Institutional factors associated with the nutritional status of residents from 10 german nursing homes (ernstes study)
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In nursing homes malnutrition among residents is widespread. Because residents place part of their personal freedom of choice into institutional hands, institution-specific factors may influence nutritional status of residents.
Multi-centre cross-sectional study.
10 nation-wide German nursing homes.
714 exclusively orally fed residents (aged 65 years and older, not in final weeks of life).
Participants’ characteristics (e. g. gender, age, level of care, dementia diagnosis), body mass index (BMI), mini nutritional assessment (MNA), energy intake (3-day dietary record, BLS II.3), and selected institution-specific factors (size of institution, daily rate for food supply, number of residents per care staff member). Metric data are given as median (P25, P75).
11 % of residents (81 % female, 85 (81, 91) years) had a BMI <20 kg/m2 (n=658). According to MNA, 10 % of the residents were malnourished (n=650). Capacity of institutions was 116 (56, 139) beds, care staff ratio was 4.1 (3.5, 4.2) residents per care person (mean over all care levels), and daily food budget was 4.45 (4.10, 4.71) Euro/d. Low daily food budget was associated with a higher risk for a BMI <20 kg/m2 (OR 3.30 [95 %CI 1.70–6.42]). Higher food budget also decreased malnutrition risk (OR 0.66 [0.46–0.95]) according to MNA. Residents’ mean energy intake was 6.1 (5.2, 7.1; n=565) MJ/day in women and 7.1 (6.2, 8.2; n=132) MJ/day in men. Intake was higher with small facility size, higher food budget, and lower care staff ratio (P <0.05).
The institutional environment affects the nutritional status of nursing home residents as an independent risk factor. The results suggest promotion of small facilities and the provision of more care staff and more financial resources for food in the structural design of residential homes.
- Statistisches Bundesamt (2011) Pflegestatistik 2009. https://www.destatis.de/DE/Publikationen/Thematisch/Soziales/Pflege/PflegeDeutschlandergebnisse5224001099004.pdf?__blob=publicationFile. Accessed 4 January 2012
- Statistisches Bundesamt (2007) Pflegestatistik 2005. https://www.destatis.de/DE/Publikationen/Thematisch/Soziales/Pflege/PflegeDeutschlandergebnisse5224001059004.pdf?__blob=publicationFile. Accessed 11 May 2012
- Pauly, L., Stehle, P., Volkert, D. (2007) Nutritional situation of elderly nursing home residents. Z Gerontol Geriatr 40: pp. 3-12 CrossRef
- Morley, J.E., Silver, A.J. (1995) Nutritional issues in nursing home care. Ann Intern Med 123: pp. 850-859
- Potter, J., Klipstein, K., Reilly, J.J., Roberts, M. (1995) The nutritional status and clinical course of acute admissions to a geriatric unit. Age Ageing 24: pp. 131-136 CrossRef
- Rajala, S.A., Kanto, A.J., Haavisto, M.V., Kaarela, R.H., Koivunen, M.J., Heikinheimo, R.J. (1990) Body weight and the three-year prognosis in very old people. Int J Obes 14: pp. 997-1003
- Crogan, N.L., Pasvogel, A. (2003) The influence of protein-calorie malnutrition on quality of life in nursing homes. J Gerontol A Biol Sci Med Sci 58: pp. 159-164 CrossRef
- Volkert D, Pauly L, Stehle P, Sieber CC (2011) Prevalence of Malnutrition in Orally and Tube-Fed Elderly Nursing Home Residents in Germany and Its Relation to Health Complaints and Dietary Intake. Gastroenterology Research and Practice. doi: 10.1155/2011/247315
- Kaiser, R., Winning, K., Uter, W., Volkert, D., Lesser, S., Stehle, P., Kaiser, M.J., Sieber, C.C., Bauer, J.M. (2010) Functionality and mortality in obese nursing home residents: an example of ‘risk factor paradox’?. J Am Med Dir Assoc 11: pp. 428-435 CrossRef
- Schmid, A., Weiss, M., Heseker, H. (2003) Recording the nutrient intake of nursing home residents by food weighing method and measuring the physical activity. J Nutr Health Aging 7: pp. 294-295
- Volkert, D., Frauenrath, C., Micol, W., Kruse, W., Oster, P., Schlierf, G. (1992) Nutritional status of the very old: anthropometric and biochemical findings in apparently healthy women in old people’s homes. Aging (Milano) 4: pp. 21-28
- Challa, S., Sharkey, J.R., Chen, M., Phillips, C.D. (2007) Association of resident, facility, and geographic characteristics with chronic undernutrition in a nationally represented sample of older residents in U. nursing homes. J Nutr Health Aging 11: pp. 179-184
- Bundesministerium der Justiz (1995) Sozialgesetzbuch (SGB) XI, §15, 1995. http://bundesrecht.juris.de/sgb_11/__15.html. Accessed 10 Januar 2012
- Guigoz, Y., Lauque, S., Vellas, B.J. (2002) Identifying the elderly at risk for malnutrition. The Mini Nutritional Assessment. Clin Geriatr Med 18: pp. 737-757 CrossRef
- Vellas, B., Guigoz, Y., Garry, P.J., Nourhashémi, F., Bennahum, D., Lauque, S., Albarede, J.L. (1999) The Mini Nutritional Assessment (MNA) and its use in grading the nutritional state of elderly patients. Nutrition 15: pp. 116-122 CrossRef
- Chumlea, W.C., Guo, S.S., Wholihan, K., Cockram, D., Kuczmarski, R.J., Johnson, C.L. (1998) Stature prediction equations for elderly non-Hispanic white, non-Hispanic black, and Mexican-American persons developed from NHANES III data. J Am Diet Assoc 98: pp. 137-142 CrossRef
- Volkert, D., Berner, Y.N., Berry, E., Cederholm, T., Coti Bertrand, P., Milne, A., Palmblad, J., Schneider, S., Sobotka, L. (2006) ESPEN Guidelines on Enteral Nutrition: Geriatrics. Clin Nutr 25: pp. 330-360 CrossRef
- Statistisches Bundesamt (2008) Pflegestatistik 2007. https://www.destatis.de/DE/Publikationen/Thematisch/Soziales/Pflege/PflegeDeutschlandergebnisse5224001079004.pdf?__blob=publicationFile. Accessed 10 January 2012
- Wan, T.T., Zhang, N.J., Unruh, L. (2006) Predictors of resident outcome improvement in nursing homes. West J Nurs Res 28: pp. 974-993 CrossRef
- O’Neill, C., Harrington, C., Kitchener, M., Saliba, D. (2003) Quality of care in nursing homes: an analysis of relationships among profit, quality, and ownership. Med Care 41: pp. 1318-1330 CrossRef
- Rantz, M.J., Hicks, L., Grando, V., Petroski, G.F., Madsen, R.W., Mehr, D.R., Conn, V., Zwygart-Staffacher, M., Scott, J. (2004) Nursing home quality, cost, staffing, and staff mix. Gerontologist 44: pp. 24-38 CrossRef
- Kane, R.A., Lum, T.Y., Cutler, L.J., Degenholtz, H.B., Yu, T.C. (2007) Resident outcomes in small-house nursing homes: a longitudinal evaluation of the initial green house program. J Am Geriatr Soc 55: pp. 832-839 CrossRef
- Kayser-Jones, J. (2002) Malnutrition, dehydration, and starvation in the midst of plenty: the political impact of qualitative inquiry. Qual Health Res 12: pp. 1391-1405 CrossRef
- Hu, T.W., Huang, L.F., Cartwright, W.S. (1986) Evaluation of the costs of caring for the senile demented elderly: a pilot study. Gerontologist 26: pp. 158-163 CrossRef
- Berkhout, A.M., Cools, H.J., Houwelingen, H.C. (1998) The relationship between difficulties in feeding oneself and loss of weight in nursing-home patients with dementia. Age Ageing 27: pp. 637-641 CrossRef
- Simmons, S.F., Keeler, E., Zhuo, X., Hickey, K.A., Sato, H.W., Schnelle, J.F. (2008) Prevention of unintentional weight loss in nursing home residents: a controlled trial of feeding assistance. J Am Geriatr Soc 56: pp. 1466-1473 CrossRef
- Franzoni, S., Frisoni, G.B., Boffelli, S., Rozzini, R., Trabucchi, M. (1996) Good nutritional oral intake is associated with equal survival in demented and nondemented very old patients. J Am Geriatr Soc 44: pp. 1366-1370
- Bourdel-Marchasson, I., Rolland, C., Jutand, M.A., Egea, C., Baratchart, B., Barberger-Gateau, P. (2009) Undernutrition in geriatric institutions in South-West France: policies and risk factors. Nutrition 25: pp. 155-164 CrossRef
- Zekry, D., Herrmann, F.R., Grandjean, R., Meynet, M.P., Michel, J.P., Gold, G., Krause, K.H. (2008) Demented versus non-demented very old inpatients: the same comorbidities but poorer functional and nutritional status. Age Ageing 37: pp. 83-89 CrossRef
- Wirth, R., Sieber, C.C. (2011) Dementia and Malnutrition — from an early symptom to a therapeutic challenge. Aktuel Ernaehrungsmed 36: pp. 90-93 CrossRef
- Institutional factors associated with the nutritional status of residents from 10 german nursing homes (ernstes study)
The journal of nutrition, health & aging
Volume 17, Issue 3 , pp 271-276
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- Nursing home resident
- energy intake
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- Author Affiliations
- 1410. Institute of Nutrition, Consumption and Health, Paderborn University, Paderborn, Germany
- 2410. IEL-Nutritional Physiology, Bonn University, Bonn, Germany
- 3410. IEL-Nutritional Physiology, Bonn University, Endenicher Allee 11-13, D-53115, Bonn, Germany