Malnutrition of Elderly People in Nursing Homes | Dissertation Paper | Navarrete| Page1 Malnutrition of Elderly People in Nursing Homes An Analysis of the Main Causes of Malnutrition among the Elderly and the Role of the Health Care Professionals in Addressing this Concern
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The Role of the Health Working in Addressing Malnutrition of Elderly People in Nursing Homes
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Malnutrition of Elderly People in Nursing Homes
An Analysis of the Main Causes of Malnutrition among the Elderly and the Role of the Health Care Professionals
in Addressing this Concern
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Abstract
Background: Malnutrition is a pressing concern among populations. It is particularly a silent plague in
nursing homes and an issue that needs to be addressed. Malnutrition is found to be the cause of many
different health conditions as well as an increase in the mortality and morbidity rate in such homes.
However, the same remains to be an easily dismissed and unrecognized condition in such settings.
Aim: The main aim of this study is to create an assemblage of the most basic and most essential
information available in current studies regarding the malnutrition of the elderly people in nursing homes.
It aims to collect and compile essential information such as the numerous causes of malnutrition among
the elderly in order to serve as a simple and direct source of reference for nursing homes and their
attending health care providers.
Methodology: This research was done through a systematic online journal search which used two
search engines, Google and Pubmedcentral. Five criteria served as the inclusion and exclusion factors in
narrowing down the relevant results. After the gathering of results, a comparative study was made to
derive the conclusions and the recommendations.
Conclusion: Malnutrition remains to be a highly unrecognized and unaddressed condition in nursing
homes. This is due to the usual notion that loss of appetite and weight loss is only common among the
elderly, even more so in nursing homes. It has been found that physiological, psychological, social as well
as environmental factors contribute greatly to this condition. Among the most prevalent factors found are
depression and functional impairment. Intervention programs should be devised and implemented by
nursing homes in order to address this issue. And the role of a health care professional enjoys great
weight in the creation, evaluation and implementation of such measures to aid the elderly involved.
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Tables of Contents and Figure Reference
Introduction
Background
Aim
Definition of Terms
Methodology
Limitations of the Study
Findings and Critique
Summary of Prominent Themes and Findings in the Journals and Articles Gathered
Conclusions
Recommendations
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Background
Malnutrition, in general, has been seen as one of the rampant concerns in the world today. In first world
countries and emerging countries alike, the concern regarding malnutrition of the people are among the
pressing concerns which public sectors and private sectors have been trying to curb for years.
Malnutrition has been one of the causes of high mortality rate in the world; its face is one that is known in
every nation. In a sense, it has been known around the world as a silent plague.
The state of malnutrition has been long defined as a bodily state characterized by the lacking or
deficiency, excess or imbalance of energy, and other nutrients in the body which is responsible for the
many unpleasant manifestation in the body, health, function, skills and clinical outcome of a person
(Stratton, 2003). Overnutrition and undernutrition are both types of malnutrition. The former is
characterized by the excess of nutrients in the body, commonly caused by the large and uncontrolled
consumption of food; while the latter is the under nourishment where a person is not able to meet the
daily nourishment requirements most commonly due to the lack of intake of food. Among these two, it is
undernutrition which is more rampant and is more alarming.
Malnutrition is most common among children of tender ages and the elderly. Due to the unmet nutritional
needs of the children starting from the womb of the mother until their birth and development to their
tender years, children remain undernourished for years. On the other hand, the elderly are malnourished
due to many reasons and their circumstances are more concerning than the first. The elderly are usually
placed in nursing homes and hospitals where they are placed in a clinical and community setting. They
are placed away from their families and are forced to adjust to new environments unlike children who
remain in the care of their mothers, fathers or other immediate families. Certainly, the health concerns of
the elderly in these cases are more needing of attention.
Studies show that the nutrition of the elderly is a major problem in nursing homes. This has been
evidenced by studies which show that up to eighty-five percent (85%) of the elderly living in nursing home
are suffering from malnutrition (Rowe & Kahn, 1998). And such problems are often left unaddressed as
they are often not diagnosed. These nutritional deficiencies in elderly homes are, in reality, frequently not
recognized (Crogan, et al., 2008). This is due to the usual misconception that the elderly, as they age,
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require less food intake and that the loss of their appetite as well as the loss of some body weight is only
normal. The major concern here is that these cases of malnutrition are actually often the common
underlying cause of adverse clinical outcomes, but remain untreated (Crogan, et al., 2008). These kinds
of setting still hold true despite the fact that many opportunities for both prevention and correction of the
many factors contributing to the malnutrition of the elderly people are often easily available and
recognizable (Crogan, et al., 2008).
Malnutrition has many effects that are detrimental to the life of the elderly people. Studies show that not
only does it affect the lifespan of the elderly, it also, in a sense, has a direct and adverse affect in the
quality of life of even the community-dwelling type of elderly people in nursing homes (Feldblum, et al.,
2007). It has been shown by studies that the undernourished elderly people in the nursing homes have
stark longer periods of illness, and are subjected to longer hospital stays with a slower rate of recovery
(Feldblum, et al., 2007). Increased mortality rates are seen among such elderly people and as such, are
among the plagues which have become a pressing concern (Payette, et al., 1999).
There are various recognizable causes of malnutrition in the nursing homes and studies about this
specific subject matter but studies are left exploring few of such given material factors. Due to such
circumstances, it is essential that these factors be amassed and analyzed together in order to come up
with an intervention program which is applicable to the elderly homes and may, ideally, address all such
concerns relating to the matter.
The role of the health care professional regarding the malnutrition of the elderly as well as the factors
which affect such malnutrition is weighted very lightly, when in fact, theirs is a role which is very material
to the addressing of such concerns. Unlike children who are suffering from malnutrition, the elderly people
in nursing homes do not have either of their parents, nor their immediate family to help them with such
worries. Therefore, their well being, as well as the quality of their life is left at the mercy of their attending
health care worker and the nursing home as a whole. The burden of addressing such matters is left at the
shoulders of their health care providers.
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The main issue sought to be addressed in this study is the fact that, evidenced by adequate studies, all
caregivers suffer from very low levels of knowledge as well as awareness of nutritional problems which
the elderly in nursing homes suffer from (Chermesh, et al., 2011). Numerous studies have shown that
caregivers are unaware of the many factors which contribute to the malnutrition of the elderly. This lack of
knowledge and awareness forces the elderly to be subjected to lack of diagnosis, at times, wrong
diagnosis and ultimately, with no refuge in addressing such concerns. The role of the health care provider
in these situations is not one to be disregarded. In the nursing home setting, they are the only ones who
can provide the elderly with the care and regard that they need. Their role in curbing this pressing
concern is one which weighs heavily, in this sense, it is very important that they are well equipped with
the information that they need in order to effectively provide such care to the elderly people who depend
on them. Through such information, they will be able to ascertain the root of the problem in their own
nursing homes and will be able to create unique intervention programs that will cater to the needs of the
elderly people under their care.
In summary, the author of this study seeks to gather the most essential, as well as the most basic of
information available regarding this issue of malnutrition in order to aid nursing homes and the health care
providers themselves to create an effective intervention program in hope of curbing the issue of
malnutrition. Ultimately, with such intervention program, the well being, quality of life, and mortality rate of
the elderly people in nursing homes may be improved.
Aim
The main aim of this study is to create an assemblage of the most basic and most essential information
available in current studies regarding the malnutrition of the elderly people in nursing homes. It aims to
collect and compile essential information such as the numerous causes of malnutrition among the elderly
in order to serve as a simple and direct source of reference for nursing homes and their attending health
care providers. As an after effect of such compilation, this study, through its conclusion and
recommendation, aims to aid these said nursing homes and their health care providers in creating a cost
effective intervention program which will be applied to their nursing homes in order to address the
malnutrition of the elderly people under their care.
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Definition of Terms
Elderly People in Nursing Homes This term, as applied in this study, is used as an umbrella term for all
elderly people embraced in this designation. Most of the studies used as a reference in this study made
no significant or substantial distinctions among the elderly in nursing homes. This term embraces elderly
people of various ages, most qualified by the age of sixty-five (65) and above as well as those suffering
and not suffering from pathological or non-pathological conditions alike.
Functional Status This is characterized by functional impairment of all kinds and gravity. Functional
status, as used in this study, ranges from the most common such as poor eye sight up to the graver
conditions such as dysphagia or impairment of oral functions which relates best to malnutrition and food
intake.
Health Care Providers and Health Care Professionals This term includes, but are not limited to,
individuals employed and tasked to provide care and aid to the elderly people while they are admitted to
nursing homes. This term includes caregivers, health care assistants, nurses, nursing assistants and all
similar kinds of such employment.
Inadequate Food Intake This term is used to depict the lack or deficiency in proper food consumption as
well as related hydration deficits experienced by the elderly people in nursing homes caused by many
different factors.
Intervention Program This is described as programs and procedures created and used by institutions to
address, prevent, and correct an existing wrong which is detrimental to the health, life, and well being of
an individual under their care.
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Malnutrition This is formally defined as a bodily state experienced by individuals which is characterized
by the inadequacy or stark deficit, the overload or lack of: energy, as well other nutrients needed in the
body which is responsible for the various adverse effects to the health, function, skills and clinical
outcome of a person (Stratton, 2003). This term has been used loosely in many of the references used in
this study and usually used interchangeably with under nutrition which mainly describes the inadequacy
and lack of nutrients which is usually manifested by the undesired weight loss and lack of energy of the
individual.
Nursing Homes This term is used in its general sense. Nursing homes are institutions and places tasked
in the care and supervision of the elderly. No significant distinctions have been made between ordinary
nursing homes and nursing homes which provide high level medical facilities and treatment for ill elderly
people.
Nutritional Deficiencies This term is defined as the lack of nutrition experienced by the individual
wherein an individual is unable to meet his body’s daily nutritional needs. This inadequacy is usually
caused by the lack of food intake.
Oral Problems This is an umbrella term used by all such oral problems conceivable. In includes concerns
as grave as dysphagia and concerns as trivial mere dental problems.
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Methodology
An organized search of science journals, articles and reference text has been used to meet the data
requirements of this study. Through the use of a systematic search, the author was able to gather thirteen
sources which were specifically and essentially related to the subject matter of this study.
Internet search or online search has been the main scheme of data gathering. Websites such as Google
(www.google.com) and Pubmedcentral (http://www.ncbi.nlm.nih.gov/pmc/) have been used to search
related journals and articles used in this study. The search engine, Google, was used to search for
complementary references while Pubmedcentral was used as the main source of references.
The author had the original idea of basing the study on malnutrition. This is due to the recognition of the
author of the fact that malnutrition is a pressing concern and there are many aspects which may become
an interest of study. The first search was effected using the simple keyword “malnutrition”. This search in
Google yielded hundreds of pages of related results. This prompted the author to another brainstorming in
order to narrow down the field of study to more specific grounds.
Since the author is a trainee in the health care department, the author listed three topics of interest
relating to the main subject matter of malnutrition. First topic is the malnutrition of patients admitted in for
a substantial length of time in hospitals. The second topic is the malnutrition of children and third is the
malnutrition of the elderly. Through a comparative search of all three topics, the author found that the first
two topics were too broad and the topics were woven too tightly and therefore, could not be taken
separately and specifically. The third topic was found to be more of interest but was still too broad.
The third search was effected through the use of Pubmedcentral. The keywords used was the topic itself
which were “malnutrition”, “elderly” and “elderly people”. With each addition of keywords, the search
results yielded results of two hundred fifty-three (253), two hundred thirty-three (233) and two hundred ten
(210). Undeniably, this was still a large number of results and the study still lack specificity.
The author analyzed the results in order to find recurring themes. One of the most rampant themes
involved the admission and care of the elderly people in nursing homes. This, the, became the final topic
study which is to aid nursing homes and health care professionals in creating a cost effective intervention
program in addressing the malnutrition of the elderly.
Through such criteria, the author was able to narrow down the results to a final count of fourteen (14)
references. Three (3) of which were reference texts and the remaining ten (10) being scientific journals
and research studies.
Limitations of the Study
The character of this study being a dissertation study, the author was limited to the review of literature
already available in the field. There was no room for testing such theories and results which were already
pre-existing at the time. However limitation, this did not operate as a bar to the study from meeting its
original aim and endeavour. This was due to the fact that the stark consistency and reliability of the
findings found in the science journals and reference texts were enough to produce adequate information
to support the study.
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Findings and Critique
Chart 1.0 Summary of Prominent Themes and Findings in the Journals and Articles Gathered (The complete publishing information of the following journals, articles and references may be found in the Bibliography section of this paper)
Titleand
Theme of the Study Author/s
Country of
Origin
Category of the
Literature
Strengths and Weaknessesof the Reference
(Applicable to Journals and Research Papers)
Main Findings and Prominent
Themes
1
Improving Nutrition Care for Nursing Home Residents Using the INRx
Process
Neva L. Crogan,
PhD, APRN, BC,
FNGNA, Ceanne
Alvine, PhD, RN, and
Alice Pasvogel, PhD, RN
Arizona,United States
OfAmerica
Research Journal
The systematic procedures applied to the research as well as the length of time dedicated to the study are among its strengths. The decision of the authors to include a comparison group in their study was also proven helpful in the crafting of their recommendations.
The limitations of the study include (but are not limited to) the small number of participants, the study being limited to only two nursing homes in Arizona. Another limitation is the mode of selection in terms of the participants. Due to the nature of the research as a feasibility study, the researchers opted to hand pick their participants instead of randomly selecting. This, in a way, may have affected the result in a small potential of having bias.
The main themes of the study were the causes of malnutrition in nursing homes in the country as well as preventive measures to avert the incidence of malnutrition.
The paper also explored the role of the health care professionals in charge as well as the role of dining assistant as factors to the addressing of such concerns.
2
Successful AgingRowe, J.
And Kahn, R.
New York,United States
of America
Reference Text
3
Under-nutrition in
the nursing home:
prevalence,
consequences,
Abbasi, AA and
Rudman, D.
Wisconsin,Milwaukee
Research Journal
Although the study was conducted in 1994 when references for this very specific study was scarce, the authors
The main themes of this research include the introduction of
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causes and
prevention
were able to gather enough sources in their review in order to serve as the foundation of their study.
the significance of malnutrition of the elderly in the nursing homes in many different clinical outcomes as well as the recognition that this issue is most often overlooked by researchers who are trying to assess the health and well being of the elderly.
As for its conclusion and recommendation, this research explored the often missed opportunities in addressing and preventing this pressing concern.
4
Nutrition in Aging3rd Edition
Schlenker, ED New York,
United States of America
Reference Text
5
Characteristics of undernourished
older medical patients and the identification of predictors for undernutrition
status
Ilana Feldblum, Larisa
German, Hana
Castel, Ilana
Harman-Boehm,N
atalya Bilenko, Miruna
Eisinger, Drora
Fraser, and Danit R Shahar
Science Journal
What served as the main limitation of this study was the sample. The authors of this study had admitted that the study was pressed for time and that the samples used in the study were handpicked through certain criteria instead of using a randomized system of selection. In a sense, this may have limited the scope of the study and may not be reflective of the reality of the situation which the authors were trying to derive at.
The main point of this study is that several unseen factors play into the malnutrition and undernutrition of the elderly which remain undetected due to the lack of proper screening and assessment by their respective health care providers.
Another highlight of this study is the recognition of the
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fact that malnutrition and undernutrition is one of the factors responsible for the heightened rate of morbidity and mortality rate in nursing homes.
6
Effect of family style mealtimes on
quality of life, physical
performance, and body weight of nursing home
residents: cluster randomised
controlled trial
Kristel A N D Nijs, PhD fellow,1 Cee
s de Graaf, professor,1 Frans
J Kok,profess
or,1 and Wija A van
Staveren, professor
emeritus1
Wageningen, Netherlands Science
JournalThe strength of this research study is the use of a simplified and very systematic methodology which helped the researchers gather data rather quickly. On the other hand, due to such simplicity the researchers were unable to discount the possibility that some of the research participants may not be fitting of the criteria which they seek for their sample population.
The main point of this study is the advantage of using family style meals in averting malnutrition in the elderly people admitted in nursing homes.
7
Senescent Swallowing:
Impact, Strategies and Interventions
Denise Ney, PhD,
RD, Jennifer Weiss,
MD, Amy Kind, MD,
and JoAnne Robbins,
PhD
Madison,United States
of America
Science Journal
The strength of this study is its specificity in the effect of functional impairment in the nutrition of the elderly. The weakness of this research, however, lies in its untested theories that remain to be subject to actual application.
The prevalence of dysphagia in adults and its impact on nutrition and hydration.
8
Disease Related Malnutrition: an Evidence Based
Approach to Treatment
Stratton, RJ
ReferenceText
9
Assessment and management of nutrition in older
people and its importance to
health
Tanvir Ahmed and
Nadim Haboubi
Wales,United
Kingdom
Science Journal
The weakness of this study is the fact that it has dismissed the possibility of malnutrition among the elderly who are not suffering from any diseases.
The main finding unique to this study is the stress on pathological and non-pathological factors which greatly affect the health and well being of the
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elderly.
10
Malnutrition and Nutrition-Therapy:
Our Neglected Responsibility
Irit Chermesh,
Lubos Sobotka, Co
rina Hartman, an
d Rémy Meier
Israel, Czech Republic,
And Switzerland
Science Journal
The weakness of this study is virtually the same with this dissertation paper in the sense that it relied solely on researches and pre published text.
The main point of this study is the alarming low levels of knowledge and awareness among health care providers concerning the causes and preventive measures relating to the malnutrition of the elderly.
It stressed the role of such health care professionals in curbing this concern.
11
Prevention of Unintentional
Weight Loss in Nursing Home Residents: A
Controlled Trial of Feeding
Assistance
Sandra F. Simmons,
Ph.D., Emmett Keeler,
Ph.D., Xiaohui Zhuo, M.
Phil, Kelly A. Hickey,
BA, Hui-wen Sato, MA,
and John F. Schnelle,
Ph.D
United States of America Science
Journal
The strength of this study lies in the system of its methodology and the length of time dedicated to the study. The presence of the control group in the study surely gave a better ground for the basis of the results.
Similar to the earlier science journal, this study recognizes the role of the health care professional in preventing and addressing this health concern among the elderly.
It suggested not only feeding assistance, but also a larger involvement of the health care professionals in the health and well being of their patients in order to ensure their adequate nutrition and timely assessment.
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12
Malnutrition in the Elderly: An
Unrecognized Health Issue
Danielle Maher, Student
Nurse and Carol Eliadi EdD, JD,
APRN, Massachusetts College of Pharmacy and Health Sciences Worcester
MA
United States of America Science
Journal
The recommendations found in the study are the strongest point of this research.
This study stressed the common mistake of health care institutions and their health care professionals alike in dismissing and not properly recognizing the malnutrition of the elderly people which operates as a kind of a silent plague that needs to be immediately addressed.
13
Weight loss and mortality among free-living frail
elders: a prospective study.
Payette H, Coulombe C, Boutier
V, Gray-Donald K.
Science Journal
The premise of this research was very simple but the same enjoyed a great weight of background and basis for the conclusions derived therefrom.
This study stresses the relation between the increased mortality and morbidity rate of the elderly people admitted in nursing homes to their malnutrition and inadequate food intake.
Theme 1: Malnutrition as a Silent Plague in Nursing Homes: A Pressing Concern
Malnutrition is a health concern which is widely recognized around the world. In every nation, the face of
malnutrition is easily seen and identified. In both manifestations, which are of under nutrition and over
nutrition, nations around the world are exerting efforts in order to curtail and to prevent the same. In fact,
this is a well recognized field of concern, resulting to it being a well recognized topic of interest in
numerous studies and movements. As a result, several factors which contribute to this condition,