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Recommendations Summary

UWL: Eating Assistance 2009

Click here to see the explanation of recommendation ratings (Strong, Fair, Weak, Consensus, Insufficient Evidence) and labels (Imperative or Conditional). To see more detail on the evidence from which the following recommendations were drawn, use the hyperlinks in the Supporting Evidence Section below.

  • Recommendation(s)

    UWL: Eating Assistance

    The Registered Dietitian (RD) should collaborate with other health care professionals and administrators to ensure that all older adults who need assistance to eat receive it.  Research indicates a positive association between eating dependency and poor nutritional status, especially in older adults with dysphagia who receive modified texture diets.  In addition, research reports an association between poor nutritional status, frailty, underweight and/or weight loss with cognitive impairment and a decrease in the activities of daily living, including decreased ability to eat independently.

    Rating: Strong

    • Risks/Harms of Implementing This Recommendation

      • Sufficient assistance at meal time may not be available

    • Conditions of Application

      • This recommendation applies to older adults needing assistance to eat
      • In nursing facilities,  only trained personnel can assist older adults with eating

    • Potential Costs Associated with Application

      • The provision of assistance with eating may increase labor and training costs 

    • Recommendation Narrative

      • Seventeen studies were evaluated regarding eating assistance in older adults. 
      • Four studies report that residents needing assistance to eat are more likely to receive assistance when staffing levels are adequate (Crogan et al, 2001; Simmons, Lam et al, 2003; Simmons and Levy-Storms, 2005; Xia and McCutcheon, 2006). 
      • Eight studies report a positive association between eating dependency and poor nutritional status (Westergren, Karlsson, Andersson et al, 2001; Westergren, Ohlsson and Hallberg, 2001; Sullivan et al, 2002; Westergren, Ohlsson and Hallberg, 2002; Westergren, Unosson et al, 2002;  Holm and Soderhamn, 2003; Suominen et al, 2004; Woo et al, 2005). 
      • Five studies evaluating the impact of eating assistance on food intake and weight status report conflicting findings due to study length and degree of comorbidity (Riviere et al, 2001; Simmons, Garcia et al, 2003; Hickson et al, 2004; Horn et al, 2005; Simmons and Patel, 2006); studies of longer duration in residents with different levels of illness acuity are needed.    
      • Seven studies were evaluated regarding the use of modified texture diets in older adults with dysphagia. 
      • People consuming modified texture diets report an increased need for assistance with eating, dissatisfaction with foods, and decreased enjoyment of eating, resulting in decreased food intake and weight loss (Ekberg et al, 2002; Nowson et al, 2003; Colodny, 2005; Wright et al, 2005; Foley et al, 2006; Lorefalt et al, 2006).
      • Recognition of the social and psychological burden of dysphagia, an individualized treatment approach and the provision of eating assistance may contribute to increased food intake and weight maintenance or weight gain (Rypkema et al, 2004).
      • Interventions may include but are not limited to:  standard high-energy diet change or protein-energy supplements in malnutrition, swallowing therapy, rehydration, better positioning, and individualizing meal timing (Rypkema et al, 2004).
      • Fifteen studies were evaluated regarding the association between underweight and/or weight loss and a decrease in the activities of daily living in adults over age 65.  All studies report an association between poor nutritional status, frailty, underweight and/or weight loss with a decrease in the activities of daily living (Payette et al, 2000; Huang et al, 2001; Pearson et al, 2001; Richardson et al, 2001; Woo et al, 2001; Zuliani et al, 2001; Corbett et al, 2002; Janssen et al, 2002; Al Snih et al, 2005; Boyd et al, 2005; Kikafunda and Lukwago, 2005; Odlund Olin et al, 2005; Ottenbacher et al, 2005; Shum et al, 2005; Woods et al, 2005).

      • Twenty-six studies were evaluated regarding the association between underweight and/or weight loss and neurological disease in adults over age 65.  All studies report an association between underweight and/or weight loss in patients who have cognitive impairment (Keller and Ostbye, 2000; Pearson et al, 2001; Shatenstein et al, 2001; Corbett et al, 2002; Brubacher et al, 2004; Keller and Ostbye, 2005; Odlund Olin et al, 2005), including Alzheimer's disease and other dementia disorders (Bedard et al, 2000; Purandare et al, 2001; Hu et al, 2002; Holm and Soderhamn, 2003; Wang et al, 2004; White et al, 2004; Buchman et al, 2005; Faxen-Irving et al, 2005; Guerin, Andrieu et al, 2005; Guerin, Soto et al, 2005; Kagansky et al, 2005; Knoops et al, 2005; Starkstein et al, 2005; Stewart et al, 2005; Johnson et al, 2006), Parkinson's disease (Chen et al, 2003; Lorefalt, Ganowiak et al, 2004; Lorefalt, Ganowiak et al, 2006),  and stroke (Poels et al, 2006). 

    • Recommendation Strength Rationale

      • Conclusion Statements in support of the recommendation received Grades I and II 

    • Minority Opinions

      Consensus reached.