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
Conditional-
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.
-
Risks/Harms of Implementing This Recommendation
-
Supporting Evidence
The recommendations were created from the evidence analysis on the following questions. To see detail of the evidence analysis, click the blue hyperlinks below (recommendations rated consensus will not have supporting evidence linked).
What is the relationship between modified texture diets and weight gain in adults over age 65?
What is the relationship between eating assistance and weight gain in adults over age 65?
What is the evidence that underweight or weight loss is associated with a decrease in the activities of daily living in adults over age 65?
What is the evidence that underweight and weight loss is associated with neurological disease in adults over age 65?-
References
Colodny N. Dysphagic independent feeders' justifications for noncompliance with recommendations by a speech-language pathologist. Am J Speech Lang Pathol 2005;14(1):61-70.
Ekberg O, Hamdy S, Woisard V, Wuttge-Hannig A, Ortega P. Social and psychological burden of dysphagia: its impact on diagnosis and treatment. Dysphagia 2002;17:139-146.
Foley N, Finestone H, Woodbury MG, Teasell R, Greene-Finestone L. Energy and protein intakes of acute stroke patients. J Nutr Health Aging 2006;10(3):171-5.
Lorefalt B, Granerus AK, Unosson M. Avoidance of solid food in weight losing older patients with Parkinson's disease. J Clin Nurs 2006;15(11):1404-12.
Nowson CA, Sherwin AJ, McPhee JG, Wark JD, Flicker L. Energy, protein, calcium, vitamin D, and fibre intakes from meals in residential care establishments in Australia. Asia Pacific J Clin Nutr 2003;12(2):172-77.
Rypkema G, Adang E, Dicke H, Naber T, De Swart B, Disselhorst L, Goluke-Willemse G, Olde Rikkert M. Cost-effectiveness of an interdisciplinary intervention in geriatric inpatients to prevent malnutrition. J Nutr Health Aging 2004;8(2):122-7.
Wright L, Cotter D, Hickson M, Frost G. Comparison of energy and protein intakes of older people consuming a texture modified diet with a normal hospital diet. J Hum Nutr Diet 2005;18(3):213-9.
Crogan NL, Shultz JA, Adams CE, Massey LK. Barriers to nutrition care for nursing home residents. J Gerontol Nurs. 2001; 27: 25-31.
Hickson M, Bulpitt C, Nunes M, Peters R, Cooke J, Nicholl C, Frost G. Does additional feeding support provided by health care assistants improve nutritional status and outcome in acutely ill older in-patients? A randomized controlled trial. Clinical Nutrition. 2004; 23: 69-77.
Holm B, Soderhamn O. Factors associated with nutritional status in a group of people in an early stage of dementia. Clin Nutr. 2003; 22: 385-389.
Horn SD, Buerhaus P, Bergstrom N, Smout RJ. RN staffing time and outcomes of long-stay nursing home residents. American Journal of Nursing. 2005; 105: 58-70.
Riviere S, Gillette-Guyonnet S, Voisin T, Reynish E, Andrieu S, Lauque S, Salva A, Frisoni G, Nourhashemi F, Micas M, Vellas B. A nutritional education program could prevent weight loss and slow cognitive decline in Alzheimer's disease. The Journal of Nutrition, Health and Aging. 2001; 5(4): 295-299.
Simmons SF, Levy-Storms L. The effect of dining location on nutritional care quality in nursing homes. Journal of Nutrition Health and Aging. 2005; 9: 434-439.
Simmons SF, Patel AV. Nursing home staff delivery of oral liquid nutritional supplements to residents at risk for unintentional weight loss. J Am Geriatr Soc 2006; 54: 1372-1376.
Simmons SF, Garcia ET, Cadogan MP, Al-Samarrai NR, Levy-Storms LF, Osterweil D, Schnelle JF. The minimum data set weight-loss quality indicator: Does it reflect differences in care processes related to weight loss? Journal of the American Gerontological Society 2003; 51: 1,410-1,418.
Simmons SF, Lam HY, Rao G, Schnelle JF. Family members' preferences for nutrition interventions to improve nursing home residents' oral food and fluid intake. J Am Geriatr Soc. 2003; 51: 69-74.
Sullivan DH, Morley JE, Johnson LE, Barber A, Olson JS, Stevens MR, Yamashita BD, Reinhart SP, Trotter JP, Olave XE. The GAIN (Geriatric Anorexia Nutrition) Registry: The impact of appetite and weight on mortality in a long-term care population. J Nutrition Health and Aging. 2002; 6 (4): 275-281.
Suominen M, Laine A, Routasalo P, Pitkala KH, Rasanen L. Nutrient content of served food, nutrient intake and nutritional status of residents with dementia in a Finnish nursing home. J Nutr Health Aging. 2004; 8 (4): 234-238.
Westergren A, Karlsson S, Andersson P, Ohlsson O, Hallberg IR. Eating difficulties, need for assisted eating, nutritional status and pressure ulcers in patients admitted for stroke rehabilitation. J Clin Nursing. 2001; 10: 257-269.
Westergren A, Ohlsson O, Hallberg IR. Eating difficulties in relation to gender, length of stay, and discharge to institutional care, among patients in stroke rehabilitation. Disability and Rehabilitation, 2002; 24: 523-533.
Westergren A, Ohlsson O, Hallberg IR. Eating difficulties, complications and nursing interventions during a period of three months after a stroke. J Adv Nurs. 2001; 35 (3): 416-426.
Westergren A, Unosson M, Ohlsson O, Lorefalt B, Hallberg IR. Eating difficulties, assisted eating and nutritional status in elderly (>65 years) patients in hospital rehabilitation. International Journal of Nursing Studies, 2002; 39: 341-351.
Woo J, Chi I, Hui E, Chan F, Sham A. Low staffing level is associated with malnutrition in long-term residential care homes. Eur J Clin Nutr. 2005; 59: 474-479.
Xia C, McCutcheon H. Mealtimes in hospital: Who does what? Journal of Clinical Nursing. 2006; 15: 1,221-1,227.
Al Snih S, Raji M, Markides K, Ottenbacher K, Goodwin J. Weight change and lower body disability in older Mexican Americans. J Am Geriatr Soc. 2005; 53: 1,730-1,737.
Boyd CM, Xue QL, Simpson CF, Guralink JM, Fried LP. Frailty, hospitalization, and progression of disability in a cohort of disabled older women. Am J Med. 2005; 118: 1,225-1,231.
Corbett CF, Crogan NL, Short RA. Using the minimum data set to predict weight loss in nursing home residents. Applied Nursing Research. 2002; 15 (4): 249-253.
Huang Y, Wueng S, Ou C, Cheng C, Su K. Nutritional status of functionally dependent and nonfunctionally dependent elderly in Taiwan. J Am College Nutr. 2001; 20: 135-142.
Janssen I, Heymsfield SB, Ross R. Low relative skeletal muscle mass (sarcopenia) in older persons is associated with functional impairment and physical disability. J Am Geriatr Soc. 2002; 50: 889-896.
Kikafunda JK, Lukwago FB. Nutritional status and functional ability of the elderly aged 60 to 90 years in the Mpigi district of central Uganda. Nutrition 2005; 21 (1): 59-66.
Odlund Olin A, Koochek A, Ljungqvist O, Cederholm T. Nutritional status, well-being and functional ability in frail elderly service flat residents. Eur J Clin Nutr. 2005; 59: 263-270.
Ottenbacher KJ, Ostir GV, Peek MK, Snih SA, Raji MA, Markides KS. Frailty in older Mexican Americans. J Am Geriatr Soc. 2005; 53(9): 1,524-1,531.
Payette H, Coulombe C, Boutier V, Gray-Donald K. Nutrition risk factors for institutionalization in a free-living functionally dependent elderly population. Journal of Clinical Epidemiology. 2000; 53: 579-587.
Pearson JM, Schlettwein-Gsell D, Brzozowska A, van Staveren WA, Bjornsbo K. Life style characteristics associated with nutritional risk in elderly subjects aged 80 - 85 years. J Nutr Health Aging. 2001; 5 (4): 278-283.
Richardson J, Bedard M, Weaver B. Changes in physical functioning in institutionalized older adults. Disabil Rehabil. 2001; 23(15): 683-689.
Shum NC, Hui WW, Chu FC, Chai J, Chow TW. Prevalence of malnutrition and risk factors in geriatric patients of a convalescent and rehabilitation hospital. Hong Kong Med J. 2005; 11(4): 234-242.
Woo J, Ho SC, Sham A. Longitudinal changes in body mass index and body composition over three years and relationship to health outcomes in Hong Kong Chinese age 70 and older. J Am Geriatric Soc. 2001; 49: 737-746.
Woods NF, LaCroix AZ, Gray SL, Aragaki AA, Cochrane BB, Brunner RL, Masaki K, Murray A, Newman AB. Frailty: Emergence and consequences in women aged 65 and older in the Women's Health Initiative Observational Study. J Am Geriatr Soc. 2005; 53 (8): 1,321-1,330.
Zuliani G, Romagnoni F, Volpato S, Soattin L, Leoci V, Bollini MC, Buttarello M, Lotto D, Fellin R. Nutritional parameters, body composition, and progression of disability in older disabled residents living in nursing homes. J Gerontol A Biol Sci Med Sci. 2001; 56(4): M212-M216.
Bedard M, Molloy DW, Bell R, Lever JA. Determinants and detection of low body mass index in community-dwelling adults with Alzheimer's disease. International Psychogeriatrics. 2000; 12(1): 87-98.
Brubacher D, Monsch AU, Stahelin HB. Weight change and cognitive performance. Int J Obes Relat Metab Disord. 2004; 28(9): 1,163-1,637.
Buchman AS, Wilson RS, Bienias JL, Shah RC, Evans DA, Bennett DA. Change in body mass index and risk of incident Alzheimer disease. Neurology. 2005; 65(6): 892-897.
Chen H, Zhang SM, Hernan MA, Willett WC, Ascherio A. Weight loss in Parkinson's disease. Ann Neurol. 2003; 53(5): 676-679.
Corbett CF, Crogan NL, Short RA. Using the minimum data set to predict weight loss in nursing home residents. Applied Nursing Research. 2002; 15 (4): 249-253.
Faxen-Irving G, Basun H, Cederholm T. Nutritional and cognitive relationships and long-term mortality in patients with various dementia disorders. Age Ageing. 2005; 34(2): 136-141.
Guerin O, Andrieu S, Schneider SM, Milano M, Boulahssass R, Brocker P, Vellas B. Different modes of weight loss in Alzheimer disease: A prospective study of 395 patients. Am J Clin Nutr. 2005; 82: 435-441.
Guerin O, Soto ME, Brocker P, Robert PH, Benoit M, Vellas B, REAL.FR Group. Nutritional status assessment during Alzheimer's disease: Results after one year (the REAL French Study Group). J Nutr Health Aging. 2005; 9(2): 81-84.
Holm B, Soderhamn O. Factors associated with nutritional status in a group of people in an early stage of dementia. Clin Nutr. 2003; 22: 385-389.
Hu X, Okamura N, Arai H, Higuchi M, Maruyama M, Itoh M, Yamaguchi K, Sasaki H. Neuroanatomical correlates of low body weight in Alzheimer's disease: A PET study. Prog Neuropsychopharmacol Biol Psychiatry. 2002; 26(7-8): 1,285-1,289.
Johnson DK, Wilkins CH, Morris JC. Accelerated weight loss may precede diagnosis in Alzheimer disease. Arch Neurol. 2006; 63(9): 1,312-1,317.
Kagansky N, Berner Y, Koren-Morag N, Perelman L, Knobler H, Levy S. Poor nutritional habits are predictors of poor outcome in very old hospitalized patients. Am J Clin Nutr. 2005; 82: 784-791.
Keller HH, Ostbye T. Do nutrition indicators predict death in elderly Canadians with cognitive impairment? Can J Public Health. 2000; 91(3): 220-224.
Keller HH, Ostbye T. Body mass index (BMI), BMI change and mortality in community-dwelling seniors without dementia. J Nutr Health Aging. 2005; 9 (5): 316-320.
Knoops KTB, Slump E, de Groot LCPGM, Wouters-Wesseling W, Brouwer ML, van Staveren WA. Body weight changes in elderly psychogeriatric nursing home residents. J Gerontol A Biol Sci Med Sci. 2005; 60 (4): 536-539.
Lorefalt B, Ganowiak W, Palhagen S, Toss G, Unosson M, Granerus AK. Factors of importance for weight loss in elderly patients with Parkinson's disease. Acta Neurol Scand. 2004; 110(3): 180-187.
Lorefalt B, Ganowiak W, Wissing U, Granerus AK, Unosson M. Food habits and intake of nutrients in elderly patients with Parkinson's disease. Gerontology. 2006; 52: 160-168.
Odlund Olin A, Koochek A, Ljungqvist O, Cederholm T. Nutritional status, well-being and functional ability in frail elderly service flat residents. Eur J Clin Nutr. 2005; 59: 263-270.
Pearson JM, Schlettwein-Gsell D, Brzozowska A, van Staveren WA, Bjornsbo K. Life style characteristics associated with nutritional risk in elderly subjects aged 80 - 85 years. J Nutr Health Aging. 2001; 5 (4): 278-283.
Poels BJ, Brinkman-Zijlker HG, Dijkstra PU, Postema K. Malnutrition, eating difficulties and feeding dependence in a stroke rehabilitation centre. Disabil Rehabil. 2006; 28(10): 637-643.
Purandare N, Burns A, Craig S, Faragher B, Scott K. Depressive symptoms in patients with Alzheimer's disease. Int J Geriatr Psychiatry. 2001; 16 (10): 960-964.
Shatenstein B, Kergoat MJ, Nadon S. Anthropometric changes over five years in elderly Canadians by age, gender and cognitive status. J Gerontol A Biol Sci Med Sci. 2001; 56(8): M483-M488.
Starkstein SE, Jorge R, Mizrahi R, Robinson RG. The construct of minor and major depression in Alzheimer's disease. Am J Psychiatry. 2005; 162 (11): 2,086-2,093.
Stewart R, Masaki K, Xue QL, Peila R, Petrovitch H, White LR, Launer LJ. A 32-year prospective study of change in body weight and incident dementia: The Honolulu-Asia Aging Study. Arch Neurol. 2005; 62: 55-60.
Wang PN, Yang CL, Lin KN, Chen WT, Chwang LC, Liu HC. Weight loss, nutritional status and physical activity in patients with Alzheimer's Disease: A controlled study. J Neurol. 2004; 251: 314-320.
White HK, McConnell ES, Bales CW, Kuchibhatla M. A six-month observational study of the relationship between weight loss and behavioral symptoms in institutionalized Alzheimer's disease subjects. J Am Med Dir Assoc. 2004; 5: 89-97.
-
References