Nutrition treatment of nursing home residents: a long term follow-up

Nikita van der Zwaluw BSc, nutritionist Division of Human Nutrition, Wageningen University, Wageningen, the Netherlands

Julie Johannesson Dietitian Department of Clinical Nutrition, Sahlgrenska University Hospital

Elisabeth Rothenberg PhD, Chief dietitian Department of Clinical Nutrition, Göteborg University, Gothenburg, Sweden

Bakgrund

Malnutrition in nursing homes is a common and serious problem; 70% are affected or at risk. The condition could cause reduced function, increased need for care, lower QoL and higher risk for morbidity and mortality. However, there is lack of long term follow-up regarding the effects of nutrition intervention. In 2005, a structured way to handle nutrition problems in nursing homes started in Gothenburg. The aim of the present study was to follow-up the effect of nutrition prescriptions in terms of weight change as main outcome.

Metod

A systematic follow-up of information from the records regarding medical and nutrition diagnosis, nutrition prescription, body weight and BMI was undertaken. Inclusion criteria were age >70 yrs, not obese, ≥ 3 follow-ups and past away. The sample was stratified into three groups with regard to weight change per yr and total weight change (from first to last weight measure); gained >5%, lost >5%, changed ≤5%.

Resultat

A total of 74 subjects were included (22% male), mean age for females 88.1 (SD 6.5) and males 81.5 (SD 4.2) yr. Mean number of follow-ups was 24.2 (SD 11.2) and follow-up time was 34.8 (SD 16.8) months. BMI at baseline for females was 20.0 (SD 3.0) and for males 21.3 (SD 4.3). For 28% no medical diagnosis was found, 27% suffered from dementia and 18% from circulatory diseases. 39% were diagnosed as at risk for malnutrition (E46.9), 27% with mild protein-energy malnutrition (E44.1) and 14% with moderate (E44.0). Nutrition prescription was based on energy and protein enriched diets, energy and protein-dense sip feeds and energy modules. Baseline weight was negatively correlated with age (r=-0.42, p<0.0001). The weight gaining group received most calories, while the stable group got the least. Per year, a majority remained weight stable (66%), but for total weight change the main part (55%) lost >5% of weight. Among the weight gaining group mean age was higher, BMI was lower, and time in the nursing home was shorter compared to weight losers. The stable weight group had the longest follow-up time. No clear differences were found between the groups for medical and nutritional diagnosis.

Sammanfattning

In conclusion, this database makes it possible to obtain long term follow-up of nursing home residents at risk for or diagnosed with nutritional problems regarding outcomes of nutrition prescriptions in terms of body weight. It is shown that even in this old and sick population weight maintenance and weight gain are both achievable over a long period.