-care hospitals.

Association Between Sarcopenia and Nutritional Status in Older Adults: A Systematic Literature Review.

HOW TO OBTAIN CONTACT HOURS BY READING THIS ARTICLE INSTRUCTIONS 1.2 contact hours will be awarded by Villanova University College of Nursing upon successful completion of this activity. A contact hour is a unit of measurement that denotes 60 minutes of an organized learning activity. This is a learner-based activity. Villanova University College of Nursing does not require submission of your answers to the quiz. A contact hour certificate will be awarded once you register, pay the registration fee, and complete the evaluation form online at http://goo.gl/gMfXaf. To obtain contact hours you must: 1. Read the article, "Association Between Sarcopenia and Nutritional Status in Older Adults: A Systematic Literature Review" found on pages 33-41, carefully noting any tables and other illustrative materials that are included to enhance your knowledge and understanding of the content. Be sure to keep track of the amount of time (number of minutes) you spend reading the article and completing the quiz. 2. Read and answer each question on the quiz. After completing all of the questions, compare your answers to those provided within this issue. If you have incorrect answers, return to the article for further study. 3. Go to the Villanova website listed above to register for contact hour credit. You will be asked to provide your name; contact information; and a VISA, MasterCard, or Discover card number for payment of the $20.00 fee. Once you complete the online evaluation, a certificate will be automatically generated. This activity is valid for continuing education credit until June 30, 2019. CONTACT HOURS This activity is co-provided by Villanova University College of Nursing and SLACK Incorporated. Villanova University College of Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. ACTIVITY OBJECTIVES 1. Describe the geriatric syndrome of sarcopenia. 2. Identify the outcome of the sarcopenia studies. DISCLOSURE STATEMENT Neither the planners nor the authors have any conflicts of interest to disclose. Sarcopenia is an important geriatric syndrome with high prevalence rates and one of the most common causes of reductions in mobility, quality of life, and increasing dependency on care. The current study examined the relationship between sarcopenia and nutritional status in adults 60 and older. A systematic literature search was conducted, and data from 33 publications were included. The currently available literature indicates that sarcopenia is correlated with poor nutritional status (e.g., low body mass index, unfavorable nutritional risk screening results, decreased nutritional laboratory parameters, anorexia). Comparison of the studies' results were complicated by the lack of a generally accepted definition for sarcopenia, as well as the use of many different instruments to detect sarcopenia. The co-occurrence of malnutrition and sarcopenia is of great relevance. Future scientific work should focus on the formation of consistent definitions and instruments for the detection of sarcopenia to improve data comparisons. [Journal of Gerontological Nursing, 42(7), 33-41.].

Muscle power and nutrition.

Sarcopenia, as defined by the European working group on sarcopenia in older people (EWGSOP), is a highly prevalent syndrome characterized by age-related loss of muscle mass and muscle strength/power with impacts on physical function, health and quality of life in older people. The complex, multifaceted and still not completely elucidated etiology of sarcopenia and loss of muscle function (dynapenia) poses challenges for the design of interventional studies to combat loss of muscle strength. Several factors, however, have been demonstrated to have major impacts for maintenance of physiological muscle functioning, including nutrition and in particular specific nutrients. For example, proteins, amino acids and micronutrients have been extensively studied regarding their impact on muscle synthesis and metabolism. This literature review focuses on the impact of nutrition on muscle strength and power as it relates to older people given that muscle changes with age can have important implications for health.

Malnutrition management and the application of medical nutrition therapy in hospitalized patients at the end of life.

OBJECTIVES: (1) To determine the prevalence of malnutrition risk in hospitalized patients at the end of life (EOL), (2) to evaluate which nutritional interventions are administered in hospitalized end-of-life patients with malnutrition risk and (3) to assess the association of end-of-life care and the administration of medical nutrition therapy in patients with malnutrition risk. DESIGN: Cross-sectional multi-center study SETTING: Hospital PARTICIPANTS: Hospitalized adult patients MEASUREMENTS: Based on the valid and reliable questionnaire of the Nursing Quality Measurement 2.0 (LPZ), the parameters of demographic data, medical diagnoses, end-of-life phase, care dependency, malnutrition risk according to the Malnutrition Universal Screening Tool (MUST) and nutritional interventions conducted in patients at risk of malnutrition were assessed. Descriptive statistics and statistical tests were conducted. Logistic regression models were established to identify odds ratios (OR) and confidence intervals (CI) for the association of end-of-life care and the provision of medical nutrition therapy. This was done separately for oral nutritional supplements (ONS), enteral nutrition and parenteral nutrition as the respective dependent variables. RESULTS: Of all 12,947 participants, 706 (5.5%) were in an end-of-life phase. The prevalence of malnutrition risk in end-of-life patients was 41.1% compared to 24.7% in other patients (p < 0.001). End-of-life patients with malnutrition risk received more nutritional interventions than other patients with malnutrition risk. The regression models showed that being at the end of life (CI 1.30, 2.63; p < 0.001), being treated by a dietitian (OR 6.02; CI 4.86, 7.45; p < 0.001), suffering from dementia (OR 1.85; CI 1.10, 3.12; p = 0.02) or cancer (OR 1.56; CI 1.25, 1.96; p < 0.001) increased the chance of receiving oral nutritional supplements. For receiving parenteral nutrition, being at the end of life (OR 1.68; CI 1.04, 2.71; p = 0.04), being treated by a dietitian (OR 5.80; CI 4.07, 8.25; p < 0.001), surgery within the previous two weeks (OR 1.58; CI 1.09, 2.30; p = 0.02), younger age (OR 0.99; CI 0.98, 1.00; p = 0.04), care dependency (OR 0.97; CI 0.96, 0.98; p < 0.001), suffering from a disease of the digestive system (OR 2.92; CI 2.07, 4.11; p < 0.001) or cancer (OR 2.44; CI 1.71, 3.49; p < 0.001) were independent predictors. Being at the end of life did not influence the application of enteral nutrition. CONCLUSION: This study showed that nutritional interventions are often applied in end-of-life patients admitted to general hospitals. Being at the end of life was positively associated with the application of oral nutritional supplementation and parenteral nutrition. This data does not allow a conclusion about the appropriateness of using medical nutrition therapy in this study sample. Judging the appropriateness of medical nutrition therapy at the end of life is challenging because of the high variability of prognostication as well as the wishes and needs of the specific patients and their relatives that influences the appraisal of adequate interventions. Every decision about nutrition and hydration in end-of-life patients should be a shared decision and be based on advanced care planning principles.