Prevalence and Determinants of Poor Food Intake of Residents Living in Long-Term Care
Prevalence and Determinants of Poor Food Intake of Residents Living in Long-Term Care
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DOI：
10.1016/j.jamda.2017.05.003
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发表时间：
2017-11-01
影响因子：
7.6
通讯作者：
Villalon, Lita
中科院分区：
文献类型：
--
作者：
Keller, Heather H.;Carrier, Natalie;Villalon, Lita
目的：食物摄入不足是众所周知的，导致营养不良的长期护理院（LTCH），但食物摄入的多层次的决定因素没有得到充分的理解，阻碍了干预措施的发展，可以保持居民的营养状况。本研究测量了LTCH居民的能量和蛋白质摄入量，描述了各种协变量的患病率，以及协变量与食物摄入量的相关性。设计：多地点横截面研究。设置：来自加拿大4个省的32家养老院。参与者：来自639名居民的样本（每个家庭随机选择20人），628名有完整数据的人被纳入分析。完成三天的称重食物摄入（主菜、估计的饮料和配菜、零食），以测量能量和蛋白质摄入。对诊断、药物和饮食处方的健康记录进行了审查。采用Mini-Nutritional Assessment-SF评估营养风险。口腔健康和吞咽困难的风险进行了评估与标准化的协议。采用爱丁堡喂养问卷（Ed-FED）确定进食挑战;采用进餐时间关系护理检查表评估与工作人员的进餐时间互动。进餐时间观察记录进餐持续时间和接受的帮助。使用用餐环境审计协议评估用餐环境的物理特征，并使用用餐扫描记录用餐体验和氛围。工作人员完成了个人定向护理问卷，管理人员完成了一项调查，描述了家庭和食品服务的特点。分层多变量回归确定预测的能量和蛋白质摄入量调整其他covariates.Results：平均年龄为86.3 +/- 7.8岁，69%的参与者是女性。平均能量摄入量为1571.9 +/- 411.93千卡，蛋白质摄入量为58.4 +/- 18.02克/天。有一个显着的相互作用被规定一个pureed/liquidized饮食和饮食的能量摄入的挑战。年龄、进食挑战次数、糊状/液化饮食以及有时需要进食帮助与能量和蛋白质摄入量呈负相关。作为男性，较高的迷你营养评估简表评分，经常需要饮食帮助，以及在痴呆症护理病房与能量和蛋白质摄入呈正相关。单独的能量摄入量与homelikeness分数呈负相关，但与以人为本的护理实践呈正相关，而蛋白质的摄入量与更多的营养师time.Conclusion：这是第一个研究考虑居民，单位，工作人员和家庭变量与食物摄入量。研究结果表明，干预措施集中在泥状食物，恢复性餐饮，饮食援助，以人为本的护理实践可能会支持改善食物摄入量，并应进一步研究的目标。(C)2017年AMDA -急性后和长期护理医学协会。
Objective: Poor food intake is known to lead to malnutrition in long-term care homes (LTCH), yet multilevel determinants of food intake are not fully understood, hampering development of interventions that can maintain the nutritional status of residents. This study measures energy and protein intake of LTCH residents, describes prevalence of diverse covariates, and the association of covariates with food intake.Design: Multisite cross-sectional study.Setting: Thirty-two nursing homes from 4 provinces in Canada.Participants: From a sample of 639 residents (20 randomly selected per home), 628 with complete data were included in analyses.Measurements: Three days of weighed food intake (main plate, estimated beverages and side dishes, snacks) were completed to measure energy and protein intake. Health records were reviewed for diagnoses, medications, and diet prescription. Mini-Nutritional Assessment-SF was used to determine nutritional risk. Oral health and dysphagia risk were assessed with standardized protocols. The Edinburgh-Feeding Questionnaire (Ed-FED) was used to identify eating challenges; mealtime interactions with staff were assessed with the Mealtime Relational Care Checklist. Mealtime observations recorded duration of meals and assistance received. Dining environments were assessed for physical features using the Dining Environment Audit Protocol, and the Mealtime Scan was used to record mealtime experience and ambiance. Staff completed the Person Directed Care questionnaire, and managers completed a survey describing features of the home and food services. Hierarchical multivariate regression determined predictors of energy and protein intake adjusted for other covariates.Results: Average age of participants was 86.3 +/- 7.8 years and 69% were female. Median energy intake was 1571.9 +/- 411.93 kcal and protein 58.4 +/- 18.02 g/d. There was a significant interaction between being prescribed a pureed/liquidized diet and eating challenges for energy intake. Age, number of eating challenges, pureed/liquidized diet, and sometimes requiring eating assistance were negatively associated with energy and protein intake. Being male, a higher Mini-Nutritional Assessment-Short Form score, often requiring eating assistance, and being on a dementia care unit were positively associated with energy and protein intake. Energy intake alone was negatively associated with homelikeness scores but positively associated with person-centered care practices, whereas protein intake was positively associated with more dietitian time.Conclusion: This is the first study to consider resident, unit, staff, and home variables that are associated with food intake. Findings indicate that interventions focused on pureed food, restorative dining, eating assistance, and person-centered care practices may support improved food intake and should be the target for further research. (C) 2017 AMDA - The Society for Post-Acute and Long-Term Care Medicine.