O C C U P A T I O N A L T H E R A P Y H E L P S I M P R O V E N U T R I T I O N A L S T A T U S T H R O U G H C U L T U R E
A N D P R O G R A M C H A N G E
P R E S E N T E D B Y E L I Z A B E T H C B A I R P A C I F I C U N I V E R S I T Y
Preventing Malnutrition in Long-term Care
Abstract
This presentation explores the issue of malnutrition among residents of long-term care (LTC) facilities discusses the importance of educating LTC leadership and staff about the far-reaching effects of this problem and clarifies how occupational therapy can facilitate cultural and program changes in LTC facilities
Such changes have been shown to improve residentsrsquo dining experiences decrease risks of malnutrition and secondary health complications increase staff morale and retention and benefit the financial health of the organization
Purpose
This presentation is intended to educate about malnutrition in LTC
introduce elements of a teaching plan and instructional
materials
describe a proposed research project
inspire you to take action
Learning Objectives
By the end of this presentation you should be able to
Identify key signs and symptoms of malnutrition Recall effects of malnutrition on cognition and health Understand how personal institutional and cultural factors
affect an individualrsquos ability to remain nutritionally sound Describe the Role of OT in managing and preventing
malnutrition in LTC residents
Malnutrition in Long-term Care
Malnutrition in LTC is a serious problem Who is at risk Long-term residents Rehabilitation patients
Prevalence
Each day in 2012 there were 1383700 residents in nursing homes (Harris-Kojetin Sengupta Park-Lee amp Valverde 2013)
Between 35 and 85 of older adults in nursing homes experience some level of malnutrition (Furman 2006)
Percentage of adults with dementia and malnutrition in nursing homes range from 14 - 56
Schussler S Dassen T amp Lohrmann C (2014)
Factors in Malnutrition
Natural aging processes Chronic medical conditions Cognitive impairment Disease Injury Frailty Environments
(Scott et al 2006 Thomas Ashmen Morley Evans amp the Council for Nutritional Strategies in Long-Term Care 2000)
Signs and Symptoms
skin breakdown and pressure wounds
anemia fatigue muscle weakness and
wasting dry skin dull dry hair and hair loss conjunctival dryness receding gums or a change in
how their dentures fit
increasing levels of confusion
loss of appetite or interest in mealtimes
loss of sensation (touch taste smell changes in vision)
Consequences of Malnutrition
Secondary health complications Postoperative complications Decreased functional independence Cognitive loss Increased mortality rates Decreased quality of life Increased costs of healthcare
Barriers to Good Nutritional Status
Lack of knowledge about risk factors No formalized screening and assessment Inadequate staff to resident ratios Lack of training in feeding and eating assistance Limited communication between disciplines Lack of understanding of impact of dementia Inattention to the cultural and personal context of
mealtime Lack of social supports
Dementia and Malnutrition
Six factors that predict low food intake Eating difficulty No feeding assistance by caregivers Moderate dependence in activities of daily living Fewer family visits Being female Older age
(Lin Watson amp Wu 2010)
Dementia and Malnutrition
It is estimated that up to 45 of people with dementia living in institutions have swallowing
difficulties (Horner Alberts Dawson amp Cook 1994)
Effects of Increased Assistance
Increases in total daily calorie intake Residents maintain or gain weight Reduced secondary health complications Improved relationship between resident and staff Improved quality of life
Role of Occupational Therapy
OTs and OTAs have foundational skills and knowledge in eating feeding and
swallowing understanding of multidimensional aspects of eating expertise in assessment evaluation and treatment a holistic view to bring to nutritional care
OT Interventions
Attention to psychosocial aspects of dining Environmental modification Adaptive equipment Dysphagia assessment and treatment Positioning Task analysis Residents Staff
Caregiver and dining assistant training Sensory integration issues internal and external
Culture Change
ldquoCulture change is an innovation anchored in values and beliefs that return the locus of control to elders and those who work closest with them Its ultimate vision is to create a culture of aging that is inclusive life-affirming satisfying humane and meaningfulrdquo
(Kantor B amp Planetree amp Picker Institute 2010)
Trends in Culture Change
Emphasis on resident choice and person-centered care as essential components to improve dining experiences
Culture change requires transformation in organizational practices physical environments workplace practices communication and relationships among all stakeholders
Benefits of Culture Change
LTCs who implement cultural changeshellip Improve quality-of-life for residents patients and staff
Increase performance on clinical outcomes
(Planetree amp Picker Institute 2010 Baier Butterfield Harris amp Gravenstei 2008)
Experience positive effects on occupancy rates and the financial bottom line of LTC (Doty Koren amp Sturla 2008 Elliot 2010 LaPorte 2010)
Key Points for Program amp Culture Change
Residents are unique individuals Facility leadership must seek further education Leaders must support the changes in environment Interdisciplinary staff education and training at all
levels Formalize screening and referral process Changes to dining organization and staffing duties Utilize expertise and unique perspective of OT
Future Work
Increase multidisciplinary collaboration
Increase knowledge base for OT through research Design and share educational programs across
disciplines and settings
Future Work
Explore and implement innovative approaches to feeding and eating assistance
Design programs specific to the dining experience of persons with dementia or cognitive impairment
Advocate with government and industry to promote
person centered care in LTC
Education is Key to Change
Industry leaders nursing home administrators and management need to be educated about the extent of malnutrition in nursing homes
There is a need for educational plans and instructional materials on preventing and treating malnutrition in LTC
Healthcare providers must take time to advocate with facilities and present educational workshops
Recognizing and preventing malnutrition in nursing homes
A teaching plan was developed and incorporated into
the coursework for the OTD 610 Practitioner as Educator course at Pacific University
An extensive literature review has been created to provide evidence and foundational knowledge for healthcare providers LTC administrators and stakeholders
Purpose
Educate skilled nursing facility administrators and management about effects of poor nutritional status skilled OT assessment analysis and Interventions improving nutritional status of residents enhancing the dining experience improving staff effectiveness and efficiency
Program Goal
LTC administrators and managers will demonstrate basic knowledge of effects of poor nutritional
status describe barriers to providing excellent nutritional care explain how skilled OT services contribute to proving holistic
nutritional care
Teaching Elements
Teaching Session
Lecture- group instruction Printed educational handouts Printed worksheets Interactive activities among learners Small and whole group discussions Self-reflection and sharing Resource table with additional learning tools Short video (added as a result of feedback to pilot
session)
Targeted learners
professionals in health care provision or administration
extensive experience in the long-term healthcare industry in the area of nutrition and dietary food service
men and women multicultural group 30 ndash 60 years of age
Setting
Intended LTC workshop Skilled nursing facility conference room during weekday
business hours
Pilot Group workshop Large open-plan diningliving space with participants around
large oval table
Outcome of Pilot
What would I do differently
Schedule more convenient time
Include more participants
Ask for feedback
More anonymous feedback option
simplify language
Proposed Changes to Workshop
Provide printed quiz to go with handouts Add video component Rework handouts for comprehension and
application to learners needs
Discussion
After learning more about the problem of malnutrition in long-term care are you considering how you might introduce this topic into your practice or your teaching
Are there other venues where this type of educational program is appropriate and might influence the management of nutritional care for elders
Questions
References
Abbasi AA amp Rudman D (1994) Undernutrition in the nursing home Prevalence consequences cause and prevention Nutrition Reviews 52(4) 113-122 Accreditation Council for Occupational Therapy Education (2006) ACOTE standards and interpretive guidelines Retrieved from
httpwwwaotaorgnonmembersarea13docs acotestandards806pdf Adams NE Bowie AJ Simmance N Murrary M amp Crowe T (2008) Recognition by medical and nursing professionals of malnutrition and risk of malnutrition in elderly hospitalised patients Nutrition and Dietetics (65) 144-150 Amella EJ (2002) Resistance at mealtimes for persons with dementia The Journal of Nutrition Health amp Aging 6 117-122 Amella EJ (2008) Mealtime difficulties In Evidence-Based Geriatric Nursing Protocols for Best Practice 3rd ed (Capezuti E Zwicker D Mezey M Fulmer T Gray-Miceli D amp Kluger M eds) Springer Publishing Company LLC New York p 337-351 American Occupational Therapy Association [AOTA] (2002) Occupational therapy practice framework Domain and process American Journal of Occupational Therapy 56
609ndash639 doi 105014ajot566609 AOTA (2007) Specialized knowledge and skills in feeding eating and swallowing for occupational therapy practice American Journal of Occupational Therapy 61(6) 686-700
doi 105014ajot616686 Asai JL (2004) Nutrition and the geriatric rehabilitation patient Challenges and solutions Topics in Geriatric Rehabilitation 20(1) 34-45 Baier RR Butterfield K Harris Y Gravenstein S (2008) Aiming for star performance the relationship between setting targets and improved nursing home quality of
care Journal of the American Medical Directors Association9(8) 594-9 Epub Dolhi C amp Rogers J (2009) Dementia nutrition and self-feeding A systematic review of the literature Occupational Therapy in Health Care 15(3-4) 59-87 Ferri C Prince M Brayne C Brodaty H Fratiglioni L Ganguli M hellip Landry G (2005) Global prevalence of dementia a delphi consensus study Lancet 366 2112-2217 Frisoni G Fanzoni S Rozzini R Ferrucci L Boffelli S amp Trabucchi M (1994) A nutritional index predicting mortality in the nursing home Journal of the American Geriatric Society 42 1167-1172 Furman EF (2006) Under-nutrition in older adults across the continuum of care Journal of Gerontological Nursing 32(1) 22-27 Groher ME amp Crary MA(2010) Dysphagia Clinical Management in Adults and Children Maryland Heights MO Mosby-Elsevier Harris-Kojetin L Sengupta M Park-Lee E Valverde R Long-term care services in the United States 2013 overview National health care statistics reports no 1 Hyattsville MD National Center for Health Statistics 2013
References
Horner J Alberts MJ Dawson DV Cook GM (1994) Swallowing in Alzheimerrsquos disease Alzheimer Disease Association Disorders 8 177 ndash 19 Kielhofner G (1985) A model of human occupation Baltimore Williams and Wilkins Lammes E amp Akner G (2006) Repeated assessment of energy and nutrient intake in 52 nursing home residents Journal of Nutritional Health and Aging 10(3) 222-30 Lin L-C Watson R amp Wu S-C (2010) What is associated with low food intake in older people with dementia Journal of Clinical Nursing 19 53-59 Doi 101111j1365-2702200902962x Maher D amp Eliad C (2014) Malnutrition in the elderly An unrecognized health issue Journal of Nursing Retrieved from httprnjournalcomjournal-of-nursingmalnutrition-in-the-elderly-an-unrecognized-health-issue Manthorpe J amp Watson R (2003) Poorly served Eating and dementia Journal of Advanced Nursing 41(2) 162-169 Nelson K Coultson A SucherKP amp Tseng R (1992) Prevalence of malnutrition in The elderly admitted to long-term-care facilities Journal of the American Dietetic Association 93(4) 459-460 Ott F Readman T amp Backman C (1990) Mealtimes of the institutionalized elderly A literature review Canadian Journal of Occupational Therapy 57(5) 261-267 Payette H (2002) Know related effects of nutrition on aging muscle function In Nutrition and Aging Vol 6 Ed by LH Rosenberg and A Sastre Nestle Workshop Series Clinical and Performance Program Nestec Ltd Vevey Switzerland P 135-150 Planetree amp Picker Institute (2010) Long term care improvement guide Retrieved from httpplanetreeorgwp-contentuploads201112LTC-Improvement-Guide-For-Downloadpdf Riviere S Gillerte-Guyonnet S Andrieu S Nourhashemi F Laugque S Cantet C hellip Vellas B (2002) Cognitive function and caregiver burden Predictive factors for eating behavior disorders in Alzhiemerrsquos disease International Journal of Geriatric Psychiatry 17 950-955 Schussler S Dassen T amp Lohrmann C (2014) Prevalence of care dependency and nursing care problems in nursing home residents with dementia A literature review International Journal of Caring Sciences 7(2) 339 Retrieved from httpwwwinternationaljournalofcaringsciencesorgdocs120SchC3BCssler-1pdf
References
Scott TM Peter L Tucker KL Arsenault L Bergethon P Bhadelia R hellip Folstein M (2006) The Nutrition Aging and Memory in Elders (NAME) study Design and methods for a study of micronutrients and cognitive function in a homebound elderly population International Journal of Geriatric Psychiatry 21(6) 519-528
doi101002gps1503735 Simmons SF Keeler E Zhuo X Hickey KA Sato HW amp Schnelle JF (2008) Prevention of unintentional weight loss in nursing home residents a controlled trial of feeding assistance Journal of American Geriatric Society 56(8) 1466-1473
Doi101111j1532-5415200801801x Sodderhamn U Backrach-Lindstrom M amp Ek AC (2007) Nutritional screening and perceived health in a group of geriatric rehabilitation patients Journal of Clinical Nursing (16) 1997-2006 Thomas DR Ashmen W Morley JE Evans WJ amp the Council for Nutritional Strategies in Long-Term Care (2000) Nutritional management in long-term care Development of a clinical guideline Journal of Gerontolology Biological Sciences and Medical Sciences 55A(12) M725- doi101093Gerona5512M725 Wu S amp Barker JC (2008) Hot tea and Juk The institutional meaning of food for Chinese elders in an American nursing home Journal of Gerontological Nursing 34(11) 46-45 doi10392800989134-20081101-11
E L I Z A B E T H C B A I R b a i r 0 7 1 2 p a c i f i c u e d u
Thank You
Abstract
This presentation explores the issue of malnutrition among residents of long-term care (LTC) facilities discusses the importance of educating LTC leadership and staff about the far-reaching effects of this problem and clarifies how occupational therapy can facilitate cultural and program changes in LTC facilities
Such changes have been shown to improve residentsrsquo dining experiences decrease risks of malnutrition and secondary health complications increase staff morale and retention and benefit the financial health of the organization
Purpose
This presentation is intended to educate about malnutrition in LTC
introduce elements of a teaching plan and instructional
materials
describe a proposed research project
inspire you to take action
Learning Objectives
By the end of this presentation you should be able to
Identify key signs and symptoms of malnutrition Recall effects of malnutrition on cognition and health Understand how personal institutional and cultural factors
affect an individualrsquos ability to remain nutritionally sound Describe the Role of OT in managing and preventing
malnutrition in LTC residents
Malnutrition in Long-term Care
Malnutrition in LTC is a serious problem Who is at risk Long-term residents Rehabilitation patients
Prevalence
Each day in 2012 there were 1383700 residents in nursing homes (Harris-Kojetin Sengupta Park-Lee amp Valverde 2013)
Between 35 and 85 of older adults in nursing homes experience some level of malnutrition (Furman 2006)
Percentage of adults with dementia and malnutrition in nursing homes range from 14 - 56
Schussler S Dassen T amp Lohrmann C (2014)
Factors in Malnutrition
Natural aging processes Chronic medical conditions Cognitive impairment Disease Injury Frailty Environments
(Scott et al 2006 Thomas Ashmen Morley Evans amp the Council for Nutritional Strategies in Long-Term Care 2000)
Signs and Symptoms
skin breakdown and pressure wounds
anemia fatigue muscle weakness and
wasting dry skin dull dry hair and hair loss conjunctival dryness receding gums or a change in
how their dentures fit
increasing levels of confusion
loss of appetite or interest in mealtimes
loss of sensation (touch taste smell changes in vision)
Consequences of Malnutrition
Secondary health complications Postoperative complications Decreased functional independence Cognitive loss Increased mortality rates Decreased quality of life Increased costs of healthcare
Barriers to Good Nutritional Status
Lack of knowledge about risk factors No formalized screening and assessment Inadequate staff to resident ratios Lack of training in feeding and eating assistance Limited communication between disciplines Lack of understanding of impact of dementia Inattention to the cultural and personal context of
mealtime Lack of social supports
Dementia and Malnutrition
Six factors that predict low food intake Eating difficulty No feeding assistance by caregivers Moderate dependence in activities of daily living Fewer family visits Being female Older age
(Lin Watson amp Wu 2010)
Dementia and Malnutrition
It is estimated that up to 45 of people with dementia living in institutions have swallowing
difficulties (Horner Alberts Dawson amp Cook 1994)
Effects of Increased Assistance
Increases in total daily calorie intake Residents maintain or gain weight Reduced secondary health complications Improved relationship between resident and staff Improved quality of life
Role of Occupational Therapy
OTs and OTAs have foundational skills and knowledge in eating feeding and
swallowing understanding of multidimensional aspects of eating expertise in assessment evaluation and treatment a holistic view to bring to nutritional care
OT Interventions
Attention to psychosocial aspects of dining Environmental modification Adaptive equipment Dysphagia assessment and treatment Positioning Task analysis Residents Staff
Caregiver and dining assistant training Sensory integration issues internal and external
Culture Change
ldquoCulture change is an innovation anchored in values and beliefs that return the locus of control to elders and those who work closest with them Its ultimate vision is to create a culture of aging that is inclusive life-affirming satisfying humane and meaningfulrdquo
(Kantor B amp Planetree amp Picker Institute 2010)
Trends in Culture Change
Emphasis on resident choice and person-centered care as essential components to improve dining experiences
Culture change requires transformation in organizational practices physical environments workplace practices communication and relationships among all stakeholders
Benefits of Culture Change
LTCs who implement cultural changeshellip Improve quality-of-life for residents patients and staff
Increase performance on clinical outcomes
(Planetree amp Picker Institute 2010 Baier Butterfield Harris amp Gravenstei 2008)
Experience positive effects on occupancy rates and the financial bottom line of LTC (Doty Koren amp Sturla 2008 Elliot 2010 LaPorte 2010)
Key Points for Program amp Culture Change
Residents are unique individuals Facility leadership must seek further education Leaders must support the changes in environment Interdisciplinary staff education and training at all
levels Formalize screening and referral process Changes to dining organization and staffing duties Utilize expertise and unique perspective of OT
Future Work
Increase multidisciplinary collaboration
Increase knowledge base for OT through research Design and share educational programs across
disciplines and settings
Future Work
Explore and implement innovative approaches to feeding and eating assistance
Design programs specific to the dining experience of persons with dementia or cognitive impairment
Advocate with government and industry to promote
person centered care in LTC
Education is Key to Change
Industry leaders nursing home administrators and management need to be educated about the extent of malnutrition in nursing homes
There is a need for educational plans and instructional materials on preventing and treating malnutrition in LTC
Healthcare providers must take time to advocate with facilities and present educational workshops
Recognizing and preventing malnutrition in nursing homes
A teaching plan was developed and incorporated into
the coursework for the OTD 610 Practitioner as Educator course at Pacific University
An extensive literature review has been created to provide evidence and foundational knowledge for healthcare providers LTC administrators and stakeholders
Purpose
Educate skilled nursing facility administrators and management about effects of poor nutritional status skilled OT assessment analysis and Interventions improving nutritional status of residents enhancing the dining experience improving staff effectiveness and efficiency
Program Goal
LTC administrators and managers will demonstrate basic knowledge of effects of poor nutritional
status describe barriers to providing excellent nutritional care explain how skilled OT services contribute to proving holistic
nutritional care
Teaching Elements
Teaching Session
Lecture- group instruction Printed educational handouts Printed worksheets Interactive activities among learners Small and whole group discussions Self-reflection and sharing Resource table with additional learning tools Short video (added as a result of feedback to pilot
session)
Targeted learners
professionals in health care provision or administration
extensive experience in the long-term healthcare industry in the area of nutrition and dietary food service
men and women multicultural group 30 ndash 60 years of age
Setting
Intended LTC workshop Skilled nursing facility conference room during weekday
business hours
Pilot Group workshop Large open-plan diningliving space with participants around
large oval table
Outcome of Pilot
What would I do differently
Schedule more convenient time
Include more participants
Ask for feedback
More anonymous feedback option
simplify language
Proposed Changes to Workshop
Provide printed quiz to go with handouts Add video component Rework handouts for comprehension and
application to learners needs
Discussion
After learning more about the problem of malnutrition in long-term care are you considering how you might introduce this topic into your practice or your teaching
Are there other venues where this type of educational program is appropriate and might influence the management of nutritional care for elders
Questions
References
Abbasi AA amp Rudman D (1994) Undernutrition in the nursing home Prevalence consequences cause and prevention Nutrition Reviews 52(4) 113-122 Accreditation Council for Occupational Therapy Education (2006) ACOTE standards and interpretive guidelines Retrieved from
httpwwwaotaorgnonmembersarea13docs acotestandards806pdf Adams NE Bowie AJ Simmance N Murrary M amp Crowe T (2008) Recognition by medical and nursing professionals of malnutrition and risk of malnutrition in elderly hospitalised patients Nutrition and Dietetics (65) 144-150 Amella EJ (2002) Resistance at mealtimes for persons with dementia The Journal of Nutrition Health amp Aging 6 117-122 Amella EJ (2008) Mealtime difficulties In Evidence-Based Geriatric Nursing Protocols for Best Practice 3rd ed (Capezuti E Zwicker D Mezey M Fulmer T Gray-Miceli D amp Kluger M eds) Springer Publishing Company LLC New York p 337-351 American Occupational Therapy Association [AOTA] (2002) Occupational therapy practice framework Domain and process American Journal of Occupational Therapy 56
609ndash639 doi 105014ajot566609 AOTA (2007) Specialized knowledge and skills in feeding eating and swallowing for occupational therapy practice American Journal of Occupational Therapy 61(6) 686-700
doi 105014ajot616686 Asai JL (2004) Nutrition and the geriatric rehabilitation patient Challenges and solutions Topics in Geriatric Rehabilitation 20(1) 34-45 Baier RR Butterfield K Harris Y Gravenstein S (2008) Aiming for star performance the relationship between setting targets and improved nursing home quality of
care Journal of the American Medical Directors Association9(8) 594-9 Epub Dolhi C amp Rogers J (2009) Dementia nutrition and self-feeding A systematic review of the literature Occupational Therapy in Health Care 15(3-4) 59-87 Ferri C Prince M Brayne C Brodaty H Fratiglioni L Ganguli M hellip Landry G (2005) Global prevalence of dementia a delphi consensus study Lancet 366 2112-2217 Frisoni G Fanzoni S Rozzini R Ferrucci L Boffelli S amp Trabucchi M (1994) A nutritional index predicting mortality in the nursing home Journal of the American Geriatric Society 42 1167-1172 Furman EF (2006) Under-nutrition in older adults across the continuum of care Journal of Gerontological Nursing 32(1) 22-27 Groher ME amp Crary MA(2010) Dysphagia Clinical Management in Adults and Children Maryland Heights MO Mosby-Elsevier Harris-Kojetin L Sengupta M Park-Lee E Valverde R Long-term care services in the United States 2013 overview National health care statistics reports no 1 Hyattsville MD National Center for Health Statistics 2013
References
Horner J Alberts MJ Dawson DV Cook GM (1994) Swallowing in Alzheimerrsquos disease Alzheimer Disease Association Disorders 8 177 ndash 19 Kielhofner G (1985) A model of human occupation Baltimore Williams and Wilkins Lammes E amp Akner G (2006) Repeated assessment of energy and nutrient intake in 52 nursing home residents Journal of Nutritional Health and Aging 10(3) 222-30 Lin L-C Watson R amp Wu S-C (2010) What is associated with low food intake in older people with dementia Journal of Clinical Nursing 19 53-59 Doi 101111j1365-2702200902962x Maher D amp Eliad C (2014) Malnutrition in the elderly An unrecognized health issue Journal of Nursing Retrieved from httprnjournalcomjournal-of-nursingmalnutrition-in-the-elderly-an-unrecognized-health-issue Manthorpe J amp Watson R (2003) Poorly served Eating and dementia Journal of Advanced Nursing 41(2) 162-169 Nelson K Coultson A SucherKP amp Tseng R (1992) Prevalence of malnutrition in The elderly admitted to long-term-care facilities Journal of the American Dietetic Association 93(4) 459-460 Ott F Readman T amp Backman C (1990) Mealtimes of the institutionalized elderly A literature review Canadian Journal of Occupational Therapy 57(5) 261-267 Payette H (2002) Know related effects of nutrition on aging muscle function In Nutrition and Aging Vol 6 Ed by LH Rosenberg and A Sastre Nestle Workshop Series Clinical and Performance Program Nestec Ltd Vevey Switzerland P 135-150 Planetree amp Picker Institute (2010) Long term care improvement guide Retrieved from httpplanetreeorgwp-contentuploads201112LTC-Improvement-Guide-For-Downloadpdf Riviere S Gillerte-Guyonnet S Andrieu S Nourhashemi F Laugque S Cantet C hellip Vellas B (2002) Cognitive function and caregiver burden Predictive factors for eating behavior disorders in Alzhiemerrsquos disease International Journal of Geriatric Psychiatry 17 950-955 Schussler S Dassen T amp Lohrmann C (2014) Prevalence of care dependency and nursing care problems in nursing home residents with dementia A literature review International Journal of Caring Sciences 7(2) 339 Retrieved from httpwwwinternationaljournalofcaringsciencesorgdocs120SchC3BCssler-1pdf
References
Scott TM Peter L Tucker KL Arsenault L Bergethon P Bhadelia R hellip Folstein M (2006) The Nutrition Aging and Memory in Elders (NAME) study Design and methods for a study of micronutrients and cognitive function in a homebound elderly population International Journal of Geriatric Psychiatry 21(6) 519-528
doi101002gps1503735 Simmons SF Keeler E Zhuo X Hickey KA Sato HW amp Schnelle JF (2008) Prevention of unintentional weight loss in nursing home residents a controlled trial of feeding assistance Journal of American Geriatric Society 56(8) 1466-1473
Doi101111j1532-5415200801801x Sodderhamn U Backrach-Lindstrom M amp Ek AC (2007) Nutritional screening and perceived health in a group of geriatric rehabilitation patients Journal of Clinical Nursing (16) 1997-2006 Thomas DR Ashmen W Morley JE Evans WJ amp the Council for Nutritional Strategies in Long-Term Care (2000) Nutritional management in long-term care Development of a clinical guideline Journal of Gerontolology Biological Sciences and Medical Sciences 55A(12) M725- doi101093Gerona5512M725 Wu S amp Barker JC (2008) Hot tea and Juk The institutional meaning of food for Chinese elders in an American nursing home Journal of Gerontological Nursing 34(11) 46-45 doi10392800989134-20081101-11
E L I Z A B E T H C B A I R b a i r 0 7 1 2 p a c i f i c u e d u
Thank You
Purpose
This presentation is intended to educate about malnutrition in LTC
introduce elements of a teaching plan and instructional
materials
describe a proposed research project
inspire you to take action
Learning Objectives
By the end of this presentation you should be able to
Identify key signs and symptoms of malnutrition Recall effects of malnutrition on cognition and health Understand how personal institutional and cultural factors
affect an individualrsquos ability to remain nutritionally sound Describe the Role of OT in managing and preventing
malnutrition in LTC residents
Malnutrition in Long-term Care
Malnutrition in LTC is a serious problem Who is at risk Long-term residents Rehabilitation patients
Prevalence
Each day in 2012 there were 1383700 residents in nursing homes (Harris-Kojetin Sengupta Park-Lee amp Valverde 2013)
Between 35 and 85 of older adults in nursing homes experience some level of malnutrition (Furman 2006)
Percentage of adults with dementia and malnutrition in nursing homes range from 14 - 56
Schussler S Dassen T amp Lohrmann C (2014)
Factors in Malnutrition
Natural aging processes Chronic medical conditions Cognitive impairment Disease Injury Frailty Environments
(Scott et al 2006 Thomas Ashmen Morley Evans amp the Council for Nutritional Strategies in Long-Term Care 2000)
Signs and Symptoms
skin breakdown and pressure wounds
anemia fatigue muscle weakness and
wasting dry skin dull dry hair and hair loss conjunctival dryness receding gums or a change in
how their dentures fit
increasing levels of confusion
loss of appetite or interest in mealtimes
loss of sensation (touch taste smell changes in vision)
Consequences of Malnutrition
Secondary health complications Postoperative complications Decreased functional independence Cognitive loss Increased mortality rates Decreased quality of life Increased costs of healthcare
Barriers to Good Nutritional Status
Lack of knowledge about risk factors No formalized screening and assessment Inadequate staff to resident ratios Lack of training in feeding and eating assistance Limited communication between disciplines Lack of understanding of impact of dementia Inattention to the cultural and personal context of
mealtime Lack of social supports
Dementia and Malnutrition
Six factors that predict low food intake Eating difficulty No feeding assistance by caregivers Moderate dependence in activities of daily living Fewer family visits Being female Older age
(Lin Watson amp Wu 2010)
Dementia and Malnutrition
It is estimated that up to 45 of people with dementia living in institutions have swallowing
difficulties (Horner Alberts Dawson amp Cook 1994)
Effects of Increased Assistance
Increases in total daily calorie intake Residents maintain or gain weight Reduced secondary health complications Improved relationship between resident and staff Improved quality of life
Role of Occupational Therapy
OTs and OTAs have foundational skills and knowledge in eating feeding and
swallowing understanding of multidimensional aspects of eating expertise in assessment evaluation and treatment a holistic view to bring to nutritional care
OT Interventions
Attention to psychosocial aspects of dining Environmental modification Adaptive equipment Dysphagia assessment and treatment Positioning Task analysis Residents Staff
Caregiver and dining assistant training Sensory integration issues internal and external
Culture Change
ldquoCulture change is an innovation anchored in values and beliefs that return the locus of control to elders and those who work closest with them Its ultimate vision is to create a culture of aging that is inclusive life-affirming satisfying humane and meaningfulrdquo
(Kantor B amp Planetree amp Picker Institute 2010)
Trends in Culture Change
Emphasis on resident choice and person-centered care as essential components to improve dining experiences
Culture change requires transformation in organizational practices physical environments workplace practices communication and relationships among all stakeholders
Benefits of Culture Change
LTCs who implement cultural changeshellip Improve quality-of-life for residents patients and staff
Increase performance on clinical outcomes
(Planetree amp Picker Institute 2010 Baier Butterfield Harris amp Gravenstei 2008)
Experience positive effects on occupancy rates and the financial bottom line of LTC (Doty Koren amp Sturla 2008 Elliot 2010 LaPorte 2010)
Key Points for Program amp Culture Change
Residents are unique individuals Facility leadership must seek further education Leaders must support the changes in environment Interdisciplinary staff education and training at all
levels Formalize screening and referral process Changes to dining organization and staffing duties Utilize expertise and unique perspective of OT
Future Work
Increase multidisciplinary collaboration
Increase knowledge base for OT through research Design and share educational programs across
disciplines and settings
Future Work
Explore and implement innovative approaches to feeding and eating assistance
Design programs specific to the dining experience of persons with dementia or cognitive impairment
Advocate with government and industry to promote
person centered care in LTC
Education is Key to Change
Industry leaders nursing home administrators and management need to be educated about the extent of malnutrition in nursing homes
There is a need for educational plans and instructional materials on preventing and treating malnutrition in LTC
Healthcare providers must take time to advocate with facilities and present educational workshops
Recognizing and preventing malnutrition in nursing homes
A teaching plan was developed and incorporated into
the coursework for the OTD 610 Practitioner as Educator course at Pacific University
An extensive literature review has been created to provide evidence and foundational knowledge for healthcare providers LTC administrators and stakeholders
Purpose
Educate skilled nursing facility administrators and management about effects of poor nutritional status skilled OT assessment analysis and Interventions improving nutritional status of residents enhancing the dining experience improving staff effectiveness and efficiency
Program Goal
LTC administrators and managers will demonstrate basic knowledge of effects of poor nutritional
status describe barriers to providing excellent nutritional care explain how skilled OT services contribute to proving holistic
nutritional care
Teaching Elements
Teaching Session
Lecture- group instruction Printed educational handouts Printed worksheets Interactive activities among learners Small and whole group discussions Self-reflection and sharing Resource table with additional learning tools Short video (added as a result of feedback to pilot
session)
Targeted learners
professionals in health care provision or administration
extensive experience in the long-term healthcare industry in the area of nutrition and dietary food service
men and women multicultural group 30 ndash 60 years of age
Setting
Intended LTC workshop Skilled nursing facility conference room during weekday
business hours
Pilot Group workshop Large open-plan diningliving space with participants around
large oval table
Outcome of Pilot
What would I do differently
Schedule more convenient time
Include more participants
Ask for feedback
More anonymous feedback option
simplify language
Proposed Changes to Workshop
Provide printed quiz to go with handouts Add video component Rework handouts for comprehension and
application to learners needs
Discussion
After learning more about the problem of malnutrition in long-term care are you considering how you might introduce this topic into your practice or your teaching
Are there other venues where this type of educational program is appropriate and might influence the management of nutritional care for elders
Questions
References
Abbasi AA amp Rudman D (1994) Undernutrition in the nursing home Prevalence consequences cause and prevention Nutrition Reviews 52(4) 113-122 Accreditation Council for Occupational Therapy Education (2006) ACOTE standards and interpretive guidelines Retrieved from
httpwwwaotaorgnonmembersarea13docs acotestandards806pdf Adams NE Bowie AJ Simmance N Murrary M amp Crowe T (2008) Recognition by medical and nursing professionals of malnutrition and risk of malnutrition in elderly hospitalised patients Nutrition and Dietetics (65) 144-150 Amella EJ (2002) Resistance at mealtimes for persons with dementia The Journal of Nutrition Health amp Aging 6 117-122 Amella EJ (2008) Mealtime difficulties In Evidence-Based Geriatric Nursing Protocols for Best Practice 3rd ed (Capezuti E Zwicker D Mezey M Fulmer T Gray-Miceli D amp Kluger M eds) Springer Publishing Company LLC New York p 337-351 American Occupational Therapy Association [AOTA] (2002) Occupational therapy practice framework Domain and process American Journal of Occupational Therapy 56
609ndash639 doi 105014ajot566609 AOTA (2007) Specialized knowledge and skills in feeding eating and swallowing for occupational therapy practice American Journal of Occupational Therapy 61(6) 686-700
doi 105014ajot616686 Asai JL (2004) Nutrition and the geriatric rehabilitation patient Challenges and solutions Topics in Geriatric Rehabilitation 20(1) 34-45 Baier RR Butterfield K Harris Y Gravenstein S (2008) Aiming for star performance the relationship between setting targets and improved nursing home quality of
care Journal of the American Medical Directors Association9(8) 594-9 Epub Dolhi C amp Rogers J (2009) Dementia nutrition and self-feeding A systematic review of the literature Occupational Therapy in Health Care 15(3-4) 59-87 Ferri C Prince M Brayne C Brodaty H Fratiglioni L Ganguli M hellip Landry G (2005) Global prevalence of dementia a delphi consensus study Lancet 366 2112-2217 Frisoni G Fanzoni S Rozzini R Ferrucci L Boffelli S amp Trabucchi M (1994) A nutritional index predicting mortality in the nursing home Journal of the American Geriatric Society 42 1167-1172 Furman EF (2006) Under-nutrition in older adults across the continuum of care Journal of Gerontological Nursing 32(1) 22-27 Groher ME amp Crary MA(2010) Dysphagia Clinical Management in Adults and Children Maryland Heights MO Mosby-Elsevier Harris-Kojetin L Sengupta M Park-Lee E Valverde R Long-term care services in the United States 2013 overview National health care statistics reports no 1 Hyattsville MD National Center for Health Statistics 2013
References
Horner J Alberts MJ Dawson DV Cook GM (1994) Swallowing in Alzheimerrsquos disease Alzheimer Disease Association Disorders 8 177 ndash 19 Kielhofner G (1985) A model of human occupation Baltimore Williams and Wilkins Lammes E amp Akner G (2006) Repeated assessment of energy and nutrient intake in 52 nursing home residents Journal of Nutritional Health and Aging 10(3) 222-30 Lin L-C Watson R amp Wu S-C (2010) What is associated with low food intake in older people with dementia Journal of Clinical Nursing 19 53-59 Doi 101111j1365-2702200902962x Maher D amp Eliad C (2014) Malnutrition in the elderly An unrecognized health issue Journal of Nursing Retrieved from httprnjournalcomjournal-of-nursingmalnutrition-in-the-elderly-an-unrecognized-health-issue Manthorpe J amp Watson R (2003) Poorly served Eating and dementia Journal of Advanced Nursing 41(2) 162-169 Nelson K Coultson A SucherKP amp Tseng R (1992) Prevalence of malnutrition in The elderly admitted to long-term-care facilities Journal of the American Dietetic Association 93(4) 459-460 Ott F Readman T amp Backman C (1990) Mealtimes of the institutionalized elderly A literature review Canadian Journal of Occupational Therapy 57(5) 261-267 Payette H (2002) Know related effects of nutrition on aging muscle function In Nutrition and Aging Vol 6 Ed by LH Rosenberg and A Sastre Nestle Workshop Series Clinical and Performance Program Nestec Ltd Vevey Switzerland P 135-150 Planetree amp Picker Institute (2010) Long term care improvement guide Retrieved from httpplanetreeorgwp-contentuploads201112LTC-Improvement-Guide-For-Downloadpdf Riviere S Gillerte-Guyonnet S Andrieu S Nourhashemi F Laugque S Cantet C hellip Vellas B (2002) Cognitive function and caregiver burden Predictive factors for eating behavior disorders in Alzhiemerrsquos disease International Journal of Geriatric Psychiatry 17 950-955 Schussler S Dassen T amp Lohrmann C (2014) Prevalence of care dependency and nursing care problems in nursing home residents with dementia A literature review International Journal of Caring Sciences 7(2) 339 Retrieved from httpwwwinternationaljournalofcaringsciencesorgdocs120SchC3BCssler-1pdf
References
Scott TM Peter L Tucker KL Arsenault L Bergethon P Bhadelia R hellip Folstein M (2006) The Nutrition Aging and Memory in Elders (NAME) study Design and methods for a study of micronutrients and cognitive function in a homebound elderly population International Journal of Geriatric Psychiatry 21(6) 519-528
doi101002gps1503735 Simmons SF Keeler E Zhuo X Hickey KA Sato HW amp Schnelle JF (2008) Prevention of unintentional weight loss in nursing home residents a controlled trial of feeding assistance Journal of American Geriatric Society 56(8) 1466-1473
Doi101111j1532-5415200801801x Sodderhamn U Backrach-Lindstrom M amp Ek AC (2007) Nutritional screening and perceived health in a group of geriatric rehabilitation patients Journal of Clinical Nursing (16) 1997-2006 Thomas DR Ashmen W Morley JE Evans WJ amp the Council for Nutritional Strategies in Long-Term Care (2000) Nutritional management in long-term care Development of a clinical guideline Journal of Gerontolology Biological Sciences and Medical Sciences 55A(12) M725- doi101093Gerona5512M725 Wu S amp Barker JC (2008) Hot tea and Juk The institutional meaning of food for Chinese elders in an American nursing home Journal of Gerontological Nursing 34(11) 46-45 doi10392800989134-20081101-11
E L I Z A B E T H C B A I R b a i r 0 7 1 2 p a c i f i c u e d u
Thank You
Learning Objectives
By the end of this presentation you should be able to
Identify key signs and symptoms of malnutrition Recall effects of malnutrition on cognition and health Understand how personal institutional and cultural factors
affect an individualrsquos ability to remain nutritionally sound Describe the Role of OT in managing and preventing
malnutrition in LTC residents
Malnutrition in Long-term Care
Malnutrition in LTC is a serious problem Who is at risk Long-term residents Rehabilitation patients
Prevalence
Each day in 2012 there were 1383700 residents in nursing homes (Harris-Kojetin Sengupta Park-Lee amp Valverde 2013)
Between 35 and 85 of older adults in nursing homes experience some level of malnutrition (Furman 2006)
Percentage of adults with dementia and malnutrition in nursing homes range from 14 - 56
Schussler S Dassen T amp Lohrmann C (2014)
Factors in Malnutrition
Natural aging processes Chronic medical conditions Cognitive impairment Disease Injury Frailty Environments
(Scott et al 2006 Thomas Ashmen Morley Evans amp the Council for Nutritional Strategies in Long-Term Care 2000)
Signs and Symptoms
skin breakdown and pressure wounds
anemia fatigue muscle weakness and
wasting dry skin dull dry hair and hair loss conjunctival dryness receding gums or a change in
how their dentures fit
increasing levels of confusion
loss of appetite or interest in mealtimes
loss of sensation (touch taste smell changes in vision)
Consequences of Malnutrition
Secondary health complications Postoperative complications Decreased functional independence Cognitive loss Increased mortality rates Decreased quality of life Increased costs of healthcare
Barriers to Good Nutritional Status
Lack of knowledge about risk factors No formalized screening and assessment Inadequate staff to resident ratios Lack of training in feeding and eating assistance Limited communication between disciplines Lack of understanding of impact of dementia Inattention to the cultural and personal context of
mealtime Lack of social supports
Dementia and Malnutrition
Six factors that predict low food intake Eating difficulty No feeding assistance by caregivers Moderate dependence in activities of daily living Fewer family visits Being female Older age
(Lin Watson amp Wu 2010)
Dementia and Malnutrition
It is estimated that up to 45 of people with dementia living in institutions have swallowing
difficulties (Horner Alberts Dawson amp Cook 1994)
Effects of Increased Assistance
Increases in total daily calorie intake Residents maintain or gain weight Reduced secondary health complications Improved relationship between resident and staff Improved quality of life
Role of Occupational Therapy
OTs and OTAs have foundational skills and knowledge in eating feeding and
swallowing understanding of multidimensional aspects of eating expertise in assessment evaluation and treatment a holistic view to bring to nutritional care
OT Interventions
Attention to psychosocial aspects of dining Environmental modification Adaptive equipment Dysphagia assessment and treatment Positioning Task analysis Residents Staff
Caregiver and dining assistant training Sensory integration issues internal and external
Culture Change
ldquoCulture change is an innovation anchored in values and beliefs that return the locus of control to elders and those who work closest with them Its ultimate vision is to create a culture of aging that is inclusive life-affirming satisfying humane and meaningfulrdquo
(Kantor B amp Planetree amp Picker Institute 2010)
Trends in Culture Change
Emphasis on resident choice and person-centered care as essential components to improve dining experiences
Culture change requires transformation in organizational practices physical environments workplace practices communication and relationships among all stakeholders
Benefits of Culture Change
LTCs who implement cultural changeshellip Improve quality-of-life for residents patients and staff
Increase performance on clinical outcomes
(Planetree amp Picker Institute 2010 Baier Butterfield Harris amp Gravenstei 2008)
Experience positive effects on occupancy rates and the financial bottom line of LTC (Doty Koren amp Sturla 2008 Elliot 2010 LaPorte 2010)
Key Points for Program amp Culture Change
Residents are unique individuals Facility leadership must seek further education Leaders must support the changes in environment Interdisciplinary staff education and training at all
levels Formalize screening and referral process Changes to dining organization and staffing duties Utilize expertise and unique perspective of OT
Future Work
Increase multidisciplinary collaboration
Increase knowledge base for OT through research Design and share educational programs across
disciplines and settings
Future Work
Explore and implement innovative approaches to feeding and eating assistance
Design programs specific to the dining experience of persons with dementia or cognitive impairment
Advocate with government and industry to promote
person centered care in LTC
Education is Key to Change
Industry leaders nursing home administrators and management need to be educated about the extent of malnutrition in nursing homes
There is a need for educational plans and instructional materials on preventing and treating malnutrition in LTC
Healthcare providers must take time to advocate with facilities and present educational workshops
Recognizing and preventing malnutrition in nursing homes
A teaching plan was developed and incorporated into
the coursework for the OTD 610 Practitioner as Educator course at Pacific University
An extensive literature review has been created to provide evidence and foundational knowledge for healthcare providers LTC administrators and stakeholders
Purpose
Educate skilled nursing facility administrators and management about effects of poor nutritional status skilled OT assessment analysis and Interventions improving nutritional status of residents enhancing the dining experience improving staff effectiveness and efficiency
Program Goal
LTC administrators and managers will demonstrate basic knowledge of effects of poor nutritional
status describe barriers to providing excellent nutritional care explain how skilled OT services contribute to proving holistic
nutritional care
Teaching Elements
Teaching Session
Lecture- group instruction Printed educational handouts Printed worksheets Interactive activities among learners Small and whole group discussions Self-reflection and sharing Resource table with additional learning tools Short video (added as a result of feedback to pilot
session)
Targeted learners
professionals in health care provision or administration
extensive experience in the long-term healthcare industry in the area of nutrition and dietary food service
men and women multicultural group 30 ndash 60 years of age
Setting
Intended LTC workshop Skilled nursing facility conference room during weekday
business hours
Pilot Group workshop Large open-plan diningliving space with participants around
large oval table
Outcome of Pilot
What would I do differently
Schedule more convenient time
Include more participants
Ask for feedback
More anonymous feedback option
simplify language
Proposed Changes to Workshop
Provide printed quiz to go with handouts Add video component Rework handouts for comprehension and
application to learners needs
Discussion
After learning more about the problem of malnutrition in long-term care are you considering how you might introduce this topic into your practice or your teaching
Are there other venues where this type of educational program is appropriate and might influence the management of nutritional care for elders
Questions
References
Abbasi AA amp Rudman D (1994) Undernutrition in the nursing home Prevalence consequences cause and prevention Nutrition Reviews 52(4) 113-122 Accreditation Council for Occupational Therapy Education (2006) ACOTE standards and interpretive guidelines Retrieved from
httpwwwaotaorgnonmembersarea13docs acotestandards806pdf Adams NE Bowie AJ Simmance N Murrary M amp Crowe T (2008) Recognition by medical and nursing professionals of malnutrition and risk of malnutrition in elderly hospitalised patients Nutrition and Dietetics (65) 144-150 Amella EJ (2002) Resistance at mealtimes for persons with dementia The Journal of Nutrition Health amp Aging 6 117-122 Amella EJ (2008) Mealtime difficulties In Evidence-Based Geriatric Nursing Protocols for Best Practice 3rd ed (Capezuti E Zwicker D Mezey M Fulmer T Gray-Miceli D amp Kluger M eds) Springer Publishing Company LLC New York p 337-351 American Occupational Therapy Association [AOTA] (2002) Occupational therapy practice framework Domain and process American Journal of Occupational Therapy 56
609ndash639 doi 105014ajot566609 AOTA (2007) Specialized knowledge and skills in feeding eating and swallowing for occupational therapy practice American Journal of Occupational Therapy 61(6) 686-700
doi 105014ajot616686 Asai JL (2004) Nutrition and the geriatric rehabilitation patient Challenges and solutions Topics in Geriatric Rehabilitation 20(1) 34-45 Baier RR Butterfield K Harris Y Gravenstein S (2008) Aiming for star performance the relationship between setting targets and improved nursing home quality of
care Journal of the American Medical Directors Association9(8) 594-9 Epub Dolhi C amp Rogers J (2009) Dementia nutrition and self-feeding A systematic review of the literature Occupational Therapy in Health Care 15(3-4) 59-87 Ferri C Prince M Brayne C Brodaty H Fratiglioni L Ganguli M hellip Landry G (2005) Global prevalence of dementia a delphi consensus study Lancet 366 2112-2217 Frisoni G Fanzoni S Rozzini R Ferrucci L Boffelli S amp Trabucchi M (1994) A nutritional index predicting mortality in the nursing home Journal of the American Geriatric Society 42 1167-1172 Furman EF (2006) Under-nutrition in older adults across the continuum of care Journal of Gerontological Nursing 32(1) 22-27 Groher ME amp Crary MA(2010) Dysphagia Clinical Management in Adults and Children Maryland Heights MO Mosby-Elsevier Harris-Kojetin L Sengupta M Park-Lee E Valverde R Long-term care services in the United States 2013 overview National health care statistics reports no 1 Hyattsville MD National Center for Health Statistics 2013
References
Horner J Alberts MJ Dawson DV Cook GM (1994) Swallowing in Alzheimerrsquos disease Alzheimer Disease Association Disorders 8 177 ndash 19 Kielhofner G (1985) A model of human occupation Baltimore Williams and Wilkins Lammes E amp Akner G (2006) Repeated assessment of energy and nutrient intake in 52 nursing home residents Journal of Nutritional Health and Aging 10(3) 222-30 Lin L-C Watson R amp Wu S-C (2010) What is associated with low food intake in older people with dementia Journal of Clinical Nursing 19 53-59 Doi 101111j1365-2702200902962x Maher D amp Eliad C (2014) Malnutrition in the elderly An unrecognized health issue Journal of Nursing Retrieved from httprnjournalcomjournal-of-nursingmalnutrition-in-the-elderly-an-unrecognized-health-issue Manthorpe J amp Watson R (2003) Poorly served Eating and dementia Journal of Advanced Nursing 41(2) 162-169 Nelson K Coultson A SucherKP amp Tseng R (1992) Prevalence of malnutrition in The elderly admitted to long-term-care facilities Journal of the American Dietetic Association 93(4) 459-460 Ott F Readman T amp Backman C (1990) Mealtimes of the institutionalized elderly A literature review Canadian Journal of Occupational Therapy 57(5) 261-267 Payette H (2002) Know related effects of nutrition on aging muscle function In Nutrition and Aging Vol 6 Ed by LH Rosenberg and A Sastre Nestle Workshop Series Clinical and Performance Program Nestec Ltd Vevey Switzerland P 135-150 Planetree amp Picker Institute (2010) Long term care improvement guide Retrieved from httpplanetreeorgwp-contentuploads201112LTC-Improvement-Guide-For-Downloadpdf Riviere S Gillerte-Guyonnet S Andrieu S Nourhashemi F Laugque S Cantet C hellip Vellas B (2002) Cognitive function and caregiver burden Predictive factors for eating behavior disorders in Alzhiemerrsquos disease International Journal of Geriatric Psychiatry 17 950-955 Schussler S Dassen T amp Lohrmann C (2014) Prevalence of care dependency and nursing care problems in nursing home residents with dementia A literature review International Journal of Caring Sciences 7(2) 339 Retrieved from httpwwwinternationaljournalofcaringsciencesorgdocs120SchC3BCssler-1pdf
References
Scott TM Peter L Tucker KL Arsenault L Bergethon P Bhadelia R hellip Folstein M (2006) The Nutrition Aging and Memory in Elders (NAME) study Design and methods for a study of micronutrients and cognitive function in a homebound elderly population International Journal of Geriatric Psychiatry 21(6) 519-528
doi101002gps1503735 Simmons SF Keeler E Zhuo X Hickey KA Sato HW amp Schnelle JF (2008) Prevention of unintentional weight loss in nursing home residents a controlled trial of feeding assistance Journal of American Geriatric Society 56(8) 1466-1473
Doi101111j1532-5415200801801x Sodderhamn U Backrach-Lindstrom M amp Ek AC (2007) Nutritional screening and perceived health in a group of geriatric rehabilitation patients Journal of Clinical Nursing (16) 1997-2006 Thomas DR Ashmen W Morley JE Evans WJ amp the Council for Nutritional Strategies in Long-Term Care (2000) Nutritional management in long-term care Development of a clinical guideline Journal of Gerontolology Biological Sciences and Medical Sciences 55A(12) M725- doi101093Gerona5512M725 Wu S amp Barker JC (2008) Hot tea and Juk The institutional meaning of food for Chinese elders in an American nursing home Journal of Gerontological Nursing 34(11) 46-45 doi10392800989134-20081101-11
E L I Z A B E T H C B A I R b a i r 0 7 1 2 p a c i f i c u e d u
Thank You
Malnutrition in Long-term Care
Malnutrition in LTC is a serious problem Who is at risk Long-term residents Rehabilitation patients
Prevalence
Each day in 2012 there were 1383700 residents in nursing homes (Harris-Kojetin Sengupta Park-Lee amp Valverde 2013)
Between 35 and 85 of older adults in nursing homes experience some level of malnutrition (Furman 2006)
Percentage of adults with dementia and malnutrition in nursing homes range from 14 - 56
Schussler S Dassen T amp Lohrmann C (2014)
Factors in Malnutrition
Natural aging processes Chronic medical conditions Cognitive impairment Disease Injury Frailty Environments
(Scott et al 2006 Thomas Ashmen Morley Evans amp the Council for Nutritional Strategies in Long-Term Care 2000)
Signs and Symptoms
skin breakdown and pressure wounds
anemia fatigue muscle weakness and
wasting dry skin dull dry hair and hair loss conjunctival dryness receding gums or a change in
how their dentures fit
increasing levels of confusion
loss of appetite or interest in mealtimes
loss of sensation (touch taste smell changes in vision)
Consequences of Malnutrition
Secondary health complications Postoperative complications Decreased functional independence Cognitive loss Increased mortality rates Decreased quality of life Increased costs of healthcare
Barriers to Good Nutritional Status
Lack of knowledge about risk factors No formalized screening and assessment Inadequate staff to resident ratios Lack of training in feeding and eating assistance Limited communication between disciplines Lack of understanding of impact of dementia Inattention to the cultural and personal context of
mealtime Lack of social supports
Dementia and Malnutrition
Six factors that predict low food intake Eating difficulty No feeding assistance by caregivers Moderate dependence in activities of daily living Fewer family visits Being female Older age
(Lin Watson amp Wu 2010)
Dementia and Malnutrition
It is estimated that up to 45 of people with dementia living in institutions have swallowing
difficulties (Horner Alberts Dawson amp Cook 1994)
Effects of Increased Assistance
Increases in total daily calorie intake Residents maintain or gain weight Reduced secondary health complications Improved relationship between resident and staff Improved quality of life
Role of Occupational Therapy
OTs and OTAs have foundational skills and knowledge in eating feeding and
swallowing understanding of multidimensional aspects of eating expertise in assessment evaluation and treatment a holistic view to bring to nutritional care
OT Interventions
Attention to psychosocial aspects of dining Environmental modification Adaptive equipment Dysphagia assessment and treatment Positioning Task analysis Residents Staff
Caregiver and dining assistant training Sensory integration issues internal and external
Culture Change
ldquoCulture change is an innovation anchored in values and beliefs that return the locus of control to elders and those who work closest with them Its ultimate vision is to create a culture of aging that is inclusive life-affirming satisfying humane and meaningfulrdquo
(Kantor B amp Planetree amp Picker Institute 2010)
Trends in Culture Change
Emphasis on resident choice and person-centered care as essential components to improve dining experiences
Culture change requires transformation in organizational practices physical environments workplace practices communication and relationships among all stakeholders
Benefits of Culture Change
LTCs who implement cultural changeshellip Improve quality-of-life for residents patients and staff
Increase performance on clinical outcomes
(Planetree amp Picker Institute 2010 Baier Butterfield Harris amp Gravenstei 2008)
Experience positive effects on occupancy rates and the financial bottom line of LTC (Doty Koren amp Sturla 2008 Elliot 2010 LaPorte 2010)
Key Points for Program amp Culture Change
Residents are unique individuals Facility leadership must seek further education Leaders must support the changes in environment Interdisciplinary staff education and training at all
levels Formalize screening and referral process Changes to dining organization and staffing duties Utilize expertise and unique perspective of OT
Future Work
Increase multidisciplinary collaboration
Increase knowledge base for OT through research Design and share educational programs across
disciplines and settings
Future Work
Explore and implement innovative approaches to feeding and eating assistance
Design programs specific to the dining experience of persons with dementia or cognitive impairment
Advocate with government and industry to promote
person centered care in LTC
Education is Key to Change
Industry leaders nursing home administrators and management need to be educated about the extent of malnutrition in nursing homes
There is a need for educational plans and instructional materials on preventing and treating malnutrition in LTC
Healthcare providers must take time to advocate with facilities and present educational workshops
Recognizing and preventing malnutrition in nursing homes
A teaching plan was developed and incorporated into
the coursework for the OTD 610 Practitioner as Educator course at Pacific University
An extensive literature review has been created to provide evidence and foundational knowledge for healthcare providers LTC administrators and stakeholders
Purpose
Educate skilled nursing facility administrators and management about effects of poor nutritional status skilled OT assessment analysis and Interventions improving nutritional status of residents enhancing the dining experience improving staff effectiveness and efficiency
Program Goal
LTC administrators and managers will demonstrate basic knowledge of effects of poor nutritional
status describe barriers to providing excellent nutritional care explain how skilled OT services contribute to proving holistic
nutritional care
Teaching Elements
Teaching Session
Lecture- group instruction Printed educational handouts Printed worksheets Interactive activities among learners Small and whole group discussions Self-reflection and sharing Resource table with additional learning tools Short video (added as a result of feedback to pilot
session)
Targeted learners
professionals in health care provision or administration
extensive experience in the long-term healthcare industry in the area of nutrition and dietary food service
men and women multicultural group 30 ndash 60 years of age
Setting
Intended LTC workshop Skilled nursing facility conference room during weekday
business hours
Pilot Group workshop Large open-plan diningliving space with participants around
large oval table
Outcome of Pilot
What would I do differently
Schedule more convenient time
Include more participants
Ask for feedback
More anonymous feedback option
simplify language
Proposed Changes to Workshop
Provide printed quiz to go with handouts Add video component Rework handouts for comprehension and
application to learners needs
Discussion
After learning more about the problem of malnutrition in long-term care are you considering how you might introduce this topic into your practice or your teaching
Are there other venues where this type of educational program is appropriate and might influence the management of nutritional care for elders
Questions
References
Abbasi AA amp Rudman D (1994) Undernutrition in the nursing home Prevalence consequences cause and prevention Nutrition Reviews 52(4) 113-122 Accreditation Council for Occupational Therapy Education (2006) ACOTE standards and interpretive guidelines Retrieved from
httpwwwaotaorgnonmembersarea13docs acotestandards806pdf Adams NE Bowie AJ Simmance N Murrary M amp Crowe T (2008) Recognition by medical and nursing professionals of malnutrition and risk of malnutrition in elderly hospitalised patients Nutrition and Dietetics (65) 144-150 Amella EJ (2002) Resistance at mealtimes for persons with dementia The Journal of Nutrition Health amp Aging 6 117-122 Amella EJ (2008) Mealtime difficulties In Evidence-Based Geriatric Nursing Protocols for Best Practice 3rd ed (Capezuti E Zwicker D Mezey M Fulmer T Gray-Miceli D amp Kluger M eds) Springer Publishing Company LLC New York p 337-351 American Occupational Therapy Association [AOTA] (2002) Occupational therapy practice framework Domain and process American Journal of Occupational Therapy 56
609ndash639 doi 105014ajot566609 AOTA (2007) Specialized knowledge and skills in feeding eating and swallowing for occupational therapy practice American Journal of Occupational Therapy 61(6) 686-700
doi 105014ajot616686 Asai JL (2004) Nutrition and the geriatric rehabilitation patient Challenges and solutions Topics in Geriatric Rehabilitation 20(1) 34-45 Baier RR Butterfield K Harris Y Gravenstein S (2008) Aiming for star performance the relationship between setting targets and improved nursing home quality of
care Journal of the American Medical Directors Association9(8) 594-9 Epub Dolhi C amp Rogers J (2009) Dementia nutrition and self-feeding A systematic review of the literature Occupational Therapy in Health Care 15(3-4) 59-87 Ferri C Prince M Brayne C Brodaty H Fratiglioni L Ganguli M hellip Landry G (2005) Global prevalence of dementia a delphi consensus study Lancet 366 2112-2217 Frisoni G Fanzoni S Rozzini R Ferrucci L Boffelli S amp Trabucchi M (1994) A nutritional index predicting mortality in the nursing home Journal of the American Geriatric Society 42 1167-1172 Furman EF (2006) Under-nutrition in older adults across the continuum of care Journal of Gerontological Nursing 32(1) 22-27 Groher ME amp Crary MA(2010) Dysphagia Clinical Management in Adults and Children Maryland Heights MO Mosby-Elsevier Harris-Kojetin L Sengupta M Park-Lee E Valverde R Long-term care services in the United States 2013 overview National health care statistics reports no 1 Hyattsville MD National Center for Health Statistics 2013
References
Horner J Alberts MJ Dawson DV Cook GM (1994) Swallowing in Alzheimerrsquos disease Alzheimer Disease Association Disorders 8 177 ndash 19 Kielhofner G (1985) A model of human occupation Baltimore Williams and Wilkins Lammes E amp Akner G (2006) Repeated assessment of energy and nutrient intake in 52 nursing home residents Journal of Nutritional Health and Aging 10(3) 222-30 Lin L-C Watson R amp Wu S-C (2010) What is associated with low food intake in older people with dementia Journal of Clinical Nursing 19 53-59 Doi 101111j1365-2702200902962x Maher D amp Eliad C (2014) Malnutrition in the elderly An unrecognized health issue Journal of Nursing Retrieved from httprnjournalcomjournal-of-nursingmalnutrition-in-the-elderly-an-unrecognized-health-issue Manthorpe J amp Watson R (2003) Poorly served Eating and dementia Journal of Advanced Nursing 41(2) 162-169 Nelson K Coultson A SucherKP amp Tseng R (1992) Prevalence of malnutrition in The elderly admitted to long-term-care facilities Journal of the American Dietetic Association 93(4) 459-460 Ott F Readman T amp Backman C (1990) Mealtimes of the institutionalized elderly A literature review Canadian Journal of Occupational Therapy 57(5) 261-267 Payette H (2002) Know related effects of nutrition on aging muscle function In Nutrition and Aging Vol 6 Ed by LH Rosenberg and A Sastre Nestle Workshop Series Clinical and Performance Program Nestec Ltd Vevey Switzerland P 135-150 Planetree amp Picker Institute (2010) Long term care improvement guide Retrieved from httpplanetreeorgwp-contentuploads201112LTC-Improvement-Guide-For-Downloadpdf Riviere S Gillerte-Guyonnet S Andrieu S Nourhashemi F Laugque S Cantet C hellip Vellas B (2002) Cognitive function and caregiver burden Predictive factors for eating behavior disorders in Alzhiemerrsquos disease International Journal of Geriatric Psychiatry 17 950-955 Schussler S Dassen T amp Lohrmann C (2014) Prevalence of care dependency and nursing care problems in nursing home residents with dementia A literature review International Journal of Caring Sciences 7(2) 339 Retrieved from httpwwwinternationaljournalofcaringsciencesorgdocs120SchC3BCssler-1pdf
References
Scott TM Peter L Tucker KL Arsenault L Bergethon P Bhadelia R hellip Folstein M (2006) The Nutrition Aging and Memory in Elders (NAME) study Design and methods for a study of micronutrients and cognitive function in a homebound elderly population International Journal of Geriatric Psychiatry 21(6) 519-528
doi101002gps1503735 Simmons SF Keeler E Zhuo X Hickey KA Sato HW amp Schnelle JF (2008) Prevention of unintentional weight loss in nursing home residents a controlled trial of feeding assistance Journal of American Geriatric Society 56(8) 1466-1473
Doi101111j1532-5415200801801x Sodderhamn U Backrach-Lindstrom M amp Ek AC (2007) Nutritional screening and perceived health in a group of geriatric rehabilitation patients Journal of Clinical Nursing (16) 1997-2006 Thomas DR Ashmen W Morley JE Evans WJ amp the Council for Nutritional Strategies in Long-Term Care (2000) Nutritional management in long-term care Development of a clinical guideline Journal of Gerontolology Biological Sciences and Medical Sciences 55A(12) M725- doi101093Gerona5512M725 Wu S amp Barker JC (2008) Hot tea and Juk The institutional meaning of food for Chinese elders in an American nursing home Journal of Gerontological Nursing 34(11) 46-45 doi10392800989134-20081101-11
E L I Z A B E T H C B A I R b a i r 0 7 1 2 p a c i f i c u e d u
Thank You
Prevalence
Each day in 2012 there were 1383700 residents in nursing homes (Harris-Kojetin Sengupta Park-Lee amp Valverde 2013)
Between 35 and 85 of older adults in nursing homes experience some level of malnutrition (Furman 2006)
Percentage of adults with dementia and malnutrition in nursing homes range from 14 - 56
Schussler S Dassen T amp Lohrmann C (2014)
Factors in Malnutrition
Natural aging processes Chronic medical conditions Cognitive impairment Disease Injury Frailty Environments
(Scott et al 2006 Thomas Ashmen Morley Evans amp the Council for Nutritional Strategies in Long-Term Care 2000)
Signs and Symptoms
skin breakdown and pressure wounds
anemia fatigue muscle weakness and
wasting dry skin dull dry hair and hair loss conjunctival dryness receding gums or a change in
how their dentures fit
increasing levels of confusion
loss of appetite or interest in mealtimes
loss of sensation (touch taste smell changes in vision)
Consequences of Malnutrition
Secondary health complications Postoperative complications Decreased functional independence Cognitive loss Increased mortality rates Decreased quality of life Increased costs of healthcare
Barriers to Good Nutritional Status
Lack of knowledge about risk factors No formalized screening and assessment Inadequate staff to resident ratios Lack of training in feeding and eating assistance Limited communication between disciplines Lack of understanding of impact of dementia Inattention to the cultural and personal context of
mealtime Lack of social supports
Dementia and Malnutrition
Six factors that predict low food intake Eating difficulty No feeding assistance by caregivers Moderate dependence in activities of daily living Fewer family visits Being female Older age
(Lin Watson amp Wu 2010)
Dementia and Malnutrition
It is estimated that up to 45 of people with dementia living in institutions have swallowing
difficulties (Horner Alberts Dawson amp Cook 1994)
Effects of Increased Assistance
Increases in total daily calorie intake Residents maintain or gain weight Reduced secondary health complications Improved relationship between resident and staff Improved quality of life
Role of Occupational Therapy
OTs and OTAs have foundational skills and knowledge in eating feeding and
swallowing understanding of multidimensional aspects of eating expertise in assessment evaluation and treatment a holistic view to bring to nutritional care
OT Interventions
Attention to psychosocial aspects of dining Environmental modification Adaptive equipment Dysphagia assessment and treatment Positioning Task analysis Residents Staff
Caregiver and dining assistant training Sensory integration issues internal and external
Culture Change
ldquoCulture change is an innovation anchored in values and beliefs that return the locus of control to elders and those who work closest with them Its ultimate vision is to create a culture of aging that is inclusive life-affirming satisfying humane and meaningfulrdquo
(Kantor B amp Planetree amp Picker Institute 2010)
Trends in Culture Change
Emphasis on resident choice and person-centered care as essential components to improve dining experiences
Culture change requires transformation in organizational practices physical environments workplace practices communication and relationships among all stakeholders
Benefits of Culture Change
LTCs who implement cultural changeshellip Improve quality-of-life for residents patients and staff
Increase performance on clinical outcomes
(Planetree amp Picker Institute 2010 Baier Butterfield Harris amp Gravenstei 2008)
Experience positive effects on occupancy rates and the financial bottom line of LTC (Doty Koren amp Sturla 2008 Elliot 2010 LaPorte 2010)
Key Points for Program amp Culture Change
Residents are unique individuals Facility leadership must seek further education Leaders must support the changes in environment Interdisciplinary staff education and training at all
levels Formalize screening and referral process Changes to dining organization and staffing duties Utilize expertise and unique perspective of OT
Future Work
Increase multidisciplinary collaboration
Increase knowledge base for OT through research Design and share educational programs across
disciplines and settings
Future Work
Explore and implement innovative approaches to feeding and eating assistance
Design programs specific to the dining experience of persons with dementia or cognitive impairment
Advocate with government and industry to promote
person centered care in LTC
Education is Key to Change
Industry leaders nursing home administrators and management need to be educated about the extent of malnutrition in nursing homes
There is a need for educational plans and instructional materials on preventing and treating malnutrition in LTC
Healthcare providers must take time to advocate with facilities and present educational workshops
Recognizing and preventing malnutrition in nursing homes
A teaching plan was developed and incorporated into
the coursework for the OTD 610 Practitioner as Educator course at Pacific University
An extensive literature review has been created to provide evidence and foundational knowledge for healthcare providers LTC administrators and stakeholders
Purpose
Educate skilled nursing facility administrators and management about effects of poor nutritional status skilled OT assessment analysis and Interventions improving nutritional status of residents enhancing the dining experience improving staff effectiveness and efficiency
Program Goal
LTC administrators and managers will demonstrate basic knowledge of effects of poor nutritional
status describe barriers to providing excellent nutritional care explain how skilled OT services contribute to proving holistic
nutritional care
Teaching Elements
Teaching Session
Lecture- group instruction Printed educational handouts Printed worksheets Interactive activities among learners Small and whole group discussions Self-reflection and sharing Resource table with additional learning tools Short video (added as a result of feedback to pilot
session)
Targeted learners
professionals in health care provision or administration
extensive experience in the long-term healthcare industry in the area of nutrition and dietary food service
men and women multicultural group 30 ndash 60 years of age
Setting
Intended LTC workshop Skilled nursing facility conference room during weekday
business hours
Pilot Group workshop Large open-plan diningliving space with participants around
large oval table
Outcome of Pilot
What would I do differently
Schedule more convenient time
Include more participants
Ask for feedback
More anonymous feedback option
simplify language
Proposed Changes to Workshop
Provide printed quiz to go with handouts Add video component Rework handouts for comprehension and
application to learners needs
Discussion
After learning more about the problem of malnutrition in long-term care are you considering how you might introduce this topic into your practice or your teaching
Are there other venues where this type of educational program is appropriate and might influence the management of nutritional care for elders
Questions
References
Abbasi AA amp Rudman D (1994) Undernutrition in the nursing home Prevalence consequences cause and prevention Nutrition Reviews 52(4) 113-122 Accreditation Council for Occupational Therapy Education (2006) ACOTE standards and interpretive guidelines Retrieved from
httpwwwaotaorgnonmembersarea13docs acotestandards806pdf Adams NE Bowie AJ Simmance N Murrary M amp Crowe T (2008) Recognition by medical and nursing professionals of malnutrition and risk of malnutrition in elderly hospitalised patients Nutrition and Dietetics (65) 144-150 Amella EJ (2002) Resistance at mealtimes for persons with dementia The Journal of Nutrition Health amp Aging 6 117-122 Amella EJ (2008) Mealtime difficulties In Evidence-Based Geriatric Nursing Protocols for Best Practice 3rd ed (Capezuti E Zwicker D Mezey M Fulmer T Gray-Miceli D amp Kluger M eds) Springer Publishing Company LLC New York p 337-351 American Occupational Therapy Association [AOTA] (2002) Occupational therapy practice framework Domain and process American Journal of Occupational Therapy 56
609ndash639 doi 105014ajot566609 AOTA (2007) Specialized knowledge and skills in feeding eating and swallowing for occupational therapy practice American Journal of Occupational Therapy 61(6) 686-700
doi 105014ajot616686 Asai JL (2004) Nutrition and the geriatric rehabilitation patient Challenges and solutions Topics in Geriatric Rehabilitation 20(1) 34-45 Baier RR Butterfield K Harris Y Gravenstein S (2008) Aiming for star performance the relationship between setting targets and improved nursing home quality of
care Journal of the American Medical Directors Association9(8) 594-9 Epub Dolhi C amp Rogers J (2009) Dementia nutrition and self-feeding A systematic review of the literature Occupational Therapy in Health Care 15(3-4) 59-87 Ferri C Prince M Brayne C Brodaty H Fratiglioni L Ganguli M hellip Landry G (2005) Global prevalence of dementia a delphi consensus study Lancet 366 2112-2217 Frisoni G Fanzoni S Rozzini R Ferrucci L Boffelli S amp Trabucchi M (1994) A nutritional index predicting mortality in the nursing home Journal of the American Geriatric Society 42 1167-1172 Furman EF (2006) Under-nutrition in older adults across the continuum of care Journal of Gerontological Nursing 32(1) 22-27 Groher ME amp Crary MA(2010) Dysphagia Clinical Management in Adults and Children Maryland Heights MO Mosby-Elsevier Harris-Kojetin L Sengupta M Park-Lee E Valverde R Long-term care services in the United States 2013 overview National health care statistics reports no 1 Hyattsville MD National Center for Health Statistics 2013
References
Horner J Alberts MJ Dawson DV Cook GM (1994) Swallowing in Alzheimerrsquos disease Alzheimer Disease Association Disorders 8 177 ndash 19 Kielhofner G (1985) A model of human occupation Baltimore Williams and Wilkins Lammes E amp Akner G (2006) Repeated assessment of energy and nutrient intake in 52 nursing home residents Journal of Nutritional Health and Aging 10(3) 222-30 Lin L-C Watson R amp Wu S-C (2010) What is associated with low food intake in older people with dementia Journal of Clinical Nursing 19 53-59 Doi 101111j1365-2702200902962x Maher D amp Eliad C (2014) Malnutrition in the elderly An unrecognized health issue Journal of Nursing Retrieved from httprnjournalcomjournal-of-nursingmalnutrition-in-the-elderly-an-unrecognized-health-issue Manthorpe J amp Watson R (2003) Poorly served Eating and dementia Journal of Advanced Nursing 41(2) 162-169 Nelson K Coultson A SucherKP amp Tseng R (1992) Prevalence of malnutrition in The elderly admitted to long-term-care facilities Journal of the American Dietetic Association 93(4) 459-460 Ott F Readman T amp Backman C (1990) Mealtimes of the institutionalized elderly A literature review Canadian Journal of Occupational Therapy 57(5) 261-267 Payette H (2002) Know related effects of nutrition on aging muscle function In Nutrition and Aging Vol 6 Ed by LH Rosenberg and A Sastre Nestle Workshop Series Clinical and Performance Program Nestec Ltd Vevey Switzerland P 135-150 Planetree amp Picker Institute (2010) Long term care improvement guide Retrieved from httpplanetreeorgwp-contentuploads201112LTC-Improvement-Guide-For-Downloadpdf Riviere S Gillerte-Guyonnet S Andrieu S Nourhashemi F Laugque S Cantet C hellip Vellas B (2002) Cognitive function and caregiver burden Predictive factors for eating behavior disorders in Alzhiemerrsquos disease International Journal of Geriatric Psychiatry 17 950-955 Schussler S Dassen T amp Lohrmann C (2014) Prevalence of care dependency and nursing care problems in nursing home residents with dementia A literature review International Journal of Caring Sciences 7(2) 339 Retrieved from httpwwwinternationaljournalofcaringsciencesorgdocs120SchC3BCssler-1pdf
References
Scott TM Peter L Tucker KL Arsenault L Bergethon P Bhadelia R hellip Folstein M (2006) The Nutrition Aging and Memory in Elders (NAME) study Design and methods for a study of micronutrients and cognitive function in a homebound elderly population International Journal of Geriatric Psychiatry 21(6) 519-528
doi101002gps1503735 Simmons SF Keeler E Zhuo X Hickey KA Sato HW amp Schnelle JF (2008) Prevention of unintentional weight loss in nursing home residents a controlled trial of feeding assistance Journal of American Geriatric Society 56(8) 1466-1473
Doi101111j1532-5415200801801x Sodderhamn U Backrach-Lindstrom M amp Ek AC (2007) Nutritional screening and perceived health in a group of geriatric rehabilitation patients Journal of Clinical Nursing (16) 1997-2006 Thomas DR Ashmen W Morley JE Evans WJ amp the Council for Nutritional Strategies in Long-Term Care (2000) Nutritional management in long-term care Development of a clinical guideline Journal of Gerontolology Biological Sciences and Medical Sciences 55A(12) M725- doi101093Gerona5512M725 Wu S amp Barker JC (2008) Hot tea and Juk The institutional meaning of food for Chinese elders in an American nursing home Journal of Gerontological Nursing 34(11) 46-45 doi10392800989134-20081101-11
E L I Z A B E T H C B A I R b a i r 0 7 1 2 p a c i f i c u e d u
Thank You
Factors in Malnutrition
Natural aging processes Chronic medical conditions Cognitive impairment Disease Injury Frailty Environments
(Scott et al 2006 Thomas Ashmen Morley Evans amp the Council for Nutritional Strategies in Long-Term Care 2000)
Signs and Symptoms
skin breakdown and pressure wounds
anemia fatigue muscle weakness and
wasting dry skin dull dry hair and hair loss conjunctival dryness receding gums or a change in
how their dentures fit
increasing levels of confusion
loss of appetite or interest in mealtimes
loss of sensation (touch taste smell changes in vision)
Consequences of Malnutrition
Secondary health complications Postoperative complications Decreased functional independence Cognitive loss Increased mortality rates Decreased quality of life Increased costs of healthcare
Barriers to Good Nutritional Status
Lack of knowledge about risk factors No formalized screening and assessment Inadequate staff to resident ratios Lack of training in feeding and eating assistance Limited communication between disciplines Lack of understanding of impact of dementia Inattention to the cultural and personal context of
mealtime Lack of social supports
Dementia and Malnutrition
Six factors that predict low food intake Eating difficulty No feeding assistance by caregivers Moderate dependence in activities of daily living Fewer family visits Being female Older age
(Lin Watson amp Wu 2010)
Dementia and Malnutrition
It is estimated that up to 45 of people with dementia living in institutions have swallowing
difficulties (Horner Alberts Dawson amp Cook 1994)
Effects of Increased Assistance
Increases in total daily calorie intake Residents maintain or gain weight Reduced secondary health complications Improved relationship between resident and staff Improved quality of life
Role of Occupational Therapy
OTs and OTAs have foundational skills and knowledge in eating feeding and
swallowing understanding of multidimensional aspects of eating expertise in assessment evaluation and treatment a holistic view to bring to nutritional care
OT Interventions
Attention to psychosocial aspects of dining Environmental modification Adaptive equipment Dysphagia assessment and treatment Positioning Task analysis Residents Staff
Caregiver and dining assistant training Sensory integration issues internal and external
Culture Change
ldquoCulture change is an innovation anchored in values and beliefs that return the locus of control to elders and those who work closest with them Its ultimate vision is to create a culture of aging that is inclusive life-affirming satisfying humane and meaningfulrdquo
(Kantor B amp Planetree amp Picker Institute 2010)
Trends in Culture Change
Emphasis on resident choice and person-centered care as essential components to improve dining experiences
Culture change requires transformation in organizational practices physical environments workplace practices communication and relationships among all stakeholders
Benefits of Culture Change
LTCs who implement cultural changeshellip Improve quality-of-life for residents patients and staff
Increase performance on clinical outcomes
(Planetree amp Picker Institute 2010 Baier Butterfield Harris amp Gravenstei 2008)
Experience positive effects on occupancy rates and the financial bottom line of LTC (Doty Koren amp Sturla 2008 Elliot 2010 LaPorte 2010)
Key Points for Program amp Culture Change
Residents are unique individuals Facility leadership must seek further education Leaders must support the changes in environment Interdisciplinary staff education and training at all
levels Formalize screening and referral process Changes to dining organization and staffing duties Utilize expertise and unique perspective of OT
Future Work
Increase multidisciplinary collaboration
Increase knowledge base for OT through research Design and share educational programs across
disciplines and settings
Future Work
Explore and implement innovative approaches to feeding and eating assistance
Design programs specific to the dining experience of persons with dementia or cognitive impairment
Advocate with government and industry to promote
person centered care in LTC
Education is Key to Change
Industry leaders nursing home administrators and management need to be educated about the extent of malnutrition in nursing homes
There is a need for educational plans and instructional materials on preventing and treating malnutrition in LTC
Healthcare providers must take time to advocate with facilities and present educational workshops
Recognizing and preventing malnutrition in nursing homes
A teaching plan was developed and incorporated into
the coursework for the OTD 610 Practitioner as Educator course at Pacific University
An extensive literature review has been created to provide evidence and foundational knowledge for healthcare providers LTC administrators and stakeholders
Purpose
Educate skilled nursing facility administrators and management about effects of poor nutritional status skilled OT assessment analysis and Interventions improving nutritional status of residents enhancing the dining experience improving staff effectiveness and efficiency
Program Goal
LTC administrators and managers will demonstrate basic knowledge of effects of poor nutritional
status describe barriers to providing excellent nutritional care explain how skilled OT services contribute to proving holistic
nutritional care
Teaching Elements
Teaching Session
Lecture- group instruction Printed educational handouts Printed worksheets Interactive activities among learners Small and whole group discussions Self-reflection and sharing Resource table with additional learning tools Short video (added as a result of feedback to pilot
session)
Targeted learners
professionals in health care provision or administration
extensive experience in the long-term healthcare industry in the area of nutrition and dietary food service
men and women multicultural group 30 ndash 60 years of age
Setting
Intended LTC workshop Skilled nursing facility conference room during weekday
business hours
Pilot Group workshop Large open-plan diningliving space with participants around
large oval table
Outcome of Pilot
What would I do differently
Schedule more convenient time
Include more participants
Ask for feedback
More anonymous feedback option
simplify language
Proposed Changes to Workshop
Provide printed quiz to go with handouts Add video component Rework handouts for comprehension and
application to learners needs
Discussion
After learning more about the problem of malnutrition in long-term care are you considering how you might introduce this topic into your practice or your teaching
Are there other venues where this type of educational program is appropriate and might influence the management of nutritional care for elders
Questions
References
Abbasi AA amp Rudman D (1994) Undernutrition in the nursing home Prevalence consequences cause and prevention Nutrition Reviews 52(4) 113-122 Accreditation Council for Occupational Therapy Education (2006) ACOTE standards and interpretive guidelines Retrieved from
httpwwwaotaorgnonmembersarea13docs acotestandards806pdf Adams NE Bowie AJ Simmance N Murrary M amp Crowe T (2008) Recognition by medical and nursing professionals of malnutrition and risk of malnutrition in elderly hospitalised patients Nutrition and Dietetics (65) 144-150 Amella EJ (2002) Resistance at mealtimes for persons with dementia The Journal of Nutrition Health amp Aging 6 117-122 Amella EJ (2008) Mealtime difficulties In Evidence-Based Geriatric Nursing Protocols for Best Practice 3rd ed (Capezuti E Zwicker D Mezey M Fulmer T Gray-Miceli D amp Kluger M eds) Springer Publishing Company LLC New York p 337-351 American Occupational Therapy Association [AOTA] (2002) Occupational therapy practice framework Domain and process American Journal of Occupational Therapy 56
609ndash639 doi 105014ajot566609 AOTA (2007) Specialized knowledge and skills in feeding eating and swallowing for occupational therapy practice American Journal of Occupational Therapy 61(6) 686-700
doi 105014ajot616686 Asai JL (2004) Nutrition and the geriatric rehabilitation patient Challenges and solutions Topics in Geriatric Rehabilitation 20(1) 34-45 Baier RR Butterfield K Harris Y Gravenstein S (2008) Aiming for star performance the relationship between setting targets and improved nursing home quality of
care Journal of the American Medical Directors Association9(8) 594-9 Epub Dolhi C amp Rogers J (2009) Dementia nutrition and self-feeding A systematic review of the literature Occupational Therapy in Health Care 15(3-4) 59-87 Ferri C Prince M Brayne C Brodaty H Fratiglioni L Ganguli M hellip Landry G (2005) Global prevalence of dementia a delphi consensus study Lancet 366 2112-2217 Frisoni G Fanzoni S Rozzini R Ferrucci L Boffelli S amp Trabucchi M (1994) A nutritional index predicting mortality in the nursing home Journal of the American Geriatric Society 42 1167-1172 Furman EF (2006) Under-nutrition in older adults across the continuum of care Journal of Gerontological Nursing 32(1) 22-27 Groher ME amp Crary MA(2010) Dysphagia Clinical Management in Adults and Children Maryland Heights MO Mosby-Elsevier Harris-Kojetin L Sengupta M Park-Lee E Valverde R Long-term care services in the United States 2013 overview National health care statistics reports no 1 Hyattsville MD National Center for Health Statistics 2013
References
Horner J Alberts MJ Dawson DV Cook GM (1994) Swallowing in Alzheimerrsquos disease Alzheimer Disease Association Disorders 8 177 ndash 19 Kielhofner G (1985) A model of human occupation Baltimore Williams and Wilkins Lammes E amp Akner G (2006) Repeated assessment of energy and nutrient intake in 52 nursing home residents Journal of Nutritional Health and Aging 10(3) 222-30 Lin L-C Watson R amp Wu S-C (2010) What is associated with low food intake in older people with dementia Journal of Clinical Nursing 19 53-59 Doi 101111j1365-2702200902962x Maher D amp Eliad C (2014) Malnutrition in the elderly An unrecognized health issue Journal of Nursing Retrieved from httprnjournalcomjournal-of-nursingmalnutrition-in-the-elderly-an-unrecognized-health-issue Manthorpe J amp Watson R (2003) Poorly served Eating and dementia Journal of Advanced Nursing 41(2) 162-169 Nelson K Coultson A SucherKP amp Tseng R (1992) Prevalence of malnutrition in The elderly admitted to long-term-care facilities Journal of the American Dietetic Association 93(4) 459-460 Ott F Readman T amp Backman C (1990) Mealtimes of the institutionalized elderly A literature review Canadian Journal of Occupational Therapy 57(5) 261-267 Payette H (2002) Know related effects of nutrition on aging muscle function In Nutrition and Aging Vol 6 Ed by LH Rosenberg and A Sastre Nestle Workshop Series Clinical and Performance Program Nestec Ltd Vevey Switzerland P 135-150 Planetree amp Picker Institute (2010) Long term care improvement guide Retrieved from httpplanetreeorgwp-contentuploads201112LTC-Improvement-Guide-For-Downloadpdf Riviere S Gillerte-Guyonnet S Andrieu S Nourhashemi F Laugque S Cantet C hellip Vellas B (2002) Cognitive function and caregiver burden Predictive factors for eating behavior disorders in Alzhiemerrsquos disease International Journal of Geriatric Psychiatry 17 950-955 Schussler S Dassen T amp Lohrmann C (2014) Prevalence of care dependency and nursing care problems in nursing home residents with dementia A literature review International Journal of Caring Sciences 7(2) 339 Retrieved from httpwwwinternationaljournalofcaringsciencesorgdocs120SchC3BCssler-1pdf
References
Scott TM Peter L Tucker KL Arsenault L Bergethon P Bhadelia R hellip Folstein M (2006) The Nutrition Aging and Memory in Elders (NAME) study Design and methods for a study of micronutrients and cognitive function in a homebound elderly population International Journal of Geriatric Psychiatry 21(6) 519-528
doi101002gps1503735 Simmons SF Keeler E Zhuo X Hickey KA Sato HW amp Schnelle JF (2008) Prevention of unintentional weight loss in nursing home residents a controlled trial of feeding assistance Journal of American Geriatric Society 56(8) 1466-1473
Doi101111j1532-5415200801801x Sodderhamn U Backrach-Lindstrom M amp Ek AC (2007) Nutritional screening and perceived health in a group of geriatric rehabilitation patients Journal of Clinical Nursing (16) 1997-2006 Thomas DR Ashmen W Morley JE Evans WJ amp the Council for Nutritional Strategies in Long-Term Care (2000) Nutritional management in long-term care Development of a clinical guideline Journal of Gerontolology Biological Sciences and Medical Sciences 55A(12) M725- doi101093Gerona5512M725 Wu S amp Barker JC (2008) Hot tea and Juk The institutional meaning of food for Chinese elders in an American nursing home Journal of Gerontological Nursing 34(11) 46-45 doi10392800989134-20081101-11
E L I Z A B E T H C B A I R b a i r 0 7 1 2 p a c i f i c u e d u
Thank You
Signs and Symptoms
skin breakdown and pressure wounds
anemia fatigue muscle weakness and
wasting dry skin dull dry hair and hair loss conjunctival dryness receding gums or a change in
how their dentures fit
increasing levels of confusion
loss of appetite or interest in mealtimes
loss of sensation (touch taste smell changes in vision)
Consequences of Malnutrition
Secondary health complications Postoperative complications Decreased functional independence Cognitive loss Increased mortality rates Decreased quality of life Increased costs of healthcare
Barriers to Good Nutritional Status
Lack of knowledge about risk factors No formalized screening and assessment Inadequate staff to resident ratios Lack of training in feeding and eating assistance Limited communication between disciplines Lack of understanding of impact of dementia Inattention to the cultural and personal context of
mealtime Lack of social supports
Dementia and Malnutrition
Six factors that predict low food intake Eating difficulty No feeding assistance by caregivers Moderate dependence in activities of daily living Fewer family visits Being female Older age
(Lin Watson amp Wu 2010)
Dementia and Malnutrition
It is estimated that up to 45 of people with dementia living in institutions have swallowing
difficulties (Horner Alberts Dawson amp Cook 1994)
Effects of Increased Assistance
Increases in total daily calorie intake Residents maintain or gain weight Reduced secondary health complications Improved relationship between resident and staff Improved quality of life
Role of Occupational Therapy
OTs and OTAs have foundational skills and knowledge in eating feeding and
swallowing understanding of multidimensional aspects of eating expertise in assessment evaluation and treatment a holistic view to bring to nutritional care
OT Interventions
Attention to psychosocial aspects of dining Environmental modification Adaptive equipment Dysphagia assessment and treatment Positioning Task analysis Residents Staff
Caregiver and dining assistant training Sensory integration issues internal and external
Culture Change
ldquoCulture change is an innovation anchored in values and beliefs that return the locus of control to elders and those who work closest with them Its ultimate vision is to create a culture of aging that is inclusive life-affirming satisfying humane and meaningfulrdquo
(Kantor B amp Planetree amp Picker Institute 2010)
Trends in Culture Change
Emphasis on resident choice and person-centered care as essential components to improve dining experiences
Culture change requires transformation in organizational practices physical environments workplace practices communication and relationships among all stakeholders
Benefits of Culture Change
LTCs who implement cultural changeshellip Improve quality-of-life for residents patients and staff
Increase performance on clinical outcomes
(Planetree amp Picker Institute 2010 Baier Butterfield Harris amp Gravenstei 2008)
Experience positive effects on occupancy rates and the financial bottom line of LTC (Doty Koren amp Sturla 2008 Elliot 2010 LaPorte 2010)
Key Points for Program amp Culture Change
Residents are unique individuals Facility leadership must seek further education Leaders must support the changes in environment Interdisciplinary staff education and training at all
levels Formalize screening and referral process Changes to dining organization and staffing duties Utilize expertise and unique perspective of OT
Future Work
Increase multidisciplinary collaboration
Increase knowledge base for OT through research Design and share educational programs across
disciplines and settings
Future Work
Explore and implement innovative approaches to feeding and eating assistance
Design programs specific to the dining experience of persons with dementia or cognitive impairment
Advocate with government and industry to promote
person centered care in LTC
Education is Key to Change
Industry leaders nursing home administrators and management need to be educated about the extent of malnutrition in nursing homes
There is a need for educational plans and instructional materials on preventing and treating malnutrition in LTC
Healthcare providers must take time to advocate with facilities and present educational workshops
Recognizing and preventing malnutrition in nursing homes
A teaching plan was developed and incorporated into
the coursework for the OTD 610 Practitioner as Educator course at Pacific University
An extensive literature review has been created to provide evidence and foundational knowledge for healthcare providers LTC administrators and stakeholders
Purpose
Educate skilled nursing facility administrators and management about effects of poor nutritional status skilled OT assessment analysis and Interventions improving nutritional status of residents enhancing the dining experience improving staff effectiveness and efficiency
Program Goal
LTC administrators and managers will demonstrate basic knowledge of effects of poor nutritional
status describe barriers to providing excellent nutritional care explain how skilled OT services contribute to proving holistic
nutritional care
Teaching Elements
Teaching Session
Lecture- group instruction Printed educational handouts Printed worksheets Interactive activities among learners Small and whole group discussions Self-reflection and sharing Resource table with additional learning tools Short video (added as a result of feedback to pilot
session)
Targeted learners
professionals in health care provision or administration
extensive experience in the long-term healthcare industry in the area of nutrition and dietary food service
men and women multicultural group 30 ndash 60 years of age
Setting
Intended LTC workshop Skilled nursing facility conference room during weekday
business hours
Pilot Group workshop Large open-plan diningliving space with participants around
large oval table
Outcome of Pilot
What would I do differently
Schedule more convenient time
Include more participants
Ask for feedback
More anonymous feedback option
simplify language
Proposed Changes to Workshop
Provide printed quiz to go with handouts Add video component Rework handouts for comprehension and
application to learners needs
Discussion
After learning more about the problem of malnutrition in long-term care are you considering how you might introduce this topic into your practice or your teaching
Are there other venues where this type of educational program is appropriate and might influence the management of nutritional care for elders
Questions
References
Abbasi AA amp Rudman D (1994) Undernutrition in the nursing home Prevalence consequences cause and prevention Nutrition Reviews 52(4) 113-122 Accreditation Council for Occupational Therapy Education (2006) ACOTE standards and interpretive guidelines Retrieved from
httpwwwaotaorgnonmembersarea13docs acotestandards806pdf Adams NE Bowie AJ Simmance N Murrary M amp Crowe T (2008) Recognition by medical and nursing professionals of malnutrition and risk of malnutrition in elderly hospitalised patients Nutrition and Dietetics (65) 144-150 Amella EJ (2002) Resistance at mealtimes for persons with dementia The Journal of Nutrition Health amp Aging 6 117-122 Amella EJ (2008) Mealtime difficulties In Evidence-Based Geriatric Nursing Protocols for Best Practice 3rd ed (Capezuti E Zwicker D Mezey M Fulmer T Gray-Miceli D amp Kluger M eds) Springer Publishing Company LLC New York p 337-351 American Occupational Therapy Association [AOTA] (2002) Occupational therapy practice framework Domain and process American Journal of Occupational Therapy 56
609ndash639 doi 105014ajot566609 AOTA (2007) Specialized knowledge and skills in feeding eating and swallowing for occupational therapy practice American Journal of Occupational Therapy 61(6) 686-700
doi 105014ajot616686 Asai JL (2004) Nutrition and the geriatric rehabilitation patient Challenges and solutions Topics in Geriatric Rehabilitation 20(1) 34-45 Baier RR Butterfield K Harris Y Gravenstein S (2008) Aiming for star performance the relationship between setting targets and improved nursing home quality of
care Journal of the American Medical Directors Association9(8) 594-9 Epub Dolhi C amp Rogers J (2009) Dementia nutrition and self-feeding A systematic review of the literature Occupational Therapy in Health Care 15(3-4) 59-87 Ferri C Prince M Brayne C Brodaty H Fratiglioni L Ganguli M hellip Landry G (2005) Global prevalence of dementia a delphi consensus study Lancet 366 2112-2217 Frisoni G Fanzoni S Rozzini R Ferrucci L Boffelli S amp Trabucchi M (1994) A nutritional index predicting mortality in the nursing home Journal of the American Geriatric Society 42 1167-1172 Furman EF (2006) Under-nutrition in older adults across the continuum of care Journal of Gerontological Nursing 32(1) 22-27 Groher ME amp Crary MA(2010) Dysphagia Clinical Management in Adults and Children Maryland Heights MO Mosby-Elsevier Harris-Kojetin L Sengupta M Park-Lee E Valverde R Long-term care services in the United States 2013 overview National health care statistics reports no 1 Hyattsville MD National Center for Health Statistics 2013
References
Horner J Alberts MJ Dawson DV Cook GM (1994) Swallowing in Alzheimerrsquos disease Alzheimer Disease Association Disorders 8 177 ndash 19 Kielhofner G (1985) A model of human occupation Baltimore Williams and Wilkins Lammes E amp Akner G (2006) Repeated assessment of energy and nutrient intake in 52 nursing home residents Journal of Nutritional Health and Aging 10(3) 222-30 Lin L-C Watson R amp Wu S-C (2010) What is associated with low food intake in older people with dementia Journal of Clinical Nursing 19 53-59 Doi 101111j1365-2702200902962x Maher D amp Eliad C (2014) Malnutrition in the elderly An unrecognized health issue Journal of Nursing Retrieved from httprnjournalcomjournal-of-nursingmalnutrition-in-the-elderly-an-unrecognized-health-issue Manthorpe J amp Watson R (2003) Poorly served Eating and dementia Journal of Advanced Nursing 41(2) 162-169 Nelson K Coultson A SucherKP amp Tseng R (1992) Prevalence of malnutrition in The elderly admitted to long-term-care facilities Journal of the American Dietetic Association 93(4) 459-460 Ott F Readman T amp Backman C (1990) Mealtimes of the institutionalized elderly A literature review Canadian Journal of Occupational Therapy 57(5) 261-267 Payette H (2002) Know related effects of nutrition on aging muscle function In Nutrition and Aging Vol 6 Ed by LH Rosenberg and A Sastre Nestle Workshop Series Clinical and Performance Program Nestec Ltd Vevey Switzerland P 135-150 Planetree amp Picker Institute (2010) Long term care improvement guide Retrieved from httpplanetreeorgwp-contentuploads201112LTC-Improvement-Guide-For-Downloadpdf Riviere S Gillerte-Guyonnet S Andrieu S Nourhashemi F Laugque S Cantet C hellip Vellas B (2002) Cognitive function and caregiver burden Predictive factors for eating behavior disorders in Alzhiemerrsquos disease International Journal of Geriatric Psychiatry 17 950-955 Schussler S Dassen T amp Lohrmann C (2014) Prevalence of care dependency and nursing care problems in nursing home residents with dementia A literature review International Journal of Caring Sciences 7(2) 339 Retrieved from httpwwwinternationaljournalofcaringsciencesorgdocs120SchC3BCssler-1pdf
References
Scott TM Peter L Tucker KL Arsenault L Bergethon P Bhadelia R hellip Folstein M (2006) The Nutrition Aging and Memory in Elders (NAME) study Design and methods for a study of micronutrients and cognitive function in a homebound elderly population International Journal of Geriatric Psychiatry 21(6) 519-528
doi101002gps1503735 Simmons SF Keeler E Zhuo X Hickey KA Sato HW amp Schnelle JF (2008) Prevention of unintentional weight loss in nursing home residents a controlled trial of feeding assistance Journal of American Geriatric Society 56(8) 1466-1473
Doi101111j1532-5415200801801x Sodderhamn U Backrach-Lindstrom M amp Ek AC (2007) Nutritional screening and perceived health in a group of geriatric rehabilitation patients Journal of Clinical Nursing (16) 1997-2006 Thomas DR Ashmen W Morley JE Evans WJ amp the Council for Nutritional Strategies in Long-Term Care (2000) Nutritional management in long-term care Development of a clinical guideline Journal of Gerontolology Biological Sciences and Medical Sciences 55A(12) M725- doi101093Gerona5512M725 Wu S amp Barker JC (2008) Hot tea and Juk The institutional meaning of food for Chinese elders in an American nursing home Journal of Gerontological Nursing 34(11) 46-45 doi10392800989134-20081101-11
E L I Z A B E T H C B A I R b a i r 0 7 1 2 p a c i f i c u e d u
Thank You
Consequences of Malnutrition
Secondary health complications Postoperative complications Decreased functional independence Cognitive loss Increased mortality rates Decreased quality of life Increased costs of healthcare
Barriers to Good Nutritional Status
Lack of knowledge about risk factors No formalized screening and assessment Inadequate staff to resident ratios Lack of training in feeding and eating assistance Limited communication between disciplines Lack of understanding of impact of dementia Inattention to the cultural and personal context of
mealtime Lack of social supports
Dementia and Malnutrition
Six factors that predict low food intake Eating difficulty No feeding assistance by caregivers Moderate dependence in activities of daily living Fewer family visits Being female Older age
(Lin Watson amp Wu 2010)
Dementia and Malnutrition
It is estimated that up to 45 of people with dementia living in institutions have swallowing
difficulties (Horner Alberts Dawson amp Cook 1994)
Effects of Increased Assistance
Increases in total daily calorie intake Residents maintain or gain weight Reduced secondary health complications Improved relationship between resident and staff Improved quality of life
Role of Occupational Therapy
OTs and OTAs have foundational skills and knowledge in eating feeding and
swallowing understanding of multidimensional aspects of eating expertise in assessment evaluation and treatment a holistic view to bring to nutritional care
OT Interventions
Attention to psychosocial aspects of dining Environmental modification Adaptive equipment Dysphagia assessment and treatment Positioning Task analysis Residents Staff
Caregiver and dining assistant training Sensory integration issues internal and external
Culture Change
ldquoCulture change is an innovation anchored in values and beliefs that return the locus of control to elders and those who work closest with them Its ultimate vision is to create a culture of aging that is inclusive life-affirming satisfying humane and meaningfulrdquo
(Kantor B amp Planetree amp Picker Institute 2010)
Trends in Culture Change
Emphasis on resident choice and person-centered care as essential components to improve dining experiences
Culture change requires transformation in organizational practices physical environments workplace practices communication and relationships among all stakeholders
Benefits of Culture Change
LTCs who implement cultural changeshellip Improve quality-of-life for residents patients and staff
Increase performance on clinical outcomes
(Planetree amp Picker Institute 2010 Baier Butterfield Harris amp Gravenstei 2008)
Experience positive effects on occupancy rates and the financial bottom line of LTC (Doty Koren amp Sturla 2008 Elliot 2010 LaPorte 2010)
Key Points for Program amp Culture Change
Residents are unique individuals Facility leadership must seek further education Leaders must support the changes in environment Interdisciplinary staff education and training at all
levels Formalize screening and referral process Changes to dining organization and staffing duties Utilize expertise and unique perspective of OT
Future Work
Increase multidisciplinary collaboration
Increase knowledge base for OT through research Design and share educational programs across
disciplines and settings
Future Work
Explore and implement innovative approaches to feeding and eating assistance
Design programs specific to the dining experience of persons with dementia or cognitive impairment
Advocate with government and industry to promote
person centered care in LTC
Education is Key to Change
Industry leaders nursing home administrators and management need to be educated about the extent of malnutrition in nursing homes
There is a need for educational plans and instructional materials on preventing and treating malnutrition in LTC
Healthcare providers must take time to advocate with facilities and present educational workshops
Recognizing and preventing malnutrition in nursing homes
A teaching plan was developed and incorporated into
the coursework for the OTD 610 Practitioner as Educator course at Pacific University
An extensive literature review has been created to provide evidence and foundational knowledge for healthcare providers LTC administrators and stakeholders
Purpose
Educate skilled nursing facility administrators and management about effects of poor nutritional status skilled OT assessment analysis and Interventions improving nutritional status of residents enhancing the dining experience improving staff effectiveness and efficiency
Program Goal
LTC administrators and managers will demonstrate basic knowledge of effects of poor nutritional
status describe barriers to providing excellent nutritional care explain how skilled OT services contribute to proving holistic
nutritional care
Teaching Elements
Teaching Session
Lecture- group instruction Printed educational handouts Printed worksheets Interactive activities among learners Small and whole group discussions Self-reflection and sharing Resource table with additional learning tools Short video (added as a result of feedback to pilot
session)
Targeted learners
professionals in health care provision or administration
extensive experience in the long-term healthcare industry in the area of nutrition and dietary food service
men and women multicultural group 30 ndash 60 years of age
Setting
Intended LTC workshop Skilled nursing facility conference room during weekday
business hours
Pilot Group workshop Large open-plan diningliving space with participants around
large oval table
Outcome of Pilot
What would I do differently
Schedule more convenient time
Include more participants
Ask for feedback
More anonymous feedback option
simplify language
Proposed Changes to Workshop
Provide printed quiz to go with handouts Add video component Rework handouts for comprehension and
application to learners needs
Discussion
After learning more about the problem of malnutrition in long-term care are you considering how you might introduce this topic into your practice or your teaching
Are there other venues where this type of educational program is appropriate and might influence the management of nutritional care for elders
Questions
References
Abbasi AA amp Rudman D (1994) Undernutrition in the nursing home Prevalence consequences cause and prevention Nutrition Reviews 52(4) 113-122 Accreditation Council for Occupational Therapy Education (2006) ACOTE standards and interpretive guidelines Retrieved from
httpwwwaotaorgnonmembersarea13docs acotestandards806pdf Adams NE Bowie AJ Simmance N Murrary M amp Crowe T (2008) Recognition by medical and nursing professionals of malnutrition and risk of malnutrition in elderly hospitalised patients Nutrition and Dietetics (65) 144-150 Amella EJ (2002) Resistance at mealtimes for persons with dementia The Journal of Nutrition Health amp Aging 6 117-122 Amella EJ (2008) Mealtime difficulties In Evidence-Based Geriatric Nursing Protocols for Best Practice 3rd ed (Capezuti E Zwicker D Mezey M Fulmer T Gray-Miceli D amp Kluger M eds) Springer Publishing Company LLC New York p 337-351 American Occupational Therapy Association [AOTA] (2002) Occupational therapy practice framework Domain and process American Journal of Occupational Therapy 56
609ndash639 doi 105014ajot566609 AOTA (2007) Specialized knowledge and skills in feeding eating and swallowing for occupational therapy practice American Journal of Occupational Therapy 61(6) 686-700
doi 105014ajot616686 Asai JL (2004) Nutrition and the geriatric rehabilitation patient Challenges and solutions Topics in Geriatric Rehabilitation 20(1) 34-45 Baier RR Butterfield K Harris Y Gravenstein S (2008) Aiming for star performance the relationship between setting targets and improved nursing home quality of
care Journal of the American Medical Directors Association9(8) 594-9 Epub Dolhi C amp Rogers J (2009) Dementia nutrition and self-feeding A systematic review of the literature Occupational Therapy in Health Care 15(3-4) 59-87 Ferri C Prince M Brayne C Brodaty H Fratiglioni L Ganguli M hellip Landry G (2005) Global prevalence of dementia a delphi consensus study Lancet 366 2112-2217 Frisoni G Fanzoni S Rozzini R Ferrucci L Boffelli S amp Trabucchi M (1994) A nutritional index predicting mortality in the nursing home Journal of the American Geriatric Society 42 1167-1172 Furman EF (2006) Under-nutrition in older adults across the continuum of care Journal of Gerontological Nursing 32(1) 22-27 Groher ME amp Crary MA(2010) Dysphagia Clinical Management in Adults and Children Maryland Heights MO Mosby-Elsevier Harris-Kojetin L Sengupta M Park-Lee E Valverde R Long-term care services in the United States 2013 overview National health care statistics reports no 1 Hyattsville MD National Center for Health Statistics 2013
References
Horner J Alberts MJ Dawson DV Cook GM (1994) Swallowing in Alzheimerrsquos disease Alzheimer Disease Association Disorders 8 177 ndash 19 Kielhofner G (1985) A model of human occupation Baltimore Williams and Wilkins Lammes E amp Akner G (2006) Repeated assessment of energy and nutrient intake in 52 nursing home residents Journal of Nutritional Health and Aging 10(3) 222-30 Lin L-C Watson R amp Wu S-C (2010) What is associated with low food intake in older people with dementia Journal of Clinical Nursing 19 53-59 Doi 101111j1365-2702200902962x Maher D amp Eliad C (2014) Malnutrition in the elderly An unrecognized health issue Journal of Nursing Retrieved from httprnjournalcomjournal-of-nursingmalnutrition-in-the-elderly-an-unrecognized-health-issue Manthorpe J amp Watson R (2003) Poorly served Eating and dementia Journal of Advanced Nursing 41(2) 162-169 Nelson K Coultson A SucherKP amp Tseng R (1992) Prevalence of malnutrition in The elderly admitted to long-term-care facilities Journal of the American Dietetic Association 93(4) 459-460 Ott F Readman T amp Backman C (1990) Mealtimes of the institutionalized elderly A literature review Canadian Journal of Occupational Therapy 57(5) 261-267 Payette H (2002) Know related effects of nutrition on aging muscle function In Nutrition and Aging Vol 6 Ed by LH Rosenberg and A Sastre Nestle Workshop Series Clinical and Performance Program Nestec Ltd Vevey Switzerland P 135-150 Planetree amp Picker Institute (2010) Long term care improvement guide Retrieved from httpplanetreeorgwp-contentuploads201112LTC-Improvement-Guide-For-Downloadpdf Riviere S Gillerte-Guyonnet S Andrieu S Nourhashemi F Laugque S Cantet C hellip Vellas B (2002) Cognitive function and caregiver burden Predictive factors for eating behavior disorders in Alzhiemerrsquos disease International Journal of Geriatric Psychiatry 17 950-955 Schussler S Dassen T amp Lohrmann C (2014) Prevalence of care dependency and nursing care problems in nursing home residents with dementia A literature review International Journal of Caring Sciences 7(2) 339 Retrieved from httpwwwinternationaljournalofcaringsciencesorgdocs120SchC3BCssler-1pdf
References
Scott TM Peter L Tucker KL Arsenault L Bergethon P Bhadelia R hellip Folstein M (2006) The Nutrition Aging and Memory in Elders (NAME) study Design and methods for a study of micronutrients and cognitive function in a homebound elderly population International Journal of Geriatric Psychiatry 21(6) 519-528
doi101002gps1503735 Simmons SF Keeler E Zhuo X Hickey KA Sato HW amp Schnelle JF (2008) Prevention of unintentional weight loss in nursing home residents a controlled trial of feeding assistance Journal of American Geriatric Society 56(8) 1466-1473
Doi101111j1532-5415200801801x Sodderhamn U Backrach-Lindstrom M amp Ek AC (2007) Nutritional screening and perceived health in a group of geriatric rehabilitation patients Journal of Clinical Nursing (16) 1997-2006 Thomas DR Ashmen W Morley JE Evans WJ amp the Council for Nutritional Strategies in Long-Term Care (2000) Nutritional management in long-term care Development of a clinical guideline Journal of Gerontolology Biological Sciences and Medical Sciences 55A(12) M725- doi101093Gerona5512M725 Wu S amp Barker JC (2008) Hot tea and Juk The institutional meaning of food for Chinese elders in an American nursing home Journal of Gerontological Nursing 34(11) 46-45 doi10392800989134-20081101-11
E L I Z A B E T H C B A I R b a i r 0 7 1 2 p a c i f i c u e d u
Thank You
Barriers to Good Nutritional Status
Lack of knowledge about risk factors No formalized screening and assessment Inadequate staff to resident ratios Lack of training in feeding and eating assistance Limited communication between disciplines Lack of understanding of impact of dementia Inattention to the cultural and personal context of
mealtime Lack of social supports
Dementia and Malnutrition
Six factors that predict low food intake Eating difficulty No feeding assistance by caregivers Moderate dependence in activities of daily living Fewer family visits Being female Older age
(Lin Watson amp Wu 2010)
Dementia and Malnutrition
It is estimated that up to 45 of people with dementia living in institutions have swallowing
difficulties (Horner Alberts Dawson amp Cook 1994)
Effects of Increased Assistance
Increases in total daily calorie intake Residents maintain or gain weight Reduced secondary health complications Improved relationship between resident and staff Improved quality of life
Role of Occupational Therapy
OTs and OTAs have foundational skills and knowledge in eating feeding and
swallowing understanding of multidimensional aspects of eating expertise in assessment evaluation and treatment a holistic view to bring to nutritional care
OT Interventions
Attention to psychosocial aspects of dining Environmental modification Adaptive equipment Dysphagia assessment and treatment Positioning Task analysis Residents Staff
Caregiver and dining assistant training Sensory integration issues internal and external
Culture Change
ldquoCulture change is an innovation anchored in values and beliefs that return the locus of control to elders and those who work closest with them Its ultimate vision is to create a culture of aging that is inclusive life-affirming satisfying humane and meaningfulrdquo
(Kantor B amp Planetree amp Picker Institute 2010)
Trends in Culture Change
Emphasis on resident choice and person-centered care as essential components to improve dining experiences
Culture change requires transformation in organizational practices physical environments workplace practices communication and relationships among all stakeholders
Benefits of Culture Change
LTCs who implement cultural changeshellip Improve quality-of-life for residents patients and staff
Increase performance on clinical outcomes
(Planetree amp Picker Institute 2010 Baier Butterfield Harris amp Gravenstei 2008)
Experience positive effects on occupancy rates and the financial bottom line of LTC (Doty Koren amp Sturla 2008 Elliot 2010 LaPorte 2010)
Key Points for Program amp Culture Change
Residents are unique individuals Facility leadership must seek further education Leaders must support the changes in environment Interdisciplinary staff education and training at all
levels Formalize screening and referral process Changes to dining organization and staffing duties Utilize expertise and unique perspective of OT
Future Work
Increase multidisciplinary collaboration
Increase knowledge base for OT through research Design and share educational programs across
disciplines and settings
Future Work
Explore and implement innovative approaches to feeding and eating assistance
Design programs specific to the dining experience of persons with dementia or cognitive impairment
Advocate with government and industry to promote
person centered care in LTC
Education is Key to Change
Industry leaders nursing home administrators and management need to be educated about the extent of malnutrition in nursing homes
There is a need for educational plans and instructional materials on preventing and treating malnutrition in LTC
Healthcare providers must take time to advocate with facilities and present educational workshops
Recognizing and preventing malnutrition in nursing homes
A teaching plan was developed and incorporated into
the coursework for the OTD 610 Practitioner as Educator course at Pacific University
An extensive literature review has been created to provide evidence and foundational knowledge for healthcare providers LTC administrators and stakeholders
Purpose
Educate skilled nursing facility administrators and management about effects of poor nutritional status skilled OT assessment analysis and Interventions improving nutritional status of residents enhancing the dining experience improving staff effectiveness and efficiency
Program Goal
LTC administrators and managers will demonstrate basic knowledge of effects of poor nutritional
status describe barriers to providing excellent nutritional care explain how skilled OT services contribute to proving holistic
nutritional care
Teaching Elements
Teaching Session
Lecture- group instruction Printed educational handouts Printed worksheets Interactive activities among learners Small and whole group discussions Self-reflection and sharing Resource table with additional learning tools Short video (added as a result of feedback to pilot
session)
Targeted learners
professionals in health care provision or administration
extensive experience in the long-term healthcare industry in the area of nutrition and dietary food service
men and women multicultural group 30 ndash 60 years of age
Setting
Intended LTC workshop Skilled nursing facility conference room during weekday
business hours
Pilot Group workshop Large open-plan diningliving space with participants around
large oval table
Outcome of Pilot
What would I do differently
Schedule more convenient time
Include more participants
Ask for feedback
More anonymous feedback option
simplify language
Proposed Changes to Workshop
Provide printed quiz to go with handouts Add video component Rework handouts for comprehension and
application to learners needs
Discussion
After learning more about the problem of malnutrition in long-term care are you considering how you might introduce this topic into your practice or your teaching
Are there other venues where this type of educational program is appropriate and might influence the management of nutritional care for elders
Questions
References
Abbasi AA amp Rudman D (1994) Undernutrition in the nursing home Prevalence consequences cause and prevention Nutrition Reviews 52(4) 113-122 Accreditation Council for Occupational Therapy Education (2006) ACOTE standards and interpretive guidelines Retrieved from
httpwwwaotaorgnonmembersarea13docs acotestandards806pdf Adams NE Bowie AJ Simmance N Murrary M amp Crowe T (2008) Recognition by medical and nursing professionals of malnutrition and risk of malnutrition in elderly hospitalised patients Nutrition and Dietetics (65) 144-150 Amella EJ (2002) Resistance at mealtimes for persons with dementia The Journal of Nutrition Health amp Aging 6 117-122 Amella EJ (2008) Mealtime difficulties In Evidence-Based Geriatric Nursing Protocols for Best Practice 3rd ed (Capezuti E Zwicker D Mezey M Fulmer T Gray-Miceli D amp Kluger M eds) Springer Publishing Company LLC New York p 337-351 American Occupational Therapy Association [AOTA] (2002) Occupational therapy practice framework Domain and process American Journal of Occupational Therapy 56
609ndash639 doi 105014ajot566609 AOTA (2007) Specialized knowledge and skills in feeding eating and swallowing for occupational therapy practice American Journal of Occupational Therapy 61(6) 686-700
doi 105014ajot616686 Asai JL (2004) Nutrition and the geriatric rehabilitation patient Challenges and solutions Topics in Geriatric Rehabilitation 20(1) 34-45 Baier RR Butterfield K Harris Y Gravenstein S (2008) Aiming for star performance the relationship between setting targets and improved nursing home quality of
care Journal of the American Medical Directors Association9(8) 594-9 Epub Dolhi C amp Rogers J (2009) Dementia nutrition and self-feeding A systematic review of the literature Occupational Therapy in Health Care 15(3-4) 59-87 Ferri C Prince M Brayne C Brodaty H Fratiglioni L Ganguli M hellip Landry G (2005) Global prevalence of dementia a delphi consensus study Lancet 366 2112-2217 Frisoni G Fanzoni S Rozzini R Ferrucci L Boffelli S amp Trabucchi M (1994) A nutritional index predicting mortality in the nursing home Journal of the American Geriatric Society 42 1167-1172 Furman EF (2006) Under-nutrition in older adults across the continuum of care Journal of Gerontological Nursing 32(1) 22-27 Groher ME amp Crary MA(2010) Dysphagia Clinical Management in Adults and Children Maryland Heights MO Mosby-Elsevier Harris-Kojetin L Sengupta M Park-Lee E Valverde R Long-term care services in the United States 2013 overview National health care statistics reports no 1 Hyattsville MD National Center for Health Statistics 2013
References
Horner J Alberts MJ Dawson DV Cook GM (1994) Swallowing in Alzheimerrsquos disease Alzheimer Disease Association Disorders 8 177 ndash 19 Kielhofner G (1985) A model of human occupation Baltimore Williams and Wilkins Lammes E amp Akner G (2006) Repeated assessment of energy and nutrient intake in 52 nursing home residents Journal of Nutritional Health and Aging 10(3) 222-30 Lin L-C Watson R amp Wu S-C (2010) What is associated with low food intake in older people with dementia Journal of Clinical Nursing 19 53-59 Doi 101111j1365-2702200902962x Maher D amp Eliad C (2014) Malnutrition in the elderly An unrecognized health issue Journal of Nursing Retrieved from httprnjournalcomjournal-of-nursingmalnutrition-in-the-elderly-an-unrecognized-health-issue Manthorpe J amp Watson R (2003) Poorly served Eating and dementia Journal of Advanced Nursing 41(2) 162-169 Nelson K Coultson A SucherKP amp Tseng R (1992) Prevalence of malnutrition in The elderly admitted to long-term-care facilities Journal of the American Dietetic Association 93(4) 459-460 Ott F Readman T amp Backman C (1990) Mealtimes of the institutionalized elderly A literature review Canadian Journal of Occupational Therapy 57(5) 261-267 Payette H (2002) Know related effects of nutrition on aging muscle function In Nutrition and Aging Vol 6 Ed by LH Rosenberg and A Sastre Nestle Workshop Series Clinical and Performance Program Nestec Ltd Vevey Switzerland P 135-150 Planetree amp Picker Institute (2010) Long term care improvement guide Retrieved from httpplanetreeorgwp-contentuploads201112LTC-Improvement-Guide-For-Downloadpdf Riviere S Gillerte-Guyonnet S Andrieu S Nourhashemi F Laugque S Cantet C hellip Vellas B (2002) Cognitive function and caregiver burden Predictive factors for eating behavior disorders in Alzhiemerrsquos disease International Journal of Geriatric Psychiatry 17 950-955 Schussler S Dassen T amp Lohrmann C (2014) Prevalence of care dependency and nursing care problems in nursing home residents with dementia A literature review International Journal of Caring Sciences 7(2) 339 Retrieved from httpwwwinternationaljournalofcaringsciencesorgdocs120SchC3BCssler-1pdf
References
Scott TM Peter L Tucker KL Arsenault L Bergethon P Bhadelia R hellip Folstein M (2006) The Nutrition Aging and Memory in Elders (NAME) study Design and methods for a study of micronutrients and cognitive function in a homebound elderly population International Journal of Geriatric Psychiatry 21(6) 519-528
doi101002gps1503735 Simmons SF Keeler E Zhuo X Hickey KA Sato HW amp Schnelle JF (2008) Prevention of unintentional weight loss in nursing home residents a controlled trial of feeding assistance Journal of American Geriatric Society 56(8) 1466-1473
Doi101111j1532-5415200801801x Sodderhamn U Backrach-Lindstrom M amp Ek AC (2007) Nutritional screening and perceived health in a group of geriatric rehabilitation patients Journal of Clinical Nursing (16) 1997-2006 Thomas DR Ashmen W Morley JE Evans WJ amp the Council for Nutritional Strategies in Long-Term Care (2000) Nutritional management in long-term care Development of a clinical guideline Journal of Gerontolology Biological Sciences and Medical Sciences 55A(12) M725- doi101093Gerona5512M725 Wu S amp Barker JC (2008) Hot tea and Juk The institutional meaning of food for Chinese elders in an American nursing home Journal of Gerontological Nursing 34(11) 46-45 doi10392800989134-20081101-11
E L I Z A B E T H C B A I R b a i r 0 7 1 2 p a c i f i c u e d u
Thank You
Dementia and Malnutrition
Six factors that predict low food intake Eating difficulty No feeding assistance by caregivers Moderate dependence in activities of daily living Fewer family visits Being female Older age
(Lin Watson amp Wu 2010)
Dementia and Malnutrition
It is estimated that up to 45 of people with dementia living in institutions have swallowing
difficulties (Horner Alberts Dawson amp Cook 1994)
Effects of Increased Assistance
Increases in total daily calorie intake Residents maintain or gain weight Reduced secondary health complications Improved relationship between resident and staff Improved quality of life
Role of Occupational Therapy
OTs and OTAs have foundational skills and knowledge in eating feeding and
swallowing understanding of multidimensional aspects of eating expertise in assessment evaluation and treatment a holistic view to bring to nutritional care
OT Interventions
Attention to psychosocial aspects of dining Environmental modification Adaptive equipment Dysphagia assessment and treatment Positioning Task analysis Residents Staff
Caregiver and dining assistant training Sensory integration issues internal and external
Culture Change
ldquoCulture change is an innovation anchored in values and beliefs that return the locus of control to elders and those who work closest with them Its ultimate vision is to create a culture of aging that is inclusive life-affirming satisfying humane and meaningfulrdquo
(Kantor B amp Planetree amp Picker Institute 2010)
Trends in Culture Change
Emphasis on resident choice and person-centered care as essential components to improve dining experiences
Culture change requires transformation in organizational practices physical environments workplace practices communication and relationships among all stakeholders
Benefits of Culture Change
LTCs who implement cultural changeshellip Improve quality-of-life for residents patients and staff
Increase performance on clinical outcomes
(Planetree amp Picker Institute 2010 Baier Butterfield Harris amp Gravenstei 2008)
Experience positive effects on occupancy rates and the financial bottom line of LTC (Doty Koren amp Sturla 2008 Elliot 2010 LaPorte 2010)
Key Points for Program amp Culture Change
Residents are unique individuals Facility leadership must seek further education Leaders must support the changes in environment Interdisciplinary staff education and training at all
levels Formalize screening and referral process Changes to dining organization and staffing duties Utilize expertise and unique perspective of OT
Future Work
Increase multidisciplinary collaboration
Increase knowledge base for OT through research Design and share educational programs across
disciplines and settings
Future Work
Explore and implement innovative approaches to feeding and eating assistance
Design programs specific to the dining experience of persons with dementia or cognitive impairment
Advocate with government and industry to promote
person centered care in LTC
Education is Key to Change
Industry leaders nursing home administrators and management need to be educated about the extent of malnutrition in nursing homes
There is a need for educational plans and instructional materials on preventing and treating malnutrition in LTC
Healthcare providers must take time to advocate with facilities and present educational workshops
Recognizing and preventing malnutrition in nursing homes
A teaching plan was developed and incorporated into
the coursework for the OTD 610 Practitioner as Educator course at Pacific University
An extensive literature review has been created to provide evidence and foundational knowledge for healthcare providers LTC administrators and stakeholders
Purpose
Educate skilled nursing facility administrators and management about effects of poor nutritional status skilled OT assessment analysis and Interventions improving nutritional status of residents enhancing the dining experience improving staff effectiveness and efficiency
Program Goal
LTC administrators and managers will demonstrate basic knowledge of effects of poor nutritional
status describe barriers to providing excellent nutritional care explain how skilled OT services contribute to proving holistic
nutritional care
Teaching Elements
Teaching Session
Lecture- group instruction Printed educational handouts Printed worksheets Interactive activities among learners Small and whole group discussions Self-reflection and sharing Resource table with additional learning tools Short video (added as a result of feedback to pilot
session)
Targeted learners
professionals in health care provision or administration
extensive experience in the long-term healthcare industry in the area of nutrition and dietary food service
men and women multicultural group 30 ndash 60 years of age
Setting
Intended LTC workshop Skilled nursing facility conference room during weekday
business hours
Pilot Group workshop Large open-plan diningliving space with participants around
large oval table
Outcome of Pilot
What would I do differently
Schedule more convenient time
Include more participants
Ask for feedback
More anonymous feedback option
simplify language
Proposed Changes to Workshop
Provide printed quiz to go with handouts Add video component Rework handouts for comprehension and
application to learners needs
Discussion
After learning more about the problem of malnutrition in long-term care are you considering how you might introduce this topic into your practice or your teaching
Are there other venues where this type of educational program is appropriate and might influence the management of nutritional care for elders
Questions
References
Abbasi AA amp Rudman D (1994) Undernutrition in the nursing home Prevalence consequences cause and prevention Nutrition Reviews 52(4) 113-122 Accreditation Council for Occupational Therapy Education (2006) ACOTE standards and interpretive guidelines Retrieved from
httpwwwaotaorgnonmembersarea13docs acotestandards806pdf Adams NE Bowie AJ Simmance N Murrary M amp Crowe T (2008) Recognition by medical and nursing professionals of malnutrition and risk of malnutrition in elderly hospitalised patients Nutrition and Dietetics (65) 144-150 Amella EJ (2002) Resistance at mealtimes for persons with dementia The Journal of Nutrition Health amp Aging 6 117-122 Amella EJ (2008) Mealtime difficulties In Evidence-Based Geriatric Nursing Protocols for Best Practice 3rd ed (Capezuti E Zwicker D Mezey M Fulmer T Gray-Miceli D amp Kluger M eds) Springer Publishing Company LLC New York p 337-351 American Occupational Therapy Association [AOTA] (2002) Occupational therapy practice framework Domain and process American Journal of Occupational Therapy 56
609ndash639 doi 105014ajot566609 AOTA (2007) Specialized knowledge and skills in feeding eating and swallowing for occupational therapy practice American Journal of Occupational Therapy 61(6) 686-700
doi 105014ajot616686 Asai JL (2004) Nutrition and the geriatric rehabilitation patient Challenges and solutions Topics in Geriatric Rehabilitation 20(1) 34-45 Baier RR Butterfield K Harris Y Gravenstein S (2008) Aiming for star performance the relationship between setting targets and improved nursing home quality of
care Journal of the American Medical Directors Association9(8) 594-9 Epub Dolhi C amp Rogers J (2009) Dementia nutrition and self-feeding A systematic review of the literature Occupational Therapy in Health Care 15(3-4) 59-87 Ferri C Prince M Brayne C Brodaty H Fratiglioni L Ganguli M hellip Landry G (2005) Global prevalence of dementia a delphi consensus study Lancet 366 2112-2217 Frisoni G Fanzoni S Rozzini R Ferrucci L Boffelli S amp Trabucchi M (1994) A nutritional index predicting mortality in the nursing home Journal of the American Geriatric Society 42 1167-1172 Furman EF (2006) Under-nutrition in older adults across the continuum of care Journal of Gerontological Nursing 32(1) 22-27 Groher ME amp Crary MA(2010) Dysphagia Clinical Management in Adults and Children Maryland Heights MO Mosby-Elsevier Harris-Kojetin L Sengupta M Park-Lee E Valverde R Long-term care services in the United States 2013 overview National health care statistics reports no 1 Hyattsville MD National Center for Health Statistics 2013
References
Horner J Alberts MJ Dawson DV Cook GM (1994) Swallowing in Alzheimerrsquos disease Alzheimer Disease Association Disorders 8 177 ndash 19 Kielhofner G (1985) A model of human occupation Baltimore Williams and Wilkins Lammes E amp Akner G (2006) Repeated assessment of energy and nutrient intake in 52 nursing home residents Journal of Nutritional Health and Aging 10(3) 222-30 Lin L-C Watson R amp Wu S-C (2010) What is associated with low food intake in older people with dementia Journal of Clinical Nursing 19 53-59 Doi 101111j1365-2702200902962x Maher D amp Eliad C (2014) Malnutrition in the elderly An unrecognized health issue Journal of Nursing Retrieved from httprnjournalcomjournal-of-nursingmalnutrition-in-the-elderly-an-unrecognized-health-issue Manthorpe J amp Watson R (2003) Poorly served Eating and dementia Journal of Advanced Nursing 41(2) 162-169 Nelson K Coultson A SucherKP amp Tseng R (1992) Prevalence of malnutrition in The elderly admitted to long-term-care facilities Journal of the American Dietetic Association 93(4) 459-460 Ott F Readman T amp Backman C (1990) Mealtimes of the institutionalized elderly A literature review Canadian Journal of Occupational Therapy 57(5) 261-267 Payette H (2002) Know related effects of nutrition on aging muscle function In Nutrition and Aging Vol 6 Ed by LH Rosenberg and A Sastre Nestle Workshop Series Clinical and Performance Program Nestec Ltd Vevey Switzerland P 135-150 Planetree amp Picker Institute (2010) Long term care improvement guide Retrieved from httpplanetreeorgwp-contentuploads201112LTC-Improvement-Guide-For-Downloadpdf Riviere S Gillerte-Guyonnet S Andrieu S Nourhashemi F Laugque S Cantet C hellip Vellas B (2002) Cognitive function and caregiver burden Predictive factors for eating behavior disorders in Alzhiemerrsquos disease International Journal of Geriatric Psychiatry 17 950-955 Schussler S Dassen T amp Lohrmann C (2014) Prevalence of care dependency and nursing care problems in nursing home residents with dementia A literature review International Journal of Caring Sciences 7(2) 339 Retrieved from httpwwwinternationaljournalofcaringsciencesorgdocs120SchC3BCssler-1pdf
References
Scott TM Peter L Tucker KL Arsenault L Bergethon P Bhadelia R hellip Folstein M (2006) The Nutrition Aging and Memory in Elders (NAME) study Design and methods for a study of micronutrients and cognitive function in a homebound elderly population International Journal of Geriatric Psychiatry 21(6) 519-528
doi101002gps1503735 Simmons SF Keeler E Zhuo X Hickey KA Sato HW amp Schnelle JF (2008) Prevention of unintentional weight loss in nursing home residents a controlled trial of feeding assistance Journal of American Geriatric Society 56(8) 1466-1473
Doi101111j1532-5415200801801x Sodderhamn U Backrach-Lindstrom M amp Ek AC (2007) Nutritional screening and perceived health in a group of geriatric rehabilitation patients Journal of Clinical Nursing (16) 1997-2006 Thomas DR Ashmen W Morley JE Evans WJ amp the Council for Nutritional Strategies in Long-Term Care (2000) Nutritional management in long-term care Development of a clinical guideline Journal of Gerontolology Biological Sciences and Medical Sciences 55A(12) M725- doi101093Gerona5512M725 Wu S amp Barker JC (2008) Hot tea and Juk The institutional meaning of food for Chinese elders in an American nursing home Journal of Gerontological Nursing 34(11) 46-45 doi10392800989134-20081101-11
E L I Z A B E T H C B A I R b a i r 0 7 1 2 p a c i f i c u e d u
Thank You
Dementia and Malnutrition
It is estimated that up to 45 of people with dementia living in institutions have swallowing
difficulties (Horner Alberts Dawson amp Cook 1994)
Effects of Increased Assistance
Increases in total daily calorie intake Residents maintain or gain weight Reduced secondary health complications Improved relationship between resident and staff Improved quality of life
Role of Occupational Therapy
OTs and OTAs have foundational skills and knowledge in eating feeding and
swallowing understanding of multidimensional aspects of eating expertise in assessment evaluation and treatment a holistic view to bring to nutritional care
OT Interventions
Attention to psychosocial aspects of dining Environmental modification Adaptive equipment Dysphagia assessment and treatment Positioning Task analysis Residents Staff
Caregiver and dining assistant training Sensory integration issues internal and external
Culture Change
ldquoCulture change is an innovation anchored in values and beliefs that return the locus of control to elders and those who work closest with them Its ultimate vision is to create a culture of aging that is inclusive life-affirming satisfying humane and meaningfulrdquo
(Kantor B amp Planetree amp Picker Institute 2010)
Trends in Culture Change
Emphasis on resident choice and person-centered care as essential components to improve dining experiences
Culture change requires transformation in organizational practices physical environments workplace practices communication and relationships among all stakeholders
Benefits of Culture Change
LTCs who implement cultural changeshellip Improve quality-of-life for residents patients and staff
Increase performance on clinical outcomes
(Planetree amp Picker Institute 2010 Baier Butterfield Harris amp Gravenstei 2008)
Experience positive effects on occupancy rates and the financial bottom line of LTC (Doty Koren amp Sturla 2008 Elliot 2010 LaPorte 2010)
Key Points for Program amp Culture Change
Residents are unique individuals Facility leadership must seek further education Leaders must support the changes in environment Interdisciplinary staff education and training at all
levels Formalize screening and referral process Changes to dining organization and staffing duties Utilize expertise and unique perspective of OT
Future Work
Increase multidisciplinary collaboration
Increase knowledge base for OT through research Design and share educational programs across
disciplines and settings
Future Work
Explore and implement innovative approaches to feeding and eating assistance
Design programs specific to the dining experience of persons with dementia or cognitive impairment
Advocate with government and industry to promote
person centered care in LTC
Education is Key to Change
Industry leaders nursing home administrators and management need to be educated about the extent of malnutrition in nursing homes
There is a need for educational plans and instructional materials on preventing and treating malnutrition in LTC
Healthcare providers must take time to advocate with facilities and present educational workshops
Recognizing and preventing malnutrition in nursing homes
A teaching plan was developed and incorporated into
the coursework for the OTD 610 Practitioner as Educator course at Pacific University
An extensive literature review has been created to provide evidence and foundational knowledge for healthcare providers LTC administrators and stakeholders
Purpose
Educate skilled nursing facility administrators and management about effects of poor nutritional status skilled OT assessment analysis and Interventions improving nutritional status of residents enhancing the dining experience improving staff effectiveness and efficiency
Program Goal
LTC administrators and managers will demonstrate basic knowledge of effects of poor nutritional
status describe barriers to providing excellent nutritional care explain how skilled OT services contribute to proving holistic
nutritional care
Teaching Elements
Teaching Session
Lecture- group instruction Printed educational handouts Printed worksheets Interactive activities among learners Small and whole group discussions Self-reflection and sharing Resource table with additional learning tools Short video (added as a result of feedback to pilot
session)
Targeted learners
professionals in health care provision or administration
extensive experience in the long-term healthcare industry in the area of nutrition and dietary food service
men and women multicultural group 30 ndash 60 years of age
Setting
Intended LTC workshop Skilled nursing facility conference room during weekday
business hours
Pilot Group workshop Large open-plan diningliving space with participants around
large oval table
Outcome of Pilot
What would I do differently
Schedule more convenient time
Include more participants
Ask for feedback
More anonymous feedback option
simplify language
Proposed Changes to Workshop
Provide printed quiz to go with handouts Add video component Rework handouts for comprehension and
application to learners needs
Discussion
After learning more about the problem of malnutrition in long-term care are you considering how you might introduce this topic into your practice or your teaching
Are there other venues where this type of educational program is appropriate and might influence the management of nutritional care for elders
Questions
References
Abbasi AA amp Rudman D (1994) Undernutrition in the nursing home Prevalence consequences cause and prevention Nutrition Reviews 52(4) 113-122 Accreditation Council for Occupational Therapy Education (2006) ACOTE standards and interpretive guidelines Retrieved from
httpwwwaotaorgnonmembersarea13docs acotestandards806pdf Adams NE Bowie AJ Simmance N Murrary M amp Crowe T (2008) Recognition by medical and nursing professionals of malnutrition and risk of malnutrition in elderly hospitalised patients Nutrition and Dietetics (65) 144-150 Amella EJ (2002) Resistance at mealtimes for persons with dementia The Journal of Nutrition Health amp Aging 6 117-122 Amella EJ (2008) Mealtime difficulties In Evidence-Based Geriatric Nursing Protocols for Best Practice 3rd ed (Capezuti E Zwicker D Mezey M Fulmer T Gray-Miceli D amp Kluger M eds) Springer Publishing Company LLC New York p 337-351 American Occupational Therapy Association [AOTA] (2002) Occupational therapy practice framework Domain and process American Journal of Occupational Therapy 56
609ndash639 doi 105014ajot566609 AOTA (2007) Specialized knowledge and skills in feeding eating and swallowing for occupational therapy practice American Journal of Occupational Therapy 61(6) 686-700
doi 105014ajot616686 Asai JL (2004) Nutrition and the geriatric rehabilitation patient Challenges and solutions Topics in Geriatric Rehabilitation 20(1) 34-45 Baier RR Butterfield K Harris Y Gravenstein S (2008) Aiming for star performance the relationship between setting targets and improved nursing home quality of
care Journal of the American Medical Directors Association9(8) 594-9 Epub Dolhi C amp Rogers J (2009) Dementia nutrition and self-feeding A systematic review of the literature Occupational Therapy in Health Care 15(3-4) 59-87 Ferri C Prince M Brayne C Brodaty H Fratiglioni L Ganguli M hellip Landry G (2005) Global prevalence of dementia a delphi consensus study Lancet 366 2112-2217 Frisoni G Fanzoni S Rozzini R Ferrucci L Boffelli S amp Trabucchi M (1994) A nutritional index predicting mortality in the nursing home Journal of the American Geriatric Society 42 1167-1172 Furman EF (2006) Under-nutrition in older adults across the continuum of care Journal of Gerontological Nursing 32(1) 22-27 Groher ME amp Crary MA(2010) Dysphagia Clinical Management in Adults and Children Maryland Heights MO Mosby-Elsevier Harris-Kojetin L Sengupta M Park-Lee E Valverde R Long-term care services in the United States 2013 overview National health care statistics reports no 1 Hyattsville MD National Center for Health Statistics 2013
References
Horner J Alberts MJ Dawson DV Cook GM (1994) Swallowing in Alzheimerrsquos disease Alzheimer Disease Association Disorders 8 177 ndash 19 Kielhofner G (1985) A model of human occupation Baltimore Williams and Wilkins Lammes E amp Akner G (2006) Repeated assessment of energy and nutrient intake in 52 nursing home residents Journal of Nutritional Health and Aging 10(3) 222-30 Lin L-C Watson R amp Wu S-C (2010) What is associated with low food intake in older people with dementia Journal of Clinical Nursing 19 53-59 Doi 101111j1365-2702200902962x Maher D amp Eliad C (2014) Malnutrition in the elderly An unrecognized health issue Journal of Nursing Retrieved from httprnjournalcomjournal-of-nursingmalnutrition-in-the-elderly-an-unrecognized-health-issue Manthorpe J amp Watson R (2003) Poorly served Eating and dementia Journal of Advanced Nursing 41(2) 162-169 Nelson K Coultson A SucherKP amp Tseng R (1992) Prevalence of malnutrition in The elderly admitted to long-term-care facilities Journal of the American Dietetic Association 93(4) 459-460 Ott F Readman T amp Backman C (1990) Mealtimes of the institutionalized elderly A literature review Canadian Journal of Occupational Therapy 57(5) 261-267 Payette H (2002) Know related effects of nutrition on aging muscle function In Nutrition and Aging Vol 6 Ed by LH Rosenberg and A Sastre Nestle Workshop Series Clinical and Performance Program Nestec Ltd Vevey Switzerland P 135-150 Planetree amp Picker Institute (2010) Long term care improvement guide Retrieved from httpplanetreeorgwp-contentuploads201112LTC-Improvement-Guide-For-Downloadpdf Riviere S Gillerte-Guyonnet S Andrieu S Nourhashemi F Laugque S Cantet C hellip Vellas B (2002) Cognitive function and caregiver burden Predictive factors for eating behavior disorders in Alzhiemerrsquos disease International Journal of Geriatric Psychiatry 17 950-955 Schussler S Dassen T amp Lohrmann C (2014) Prevalence of care dependency and nursing care problems in nursing home residents with dementia A literature review International Journal of Caring Sciences 7(2) 339 Retrieved from httpwwwinternationaljournalofcaringsciencesorgdocs120SchC3BCssler-1pdf
References
Scott TM Peter L Tucker KL Arsenault L Bergethon P Bhadelia R hellip Folstein M (2006) The Nutrition Aging and Memory in Elders (NAME) study Design and methods for a study of micronutrients and cognitive function in a homebound elderly population International Journal of Geriatric Psychiatry 21(6) 519-528
doi101002gps1503735 Simmons SF Keeler E Zhuo X Hickey KA Sato HW amp Schnelle JF (2008) Prevention of unintentional weight loss in nursing home residents a controlled trial of feeding assistance Journal of American Geriatric Society 56(8) 1466-1473
Doi101111j1532-5415200801801x Sodderhamn U Backrach-Lindstrom M amp Ek AC (2007) Nutritional screening and perceived health in a group of geriatric rehabilitation patients Journal of Clinical Nursing (16) 1997-2006 Thomas DR Ashmen W Morley JE Evans WJ amp the Council for Nutritional Strategies in Long-Term Care (2000) Nutritional management in long-term care Development of a clinical guideline Journal of Gerontolology Biological Sciences and Medical Sciences 55A(12) M725- doi101093Gerona5512M725 Wu S amp Barker JC (2008) Hot tea and Juk The institutional meaning of food for Chinese elders in an American nursing home Journal of Gerontological Nursing 34(11) 46-45 doi10392800989134-20081101-11
E L I Z A B E T H C B A I R b a i r 0 7 1 2 p a c i f i c u e d u
Thank You
Effects of Increased Assistance
Increases in total daily calorie intake Residents maintain or gain weight Reduced secondary health complications Improved relationship between resident and staff Improved quality of life
Role of Occupational Therapy
OTs and OTAs have foundational skills and knowledge in eating feeding and
swallowing understanding of multidimensional aspects of eating expertise in assessment evaluation and treatment a holistic view to bring to nutritional care
OT Interventions
Attention to psychosocial aspects of dining Environmental modification Adaptive equipment Dysphagia assessment and treatment Positioning Task analysis Residents Staff
Caregiver and dining assistant training Sensory integration issues internal and external
Culture Change
ldquoCulture change is an innovation anchored in values and beliefs that return the locus of control to elders and those who work closest with them Its ultimate vision is to create a culture of aging that is inclusive life-affirming satisfying humane and meaningfulrdquo
(Kantor B amp Planetree amp Picker Institute 2010)
Trends in Culture Change
Emphasis on resident choice and person-centered care as essential components to improve dining experiences
Culture change requires transformation in organizational practices physical environments workplace practices communication and relationships among all stakeholders
Benefits of Culture Change
LTCs who implement cultural changeshellip Improve quality-of-life for residents patients and staff
Increase performance on clinical outcomes
(Planetree amp Picker Institute 2010 Baier Butterfield Harris amp Gravenstei 2008)
Experience positive effects on occupancy rates and the financial bottom line of LTC (Doty Koren amp Sturla 2008 Elliot 2010 LaPorte 2010)
Key Points for Program amp Culture Change
Residents are unique individuals Facility leadership must seek further education Leaders must support the changes in environment Interdisciplinary staff education and training at all
levels Formalize screening and referral process Changes to dining organization and staffing duties Utilize expertise and unique perspective of OT
Future Work
Increase multidisciplinary collaboration
Increase knowledge base for OT through research Design and share educational programs across
disciplines and settings
Future Work
Explore and implement innovative approaches to feeding and eating assistance
Design programs specific to the dining experience of persons with dementia or cognitive impairment
Advocate with government and industry to promote
person centered care in LTC
Education is Key to Change
Industry leaders nursing home administrators and management need to be educated about the extent of malnutrition in nursing homes
There is a need for educational plans and instructional materials on preventing and treating malnutrition in LTC
Healthcare providers must take time to advocate with facilities and present educational workshops
Recognizing and preventing malnutrition in nursing homes
A teaching plan was developed and incorporated into
the coursework for the OTD 610 Practitioner as Educator course at Pacific University
An extensive literature review has been created to provide evidence and foundational knowledge for healthcare providers LTC administrators and stakeholders
Purpose
Educate skilled nursing facility administrators and management about effects of poor nutritional status skilled OT assessment analysis and Interventions improving nutritional status of residents enhancing the dining experience improving staff effectiveness and efficiency
Program Goal
LTC administrators and managers will demonstrate basic knowledge of effects of poor nutritional
status describe barriers to providing excellent nutritional care explain how skilled OT services contribute to proving holistic
nutritional care
Teaching Elements
Teaching Session
Lecture- group instruction Printed educational handouts Printed worksheets Interactive activities among learners Small and whole group discussions Self-reflection and sharing Resource table with additional learning tools Short video (added as a result of feedback to pilot
session)
Targeted learners
professionals in health care provision or administration
extensive experience in the long-term healthcare industry in the area of nutrition and dietary food service
men and women multicultural group 30 ndash 60 years of age
Setting
Intended LTC workshop Skilled nursing facility conference room during weekday
business hours
Pilot Group workshop Large open-plan diningliving space with participants around
large oval table
Outcome of Pilot
What would I do differently
Schedule more convenient time
Include more participants
Ask for feedback
More anonymous feedback option
simplify language
Proposed Changes to Workshop
Provide printed quiz to go with handouts Add video component Rework handouts for comprehension and
application to learners needs
Discussion
After learning more about the problem of malnutrition in long-term care are you considering how you might introduce this topic into your practice or your teaching
Are there other venues where this type of educational program is appropriate and might influence the management of nutritional care for elders
Questions
References
Abbasi AA amp Rudman D (1994) Undernutrition in the nursing home Prevalence consequences cause and prevention Nutrition Reviews 52(4) 113-122 Accreditation Council for Occupational Therapy Education (2006) ACOTE standards and interpretive guidelines Retrieved from
httpwwwaotaorgnonmembersarea13docs acotestandards806pdf Adams NE Bowie AJ Simmance N Murrary M amp Crowe T (2008) Recognition by medical and nursing professionals of malnutrition and risk of malnutrition in elderly hospitalised patients Nutrition and Dietetics (65) 144-150 Amella EJ (2002) Resistance at mealtimes for persons with dementia The Journal of Nutrition Health amp Aging 6 117-122 Amella EJ (2008) Mealtime difficulties In Evidence-Based Geriatric Nursing Protocols for Best Practice 3rd ed (Capezuti E Zwicker D Mezey M Fulmer T Gray-Miceli D amp Kluger M eds) Springer Publishing Company LLC New York p 337-351 American Occupational Therapy Association [AOTA] (2002) Occupational therapy practice framework Domain and process American Journal of Occupational Therapy 56
609ndash639 doi 105014ajot566609 AOTA (2007) Specialized knowledge and skills in feeding eating and swallowing for occupational therapy practice American Journal of Occupational Therapy 61(6) 686-700
doi 105014ajot616686 Asai JL (2004) Nutrition and the geriatric rehabilitation patient Challenges and solutions Topics in Geriatric Rehabilitation 20(1) 34-45 Baier RR Butterfield K Harris Y Gravenstein S (2008) Aiming for star performance the relationship between setting targets and improved nursing home quality of
care Journal of the American Medical Directors Association9(8) 594-9 Epub Dolhi C amp Rogers J (2009) Dementia nutrition and self-feeding A systematic review of the literature Occupational Therapy in Health Care 15(3-4) 59-87 Ferri C Prince M Brayne C Brodaty H Fratiglioni L Ganguli M hellip Landry G (2005) Global prevalence of dementia a delphi consensus study Lancet 366 2112-2217 Frisoni G Fanzoni S Rozzini R Ferrucci L Boffelli S amp Trabucchi M (1994) A nutritional index predicting mortality in the nursing home Journal of the American Geriatric Society 42 1167-1172 Furman EF (2006) Under-nutrition in older adults across the continuum of care Journal of Gerontological Nursing 32(1) 22-27 Groher ME amp Crary MA(2010) Dysphagia Clinical Management in Adults and Children Maryland Heights MO Mosby-Elsevier Harris-Kojetin L Sengupta M Park-Lee E Valverde R Long-term care services in the United States 2013 overview National health care statistics reports no 1 Hyattsville MD National Center for Health Statistics 2013
References
Horner J Alberts MJ Dawson DV Cook GM (1994) Swallowing in Alzheimerrsquos disease Alzheimer Disease Association Disorders 8 177 ndash 19 Kielhofner G (1985) A model of human occupation Baltimore Williams and Wilkins Lammes E amp Akner G (2006) Repeated assessment of energy and nutrient intake in 52 nursing home residents Journal of Nutritional Health and Aging 10(3) 222-30 Lin L-C Watson R amp Wu S-C (2010) What is associated with low food intake in older people with dementia Journal of Clinical Nursing 19 53-59 Doi 101111j1365-2702200902962x Maher D amp Eliad C (2014) Malnutrition in the elderly An unrecognized health issue Journal of Nursing Retrieved from httprnjournalcomjournal-of-nursingmalnutrition-in-the-elderly-an-unrecognized-health-issue Manthorpe J amp Watson R (2003) Poorly served Eating and dementia Journal of Advanced Nursing 41(2) 162-169 Nelson K Coultson A SucherKP amp Tseng R (1992) Prevalence of malnutrition in The elderly admitted to long-term-care facilities Journal of the American Dietetic Association 93(4) 459-460 Ott F Readman T amp Backman C (1990) Mealtimes of the institutionalized elderly A literature review Canadian Journal of Occupational Therapy 57(5) 261-267 Payette H (2002) Know related effects of nutrition on aging muscle function In Nutrition and Aging Vol 6 Ed by LH Rosenberg and A Sastre Nestle Workshop Series Clinical and Performance Program Nestec Ltd Vevey Switzerland P 135-150 Planetree amp Picker Institute (2010) Long term care improvement guide Retrieved from httpplanetreeorgwp-contentuploads201112LTC-Improvement-Guide-For-Downloadpdf Riviere S Gillerte-Guyonnet S Andrieu S Nourhashemi F Laugque S Cantet C hellip Vellas B (2002) Cognitive function and caregiver burden Predictive factors for eating behavior disorders in Alzhiemerrsquos disease International Journal of Geriatric Psychiatry 17 950-955 Schussler S Dassen T amp Lohrmann C (2014) Prevalence of care dependency and nursing care problems in nursing home residents with dementia A literature review International Journal of Caring Sciences 7(2) 339 Retrieved from httpwwwinternationaljournalofcaringsciencesorgdocs120SchC3BCssler-1pdf
References
Scott TM Peter L Tucker KL Arsenault L Bergethon P Bhadelia R hellip Folstein M (2006) The Nutrition Aging and Memory in Elders (NAME) study Design and methods for a study of micronutrients and cognitive function in a homebound elderly population International Journal of Geriatric Psychiatry 21(6) 519-528
doi101002gps1503735 Simmons SF Keeler E Zhuo X Hickey KA Sato HW amp Schnelle JF (2008) Prevention of unintentional weight loss in nursing home residents a controlled trial of feeding assistance Journal of American Geriatric Society 56(8) 1466-1473
Doi101111j1532-5415200801801x Sodderhamn U Backrach-Lindstrom M amp Ek AC (2007) Nutritional screening and perceived health in a group of geriatric rehabilitation patients Journal of Clinical Nursing (16) 1997-2006 Thomas DR Ashmen W Morley JE Evans WJ amp the Council for Nutritional Strategies in Long-Term Care (2000) Nutritional management in long-term care Development of a clinical guideline Journal of Gerontolology Biological Sciences and Medical Sciences 55A(12) M725- doi101093Gerona5512M725 Wu S amp Barker JC (2008) Hot tea and Juk The institutional meaning of food for Chinese elders in an American nursing home Journal of Gerontological Nursing 34(11) 46-45 doi10392800989134-20081101-11
E L I Z A B E T H C B A I R b a i r 0 7 1 2 p a c i f i c u e d u
Thank You
Role of Occupational Therapy
OTs and OTAs have foundational skills and knowledge in eating feeding and
swallowing understanding of multidimensional aspects of eating expertise in assessment evaluation and treatment a holistic view to bring to nutritional care
OT Interventions
Attention to psychosocial aspects of dining Environmental modification Adaptive equipment Dysphagia assessment and treatment Positioning Task analysis Residents Staff
Caregiver and dining assistant training Sensory integration issues internal and external
Culture Change
ldquoCulture change is an innovation anchored in values and beliefs that return the locus of control to elders and those who work closest with them Its ultimate vision is to create a culture of aging that is inclusive life-affirming satisfying humane and meaningfulrdquo
(Kantor B amp Planetree amp Picker Institute 2010)
Trends in Culture Change
Emphasis on resident choice and person-centered care as essential components to improve dining experiences
Culture change requires transformation in organizational practices physical environments workplace practices communication and relationships among all stakeholders
Benefits of Culture Change
LTCs who implement cultural changeshellip Improve quality-of-life for residents patients and staff
Increase performance on clinical outcomes
(Planetree amp Picker Institute 2010 Baier Butterfield Harris amp Gravenstei 2008)
Experience positive effects on occupancy rates and the financial bottom line of LTC (Doty Koren amp Sturla 2008 Elliot 2010 LaPorte 2010)
Key Points for Program amp Culture Change
Residents are unique individuals Facility leadership must seek further education Leaders must support the changes in environment Interdisciplinary staff education and training at all
levels Formalize screening and referral process Changes to dining organization and staffing duties Utilize expertise and unique perspective of OT
Future Work
Increase multidisciplinary collaboration
Increase knowledge base for OT through research Design and share educational programs across
disciplines and settings
Future Work
Explore and implement innovative approaches to feeding and eating assistance
Design programs specific to the dining experience of persons with dementia or cognitive impairment
Advocate with government and industry to promote
person centered care in LTC
Education is Key to Change
Industry leaders nursing home administrators and management need to be educated about the extent of malnutrition in nursing homes
There is a need for educational plans and instructional materials on preventing and treating malnutrition in LTC
Healthcare providers must take time to advocate with facilities and present educational workshops
Recognizing and preventing malnutrition in nursing homes
A teaching plan was developed and incorporated into
the coursework for the OTD 610 Practitioner as Educator course at Pacific University
An extensive literature review has been created to provide evidence and foundational knowledge for healthcare providers LTC administrators and stakeholders
Purpose
Educate skilled nursing facility administrators and management about effects of poor nutritional status skilled OT assessment analysis and Interventions improving nutritional status of residents enhancing the dining experience improving staff effectiveness and efficiency
Program Goal
LTC administrators and managers will demonstrate basic knowledge of effects of poor nutritional
status describe barriers to providing excellent nutritional care explain how skilled OT services contribute to proving holistic
nutritional care
Teaching Elements
Teaching Session
Lecture- group instruction Printed educational handouts Printed worksheets Interactive activities among learners Small and whole group discussions Self-reflection and sharing Resource table with additional learning tools Short video (added as a result of feedback to pilot
session)
Targeted learners
professionals in health care provision or administration
extensive experience in the long-term healthcare industry in the area of nutrition and dietary food service
men and women multicultural group 30 ndash 60 years of age
Setting
Intended LTC workshop Skilled nursing facility conference room during weekday
business hours
Pilot Group workshop Large open-plan diningliving space with participants around
large oval table
Outcome of Pilot
What would I do differently
Schedule more convenient time
Include more participants
Ask for feedback
More anonymous feedback option
simplify language
Proposed Changes to Workshop
Provide printed quiz to go with handouts Add video component Rework handouts for comprehension and
application to learners needs
Discussion
After learning more about the problem of malnutrition in long-term care are you considering how you might introduce this topic into your practice or your teaching
Are there other venues where this type of educational program is appropriate and might influence the management of nutritional care for elders
Questions
References
Abbasi AA amp Rudman D (1994) Undernutrition in the nursing home Prevalence consequences cause and prevention Nutrition Reviews 52(4) 113-122 Accreditation Council for Occupational Therapy Education (2006) ACOTE standards and interpretive guidelines Retrieved from
httpwwwaotaorgnonmembersarea13docs acotestandards806pdf Adams NE Bowie AJ Simmance N Murrary M amp Crowe T (2008) Recognition by medical and nursing professionals of malnutrition and risk of malnutrition in elderly hospitalised patients Nutrition and Dietetics (65) 144-150 Amella EJ (2002) Resistance at mealtimes for persons with dementia The Journal of Nutrition Health amp Aging 6 117-122 Amella EJ (2008) Mealtime difficulties In Evidence-Based Geriatric Nursing Protocols for Best Practice 3rd ed (Capezuti E Zwicker D Mezey M Fulmer T Gray-Miceli D amp Kluger M eds) Springer Publishing Company LLC New York p 337-351 American Occupational Therapy Association [AOTA] (2002) Occupational therapy practice framework Domain and process American Journal of Occupational Therapy 56
609ndash639 doi 105014ajot566609 AOTA (2007) Specialized knowledge and skills in feeding eating and swallowing for occupational therapy practice American Journal of Occupational Therapy 61(6) 686-700
doi 105014ajot616686 Asai JL (2004) Nutrition and the geriatric rehabilitation patient Challenges and solutions Topics in Geriatric Rehabilitation 20(1) 34-45 Baier RR Butterfield K Harris Y Gravenstein S (2008) Aiming for star performance the relationship between setting targets and improved nursing home quality of
care Journal of the American Medical Directors Association9(8) 594-9 Epub Dolhi C amp Rogers J (2009) Dementia nutrition and self-feeding A systematic review of the literature Occupational Therapy in Health Care 15(3-4) 59-87 Ferri C Prince M Brayne C Brodaty H Fratiglioni L Ganguli M hellip Landry G (2005) Global prevalence of dementia a delphi consensus study Lancet 366 2112-2217 Frisoni G Fanzoni S Rozzini R Ferrucci L Boffelli S amp Trabucchi M (1994) A nutritional index predicting mortality in the nursing home Journal of the American Geriatric Society 42 1167-1172 Furman EF (2006) Under-nutrition in older adults across the continuum of care Journal of Gerontological Nursing 32(1) 22-27 Groher ME amp Crary MA(2010) Dysphagia Clinical Management in Adults and Children Maryland Heights MO Mosby-Elsevier Harris-Kojetin L Sengupta M Park-Lee E Valverde R Long-term care services in the United States 2013 overview National health care statistics reports no 1 Hyattsville MD National Center for Health Statistics 2013
References
Horner J Alberts MJ Dawson DV Cook GM (1994) Swallowing in Alzheimerrsquos disease Alzheimer Disease Association Disorders 8 177 ndash 19 Kielhofner G (1985) A model of human occupation Baltimore Williams and Wilkins Lammes E amp Akner G (2006) Repeated assessment of energy and nutrient intake in 52 nursing home residents Journal of Nutritional Health and Aging 10(3) 222-30 Lin L-C Watson R amp Wu S-C (2010) What is associated with low food intake in older people with dementia Journal of Clinical Nursing 19 53-59 Doi 101111j1365-2702200902962x Maher D amp Eliad C (2014) Malnutrition in the elderly An unrecognized health issue Journal of Nursing Retrieved from httprnjournalcomjournal-of-nursingmalnutrition-in-the-elderly-an-unrecognized-health-issue Manthorpe J amp Watson R (2003) Poorly served Eating and dementia Journal of Advanced Nursing 41(2) 162-169 Nelson K Coultson A SucherKP amp Tseng R (1992) Prevalence of malnutrition in The elderly admitted to long-term-care facilities Journal of the American Dietetic Association 93(4) 459-460 Ott F Readman T amp Backman C (1990) Mealtimes of the institutionalized elderly A literature review Canadian Journal of Occupational Therapy 57(5) 261-267 Payette H (2002) Know related effects of nutrition on aging muscle function In Nutrition and Aging Vol 6 Ed by LH Rosenberg and A Sastre Nestle Workshop Series Clinical and Performance Program Nestec Ltd Vevey Switzerland P 135-150 Planetree amp Picker Institute (2010) Long term care improvement guide Retrieved from httpplanetreeorgwp-contentuploads201112LTC-Improvement-Guide-For-Downloadpdf Riviere S Gillerte-Guyonnet S Andrieu S Nourhashemi F Laugque S Cantet C hellip Vellas B (2002) Cognitive function and caregiver burden Predictive factors for eating behavior disorders in Alzhiemerrsquos disease International Journal of Geriatric Psychiatry 17 950-955 Schussler S Dassen T amp Lohrmann C (2014) Prevalence of care dependency and nursing care problems in nursing home residents with dementia A literature review International Journal of Caring Sciences 7(2) 339 Retrieved from httpwwwinternationaljournalofcaringsciencesorgdocs120SchC3BCssler-1pdf
References
Scott TM Peter L Tucker KL Arsenault L Bergethon P Bhadelia R hellip Folstein M (2006) The Nutrition Aging and Memory in Elders (NAME) study Design and methods for a study of micronutrients and cognitive function in a homebound elderly population International Journal of Geriatric Psychiatry 21(6) 519-528
doi101002gps1503735 Simmons SF Keeler E Zhuo X Hickey KA Sato HW amp Schnelle JF (2008) Prevention of unintentional weight loss in nursing home residents a controlled trial of feeding assistance Journal of American Geriatric Society 56(8) 1466-1473
Doi101111j1532-5415200801801x Sodderhamn U Backrach-Lindstrom M amp Ek AC (2007) Nutritional screening and perceived health in a group of geriatric rehabilitation patients Journal of Clinical Nursing (16) 1997-2006 Thomas DR Ashmen W Morley JE Evans WJ amp the Council for Nutritional Strategies in Long-Term Care (2000) Nutritional management in long-term care Development of a clinical guideline Journal of Gerontolology Biological Sciences and Medical Sciences 55A(12) M725- doi101093Gerona5512M725 Wu S amp Barker JC (2008) Hot tea and Juk The institutional meaning of food for Chinese elders in an American nursing home Journal of Gerontological Nursing 34(11) 46-45 doi10392800989134-20081101-11
E L I Z A B E T H C B A I R b a i r 0 7 1 2 p a c i f i c u e d u
Thank You
OT Interventions
Attention to psychosocial aspects of dining Environmental modification Adaptive equipment Dysphagia assessment and treatment Positioning Task analysis Residents Staff
Caregiver and dining assistant training Sensory integration issues internal and external
Culture Change
ldquoCulture change is an innovation anchored in values and beliefs that return the locus of control to elders and those who work closest with them Its ultimate vision is to create a culture of aging that is inclusive life-affirming satisfying humane and meaningfulrdquo
(Kantor B amp Planetree amp Picker Institute 2010)
Trends in Culture Change
Emphasis on resident choice and person-centered care as essential components to improve dining experiences
Culture change requires transformation in organizational practices physical environments workplace practices communication and relationships among all stakeholders
Benefits of Culture Change
LTCs who implement cultural changeshellip Improve quality-of-life for residents patients and staff
Increase performance on clinical outcomes
(Planetree amp Picker Institute 2010 Baier Butterfield Harris amp Gravenstei 2008)
Experience positive effects on occupancy rates and the financial bottom line of LTC (Doty Koren amp Sturla 2008 Elliot 2010 LaPorte 2010)
Key Points for Program amp Culture Change
Residents are unique individuals Facility leadership must seek further education Leaders must support the changes in environment Interdisciplinary staff education and training at all
levels Formalize screening and referral process Changes to dining organization and staffing duties Utilize expertise and unique perspective of OT
Future Work
Increase multidisciplinary collaboration
Increase knowledge base for OT through research Design and share educational programs across
disciplines and settings
Future Work
Explore and implement innovative approaches to feeding and eating assistance
Design programs specific to the dining experience of persons with dementia or cognitive impairment
Advocate with government and industry to promote
person centered care in LTC
Education is Key to Change
Industry leaders nursing home administrators and management need to be educated about the extent of malnutrition in nursing homes
There is a need for educational plans and instructional materials on preventing and treating malnutrition in LTC
Healthcare providers must take time to advocate with facilities and present educational workshops
Recognizing and preventing malnutrition in nursing homes
A teaching plan was developed and incorporated into
the coursework for the OTD 610 Practitioner as Educator course at Pacific University
An extensive literature review has been created to provide evidence and foundational knowledge for healthcare providers LTC administrators and stakeholders
Purpose
Educate skilled nursing facility administrators and management about effects of poor nutritional status skilled OT assessment analysis and Interventions improving nutritional status of residents enhancing the dining experience improving staff effectiveness and efficiency
Program Goal
LTC administrators and managers will demonstrate basic knowledge of effects of poor nutritional
status describe barriers to providing excellent nutritional care explain how skilled OT services contribute to proving holistic
nutritional care
Teaching Elements
Teaching Session
Lecture- group instruction Printed educational handouts Printed worksheets Interactive activities among learners Small and whole group discussions Self-reflection and sharing Resource table with additional learning tools Short video (added as a result of feedback to pilot
session)
Targeted learners
professionals in health care provision or administration
extensive experience in the long-term healthcare industry in the area of nutrition and dietary food service
men and women multicultural group 30 ndash 60 years of age
Setting
Intended LTC workshop Skilled nursing facility conference room during weekday
business hours
Pilot Group workshop Large open-plan diningliving space with participants around
large oval table
Outcome of Pilot
What would I do differently
Schedule more convenient time
Include more participants
Ask for feedback
More anonymous feedback option
simplify language
Proposed Changes to Workshop
Provide printed quiz to go with handouts Add video component Rework handouts for comprehension and
application to learners needs
Discussion
After learning more about the problem of malnutrition in long-term care are you considering how you might introduce this topic into your practice or your teaching
Are there other venues where this type of educational program is appropriate and might influence the management of nutritional care for elders
Questions
References
Abbasi AA amp Rudman D (1994) Undernutrition in the nursing home Prevalence consequences cause and prevention Nutrition Reviews 52(4) 113-122 Accreditation Council for Occupational Therapy Education (2006) ACOTE standards and interpretive guidelines Retrieved from
httpwwwaotaorgnonmembersarea13docs acotestandards806pdf Adams NE Bowie AJ Simmance N Murrary M amp Crowe T (2008) Recognition by medical and nursing professionals of malnutrition and risk of malnutrition in elderly hospitalised patients Nutrition and Dietetics (65) 144-150 Amella EJ (2002) Resistance at mealtimes for persons with dementia The Journal of Nutrition Health amp Aging 6 117-122 Amella EJ (2008) Mealtime difficulties In Evidence-Based Geriatric Nursing Protocols for Best Practice 3rd ed (Capezuti E Zwicker D Mezey M Fulmer T Gray-Miceli D amp Kluger M eds) Springer Publishing Company LLC New York p 337-351 American Occupational Therapy Association [AOTA] (2002) Occupational therapy practice framework Domain and process American Journal of Occupational Therapy 56
609ndash639 doi 105014ajot566609 AOTA (2007) Specialized knowledge and skills in feeding eating and swallowing for occupational therapy practice American Journal of Occupational Therapy 61(6) 686-700
doi 105014ajot616686 Asai JL (2004) Nutrition and the geriatric rehabilitation patient Challenges and solutions Topics in Geriatric Rehabilitation 20(1) 34-45 Baier RR Butterfield K Harris Y Gravenstein S (2008) Aiming for star performance the relationship between setting targets and improved nursing home quality of
care Journal of the American Medical Directors Association9(8) 594-9 Epub Dolhi C amp Rogers J (2009) Dementia nutrition and self-feeding A systematic review of the literature Occupational Therapy in Health Care 15(3-4) 59-87 Ferri C Prince M Brayne C Brodaty H Fratiglioni L Ganguli M hellip Landry G (2005) Global prevalence of dementia a delphi consensus study Lancet 366 2112-2217 Frisoni G Fanzoni S Rozzini R Ferrucci L Boffelli S amp Trabucchi M (1994) A nutritional index predicting mortality in the nursing home Journal of the American Geriatric Society 42 1167-1172 Furman EF (2006) Under-nutrition in older adults across the continuum of care Journal of Gerontological Nursing 32(1) 22-27 Groher ME amp Crary MA(2010) Dysphagia Clinical Management in Adults and Children Maryland Heights MO Mosby-Elsevier Harris-Kojetin L Sengupta M Park-Lee E Valverde R Long-term care services in the United States 2013 overview National health care statistics reports no 1 Hyattsville MD National Center for Health Statistics 2013
References
Horner J Alberts MJ Dawson DV Cook GM (1994) Swallowing in Alzheimerrsquos disease Alzheimer Disease Association Disorders 8 177 ndash 19 Kielhofner G (1985) A model of human occupation Baltimore Williams and Wilkins Lammes E amp Akner G (2006) Repeated assessment of energy and nutrient intake in 52 nursing home residents Journal of Nutritional Health and Aging 10(3) 222-30 Lin L-C Watson R amp Wu S-C (2010) What is associated with low food intake in older people with dementia Journal of Clinical Nursing 19 53-59 Doi 101111j1365-2702200902962x Maher D amp Eliad C (2014) Malnutrition in the elderly An unrecognized health issue Journal of Nursing Retrieved from httprnjournalcomjournal-of-nursingmalnutrition-in-the-elderly-an-unrecognized-health-issue Manthorpe J amp Watson R (2003) Poorly served Eating and dementia Journal of Advanced Nursing 41(2) 162-169 Nelson K Coultson A SucherKP amp Tseng R (1992) Prevalence of malnutrition in The elderly admitted to long-term-care facilities Journal of the American Dietetic Association 93(4) 459-460 Ott F Readman T amp Backman C (1990) Mealtimes of the institutionalized elderly A literature review Canadian Journal of Occupational Therapy 57(5) 261-267 Payette H (2002) Know related effects of nutrition on aging muscle function In Nutrition and Aging Vol 6 Ed by LH Rosenberg and A Sastre Nestle Workshop Series Clinical and Performance Program Nestec Ltd Vevey Switzerland P 135-150 Planetree amp Picker Institute (2010) Long term care improvement guide Retrieved from httpplanetreeorgwp-contentuploads201112LTC-Improvement-Guide-For-Downloadpdf Riviere S Gillerte-Guyonnet S Andrieu S Nourhashemi F Laugque S Cantet C hellip Vellas B (2002) Cognitive function and caregiver burden Predictive factors for eating behavior disorders in Alzhiemerrsquos disease International Journal of Geriatric Psychiatry 17 950-955 Schussler S Dassen T amp Lohrmann C (2014) Prevalence of care dependency and nursing care problems in nursing home residents with dementia A literature review International Journal of Caring Sciences 7(2) 339 Retrieved from httpwwwinternationaljournalofcaringsciencesorgdocs120SchC3BCssler-1pdf
References
Scott TM Peter L Tucker KL Arsenault L Bergethon P Bhadelia R hellip Folstein M (2006) The Nutrition Aging and Memory in Elders (NAME) study Design and methods for a study of micronutrients and cognitive function in a homebound elderly population International Journal of Geriatric Psychiatry 21(6) 519-528
doi101002gps1503735 Simmons SF Keeler E Zhuo X Hickey KA Sato HW amp Schnelle JF (2008) Prevention of unintentional weight loss in nursing home residents a controlled trial of feeding assistance Journal of American Geriatric Society 56(8) 1466-1473
Doi101111j1532-5415200801801x Sodderhamn U Backrach-Lindstrom M amp Ek AC (2007) Nutritional screening and perceived health in a group of geriatric rehabilitation patients Journal of Clinical Nursing (16) 1997-2006 Thomas DR Ashmen W Morley JE Evans WJ amp the Council for Nutritional Strategies in Long-Term Care (2000) Nutritional management in long-term care Development of a clinical guideline Journal of Gerontolology Biological Sciences and Medical Sciences 55A(12) M725- doi101093Gerona5512M725 Wu S amp Barker JC (2008) Hot tea and Juk The institutional meaning of food for Chinese elders in an American nursing home Journal of Gerontological Nursing 34(11) 46-45 doi10392800989134-20081101-11
E L I Z A B E T H C B A I R b a i r 0 7 1 2 p a c i f i c u e d u
Thank You
Culture Change
ldquoCulture change is an innovation anchored in values and beliefs that return the locus of control to elders and those who work closest with them Its ultimate vision is to create a culture of aging that is inclusive life-affirming satisfying humane and meaningfulrdquo
(Kantor B amp Planetree amp Picker Institute 2010)
Trends in Culture Change
Emphasis on resident choice and person-centered care as essential components to improve dining experiences
Culture change requires transformation in organizational practices physical environments workplace practices communication and relationships among all stakeholders
Benefits of Culture Change
LTCs who implement cultural changeshellip Improve quality-of-life for residents patients and staff
Increase performance on clinical outcomes
(Planetree amp Picker Institute 2010 Baier Butterfield Harris amp Gravenstei 2008)
Experience positive effects on occupancy rates and the financial bottom line of LTC (Doty Koren amp Sturla 2008 Elliot 2010 LaPorte 2010)
Key Points for Program amp Culture Change
Residents are unique individuals Facility leadership must seek further education Leaders must support the changes in environment Interdisciplinary staff education and training at all
levels Formalize screening and referral process Changes to dining organization and staffing duties Utilize expertise and unique perspective of OT
Future Work
Increase multidisciplinary collaboration
Increase knowledge base for OT through research Design and share educational programs across
disciplines and settings
Future Work
Explore and implement innovative approaches to feeding and eating assistance
Design programs specific to the dining experience of persons with dementia or cognitive impairment
Advocate with government and industry to promote
person centered care in LTC
Education is Key to Change
Industry leaders nursing home administrators and management need to be educated about the extent of malnutrition in nursing homes
There is a need for educational plans and instructional materials on preventing and treating malnutrition in LTC
Healthcare providers must take time to advocate with facilities and present educational workshops
Recognizing and preventing malnutrition in nursing homes
A teaching plan was developed and incorporated into
the coursework for the OTD 610 Practitioner as Educator course at Pacific University
An extensive literature review has been created to provide evidence and foundational knowledge for healthcare providers LTC administrators and stakeholders
Purpose
Educate skilled nursing facility administrators and management about effects of poor nutritional status skilled OT assessment analysis and Interventions improving nutritional status of residents enhancing the dining experience improving staff effectiveness and efficiency
Program Goal
LTC administrators and managers will demonstrate basic knowledge of effects of poor nutritional
status describe barriers to providing excellent nutritional care explain how skilled OT services contribute to proving holistic
nutritional care
Teaching Elements
Teaching Session
Lecture- group instruction Printed educational handouts Printed worksheets Interactive activities among learners Small and whole group discussions Self-reflection and sharing Resource table with additional learning tools Short video (added as a result of feedback to pilot
session)
Targeted learners
professionals in health care provision or administration
extensive experience in the long-term healthcare industry in the area of nutrition and dietary food service
men and women multicultural group 30 ndash 60 years of age
Setting
Intended LTC workshop Skilled nursing facility conference room during weekday
business hours
Pilot Group workshop Large open-plan diningliving space with participants around
large oval table
Outcome of Pilot
What would I do differently
Schedule more convenient time
Include more participants
Ask for feedback
More anonymous feedback option
simplify language
Proposed Changes to Workshop
Provide printed quiz to go with handouts Add video component Rework handouts for comprehension and
application to learners needs
Discussion
After learning more about the problem of malnutrition in long-term care are you considering how you might introduce this topic into your practice or your teaching
Are there other venues where this type of educational program is appropriate and might influence the management of nutritional care for elders
Questions
References
Abbasi AA amp Rudman D (1994) Undernutrition in the nursing home Prevalence consequences cause and prevention Nutrition Reviews 52(4) 113-122 Accreditation Council for Occupational Therapy Education (2006) ACOTE standards and interpretive guidelines Retrieved from
httpwwwaotaorgnonmembersarea13docs acotestandards806pdf Adams NE Bowie AJ Simmance N Murrary M amp Crowe T (2008) Recognition by medical and nursing professionals of malnutrition and risk of malnutrition in elderly hospitalised patients Nutrition and Dietetics (65) 144-150 Amella EJ (2002) Resistance at mealtimes for persons with dementia The Journal of Nutrition Health amp Aging 6 117-122 Amella EJ (2008) Mealtime difficulties In Evidence-Based Geriatric Nursing Protocols for Best Practice 3rd ed (Capezuti E Zwicker D Mezey M Fulmer T Gray-Miceli D amp Kluger M eds) Springer Publishing Company LLC New York p 337-351 American Occupational Therapy Association [AOTA] (2002) Occupational therapy practice framework Domain and process American Journal of Occupational Therapy 56
609ndash639 doi 105014ajot566609 AOTA (2007) Specialized knowledge and skills in feeding eating and swallowing for occupational therapy practice American Journal of Occupational Therapy 61(6) 686-700
doi 105014ajot616686 Asai JL (2004) Nutrition and the geriatric rehabilitation patient Challenges and solutions Topics in Geriatric Rehabilitation 20(1) 34-45 Baier RR Butterfield K Harris Y Gravenstein S (2008) Aiming for star performance the relationship between setting targets and improved nursing home quality of
care Journal of the American Medical Directors Association9(8) 594-9 Epub Dolhi C amp Rogers J (2009) Dementia nutrition and self-feeding A systematic review of the literature Occupational Therapy in Health Care 15(3-4) 59-87 Ferri C Prince M Brayne C Brodaty H Fratiglioni L Ganguli M hellip Landry G (2005) Global prevalence of dementia a delphi consensus study Lancet 366 2112-2217 Frisoni G Fanzoni S Rozzini R Ferrucci L Boffelli S amp Trabucchi M (1994) A nutritional index predicting mortality in the nursing home Journal of the American Geriatric Society 42 1167-1172 Furman EF (2006) Under-nutrition in older adults across the continuum of care Journal of Gerontological Nursing 32(1) 22-27 Groher ME amp Crary MA(2010) Dysphagia Clinical Management in Adults and Children Maryland Heights MO Mosby-Elsevier Harris-Kojetin L Sengupta M Park-Lee E Valverde R Long-term care services in the United States 2013 overview National health care statistics reports no 1 Hyattsville MD National Center for Health Statistics 2013
References
Horner J Alberts MJ Dawson DV Cook GM (1994) Swallowing in Alzheimerrsquos disease Alzheimer Disease Association Disorders 8 177 ndash 19 Kielhofner G (1985) A model of human occupation Baltimore Williams and Wilkins Lammes E amp Akner G (2006) Repeated assessment of energy and nutrient intake in 52 nursing home residents Journal of Nutritional Health and Aging 10(3) 222-30 Lin L-C Watson R amp Wu S-C (2010) What is associated with low food intake in older people with dementia Journal of Clinical Nursing 19 53-59 Doi 101111j1365-2702200902962x Maher D amp Eliad C (2014) Malnutrition in the elderly An unrecognized health issue Journal of Nursing Retrieved from httprnjournalcomjournal-of-nursingmalnutrition-in-the-elderly-an-unrecognized-health-issue Manthorpe J amp Watson R (2003) Poorly served Eating and dementia Journal of Advanced Nursing 41(2) 162-169 Nelson K Coultson A SucherKP amp Tseng R (1992) Prevalence of malnutrition in The elderly admitted to long-term-care facilities Journal of the American Dietetic Association 93(4) 459-460 Ott F Readman T amp Backman C (1990) Mealtimes of the institutionalized elderly A literature review Canadian Journal of Occupational Therapy 57(5) 261-267 Payette H (2002) Know related effects of nutrition on aging muscle function In Nutrition and Aging Vol 6 Ed by LH Rosenberg and A Sastre Nestle Workshop Series Clinical and Performance Program Nestec Ltd Vevey Switzerland P 135-150 Planetree amp Picker Institute (2010) Long term care improvement guide Retrieved from httpplanetreeorgwp-contentuploads201112LTC-Improvement-Guide-For-Downloadpdf Riviere S Gillerte-Guyonnet S Andrieu S Nourhashemi F Laugque S Cantet C hellip Vellas B (2002) Cognitive function and caregiver burden Predictive factors for eating behavior disorders in Alzhiemerrsquos disease International Journal of Geriatric Psychiatry 17 950-955 Schussler S Dassen T amp Lohrmann C (2014) Prevalence of care dependency and nursing care problems in nursing home residents with dementia A literature review International Journal of Caring Sciences 7(2) 339 Retrieved from httpwwwinternationaljournalofcaringsciencesorgdocs120SchC3BCssler-1pdf
References
Scott TM Peter L Tucker KL Arsenault L Bergethon P Bhadelia R hellip Folstein M (2006) The Nutrition Aging and Memory in Elders (NAME) study Design and methods for a study of micronutrients and cognitive function in a homebound elderly population International Journal of Geriatric Psychiatry 21(6) 519-528
doi101002gps1503735 Simmons SF Keeler E Zhuo X Hickey KA Sato HW amp Schnelle JF (2008) Prevention of unintentional weight loss in nursing home residents a controlled trial of feeding assistance Journal of American Geriatric Society 56(8) 1466-1473
Doi101111j1532-5415200801801x Sodderhamn U Backrach-Lindstrom M amp Ek AC (2007) Nutritional screening and perceived health in a group of geriatric rehabilitation patients Journal of Clinical Nursing (16) 1997-2006 Thomas DR Ashmen W Morley JE Evans WJ amp the Council for Nutritional Strategies in Long-Term Care (2000) Nutritional management in long-term care Development of a clinical guideline Journal of Gerontolology Biological Sciences and Medical Sciences 55A(12) M725- doi101093Gerona5512M725 Wu S amp Barker JC (2008) Hot tea and Juk The institutional meaning of food for Chinese elders in an American nursing home Journal of Gerontological Nursing 34(11) 46-45 doi10392800989134-20081101-11
E L I Z A B E T H C B A I R b a i r 0 7 1 2 p a c i f i c u e d u
Thank You
Trends in Culture Change
Emphasis on resident choice and person-centered care as essential components to improve dining experiences
Culture change requires transformation in organizational practices physical environments workplace practices communication and relationships among all stakeholders
Benefits of Culture Change
LTCs who implement cultural changeshellip Improve quality-of-life for residents patients and staff
Increase performance on clinical outcomes
(Planetree amp Picker Institute 2010 Baier Butterfield Harris amp Gravenstei 2008)
Experience positive effects on occupancy rates and the financial bottom line of LTC (Doty Koren amp Sturla 2008 Elliot 2010 LaPorte 2010)
Key Points for Program amp Culture Change
Residents are unique individuals Facility leadership must seek further education Leaders must support the changes in environment Interdisciplinary staff education and training at all
levels Formalize screening and referral process Changes to dining organization and staffing duties Utilize expertise and unique perspective of OT
Future Work
Increase multidisciplinary collaboration
Increase knowledge base for OT through research Design and share educational programs across
disciplines and settings
Future Work
Explore and implement innovative approaches to feeding and eating assistance
Design programs specific to the dining experience of persons with dementia or cognitive impairment
Advocate with government and industry to promote
person centered care in LTC
Education is Key to Change
Industry leaders nursing home administrators and management need to be educated about the extent of malnutrition in nursing homes
There is a need for educational plans and instructional materials on preventing and treating malnutrition in LTC
Healthcare providers must take time to advocate with facilities and present educational workshops
Recognizing and preventing malnutrition in nursing homes
A teaching plan was developed and incorporated into
the coursework for the OTD 610 Practitioner as Educator course at Pacific University
An extensive literature review has been created to provide evidence and foundational knowledge for healthcare providers LTC administrators and stakeholders
Purpose
Educate skilled nursing facility administrators and management about effects of poor nutritional status skilled OT assessment analysis and Interventions improving nutritional status of residents enhancing the dining experience improving staff effectiveness and efficiency
Program Goal
LTC administrators and managers will demonstrate basic knowledge of effects of poor nutritional
status describe barriers to providing excellent nutritional care explain how skilled OT services contribute to proving holistic
nutritional care
Teaching Elements
Teaching Session
Lecture- group instruction Printed educational handouts Printed worksheets Interactive activities among learners Small and whole group discussions Self-reflection and sharing Resource table with additional learning tools Short video (added as a result of feedback to pilot
session)
Targeted learners
professionals in health care provision or administration
extensive experience in the long-term healthcare industry in the area of nutrition and dietary food service
men and women multicultural group 30 ndash 60 years of age
Setting
Intended LTC workshop Skilled nursing facility conference room during weekday
business hours
Pilot Group workshop Large open-plan diningliving space with participants around
large oval table
Outcome of Pilot
What would I do differently
Schedule more convenient time
Include more participants
Ask for feedback
More anonymous feedback option
simplify language
Proposed Changes to Workshop
Provide printed quiz to go with handouts Add video component Rework handouts for comprehension and
application to learners needs
Discussion
After learning more about the problem of malnutrition in long-term care are you considering how you might introduce this topic into your practice or your teaching
Are there other venues where this type of educational program is appropriate and might influence the management of nutritional care for elders
Questions
References
Abbasi AA amp Rudman D (1994) Undernutrition in the nursing home Prevalence consequences cause and prevention Nutrition Reviews 52(4) 113-122 Accreditation Council for Occupational Therapy Education (2006) ACOTE standards and interpretive guidelines Retrieved from
httpwwwaotaorgnonmembersarea13docs acotestandards806pdf Adams NE Bowie AJ Simmance N Murrary M amp Crowe T (2008) Recognition by medical and nursing professionals of malnutrition and risk of malnutrition in elderly hospitalised patients Nutrition and Dietetics (65) 144-150 Amella EJ (2002) Resistance at mealtimes for persons with dementia The Journal of Nutrition Health amp Aging 6 117-122 Amella EJ (2008) Mealtime difficulties In Evidence-Based Geriatric Nursing Protocols for Best Practice 3rd ed (Capezuti E Zwicker D Mezey M Fulmer T Gray-Miceli D amp Kluger M eds) Springer Publishing Company LLC New York p 337-351 American Occupational Therapy Association [AOTA] (2002) Occupational therapy practice framework Domain and process American Journal of Occupational Therapy 56
609ndash639 doi 105014ajot566609 AOTA (2007) Specialized knowledge and skills in feeding eating and swallowing for occupational therapy practice American Journal of Occupational Therapy 61(6) 686-700
doi 105014ajot616686 Asai JL (2004) Nutrition and the geriatric rehabilitation patient Challenges and solutions Topics in Geriatric Rehabilitation 20(1) 34-45 Baier RR Butterfield K Harris Y Gravenstein S (2008) Aiming for star performance the relationship between setting targets and improved nursing home quality of
care Journal of the American Medical Directors Association9(8) 594-9 Epub Dolhi C amp Rogers J (2009) Dementia nutrition and self-feeding A systematic review of the literature Occupational Therapy in Health Care 15(3-4) 59-87 Ferri C Prince M Brayne C Brodaty H Fratiglioni L Ganguli M hellip Landry G (2005) Global prevalence of dementia a delphi consensus study Lancet 366 2112-2217 Frisoni G Fanzoni S Rozzini R Ferrucci L Boffelli S amp Trabucchi M (1994) A nutritional index predicting mortality in the nursing home Journal of the American Geriatric Society 42 1167-1172 Furman EF (2006) Under-nutrition in older adults across the continuum of care Journal of Gerontological Nursing 32(1) 22-27 Groher ME amp Crary MA(2010) Dysphagia Clinical Management in Adults and Children Maryland Heights MO Mosby-Elsevier Harris-Kojetin L Sengupta M Park-Lee E Valverde R Long-term care services in the United States 2013 overview National health care statistics reports no 1 Hyattsville MD National Center for Health Statistics 2013
References
Horner J Alberts MJ Dawson DV Cook GM (1994) Swallowing in Alzheimerrsquos disease Alzheimer Disease Association Disorders 8 177 ndash 19 Kielhofner G (1985) A model of human occupation Baltimore Williams and Wilkins Lammes E amp Akner G (2006) Repeated assessment of energy and nutrient intake in 52 nursing home residents Journal of Nutritional Health and Aging 10(3) 222-30 Lin L-C Watson R amp Wu S-C (2010) What is associated with low food intake in older people with dementia Journal of Clinical Nursing 19 53-59 Doi 101111j1365-2702200902962x Maher D amp Eliad C (2014) Malnutrition in the elderly An unrecognized health issue Journal of Nursing Retrieved from httprnjournalcomjournal-of-nursingmalnutrition-in-the-elderly-an-unrecognized-health-issue Manthorpe J amp Watson R (2003) Poorly served Eating and dementia Journal of Advanced Nursing 41(2) 162-169 Nelson K Coultson A SucherKP amp Tseng R (1992) Prevalence of malnutrition in The elderly admitted to long-term-care facilities Journal of the American Dietetic Association 93(4) 459-460 Ott F Readman T amp Backman C (1990) Mealtimes of the institutionalized elderly A literature review Canadian Journal of Occupational Therapy 57(5) 261-267 Payette H (2002) Know related effects of nutrition on aging muscle function In Nutrition and Aging Vol 6 Ed by LH Rosenberg and A Sastre Nestle Workshop Series Clinical and Performance Program Nestec Ltd Vevey Switzerland P 135-150 Planetree amp Picker Institute (2010) Long term care improvement guide Retrieved from httpplanetreeorgwp-contentuploads201112LTC-Improvement-Guide-For-Downloadpdf Riviere S Gillerte-Guyonnet S Andrieu S Nourhashemi F Laugque S Cantet C hellip Vellas B (2002) Cognitive function and caregiver burden Predictive factors for eating behavior disorders in Alzhiemerrsquos disease International Journal of Geriatric Psychiatry 17 950-955 Schussler S Dassen T amp Lohrmann C (2014) Prevalence of care dependency and nursing care problems in nursing home residents with dementia A literature review International Journal of Caring Sciences 7(2) 339 Retrieved from httpwwwinternationaljournalofcaringsciencesorgdocs120SchC3BCssler-1pdf
References
Scott TM Peter L Tucker KL Arsenault L Bergethon P Bhadelia R hellip Folstein M (2006) The Nutrition Aging and Memory in Elders (NAME) study Design and methods for a study of micronutrients and cognitive function in a homebound elderly population International Journal of Geriatric Psychiatry 21(6) 519-528
doi101002gps1503735 Simmons SF Keeler E Zhuo X Hickey KA Sato HW amp Schnelle JF (2008) Prevention of unintentional weight loss in nursing home residents a controlled trial of feeding assistance Journal of American Geriatric Society 56(8) 1466-1473
Doi101111j1532-5415200801801x Sodderhamn U Backrach-Lindstrom M amp Ek AC (2007) Nutritional screening and perceived health in a group of geriatric rehabilitation patients Journal of Clinical Nursing (16) 1997-2006 Thomas DR Ashmen W Morley JE Evans WJ amp the Council for Nutritional Strategies in Long-Term Care (2000) Nutritional management in long-term care Development of a clinical guideline Journal of Gerontolology Biological Sciences and Medical Sciences 55A(12) M725- doi101093Gerona5512M725 Wu S amp Barker JC (2008) Hot tea and Juk The institutional meaning of food for Chinese elders in an American nursing home Journal of Gerontological Nursing 34(11) 46-45 doi10392800989134-20081101-11
E L I Z A B E T H C B A I R b a i r 0 7 1 2 p a c i f i c u e d u
Thank You
Benefits of Culture Change
LTCs who implement cultural changeshellip Improve quality-of-life for residents patients and staff
Increase performance on clinical outcomes
(Planetree amp Picker Institute 2010 Baier Butterfield Harris amp Gravenstei 2008)
Experience positive effects on occupancy rates and the financial bottom line of LTC (Doty Koren amp Sturla 2008 Elliot 2010 LaPorte 2010)
Key Points for Program amp Culture Change
Residents are unique individuals Facility leadership must seek further education Leaders must support the changes in environment Interdisciplinary staff education and training at all
levels Formalize screening and referral process Changes to dining organization and staffing duties Utilize expertise and unique perspective of OT
Future Work
Increase multidisciplinary collaboration
Increase knowledge base for OT through research Design and share educational programs across
disciplines and settings
Future Work
Explore and implement innovative approaches to feeding and eating assistance
Design programs specific to the dining experience of persons with dementia or cognitive impairment
Advocate with government and industry to promote
person centered care in LTC
Education is Key to Change
Industry leaders nursing home administrators and management need to be educated about the extent of malnutrition in nursing homes
There is a need for educational plans and instructional materials on preventing and treating malnutrition in LTC
Healthcare providers must take time to advocate with facilities and present educational workshops
Recognizing and preventing malnutrition in nursing homes
A teaching plan was developed and incorporated into
the coursework for the OTD 610 Practitioner as Educator course at Pacific University
An extensive literature review has been created to provide evidence and foundational knowledge for healthcare providers LTC administrators and stakeholders
Purpose
Educate skilled nursing facility administrators and management about effects of poor nutritional status skilled OT assessment analysis and Interventions improving nutritional status of residents enhancing the dining experience improving staff effectiveness and efficiency
Program Goal
LTC administrators and managers will demonstrate basic knowledge of effects of poor nutritional
status describe barriers to providing excellent nutritional care explain how skilled OT services contribute to proving holistic
nutritional care
Teaching Elements
Teaching Session
Lecture- group instruction Printed educational handouts Printed worksheets Interactive activities among learners Small and whole group discussions Self-reflection and sharing Resource table with additional learning tools Short video (added as a result of feedback to pilot
session)
Targeted learners
professionals in health care provision or administration
extensive experience in the long-term healthcare industry in the area of nutrition and dietary food service
men and women multicultural group 30 ndash 60 years of age
Setting
Intended LTC workshop Skilled nursing facility conference room during weekday
business hours
Pilot Group workshop Large open-plan diningliving space with participants around
large oval table
Outcome of Pilot
What would I do differently
Schedule more convenient time
Include more participants
Ask for feedback
More anonymous feedback option
simplify language
Proposed Changes to Workshop
Provide printed quiz to go with handouts Add video component Rework handouts for comprehension and
application to learners needs
Discussion
After learning more about the problem of malnutrition in long-term care are you considering how you might introduce this topic into your practice or your teaching
Are there other venues where this type of educational program is appropriate and might influence the management of nutritional care for elders
Questions
References
Abbasi AA amp Rudman D (1994) Undernutrition in the nursing home Prevalence consequences cause and prevention Nutrition Reviews 52(4) 113-122 Accreditation Council for Occupational Therapy Education (2006) ACOTE standards and interpretive guidelines Retrieved from
httpwwwaotaorgnonmembersarea13docs acotestandards806pdf Adams NE Bowie AJ Simmance N Murrary M amp Crowe T (2008) Recognition by medical and nursing professionals of malnutrition and risk of malnutrition in elderly hospitalised patients Nutrition and Dietetics (65) 144-150 Amella EJ (2002) Resistance at mealtimes for persons with dementia The Journal of Nutrition Health amp Aging 6 117-122 Amella EJ (2008) Mealtime difficulties In Evidence-Based Geriatric Nursing Protocols for Best Practice 3rd ed (Capezuti E Zwicker D Mezey M Fulmer T Gray-Miceli D amp Kluger M eds) Springer Publishing Company LLC New York p 337-351 American Occupational Therapy Association [AOTA] (2002) Occupational therapy practice framework Domain and process American Journal of Occupational Therapy 56
609ndash639 doi 105014ajot566609 AOTA (2007) Specialized knowledge and skills in feeding eating and swallowing for occupational therapy practice American Journal of Occupational Therapy 61(6) 686-700
doi 105014ajot616686 Asai JL (2004) Nutrition and the geriatric rehabilitation patient Challenges and solutions Topics in Geriatric Rehabilitation 20(1) 34-45 Baier RR Butterfield K Harris Y Gravenstein S (2008) Aiming for star performance the relationship between setting targets and improved nursing home quality of
care Journal of the American Medical Directors Association9(8) 594-9 Epub Dolhi C amp Rogers J (2009) Dementia nutrition and self-feeding A systematic review of the literature Occupational Therapy in Health Care 15(3-4) 59-87 Ferri C Prince M Brayne C Brodaty H Fratiglioni L Ganguli M hellip Landry G (2005) Global prevalence of dementia a delphi consensus study Lancet 366 2112-2217 Frisoni G Fanzoni S Rozzini R Ferrucci L Boffelli S amp Trabucchi M (1994) A nutritional index predicting mortality in the nursing home Journal of the American Geriatric Society 42 1167-1172 Furman EF (2006) Under-nutrition in older adults across the continuum of care Journal of Gerontological Nursing 32(1) 22-27 Groher ME amp Crary MA(2010) Dysphagia Clinical Management in Adults and Children Maryland Heights MO Mosby-Elsevier Harris-Kojetin L Sengupta M Park-Lee E Valverde R Long-term care services in the United States 2013 overview National health care statistics reports no 1 Hyattsville MD National Center for Health Statistics 2013
References
Horner J Alberts MJ Dawson DV Cook GM (1994) Swallowing in Alzheimerrsquos disease Alzheimer Disease Association Disorders 8 177 ndash 19 Kielhofner G (1985) A model of human occupation Baltimore Williams and Wilkins Lammes E amp Akner G (2006) Repeated assessment of energy and nutrient intake in 52 nursing home residents Journal of Nutritional Health and Aging 10(3) 222-30 Lin L-C Watson R amp Wu S-C (2010) What is associated with low food intake in older people with dementia Journal of Clinical Nursing 19 53-59 Doi 101111j1365-2702200902962x Maher D amp Eliad C (2014) Malnutrition in the elderly An unrecognized health issue Journal of Nursing Retrieved from httprnjournalcomjournal-of-nursingmalnutrition-in-the-elderly-an-unrecognized-health-issue Manthorpe J amp Watson R (2003) Poorly served Eating and dementia Journal of Advanced Nursing 41(2) 162-169 Nelson K Coultson A SucherKP amp Tseng R (1992) Prevalence of malnutrition in The elderly admitted to long-term-care facilities Journal of the American Dietetic Association 93(4) 459-460 Ott F Readman T amp Backman C (1990) Mealtimes of the institutionalized elderly A literature review Canadian Journal of Occupational Therapy 57(5) 261-267 Payette H (2002) Know related effects of nutrition on aging muscle function In Nutrition and Aging Vol 6 Ed by LH Rosenberg and A Sastre Nestle Workshop Series Clinical and Performance Program Nestec Ltd Vevey Switzerland P 135-150 Planetree amp Picker Institute (2010) Long term care improvement guide Retrieved from httpplanetreeorgwp-contentuploads201112LTC-Improvement-Guide-For-Downloadpdf Riviere S Gillerte-Guyonnet S Andrieu S Nourhashemi F Laugque S Cantet C hellip Vellas B (2002) Cognitive function and caregiver burden Predictive factors for eating behavior disorders in Alzhiemerrsquos disease International Journal of Geriatric Psychiatry 17 950-955 Schussler S Dassen T amp Lohrmann C (2014) Prevalence of care dependency and nursing care problems in nursing home residents with dementia A literature review International Journal of Caring Sciences 7(2) 339 Retrieved from httpwwwinternationaljournalofcaringsciencesorgdocs120SchC3BCssler-1pdf
References
Scott TM Peter L Tucker KL Arsenault L Bergethon P Bhadelia R hellip Folstein M (2006) The Nutrition Aging and Memory in Elders (NAME) study Design and methods for a study of micronutrients and cognitive function in a homebound elderly population International Journal of Geriatric Psychiatry 21(6) 519-528
doi101002gps1503735 Simmons SF Keeler E Zhuo X Hickey KA Sato HW amp Schnelle JF (2008) Prevention of unintentional weight loss in nursing home residents a controlled trial of feeding assistance Journal of American Geriatric Society 56(8) 1466-1473
Doi101111j1532-5415200801801x Sodderhamn U Backrach-Lindstrom M amp Ek AC (2007) Nutritional screening and perceived health in a group of geriatric rehabilitation patients Journal of Clinical Nursing (16) 1997-2006 Thomas DR Ashmen W Morley JE Evans WJ amp the Council for Nutritional Strategies in Long-Term Care (2000) Nutritional management in long-term care Development of a clinical guideline Journal of Gerontolology Biological Sciences and Medical Sciences 55A(12) M725- doi101093Gerona5512M725 Wu S amp Barker JC (2008) Hot tea and Juk The institutional meaning of food for Chinese elders in an American nursing home Journal of Gerontological Nursing 34(11) 46-45 doi10392800989134-20081101-11
E L I Z A B E T H C B A I R b a i r 0 7 1 2 p a c i f i c u e d u
Thank You
Key Points for Program amp Culture Change
Residents are unique individuals Facility leadership must seek further education Leaders must support the changes in environment Interdisciplinary staff education and training at all
levels Formalize screening and referral process Changes to dining organization and staffing duties Utilize expertise and unique perspective of OT
Future Work
Increase multidisciplinary collaboration
Increase knowledge base for OT through research Design and share educational programs across
disciplines and settings
Future Work
Explore and implement innovative approaches to feeding and eating assistance
Design programs specific to the dining experience of persons with dementia or cognitive impairment
Advocate with government and industry to promote
person centered care in LTC
Education is Key to Change
Industry leaders nursing home administrators and management need to be educated about the extent of malnutrition in nursing homes
There is a need for educational plans and instructional materials on preventing and treating malnutrition in LTC
Healthcare providers must take time to advocate with facilities and present educational workshops
Recognizing and preventing malnutrition in nursing homes
A teaching plan was developed and incorporated into
the coursework for the OTD 610 Practitioner as Educator course at Pacific University
An extensive literature review has been created to provide evidence and foundational knowledge for healthcare providers LTC administrators and stakeholders
Purpose
Educate skilled nursing facility administrators and management about effects of poor nutritional status skilled OT assessment analysis and Interventions improving nutritional status of residents enhancing the dining experience improving staff effectiveness and efficiency
Program Goal
LTC administrators and managers will demonstrate basic knowledge of effects of poor nutritional
status describe barriers to providing excellent nutritional care explain how skilled OT services contribute to proving holistic
nutritional care
Teaching Elements
Teaching Session
Lecture- group instruction Printed educational handouts Printed worksheets Interactive activities among learners Small and whole group discussions Self-reflection and sharing Resource table with additional learning tools Short video (added as a result of feedback to pilot
session)
Targeted learners
professionals in health care provision or administration
extensive experience in the long-term healthcare industry in the area of nutrition and dietary food service
men and women multicultural group 30 ndash 60 years of age
Setting
Intended LTC workshop Skilled nursing facility conference room during weekday
business hours
Pilot Group workshop Large open-plan diningliving space with participants around
large oval table
Outcome of Pilot
What would I do differently
Schedule more convenient time
Include more participants
Ask for feedback
More anonymous feedback option
simplify language
Proposed Changes to Workshop
Provide printed quiz to go with handouts Add video component Rework handouts for comprehension and
application to learners needs
Discussion
After learning more about the problem of malnutrition in long-term care are you considering how you might introduce this topic into your practice or your teaching
Are there other venues where this type of educational program is appropriate and might influence the management of nutritional care for elders
Questions
References
Abbasi AA amp Rudman D (1994) Undernutrition in the nursing home Prevalence consequences cause and prevention Nutrition Reviews 52(4) 113-122 Accreditation Council for Occupational Therapy Education (2006) ACOTE standards and interpretive guidelines Retrieved from
httpwwwaotaorgnonmembersarea13docs acotestandards806pdf Adams NE Bowie AJ Simmance N Murrary M amp Crowe T (2008) Recognition by medical and nursing professionals of malnutrition and risk of malnutrition in elderly hospitalised patients Nutrition and Dietetics (65) 144-150 Amella EJ (2002) Resistance at mealtimes for persons with dementia The Journal of Nutrition Health amp Aging 6 117-122 Amella EJ (2008) Mealtime difficulties In Evidence-Based Geriatric Nursing Protocols for Best Practice 3rd ed (Capezuti E Zwicker D Mezey M Fulmer T Gray-Miceli D amp Kluger M eds) Springer Publishing Company LLC New York p 337-351 American Occupational Therapy Association [AOTA] (2002) Occupational therapy practice framework Domain and process American Journal of Occupational Therapy 56
609ndash639 doi 105014ajot566609 AOTA (2007) Specialized knowledge and skills in feeding eating and swallowing for occupational therapy practice American Journal of Occupational Therapy 61(6) 686-700
doi 105014ajot616686 Asai JL (2004) Nutrition and the geriatric rehabilitation patient Challenges and solutions Topics in Geriatric Rehabilitation 20(1) 34-45 Baier RR Butterfield K Harris Y Gravenstein S (2008) Aiming for star performance the relationship between setting targets and improved nursing home quality of
care Journal of the American Medical Directors Association9(8) 594-9 Epub Dolhi C amp Rogers J (2009) Dementia nutrition and self-feeding A systematic review of the literature Occupational Therapy in Health Care 15(3-4) 59-87 Ferri C Prince M Brayne C Brodaty H Fratiglioni L Ganguli M hellip Landry G (2005) Global prevalence of dementia a delphi consensus study Lancet 366 2112-2217 Frisoni G Fanzoni S Rozzini R Ferrucci L Boffelli S amp Trabucchi M (1994) A nutritional index predicting mortality in the nursing home Journal of the American Geriatric Society 42 1167-1172 Furman EF (2006) Under-nutrition in older adults across the continuum of care Journal of Gerontological Nursing 32(1) 22-27 Groher ME amp Crary MA(2010) Dysphagia Clinical Management in Adults and Children Maryland Heights MO Mosby-Elsevier Harris-Kojetin L Sengupta M Park-Lee E Valverde R Long-term care services in the United States 2013 overview National health care statistics reports no 1 Hyattsville MD National Center for Health Statistics 2013
References
Horner J Alberts MJ Dawson DV Cook GM (1994) Swallowing in Alzheimerrsquos disease Alzheimer Disease Association Disorders 8 177 ndash 19 Kielhofner G (1985) A model of human occupation Baltimore Williams and Wilkins Lammes E amp Akner G (2006) Repeated assessment of energy and nutrient intake in 52 nursing home residents Journal of Nutritional Health and Aging 10(3) 222-30 Lin L-C Watson R amp Wu S-C (2010) What is associated with low food intake in older people with dementia Journal of Clinical Nursing 19 53-59 Doi 101111j1365-2702200902962x Maher D amp Eliad C (2014) Malnutrition in the elderly An unrecognized health issue Journal of Nursing Retrieved from httprnjournalcomjournal-of-nursingmalnutrition-in-the-elderly-an-unrecognized-health-issue Manthorpe J amp Watson R (2003) Poorly served Eating and dementia Journal of Advanced Nursing 41(2) 162-169 Nelson K Coultson A SucherKP amp Tseng R (1992) Prevalence of malnutrition in The elderly admitted to long-term-care facilities Journal of the American Dietetic Association 93(4) 459-460 Ott F Readman T amp Backman C (1990) Mealtimes of the institutionalized elderly A literature review Canadian Journal of Occupational Therapy 57(5) 261-267 Payette H (2002) Know related effects of nutrition on aging muscle function In Nutrition and Aging Vol 6 Ed by LH Rosenberg and A Sastre Nestle Workshop Series Clinical and Performance Program Nestec Ltd Vevey Switzerland P 135-150 Planetree amp Picker Institute (2010) Long term care improvement guide Retrieved from httpplanetreeorgwp-contentuploads201112LTC-Improvement-Guide-For-Downloadpdf Riviere S Gillerte-Guyonnet S Andrieu S Nourhashemi F Laugque S Cantet C hellip Vellas B (2002) Cognitive function and caregiver burden Predictive factors for eating behavior disorders in Alzhiemerrsquos disease International Journal of Geriatric Psychiatry 17 950-955 Schussler S Dassen T amp Lohrmann C (2014) Prevalence of care dependency and nursing care problems in nursing home residents with dementia A literature review International Journal of Caring Sciences 7(2) 339 Retrieved from httpwwwinternationaljournalofcaringsciencesorgdocs120SchC3BCssler-1pdf
References
Scott TM Peter L Tucker KL Arsenault L Bergethon P Bhadelia R hellip Folstein M (2006) The Nutrition Aging and Memory in Elders (NAME) study Design and methods for a study of micronutrients and cognitive function in a homebound elderly population International Journal of Geriatric Psychiatry 21(6) 519-528
doi101002gps1503735 Simmons SF Keeler E Zhuo X Hickey KA Sato HW amp Schnelle JF (2008) Prevention of unintentional weight loss in nursing home residents a controlled trial of feeding assistance Journal of American Geriatric Society 56(8) 1466-1473
Doi101111j1532-5415200801801x Sodderhamn U Backrach-Lindstrom M amp Ek AC (2007) Nutritional screening and perceived health in a group of geriatric rehabilitation patients Journal of Clinical Nursing (16) 1997-2006 Thomas DR Ashmen W Morley JE Evans WJ amp the Council for Nutritional Strategies in Long-Term Care (2000) Nutritional management in long-term care Development of a clinical guideline Journal of Gerontolology Biological Sciences and Medical Sciences 55A(12) M725- doi101093Gerona5512M725 Wu S amp Barker JC (2008) Hot tea and Juk The institutional meaning of food for Chinese elders in an American nursing home Journal of Gerontological Nursing 34(11) 46-45 doi10392800989134-20081101-11
E L I Z A B E T H C B A I R b a i r 0 7 1 2 p a c i f i c u e d u
Thank You
Future Work
Increase multidisciplinary collaboration
Increase knowledge base for OT through research Design and share educational programs across
disciplines and settings
Future Work
Explore and implement innovative approaches to feeding and eating assistance
Design programs specific to the dining experience of persons with dementia or cognitive impairment
Advocate with government and industry to promote
person centered care in LTC
Education is Key to Change
Industry leaders nursing home administrators and management need to be educated about the extent of malnutrition in nursing homes
There is a need for educational plans and instructional materials on preventing and treating malnutrition in LTC
Healthcare providers must take time to advocate with facilities and present educational workshops
Recognizing and preventing malnutrition in nursing homes
A teaching plan was developed and incorporated into
the coursework for the OTD 610 Practitioner as Educator course at Pacific University
An extensive literature review has been created to provide evidence and foundational knowledge for healthcare providers LTC administrators and stakeholders
Purpose
Educate skilled nursing facility administrators and management about effects of poor nutritional status skilled OT assessment analysis and Interventions improving nutritional status of residents enhancing the dining experience improving staff effectiveness and efficiency
Program Goal
LTC administrators and managers will demonstrate basic knowledge of effects of poor nutritional
status describe barriers to providing excellent nutritional care explain how skilled OT services contribute to proving holistic
nutritional care
Teaching Elements
Teaching Session
Lecture- group instruction Printed educational handouts Printed worksheets Interactive activities among learners Small and whole group discussions Self-reflection and sharing Resource table with additional learning tools Short video (added as a result of feedback to pilot
session)
Targeted learners
professionals in health care provision or administration
extensive experience in the long-term healthcare industry in the area of nutrition and dietary food service
men and women multicultural group 30 ndash 60 years of age
Setting
Intended LTC workshop Skilled nursing facility conference room during weekday
business hours
Pilot Group workshop Large open-plan diningliving space with participants around
large oval table
Outcome of Pilot
What would I do differently
Schedule more convenient time
Include more participants
Ask for feedback
More anonymous feedback option
simplify language
Proposed Changes to Workshop
Provide printed quiz to go with handouts Add video component Rework handouts for comprehension and
application to learners needs
Discussion
After learning more about the problem of malnutrition in long-term care are you considering how you might introduce this topic into your practice or your teaching
Are there other venues where this type of educational program is appropriate and might influence the management of nutritional care for elders
Questions
References
Abbasi AA amp Rudman D (1994) Undernutrition in the nursing home Prevalence consequences cause and prevention Nutrition Reviews 52(4) 113-122 Accreditation Council for Occupational Therapy Education (2006) ACOTE standards and interpretive guidelines Retrieved from
httpwwwaotaorgnonmembersarea13docs acotestandards806pdf Adams NE Bowie AJ Simmance N Murrary M amp Crowe T (2008) Recognition by medical and nursing professionals of malnutrition and risk of malnutrition in elderly hospitalised patients Nutrition and Dietetics (65) 144-150 Amella EJ (2002) Resistance at mealtimes for persons with dementia The Journal of Nutrition Health amp Aging 6 117-122 Amella EJ (2008) Mealtime difficulties In Evidence-Based Geriatric Nursing Protocols for Best Practice 3rd ed (Capezuti E Zwicker D Mezey M Fulmer T Gray-Miceli D amp Kluger M eds) Springer Publishing Company LLC New York p 337-351 American Occupational Therapy Association [AOTA] (2002) Occupational therapy practice framework Domain and process American Journal of Occupational Therapy 56
609ndash639 doi 105014ajot566609 AOTA (2007) Specialized knowledge and skills in feeding eating and swallowing for occupational therapy practice American Journal of Occupational Therapy 61(6) 686-700
doi 105014ajot616686 Asai JL (2004) Nutrition and the geriatric rehabilitation patient Challenges and solutions Topics in Geriatric Rehabilitation 20(1) 34-45 Baier RR Butterfield K Harris Y Gravenstein S (2008) Aiming for star performance the relationship between setting targets and improved nursing home quality of
care Journal of the American Medical Directors Association9(8) 594-9 Epub Dolhi C amp Rogers J (2009) Dementia nutrition and self-feeding A systematic review of the literature Occupational Therapy in Health Care 15(3-4) 59-87 Ferri C Prince M Brayne C Brodaty H Fratiglioni L Ganguli M hellip Landry G (2005) Global prevalence of dementia a delphi consensus study Lancet 366 2112-2217 Frisoni G Fanzoni S Rozzini R Ferrucci L Boffelli S amp Trabucchi M (1994) A nutritional index predicting mortality in the nursing home Journal of the American Geriatric Society 42 1167-1172 Furman EF (2006) Under-nutrition in older adults across the continuum of care Journal of Gerontological Nursing 32(1) 22-27 Groher ME amp Crary MA(2010) Dysphagia Clinical Management in Adults and Children Maryland Heights MO Mosby-Elsevier Harris-Kojetin L Sengupta M Park-Lee E Valverde R Long-term care services in the United States 2013 overview National health care statistics reports no 1 Hyattsville MD National Center for Health Statistics 2013
References
Horner J Alberts MJ Dawson DV Cook GM (1994) Swallowing in Alzheimerrsquos disease Alzheimer Disease Association Disorders 8 177 ndash 19 Kielhofner G (1985) A model of human occupation Baltimore Williams and Wilkins Lammes E amp Akner G (2006) Repeated assessment of energy and nutrient intake in 52 nursing home residents Journal of Nutritional Health and Aging 10(3) 222-30 Lin L-C Watson R amp Wu S-C (2010) What is associated with low food intake in older people with dementia Journal of Clinical Nursing 19 53-59 Doi 101111j1365-2702200902962x Maher D amp Eliad C (2014) Malnutrition in the elderly An unrecognized health issue Journal of Nursing Retrieved from httprnjournalcomjournal-of-nursingmalnutrition-in-the-elderly-an-unrecognized-health-issue Manthorpe J amp Watson R (2003) Poorly served Eating and dementia Journal of Advanced Nursing 41(2) 162-169 Nelson K Coultson A SucherKP amp Tseng R (1992) Prevalence of malnutrition in The elderly admitted to long-term-care facilities Journal of the American Dietetic Association 93(4) 459-460 Ott F Readman T amp Backman C (1990) Mealtimes of the institutionalized elderly A literature review Canadian Journal of Occupational Therapy 57(5) 261-267 Payette H (2002) Know related effects of nutrition on aging muscle function In Nutrition and Aging Vol 6 Ed by LH Rosenberg and A Sastre Nestle Workshop Series Clinical and Performance Program Nestec Ltd Vevey Switzerland P 135-150 Planetree amp Picker Institute (2010) Long term care improvement guide Retrieved from httpplanetreeorgwp-contentuploads201112LTC-Improvement-Guide-For-Downloadpdf Riviere S Gillerte-Guyonnet S Andrieu S Nourhashemi F Laugque S Cantet C hellip Vellas B (2002) Cognitive function and caregiver burden Predictive factors for eating behavior disorders in Alzhiemerrsquos disease International Journal of Geriatric Psychiatry 17 950-955 Schussler S Dassen T amp Lohrmann C (2014) Prevalence of care dependency and nursing care problems in nursing home residents with dementia A literature review International Journal of Caring Sciences 7(2) 339 Retrieved from httpwwwinternationaljournalofcaringsciencesorgdocs120SchC3BCssler-1pdf
References
Scott TM Peter L Tucker KL Arsenault L Bergethon P Bhadelia R hellip Folstein M (2006) The Nutrition Aging and Memory in Elders (NAME) study Design and methods for a study of micronutrients and cognitive function in a homebound elderly population International Journal of Geriatric Psychiatry 21(6) 519-528
doi101002gps1503735 Simmons SF Keeler E Zhuo X Hickey KA Sato HW amp Schnelle JF (2008) Prevention of unintentional weight loss in nursing home residents a controlled trial of feeding assistance Journal of American Geriatric Society 56(8) 1466-1473
Doi101111j1532-5415200801801x Sodderhamn U Backrach-Lindstrom M amp Ek AC (2007) Nutritional screening and perceived health in a group of geriatric rehabilitation patients Journal of Clinical Nursing (16) 1997-2006 Thomas DR Ashmen W Morley JE Evans WJ amp the Council for Nutritional Strategies in Long-Term Care (2000) Nutritional management in long-term care Development of a clinical guideline Journal of Gerontolology Biological Sciences and Medical Sciences 55A(12) M725- doi101093Gerona5512M725 Wu S amp Barker JC (2008) Hot tea and Juk The institutional meaning of food for Chinese elders in an American nursing home Journal of Gerontological Nursing 34(11) 46-45 doi10392800989134-20081101-11
E L I Z A B E T H C B A I R b a i r 0 7 1 2 p a c i f i c u e d u
Thank You
Future Work
Explore and implement innovative approaches to feeding and eating assistance
Design programs specific to the dining experience of persons with dementia or cognitive impairment
Advocate with government and industry to promote
person centered care in LTC
Education is Key to Change
Industry leaders nursing home administrators and management need to be educated about the extent of malnutrition in nursing homes
There is a need for educational plans and instructional materials on preventing and treating malnutrition in LTC
Healthcare providers must take time to advocate with facilities and present educational workshops
Recognizing and preventing malnutrition in nursing homes
A teaching plan was developed and incorporated into
the coursework for the OTD 610 Practitioner as Educator course at Pacific University
An extensive literature review has been created to provide evidence and foundational knowledge for healthcare providers LTC administrators and stakeholders
Purpose
Educate skilled nursing facility administrators and management about effects of poor nutritional status skilled OT assessment analysis and Interventions improving nutritional status of residents enhancing the dining experience improving staff effectiveness and efficiency
Program Goal
LTC administrators and managers will demonstrate basic knowledge of effects of poor nutritional
status describe barriers to providing excellent nutritional care explain how skilled OT services contribute to proving holistic
nutritional care
Teaching Elements
Teaching Session
Lecture- group instruction Printed educational handouts Printed worksheets Interactive activities among learners Small and whole group discussions Self-reflection and sharing Resource table with additional learning tools Short video (added as a result of feedback to pilot
session)
Targeted learners
professionals in health care provision or administration
extensive experience in the long-term healthcare industry in the area of nutrition and dietary food service
men and women multicultural group 30 ndash 60 years of age
Setting
Intended LTC workshop Skilled nursing facility conference room during weekday
business hours
Pilot Group workshop Large open-plan diningliving space with participants around
large oval table
Outcome of Pilot
What would I do differently
Schedule more convenient time
Include more participants
Ask for feedback
More anonymous feedback option
simplify language
Proposed Changes to Workshop
Provide printed quiz to go with handouts Add video component Rework handouts for comprehension and
application to learners needs
Discussion
After learning more about the problem of malnutrition in long-term care are you considering how you might introduce this topic into your practice or your teaching
Are there other venues where this type of educational program is appropriate and might influence the management of nutritional care for elders
Questions
References
Abbasi AA amp Rudman D (1994) Undernutrition in the nursing home Prevalence consequences cause and prevention Nutrition Reviews 52(4) 113-122 Accreditation Council for Occupational Therapy Education (2006) ACOTE standards and interpretive guidelines Retrieved from
httpwwwaotaorgnonmembersarea13docs acotestandards806pdf Adams NE Bowie AJ Simmance N Murrary M amp Crowe T (2008) Recognition by medical and nursing professionals of malnutrition and risk of malnutrition in elderly hospitalised patients Nutrition and Dietetics (65) 144-150 Amella EJ (2002) Resistance at mealtimes for persons with dementia The Journal of Nutrition Health amp Aging 6 117-122 Amella EJ (2008) Mealtime difficulties In Evidence-Based Geriatric Nursing Protocols for Best Practice 3rd ed (Capezuti E Zwicker D Mezey M Fulmer T Gray-Miceli D amp Kluger M eds) Springer Publishing Company LLC New York p 337-351 American Occupational Therapy Association [AOTA] (2002) Occupational therapy practice framework Domain and process American Journal of Occupational Therapy 56
609ndash639 doi 105014ajot566609 AOTA (2007) Specialized knowledge and skills in feeding eating and swallowing for occupational therapy practice American Journal of Occupational Therapy 61(6) 686-700
doi 105014ajot616686 Asai JL (2004) Nutrition and the geriatric rehabilitation patient Challenges and solutions Topics in Geriatric Rehabilitation 20(1) 34-45 Baier RR Butterfield K Harris Y Gravenstein S (2008) Aiming for star performance the relationship between setting targets and improved nursing home quality of
care Journal of the American Medical Directors Association9(8) 594-9 Epub Dolhi C amp Rogers J (2009) Dementia nutrition and self-feeding A systematic review of the literature Occupational Therapy in Health Care 15(3-4) 59-87 Ferri C Prince M Brayne C Brodaty H Fratiglioni L Ganguli M hellip Landry G (2005) Global prevalence of dementia a delphi consensus study Lancet 366 2112-2217 Frisoni G Fanzoni S Rozzini R Ferrucci L Boffelli S amp Trabucchi M (1994) A nutritional index predicting mortality in the nursing home Journal of the American Geriatric Society 42 1167-1172 Furman EF (2006) Under-nutrition in older adults across the continuum of care Journal of Gerontological Nursing 32(1) 22-27 Groher ME amp Crary MA(2010) Dysphagia Clinical Management in Adults and Children Maryland Heights MO Mosby-Elsevier Harris-Kojetin L Sengupta M Park-Lee E Valverde R Long-term care services in the United States 2013 overview National health care statistics reports no 1 Hyattsville MD National Center for Health Statistics 2013
References
Horner J Alberts MJ Dawson DV Cook GM (1994) Swallowing in Alzheimerrsquos disease Alzheimer Disease Association Disorders 8 177 ndash 19 Kielhofner G (1985) A model of human occupation Baltimore Williams and Wilkins Lammes E amp Akner G (2006) Repeated assessment of energy and nutrient intake in 52 nursing home residents Journal of Nutritional Health and Aging 10(3) 222-30 Lin L-C Watson R amp Wu S-C (2010) What is associated with low food intake in older people with dementia Journal of Clinical Nursing 19 53-59 Doi 101111j1365-2702200902962x Maher D amp Eliad C (2014) Malnutrition in the elderly An unrecognized health issue Journal of Nursing Retrieved from httprnjournalcomjournal-of-nursingmalnutrition-in-the-elderly-an-unrecognized-health-issue Manthorpe J amp Watson R (2003) Poorly served Eating and dementia Journal of Advanced Nursing 41(2) 162-169 Nelson K Coultson A SucherKP amp Tseng R (1992) Prevalence of malnutrition in The elderly admitted to long-term-care facilities Journal of the American Dietetic Association 93(4) 459-460 Ott F Readman T amp Backman C (1990) Mealtimes of the institutionalized elderly A literature review Canadian Journal of Occupational Therapy 57(5) 261-267 Payette H (2002) Know related effects of nutrition on aging muscle function In Nutrition and Aging Vol 6 Ed by LH Rosenberg and A Sastre Nestle Workshop Series Clinical and Performance Program Nestec Ltd Vevey Switzerland P 135-150 Planetree amp Picker Institute (2010) Long term care improvement guide Retrieved from httpplanetreeorgwp-contentuploads201112LTC-Improvement-Guide-For-Downloadpdf Riviere S Gillerte-Guyonnet S Andrieu S Nourhashemi F Laugque S Cantet C hellip Vellas B (2002) Cognitive function and caregiver burden Predictive factors for eating behavior disorders in Alzhiemerrsquos disease International Journal of Geriatric Psychiatry 17 950-955 Schussler S Dassen T amp Lohrmann C (2014) Prevalence of care dependency and nursing care problems in nursing home residents with dementia A literature review International Journal of Caring Sciences 7(2) 339 Retrieved from httpwwwinternationaljournalofcaringsciencesorgdocs120SchC3BCssler-1pdf
References
Scott TM Peter L Tucker KL Arsenault L Bergethon P Bhadelia R hellip Folstein M (2006) The Nutrition Aging and Memory in Elders (NAME) study Design and methods for a study of micronutrients and cognitive function in a homebound elderly population International Journal of Geriatric Psychiatry 21(6) 519-528
doi101002gps1503735 Simmons SF Keeler E Zhuo X Hickey KA Sato HW amp Schnelle JF (2008) Prevention of unintentional weight loss in nursing home residents a controlled trial of feeding assistance Journal of American Geriatric Society 56(8) 1466-1473
Doi101111j1532-5415200801801x Sodderhamn U Backrach-Lindstrom M amp Ek AC (2007) Nutritional screening and perceived health in a group of geriatric rehabilitation patients Journal of Clinical Nursing (16) 1997-2006 Thomas DR Ashmen W Morley JE Evans WJ amp the Council for Nutritional Strategies in Long-Term Care (2000) Nutritional management in long-term care Development of a clinical guideline Journal of Gerontolology Biological Sciences and Medical Sciences 55A(12) M725- doi101093Gerona5512M725 Wu S amp Barker JC (2008) Hot tea and Juk The institutional meaning of food for Chinese elders in an American nursing home Journal of Gerontological Nursing 34(11) 46-45 doi10392800989134-20081101-11
E L I Z A B E T H C B A I R b a i r 0 7 1 2 p a c i f i c u e d u
Thank You
Education is Key to Change
Industry leaders nursing home administrators and management need to be educated about the extent of malnutrition in nursing homes
There is a need for educational plans and instructional materials on preventing and treating malnutrition in LTC
Healthcare providers must take time to advocate with facilities and present educational workshops
Recognizing and preventing malnutrition in nursing homes
A teaching plan was developed and incorporated into
the coursework for the OTD 610 Practitioner as Educator course at Pacific University
An extensive literature review has been created to provide evidence and foundational knowledge for healthcare providers LTC administrators and stakeholders
Purpose
Educate skilled nursing facility administrators and management about effects of poor nutritional status skilled OT assessment analysis and Interventions improving nutritional status of residents enhancing the dining experience improving staff effectiveness and efficiency
Program Goal
LTC administrators and managers will demonstrate basic knowledge of effects of poor nutritional
status describe barriers to providing excellent nutritional care explain how skilled OT services contribute to proving holistic
nutritional care
Teaching Elements
Teaching Session
Lecture- group instruction Printed educational handouts Printed worksheets Interactive activities among learners Small and whole group discussions Self-reflection and sharing Resource table with additional learning tools Short video (added as a result of feedback to pilot
session)
Targeted learners
professionals in health care provision or administration
extensive experience in the long-term healthcare industry in the area of nutrition and dietary food service
men and women multicultural group 30 ndash 60 years of age
Setting
Intended LTC workshop Skilled nursing facility conference room during weekday
business hours
Pilot Group workshop Large open-plan diningliving space with participants around
large oval table
Outcome of Pilot
What would I do differently
Schedule more convenient time
Include more participants
Ask for feedback
More anonymous feedback option
simplify language
Proposed Changes to Workshop
Provide printed quiz to go with handouts Add video component Rework handouts for comprehension and
application to learners needs
Discussion
After learning more about the problem of malnutrition in long-term care are you considering how you might introduce this topic into your practice or your teaching
Are there other venues where this type of educational program is appropriate and might influence the management of nutritional care for elders
Questions
References
Abbasi AA amp Rudman D (1994) Undernutrition in the nursing home Prevalence consequences cause and prevention Nutrition Reviews 52(4) 113-122 Accreditation Council for Occupational Therapy Education (2006) ACOTE standards and interpretive guidelines Retrieved from
httpwwwaotaorgnonmembersarea13docs acotestandards806pdf Adams NE Bowie AJ Simmance N Murrary M amp Crowe T (2008) Recognition by medical and nursing professionals of malnutrition and risk of malnutrition in elderly hospitalised patients Nutrition and Dietetics (65) 144-150 Amella EJ (2002) Resistance at mealtimes for persons with dementia The Journal of Nutrition Health amp Aging 6 117-122 Amella EJ (2008) Mealtime difficulties In Evidence-Based Geriatric Nursing Protocols for Best Practice 3rd ed (Capezuti E Zwicker D Mezey M Fulmer T Gray-Miceli D amp Kluger M eds) Springer Publishing Company LLC New York p 337-351 American Occupational Therapy Association [AOTA] (2002) Occupational therapy practice framework Domain and process American Journal of Occupational Therapy 56
609ndash639 doi 105014ajot566609 AOTA (2007) Specialized knowledge and skills in feeding eating and swallowing for occupational therapy practice American Journal of Occupational Therapy 61(6) 686-700
doi 105014ajot616686 Asai JL (2004) Nutrition and the geriatric rehabilitation patient Challenges and solutions Topics in Geriatric Rehabilitation 20(1) 34-45 Baier RR Butterfield K Harris Y Gravenstein S (2008) Aiming for star performance the relationship between setting targets and improved nursing home quality of
care Journal of the American Medical Directors Association9(8) 594-9 Epub Dolhi C amp Rogers J (2009) Dementia nutrition and self-feeding A systematic review of the literature Occupational Therapy in Health Care 15(3-4) 59-87 Ferri C Prince M Brayne C Brodaty H Fratiglioni L Ganguli M hellip Landry G (2005) Global prevalence of dementia a delphi consensus study Lancet 366 2112-2217 Frisoni G Fanzoni S Rozzini R Ferrucci L Boffelli S amp Trabucchi M (1994) A nutritional index predicting mortality in the nursing home Journal of the American Geriatric Society 42 1167-1172 Furman EF (2006) Under-nutrition in older adults across the continuum of care Journal of Gerontological Nursing 32(1) 22-27 Groher ME amp Crary MA(2010) Dysphagia Clinical Management in Adults and Children Maryland Heights MO Mosby-Elsevier Harris-Kojetin L Sengupta M Park-Lee E Valverde R Long-term care services in the United States 2013 overview National health care statistics reports no 1 Hyattsville MD National Center for Health Statistics 2013
References
Horner J Alberts MJ Dawson DV Cook GM (1994) Swallowing in Alzheimerrsquos disease Alzheimer Disease Association Disorders 8 177 ndash 19 Kielhofner G (1985) A model of human occupation Baltimore Williams and Wilkins Lammes E amp Akner G (2006) Repeated assessment of energy and nutrient intake in 52 nursing home residents Journal of Nutritional Health and Aging 10(3) 222-30 Lin L-C Watson R amp Wu S-C (2010) What is associated with low food intake in older people with dementia Journal of Clinical Nursing 19 53-59 Doi 101111j1365-2702200902962x Maher D amp Eliad C (2014) Malnutrition in the elderly An unrecognized health issue Journal of Nursing Retrieved from httprnjournalcomjournal-of-nursingmalnutrition-in-the-elderly-an-unrecognized-health-issue Manthorpe J amp Watson R (2003) Poorly served Eating and dementia Journal of Advanced Nursing 41(2) 162-169 Nelson K Coultson A SucherKP amp Tseng R (1992) Prevalence of malnutrition in The elderly admitted to long-term-care facilities Journal of the American Dietetic Association 93(4) 459-460 Ott F Readman T amp Backman C (1990) Mealtimes of the institutionalized elderly A literature review Canadian Journal of Occupational Therapy 57(5) 261-267 Payette H (2002) Know related effects of nutrition on aging muscle function In Nutrition and Aging Vol 6 Ed by LH Rosenberg and A Sastre Nestle Workshop Series Clinical and Performance Program Nestec Ltd Vevey Switzerland P 135-150 Planetree amp Picker Institute (2010) Long term care improvement guide Retrieved from httpplanetreeorgwp-contentuploads201112LTC-Improvement-Guide-For-Downloadpdf Riviere S Gillerte-Guyonnet S Andrieu S Nourhashemi F Laugque S Cantet C hellip Vellas B (2002) Cognitive function and caregiver burden Predictive factors for eating behavior disorders in Alzhiemerrsquos disease International Journal of Geriatric Psychiatry 17 950-955 Schussler S Dassen T amp Lohrmann C (2014) Prevalence of care dependency and nursing care problems in nursing home residents with dementia A literature review International Journal of Caring Sciences 7(2) 339 Retrieved from httpwwwinternationaljournalofcaringsciencesorgdocs120SchC3BCssler-1pdf
References
Scott TM Peter L Tucker KL Arsenault L Bergethon P Bhadelia R hellip Folstein M (2006) The Nutrition Aging and Memory in Elders (NAME) study Design and methods for a study of micronutrients and cognitive function in a homebound elderly population International Journal of Geriatric Psychiatry 21(6) 519-528
doi101002gps1503735 Simmons SF Keeler E Zhuo X Hickey KA Sato HW amp Schnelle JF (2008) Prevention of unintentional weight loss in nursing home residents a controlled trial of feeding assistance Journal of American Geriatric Society 56(8) 1466-1473
Doi101111j1532-5415200801801x Sodderhamn U Backrach-Lindstrom M amp Ek AC (2007) Nutritional screening and perceived health in a group of geriatric rehabilitation patients Journal of Clinical Nursing (16) 1997-2006 Thomas DR Ashmen W Morley JE Evans WJ amp the Council for Nutritional Strategies in Long-Term Care (2000) Nutritional management in long-term care Development of a clinical guideline Journal of Gerontolology Biological Sciences and Medical Sciences 55A(12) M725- doi101093Gerona5512M725 Wu S amp Barker JC (2008) Hot tea and Juk The institutional meaning of food for Chinese elders in an American nursing home Journal of Gerontological Nursing 34(11) 46-45 doi10392800989134-20081101-11
E L I Z A B E T H C B A I R b a i r 0 7 1 2 p a c i f i c u e d u
Thank You
Recognizing and preventing malnutrition in nursing homes
A teaching plan was developed and incorporated into
the coursework for the OTD 610 Practitioner as Educator course at Pacific University
An extensive literature review has been created to provide evidence and foundational knowledge for healthcare providers LTC administrators and stakeholders
Purpose
Educate skilled nursing facility administrators and management about effects of poor nutritional status skilled OT assessment analysis and Interventions improving nutritional status of residents enhancing the dining experience improving staff effectiveness and efficiency
Program Goal
LTC administrators and managers will demonstrate basic knowledge of effects of poor nutritional
status describe barriers to providing excellent nutritional care explain how skilled OT services contribute to proving holistic
nutritional care
Teaching Elements
Teaching Session
Lecture- group instruction Printed educational handouts Printed worksheets Interactive activities among learners Small and whole group discussions Self-reflection and sharing Resource table with additional learning tools Short video (added as a result of feedback to pilot
session)
Targeted learners
professionals in health care provision or administration
extensive experience in the long-term healthcare industry in the area of nutrition and dietary food service
men and women multicultural group 30 ndash 60 years of age
Setting
Intended LTC workshop Skilled nursing facility conference room during weekday
business hours
Pilot Group workshop Large open-plan diningliving space with participants around
large oval table
Outcome of Pilot
What would I do differently
Schedule more convenient time
Include more participants
Ask for feedback
More anonymous feedback option
simplify language
Proposed Changes to Workshop
Provide printed quiz to go with handouts Add video component Rework handouts for comprehension and
application to learners needs
Discussion
After learning more about the problem of malnutrition in long-term care are you considering how you might introduce this topic into your practice or your teaching
Are there other venues where this type of educational program is appropriate and might influence the management of nutritional care for elders
Questions
References
Abbasi AA amp Rudman D (1994) Undernutrition in the nursing home Prevalence consequences cause and prevention Nutrition Reviews 52(4) 113-122 Accreditation Council for Occupational Therapy Education (2006) ACOTE standards and interpretive guidelines Retrieved from
httpwwwaotaorgnonmembersarea13docs acotestandards806pdf Adams NE Bowie AJ Simmance N Murrary M amp Crowe T (2008) Recognition by medical and nursing professionals of malnutrition and risk of malnutrition in elderly hospitalised patients Nutrition and Dietetics (65) 144-150 Amella EJ (2002) Resistance at mealtimes for persons with dementia The Journal of Nutrition Health amp Aging 6 117-122 Amella EJ (2008) Mealtime difficulties In Evidence-Based Geriatric Nursing Protocols for Best Practice 3rd ed (Capezuti E Zwicker D Mezey M Fulmer T Gray-Miceli D amp Kluger M eds) Springer Publishing Company LLC New York p 337-351 American Occupational Therapy Association [AOTA] (2002) Occupational therapy practice framework Domain and process American Journal of Occupational Therapy 56
609ndash639 doi 105014ajot566609 AOTA (2007) Specialized knowledge and skills in feeding eating and swallowing for occupational therapy practice American Journal of Occupational Therapy 61(6) 686-700
doi 105014ajot616686 Asai JL (2004) Nutrition and the geriatric rehabilitation patient Challenges and solutions Topics in Geriatric Rehabilitation 20(1) 34-45 Baier RR Butterfield K Harris Y Gravenstein S (2008) Aiming for star performance the relationship between setting targets and improved nursing home quality of
care Journal of the American Medical Directors Association9(8) 594-9 Epub Dolhi C amp Rogers J (2009) Dementia nutrition and self-feeding A systematic review of the literature Occupational Therapy in Health Care 15(3-4) 59-87 Ferri C Prince M Brayne C Brodaty H Fratiglioni L Ganguli M hellip Landry G (2005) Global prevalence of dementia a delphi consensus study Lancet 366 2112-2217 Frisoni G Fanzoni S Rozzini R Ferrucci L Boffelli S amp Trabucchi M (1994) A nutritional index predicting mortality in the nursing home Journal of the American Geriatric Society 42 1167-1172 Furman EF (2006) Under-nutrition in older adults across the continuum of care Journal of Gerontological Nursing 32(1) 22-27 Groher ME amp Crary MA(2010) Dysphagia Clinical Management in Adults and Children Maryland Heights MO Mosby-Elsevier Harris-Kojetin L Sengupta M Park-Lee E Valverde R Long-term care services in the United States 2013 overview National health care statistics reports no 1 Hyattsville MD National Center for Health Statistics 2013
References
Horner J Alberts MJ Dawson DV Cook GM (1994) Swallowing in Alzheimerrsquos disease Alzheimer Disease Association Disorders 8 177 ndash 19 Kielhofner G (1985) A model of human occupation Baltimore Williams and Wilkins Lammes E amp Akner G (2006) Repeated assessment of energy and nutrient intake in 52 nursing home residents Journal of Nutritional Health and Aging 10(3) 222-30 Lin L-C Watson R amp Wu S-C (2010) What is associated with low food intake in older people with dementia Journal of Clinical Nursing 19 53-59 Doi 101111j1365-2702200902962x Maher D amp Eliad C (2014) Malnutrition in the elderly An unrecognized health issue Journal of Nursing Retrieved from httprnjournalcomjournal-of-nursingmalnutrition-in-the-elderly-an-unrecognized-health-issue Manthorpe J amp Watson R (2003) Poorly served Eating and dementia Journal of Advanced Nursing 41(2) 162-169 Nelson K Coultson A SucherKP amp Tseng R (1992) Prevalence of malnutrition in The elderly admitted to long-term-care facilities Journal of the American Dietetic Association 93(4) 459-460 Ott F Readman T amp Backman C (1990) Mealtimes of the institutionalized elderly A literature review Canadian Journal of Occupational Therapy 57(5) 261-267 Payette H (2002) Know related effects of nutrition on aging muscle function In Nutrition and Aging Vol 6 Ed by LH Rosenberg and A Sastre Nestle Workshop Series Clinical and Performance Program Nestec Ltd Vevey Switzerland P 135-150 Planetree amp Picker Institute (2010) Long term care improvement guide Retrieved from httpplanetreeorgwp-contentuploads201112LTC-Improvement-Guide-For-Downloadpdf Riviere S Gillerte-Guyonnet S Andrieu S Nourhashemi F Laugque S Cantet C hellip Vellas B (2002) Cognitive function and caregiver burden Predictive factors for eating behavior disorders in Alzhiemerrsquos disease International Journal of Geriatric Psychiatry 17 950-955 Schussler S Dassen T amp Lohrmann C (2014) Prevalence of care dependency and nursing care problems in nursing home residents with dementia A literature review International Journal of Caring Sciences 7(2) 339 Retrieved from httpwwwinternationaljournalofcaringsciencesorgdocs120SchC3BCssler-1pdf
References
Scott TM Peter L Tucker KL Arsenault L Bergethon P Bhadelia R hellip Folstein M (2006) The Nutrition Aging and Memory in Elders (NAME) study Design and methods for a study of micronutrients and cognitive function in a homebound elderly population International Journal of Geriatric Psychiatry 21(6) 519-528
doi101002gps1503735 Simmons SF Keeler E Zhuo X Hickey KA Sato HW amp Schnelle JF (2008) Prevention of unintentional weight loss in nursing home residents a controlled trial of feeding assistance Journal of American Geriatric Society 56(8) 1466-1473
Doi101111j1532-5415200801801x Sodderhamn U Backrach-Lindstrom M amp Ek AC (2007) Nutritional screening and perceived health in a group of geriatric rehabilitation patients Journal of Clinical Nursing (16) 1997-2006 Thomas DR Ashmen W Morley JE Evans WJ amp the Council for Nutritional Strategies in Long-Term Care (2000) Nutritional management in long-term care Development of a clinical guideline Journal of Gerontolology Biological Sciences and Medical Sciences 55A(12) M725- doi101093Gerona5512M725 Wu S amp Barker JC (2008) Hot tea and Juk The institutional meaning of food for Chinese elders in an American nursing home Journal of Gerontological Nursing 34(11) 46-45 doi10392800989134-20081101-11
E L I Z A B E T H C B A I R b a i r 0 7 1 2 p a c i f i c u e d u
Thank You
Purpose
Educate skilled nursing facility administrators and management about effects of poor nutritional status skilled OT assessment analysis and Interventions improving nutritional status of residents enhancing the dining experience improving staff effectiveness and efficiency
Program Goal
LTC administrators and managers will demonstrate basic knowledge of effects of poor nutritional
status describe barriers to providing excellent nutritional care explain how skilled OT services contribute to proving holistic
nutritional care
Teaching Elements
Teaching Session
Lecture- group instruction Printed educational handouts Printed worksheets Interactive activities among learners Small and whole group discussions Self-reflection and sharing Resource table with additional learning tools Short video (added as a result of feedback to pilot
session)
Targeted learners
professionals in health care provision or administration
extensive experience in the long-term healthcare industry in the area of nutrition and dietary food service
men and women multicultural group 30 ndash 60 years of age
Setting
Intended LTC workshop Skilled nursing facility conference room during weekday
business hours
Pilot Group workshop Large open-plan diningliving space with participants around
large oval table
Outcome of Pilot
What would I do differently
Schedule more convenient time
Include more participants
Ask for feedback
More anonymous feedback option
simplify language
Proposed Changes to Workshop
Provide printed quiz to go with handouts Add video component Rework handouts for comprehension and
application to learners needs
Discussion
After learning more about the problem of malnutrition in long-term care are you considering how you might introduce this topic into your practice or your teaching
Are there other venues where this type of educational program is appropriate and might influence the management of nutritional care for elders
Questions
References
Abbasi AA amp Rudman D (1994) Undernutrition in the nursing home Prevalence consequences cause and prevention Nutrition Reviews 52(4) 113-122 Accreditation Council for Occupational Therapy Education (2006) ACOTE standards and interpretive guidelines Retrieved from
httpwwwaotaorgnonmembersarea13docs acotestandards806pdf Adams NE Bowie AJ Simmance N Murrary M amp Crowe T (2008) Recognition by medical and nursing professionals of malnutrition and risk of malnutrition in elderly hospitalised patients Nutrition and Dietetics (65) 144-150 Amella EJ (2002) Resistance at mealtimes for persons with dementia The Journal of Nutrition Health amp Aging 6 117-122 Amella EJ (2008) Mealtime difficulties In Evidence-Based Geriatric Nursing Protocols for Best Practice 3rd ed (Capezuti E Zwicker D Mezey M Fulmer T Gray-Miceli D amp Kluger M eds) Springer Publishing Company LLC New York p 337-351 American Occupational Therapy Association [AOTA] (2002) Occupational therapy practice framework Domain and process American Journal of Occupational Therapy 56
609ndash639 doi 105014ajot566609 AOTA (2007) Specialized knowledge and skills in feeding eating and swallowing for occupational therapy practice American Journal of Occupational Therapy 61(6) 686-700
doi 105014ajot616686 Asai JL (2004) Nutrition and the geriatric rehabilitation patient Challenges and solutions Topics in Geriatric Rehabilitation 20(1) 34-45 Baier RR Butterfield K Harris Y Gravenstein S (2008) Aiming for star performance the relationship between setting targets and improved nursing home quality of
care Journal of the American Medical Directors Association9(8) 594-9 Epub Dolhi C amp Rogers J (2009) Dementia nutrition and self-feeding A systematic review of the literature Occupational Therapy in Health Care 15(3-4) 59-87 Ferri C Prince M Brayne C Brodaty H Fratiglioni L Ganguli M hellip Landry G (2005) Global prevalence of dementia a delphi consensus study Lancet 366 2112-2217 Frisoni G Fanzoni S Rozzini R Ferrucci L Boffelli S amp Trabucchi M (1994) A nutritional index predicting mortality in the nursing home Journal of the American Geriatric Society 42 1167-1172 Furman EF (2006) Under-nutrition in older adults across the continuum of care Journal of Gerontological Nursing 32(1) 22-27 Groher ME amp Crary MA(2010) Dysphagia Clinical Management in Adults and Children Maryland Heights MO Mosby-Elsevier Harris-Kojetin L Sengupta M Park-Lee E Valverde R Long-term care services in the United States 2013 overview National health care statistics reports no 1 Hyattsville MD National Center for Health Statistics 2013
References
Horner J Alberts MJ Dawson DV Cook GM (1994) Swallowing in Alzheimerrsquos disease Alzheimer Disease Association Disorders 8 177 ndash 19 Kielhofner G (1985) A model of human occupation Baltimore Williams and Wilkins Lammes E amp Akner G (2006) Repeated assessment of energy and nutrient intake in 52 nursing home residents Journal of Nutritional Health and Aging 10(3) 222-30 Lin L-C Watson R amp Wu S-C (2010) What is associated with low food intake in older people with dementia Journal of Clinical Nursing 19 53-59 Doi 101111j1365-2702200902962x Maher D amp Eliad C (2014) Malnutrition in the elderly An unrecognized health issue Journal of Nursing Retrieved from httprnjournalcomjournal-of-nursingmalnutrition-in-the-elderly-an-unrecognized-health-issue Manthorpe J amp Watson R (2003) Poorly served Eating and dementia Journal of Advanced Nursing 41(2) 162-169 Nelson K Coultson A SucherKP amp Tseng R (1992) Prevalence of malnutrition in The elderly admitted to long-term-care facilities Journal of the American Dietetic Association 93(4) 459-460 Ott F Readman T amp Backman C (1990) Mealtimes of the institutionalized elderly A literature review Canadian Journal of Occupational Therapy 57(5) 261-267 Payette H (2002) Know related effects of nutrition on aging muscle function In Nutrition and Aging Vol 6 Ed by LH Rosenberg and A Sastre Nestle Workshop Series Clinical and Performance Program Nestec Ltd Vevey Switzerland P 135-150 Planetree amp Picker Institute (2010) Long term care improvement guide Retrieved from httpplanetreeorgwp-contentuploads201112LTC-Improvement-Guide-For-Downloadpdf Riviere S Gillerte-Guyonnet S Andrieu S Nourhashemi F Laugque S Cantet C hellip Vellas B (2002) Cognitive function and caregiver burden Predictive factors for eating behavior disorders in Alzhiemerrsquos disease International Journal of Geriatric Psychiatry 17 950-955 Schussler S Dassen T amp Lohrmann C (2014) Prevalence of care dependency and nursing care problems in nursing home residents with dementia A literature review International Journal of Caring Sciences 7(2) 339 Retrieved from httpwwwinternationaljournalofcaringsciencesorgdocs120SchC3BCssler-1pdf
References
Scott TM Peter L Tucker KL Arsenault L Bergethon P Bhadelia R hellip Folstein M (2006) The Nutrition Aging and Memory in Elders (NAME) study Design and methods for a study of micronutrients and cognitive function in a homebound elderly population International Journal of Geriatric Psychiatry 21(6) 519-528
doi101002gps1503735 Simmons SF Keeler E Zhuo X Hickey KA Sato HW amp Schnelle JF (2008) Prevention of unintentional weight loss in nursing home residents a controlled trial of feeding assistance Journal of American Geriatric Society 56(8) 1466-1473
Doi101111j1532-5415200801801x Sodderhamn U Backrach-Lindstrom M amp Ek AC (2007) Nutritional screening and perceived health in a group of geriatric rehabilitation patients Journal of Clinical Nursing (16) 1997-2006 Thomas DR Ashmen W Morley JE Evans WJ amp the Council for Nutritional Strategies in Long-Term Care (2000) Nutritional management in long-term care Development of a clinical guideline Journal of Gerontolology Biological Sciences and Medical Sciences 55A(12) M725- doi101093Gerona5512M725 Wu S amp Barker JC (2008) Hot tea and Juk The institutional meaning of food for Chinese elders in an American nursing home Journal of Gerontological Nursing 34(11) 46-45 doi10392800989134-20081101-11
E L I Z A B E T H C B A I R b a i r 0 7 1 2 p a c i f i c u e d u
Thank You
Program Goal
LTC administrators and managers will demonstrate basic knowledge of effects of poor nutritional
status describe barriers to providing excellent nutritional care explain how skilled OT services contribute to proving holistic
nutritional care
Teaching Elements
Teaching Session
Lecture- group instruction Printed educational handouts Printed worksheets Interactive activities among learners Small and whole group discussions Self-reflection and sharing Resource table with additional learning tools Short video (added as a result of feedback to pilot
session)
Targeted learners
professionals in health care provision or administration
extensive experience in the long-term healthcare industry in the area of nutrition and dietary food service
men and women multicultural group 30 ndash 60 years of age
Setting
Intended LTC workshop Skilled nursing facility conference room during weekday
business hours
Pilot Group workshop Large open-plan diningliving space with participants around
large oval table
Outcome of Pilot
What would I do differently
Schedule more convenient time
Include more participants
Ask for feedback
More anonymous feedback option
simplify language
Proposed Changes to Workshop
Provide printed quiz to go with handouts Add video component Rework handouts for comprehension and
application to learners needs
Discussion
After learning more about the problem of malnutrition in long-term care are you considering how you might introduce this topic into your practice or your teaching
Are there other venues where this type of educational program is appropriate and might influence the management of nutritional care for elders
Questions
References
Abbasi AA amp Rudman D (1994) Undernutrition in the nursing home Prevalence consequences cause and prevention Nutrition Reviews 52(4) 113-122 Accreditation Council for Occupational Therapy Education (2006) ACOTE standards and interpretive guidelines Retrieved from
httpwwwaotaorgnonmembersarea13docs acotestandards806pdf Adams NE Bowie AJ Simmance N Murrary M amp Crowe T (2008) Recognition by medical and nursing professionals of malnutrition and risk of malnutrition in elderly hospitalised patients Nutrition and Dietetics (65) 144-150 Amella EJ (2002) Resistance at mealtimes for persons with dementia The Journal of Nutrition Health amp Aging 6 117-122 Amella EJ (2008) Mealtime difficulties In Evidence-Based Geriatric Nursing Protocols for Best Practice 3rd ed (Capezuti E Zwicker D Mezey M Fulmer T Gray-Miceli D amp Kluger M eds) Springer Publishing Company LLC New York p 337-351 American Occupational Therapy Association [AOTA] (2002) Occupational therapy practice framework Domain and process American Journal of Occupational Therapy 56
609ndash639 doi 105014ajot566609 AOTA (2007) Specialized knowledge and skills in feeding eating and swallowing for occupational therapy practice American Journal of Occupational Therapy 61(6) 686-700
doi 105014ajot616686 Asai JL (2004) Nutrition and the geriatric rehabilitation patient Challenges and solutions Topics in Geriatric Rehabilitation 20(1) 34-45 Baier RR Butterfield K Harris Y Gravenstein S (2008) Aiming for star performance the relationship between setting targets and improved nursing home quality of
care Journal of the American Medical Directors Association9(8) 594-9 Epub Dolhi C amp Rogers J (2009) Dementia nutrition and self-feeding A systematic review of the literature Occupational Therapy in Health Care 15(3-4) 59-87 Ferri C Prince M Brayne C Brodaty H Fratiglioni L Ganguli M hellip Landry G (2005) Global prevalence of dementia a delphi consensus study Lancet 366 2112-2217 Frisoni G Fanzoni S Rozzini R Ferrucci L Boffelli S amp Trabucchi M (1994) A nutritional index predicting mortality in the nursing home Journal of the American Geriatric Society 42 1167-1172 Furman EF (2006) Under-nutrition in older adults across the continuum of care Journal of Gerontological Nursing 32(1) 22-27 Groher ME amp Crary MA(2010) Dysphagia Clinical Management in Adults and Children Maryland Heights MO Mosby-Elsevier Harris-Kojetin L Sengupta M Park-Lee E Valverde R Long-term care services in the United States 2013 overview National health care statistics reports no 1 Hyattsville MD National Center for Health Statistics 2013
References
Horner J Alberts MJ Dawson DV Cook GM (1994) Swallowing in Alzheimerrsquos disease Alzheimer Disease Association Disorders 8 177 ndash 19 Kielhofner G (1985) A model of human occupation Baltimore Williams and Wilkins Lammes E amp Akner G (2006) Repeated assessment of energy and nutrient intake in 52 nursing home residents Journal of Nutritional Health and Aging 10(3) 222-30 Lin L-C Watson R amp Wu S-C (2010) What is associated with low food intake in older people with dementia Journal of Clinical Nursing 19 53-59 Doi 101111j1365-2702200902962x Maher D amp Eliad C (2014) Malnutrition in the elderly An unrecognized health issue Journal of Nursing Retrieved from httprnjournalcomjournal-of-nursingmalnutrition-in-the-elderly-an-unrecognized-health-issue Manthorpe J amp Watson R (2003) Poorly served Eating and dementia Journal of Advanced Nursing 41(2) 162-169 Nelson K Coultson A SucherKP amp Tseng R (1992) Prevalence of malnutrition in The elderly admitted to long-term-care facilities Journal of the American Dietetic Association 93(4) 459-460 Ott F Readman T amp Backman C (1990) Mealtimes of the institutionalized elderly A literature review Canadian Journal of Occupational Therapy 57(5) 261-267 Payette H (2002) Know related effects of nutrition on aging muscle function In Nutrition and Aging Vol 6 Ed by LH Rosenberg and A Sastre Nestle Workshop Series Clinical and Performance Program Nestec Ltd Vevey Switzerland P 135-150 Planetree amp Picker Institute (2010) Long term care improvement guide Retrieved from httpplanetreeorgwp-contentuploads201112LTC-Improvement-Guide-For-Downloadpdf Riviere S Gillerte-Guyonnet S Andrieu S Nourhashemi F Laugque S Cantet C hellip Vellas B (2002) Cognitive function and caregiver burden Predictive factors for eating behavior disorders in Alzhiemerrsquos disease International Journal of Geriatric Psychiatry 17 950-955 Schussler S Dassen T amp Lohrmann C (2014) Prevalence of care dependency and nursing care problems in nursing home residents with dementia A literature review International Journal of Caring Sciences 7(2) 339 Retrieved from httpwwwinternationaljournalofcaringsciencesorgdocs120SchC3BCssler-1pdf
References
Scott TM Peter L Tucker KL Arsenault L Bergethon P Bhadelia R hellip Folstein M (2006) The Nutrition Aging and Memory in Elders (NAME) study Design and methods for a study of micronutrients and cognitive function in a homebound elderly population International Journal of Geriatric Psychiatry 21(6) 519-528
doi101002gps1503735 Simmons SF Keeler E Zhuo X Hickey KA Sato HW amp Schnelle JF (2008) Prevention of unintentional weight loss in nursing home residents a controlled trial of feeding assistance Journal of American Geriatric Society 56(8) 1466-1473
Doi101111j1532-5415200801801x Sodderhamn U Backrach-Lindstrom M amp Ek AC (2007) Nutritional screening and perceived health in a group of geriatric rehabilitation patients Journal of Clinical Nursing (16) 1997-2006 Thomas DR Ashmen W Morley JE Evans WJ amp the Council for Nutritional Strategies in Long-Term Care (2000) Nutritional management in long-term care Development of a clinical guideline Journal of Gerontolology Biological Sciences and Medical Sciences 55A(12) M725- doi101093Gerona5512M725 Wu S amp Barker JC (2008) Hot tea and Juk The institutional meaning of food for Chinese elders in an American nursing home Journal of Gerontological Nursing 34(11) 46-45 doi10392800989134-20081101-11
E L I Z A B E T H C B A I R b a i r 0 7 1 2 p a c i f i c u e d u
Thank You
Teaching Elements
Teaching Session
Lecture- group instruction Printed educational handouts Printed worksheets Interactive activities among learners Small and whole group discussions Self-reflection and sharing Resource table with additional learning tools Short video (added as a result of feedback to pilot
session)
Targeted learners
professionals in health care provision or administration
extensive experience in the long-term healthcare industry in the area of nutrition and dietary food service
men and women multicultural group 30 ndash 60 years of age
Setting
Intended LTC workshop Skilled nursing facility conference room during weekday
business hours
Pilot Group workshop Large open-plan diningliving space with participants around
large oval table
Outcome of Pilot
What would I do differently
Schedule more convenient time
Include more participants
Ask for feedback
More anonymous feedback option
simplify language
Proposed Changes to Workshop
Provide printed quiz to go with handouts Add video component Rework handouts for comprehension and
application to learners needs
Discussion
After learning more about the problem of malnutrition in long-term care are you considering how you might introduce this topic into your practice or your teaching
Are there other venues where this type of educational program is appropriate and might influence the management of nutritional care for elders
Questions
References
Abbasi AA amp Rudman D (1994) Undernutrition in the nursing home Prevalence consequences cause and prevention Nutrition Reviews 52(4) 113-122 Accreditation Council for Occupational Therapy Education (2006) ACOTE standards and interpretive guidelines Retrieved from
httpwwwaotaorgnonmembersarea13docs acotestandards806pdf Adams NE Bowie AJ Simmance N Murrary M amp Crowe T (2008) Recognition by medical and nursing professionals of malnutrition and risk of malnutrition in elderly hospitalised patients Nutrition and Dietetics (65) 144-150 Amella EJ (2002) Resistance at mealtimes for persons with dementia The Journal of Nutrition Health amp Aging 6 117-122 Amella EJ (2008) Mealtime difficulties In Evidence-Based Geriatric Nursing Protocols for Best Practice 3rd ed (Capezuti E Zwicker D Mezey M Fulmer T Gray-Miceli D amp Kluger M eds) Springer Publishing Company LLC New York p 337-351 American Occupational Therapy Association [AOTA] (2002) Occupational therapy practice framework Domain and process American Journal of Occupational Therapy 56
609ndash639 doi 105014ajot566609 AOTA (2007) Specialized knowledge and skills in feeding eating and swallowing for occupational therapy practice American Journal of Occupational Therapy 61(6) 686-700
doi 105014ajot616686 Asai JL (2004) Nutrition and the geriatric rehabilitation patient Challenges and solutions Topics in Geriatric Rehabilitation 20(1) 34-45 Baier RR Butterfield K Harris Y Gravenstein S (2008) Aiming for star performance the relationship between setting targets and improved nursing home quality of
care Journal of the American Medical Directors Association9(8) 594-9 Epub Dolhi C amp Rogers J (2009) Dementia nutrition and self-feeding A systematic review of the literature Occupational Therapy in Health Care 15(3-4) 59-87 Ferri C Prince M Brayne C Brodaty H Fratiglioni L Ganguli M hellip Landry G (2005) Global prevalence of dementia a delphi consensus study Lancet 366 2112-2217 Frisoni G Fanzoni S Rozzini R Ferrucci L Boffelli S amp Trabucchi M (1994) A nutritional index predicting mortality in the nursing home Journal of the American Geriatric Society 42 1167-1172 Furman EF (2006) Under-nutrition in older adults across the continuum of care Journal of Gerontological Nursing 32(1) 22-27 Groher ME amp Crary MA(2010) Dysphagia Clinical Management in Adults and Children Maryland Heights MO Mosby-Elsevier Harris-Kojetin L Sengupta M Park-Lee E Valverde R Long-term care services in the United States 2013 overview National health care statistics reports no 1 Hyattsville MD National Center for Health Statistics 2013
References
Horner J Alberts MJ Dawson DV Cook GM (1994) Swallowing in Alzheimerrsquos disease Alzheimer Disease Association Disorders 8 177 ndash 19 Kielhofner G (1985) A model of human occupation Baltimore Williams and Wilkins Lammes E amp Akner G (2006) Repeated assessment of energy and nutrient intake in 52 nursing home residents Journal of Nutritional Health and Aging 10(3) 222-30 Lin L-C Watson R amp Wu S-C (2010) What is associated with low food intake in older people with dementia Journal of Clinical Nursing 19 53-59 Doi 101111j1365-2702200902962x Maher D amp Eliad C (2014) Malnutrition in the elderly An unrecognized health issue Journal of Nursing Retrieved from httprnjournalcomjournal-of-nursingmalnutrition-in-the-elderly-an-unrecognized-health-issue Manthorpe J amp Watson R (2003) Poorly served Eating and dementia Journal of Advanced Nursing 41(2) 162-169 Nelson K Coultson A SucherKP amp Tseng R (1992) Prevalence of malnutrition in The elderly admitted to long-term-care facilities Journal of the American Dietetic Association 93(4) 459-460 Ott F Readman T amp Backman C (1990) Mealtimes of the institutionalized elderly A literature review Canadian Journal of Occupational Therapy 57(5) 261-267 Payette H (2002) Know related effects of nutrition on aging muscle function In Nutrition and Aging Vol 6 Ed by LH Rosenberg and A Sastre Nestle Workshop Series Clinical and Performance Program Nestec Ltd Vevey Switzerland P 135-150 Planetree amp Picker Institute (2010) Long term care improvement guide Retrieved from httpplanetreeorgwp-contentuploads201112LTC-Improvement-Guide-For-Downloadpdf Riviere S Gillerte-Guyonnet S Andrieu S Nourhashemi F Laugque S Cantet C hellip Vellas B (2002) Cognitive function and caregiver burden Predictive factors for eating behavior disorders in Alzhiemerrsquos disease International Journal of Geriatric Psychiatry 17 950-955 Schussler S Dassen T amp Lohrmann C (2014) Prevalence of care dependency and nursing care problems in nursing home residents with dementia A literature review International Journal of Caring Sciences 7(2) 339 Retrieved from httpwwwinternationaljournalofcaringsciencesorgdocs120SchC3BCssler-1pdf
References
Scott TM Peter L Tucker KL Arsenault L Bergethon P Bhadelia R hellip Folstein M (2006) The Nutrition Aging and Memory in Elders (NAME) study Design and methods for a study of micronutrients and cognitive function in a homebound elderly population International Journal of Geriatric Psychiatry 21(6) 519-528
doi101002gps1503735 Simmons SF Keeler E Zhuo X Hickey KA Sato HW amp Schnelle JF (2008) Prevention of unintentional weight loss in nursing home residents a controlled trial of feeding assistance Journal of American Geriatric Society 56(8) 1466-1473
Doi101111j1532-5415200801801x Sodderhamn U Backrach-Lindstrom M amp Ek AC (2007) Nutritional screening and perceived health in a group of geriatric rehabilitation patients Journal of Clinical Nursing (16) 1997-2006 Thomas DR Ashmen W Morley JE Evans WJ amp the Council for Nutritional Strategies in Long-Term Care (2000) Nutritional management in long-term care Development of a clinical guideline Journal of Gerontolology Biological Sciences and Medical Sciences 55A(12) M725- doi101093Gerona5512M725 Wu S amp Barker JC (2008) Hot tea and Juk The institutional meaning of food for Chinese elders in an American nursing home Journal of Gerontological Nursing 34(11) 46-45 doi10392800989134-20081101-11
E L I Z A B E T H C B A I R b a i r 0 7 1 2 p a c i f i c u e d u
Thank You
Teaching Session
Lecture- group instruction Printed educational handouts Printed worksheets Interactive activities among learners Small and whole group discussions Self-reflection and sharing Resource table with additional learning tools Short video (added as a result of feedback to pilot
session)
Targeted learners
professionals in health care provision or administration
extensive experience in the long-term healthcare industry in the area of nutrition and dietary food service
men and women multicultural group 30 ndash 60 years of age
Setting
Intended LTC workshop Skilled nursing facility conference room during weekday
business hours
Pilot Group workshop Large open-plan diningliving space with participants around
large oval table
Outcome of Pilot
What would I do differently
Schedule more convenient time
Include more participants
Ask for feedback
More anonymous feedback option
simplify language
Proposed Changes to Workshop
Provide printed quiz to go with handouts Add video component Rework handouts for comprehension and
application to learners needs
Discussion
After learning more about the problem of malnutrition in long-term care are you considering how you might introduce this topic into your practice or your teaching
Are there other venues where this type of educational program is appropriate and might influence the management of nutritional care for elders
Questions
References
Abbasi AA amp Rudman D (1994) Undernutrition in the nursing home Prevalence consequences cause and prevention Nutrition Reviews 52(4) 113-122 Accreditation Council for Occupational Therapy Education (2006) ACOTE standards and interpretive guidelines Retrieved from
httpwwwaotaorgnonmembersarea13docs acotestandards806pdf Adams NE Bowie AJ Simmance N Murrary M amp Crowe T (2008) Recognition by medical and nursing professionals of malnutrition and risk of malnutrition in elderly hospitalised patients Nutrition and Dietetics (65) 144-150 Amella EJ (2002) Resistance at mealtimes for persons with dementia The Journal of Nutrition Health amp Aging 6 117-122 Amella EJ (2008) Mealtime difficulties In Evidence-Based Geriatric Nursing Protocols for Best Practice 3rd ed (Capezuti E Zwicker D Mezey M Fulmer T Gray-Miceli D amp Kluger M eds) Springer Publishing Company LLC New York p 337-351 American Occupational Therapy Association [AOTA] (2002) Occupational therapy practice framework Domain and process American Journal of Occupational Therapy 56
609ndash639 doi 105014ajot566609 AOTA (2007) Specialized knowledge and skills in feeding eating and swallowing for occupational therapy practice American Journal of Occupational Therapy 61(6) 686-700
doi 105014ajot616686 Asai JL (2004) Nutrition and the geriatric rehabilitation patient Challenges and solutions Topics in Geriatric Rehabilitation 20(1) 34-45 Baier RR Butterfield K Harris Y Gravenstein S (2008) Aiming for star performance the relationship between setting targets and improved nursing home quality of
care Journal of the American Medical Directors Association9(8) 594-9 Epub Dolhi C amp Rogers J (2009) Dementia nutrition and self-feeding A systematic review of the literature Occupational Therapy in Health Care 15(3-4) 59-87 Ferri C Prince M Brayne C Brodaty H Fratiglioni L Ganguli M hellip Landry G (2005) Global prevalence of dementia a delphi consensus study Lancet 366 2112-2217 Frisoni G Fanzoni S Rozzini R Ferrucci L Boffelli S amp Trabucchi M (1994) A nutritional index predicting mortality in the nursing home Journal of the American Geriatric Society 42 1167-1172 Furman EF (2006) Under-nutrition in older adults across the continuum of care Journal of Gerontological Nursing 32(1) 22-27 Groher ME amp Crary MA(2010) Dysphagia Clinical Management in Adults and Children Maryland Heights MO Mosby-Elsevier Harris-Kojetin L Sengupta M Park-Lee E Valverde R Long-term care services in the United States 2013 overview National health care statistics reports no 1 Hyattsville MD National Center for Health Statistics 2013
References
Horner J Alberts MJ Dawson DV Cook GM (1994) Swallowing in Alzheimerrsquos disease Alzheimer Disease Association Disorders 8 177 ndash 19 Kielhofner G (1985) A model of human occupation Baltimore Williams and Wilkins Lammes E amp Akner G (2006) Repeated assessment of energy and nutrient intake in 52 nursing home residents Journal of Nutritional Health and Aging 10(3) 222-30 Lin L-C Watson R amp Wu S-C (2010) What is associated with low food intake in older people with dementia Journal of Clinical Nursing 19 53-59 Doi 101111j1365-2702200902962x Maher D amp Eliad C (2014) Malnutrition in the elderly An unrecognized health issue Journal of Nursing Retrieved from httprnjournalcomjournal-of-nursingmalnutrition-in-the-elderly-an-unrecognized-health-issue Manthorpe J amp Watson R (2003) Poorly served Eating and dementia Journal of Advanced Nursing 41(2) 162-169 Nelson K Coultson A SucherKP amp Tseng R (1992) Prevalence of malnutrition in The elderly admitted to long-term-care facilities Journal of the American Dietetic Association 93(4) 459-460 Ott F Readman T amp Backman C (1990) Mealtimes of the institutionalized elderly A literature review Canadian Journal of Occupational Therapy 57(5) 261-267 Payette H (2002) Know related effects of nutrition on aging muscle function In Nutrition and Aging Vol 6 Ed by LH Rosenberg and A Sastre Nestle Workshop Series Clinical and Performance Program Nestec Ltd Vevey Switzerland P 135-150 Planetree amp Picker Institute (2010) Long term care improvement guide Retrieved from httpplanetreeorgwp-contentuploads201112LTC-Improvement-Guide-For-Downloadpdf Riviere S Gillerte-Guyonnet S Andrieu S Nourhashemi F Laugque S Cantet C hellip Vellas B (2002) Cognitive function and caregiver burden Predictive factors for eating behavior disorders in Alzhiemerrsquos disease International Journal of Geriatric Psychiatry 17 950-955 Schussler S Dassen T amp Lohrmann C (2014) Prevalence of care dependency and nursing care problems in nursing home residents with dementia A literature review International Journal of Caring Sciences 7(2) 339 Retrieved from httpwwwinternationaljournalofcaringsciencesorgdocs120SchC3BCssler-1pdf
References
Scott TM Peter L Tucker KL Arsenault L Bergethon P Bhadelia R hellip Folstein M (2006) The Nutrition Aging and Memory in Elders (NAME) study Design and methods for a study of micronutrients and cognitive function in a homebound elderly population International Journal of Geriatric Psychiatry 21(6) 519-528
doi101002gps1503735 Simmons SF Keeler E Zhuo X Hickey KA Sato HW amp Schnelle JF (2008) Prevention of unintentional weight loss in nursing home residents a controlled trial of feeding assistance Journal of American Geriatric Society 56(8) 1466-1473
Doi101111j1532-5415200801801x Sodderhamn U Backrach-Lindstrom M amp Ek AC (2007) Nutritional screening and perceived health in a group of geriatric rehabilitation patients Journal of Clinical Nursing (16) 1997-2006 Thomas DR Ashmen W Morley JE Evans WJ amp the Council for Nutritional Strategies in Long-Term Care (2000) Nutritional management in long-term care Development of a clinical guideline Journal of Gerontolology Biological Sciences and Medical Sciences 55A(12) M725- doi101093Gerona5512M725 Wu S amp Barker JC (2008) Hot tea and Juk The institutional meaning of food for Chinese elders in an American nursing home Journal of Gerontological Nursing 34(11) 46-45 doi10392800989134-20081101-11
E L I Z A B E T H C B A I R b a i r 0 7 1 2 p a c i f i c u e d u
Thank You
Targeted learners
professionals in health care provision or administration
extensive experience in the long-term healthcare industry in the area of nutrition and dietary food service
men and women multicultural group 30 ndash 60 years of age
Setting
Intended LTC workshop Skilled nursing facility conference room during weekday
business hours
Pilot Group workshop Large open-plan diningliving space with participants around
large oval table
Outcome of Pilot
What would I do differently
Schedule more convenient time
Include more participants
Ask for feedback
More anonymous feedback option
simplify language
Proposed Changes to Workshop
Provide printed quiz to go with handouts Add video component Rework handouts for comprehension and
application to learners needs
Discussion
After learning more about the problem of malnutrition in long-term care are you considering how you might introduce this topic into your practice or your teaching
Are there other venues where this type of educational program is appropriate and might influence the management of nutritional care for elders
Questions
References
Abbasi AA amp Rudman D (1994) Undernutrition in the nursing home Prevalence consequences cause and prevention Nutrition Reviews 52(4) 113-122 Accreditation Council for Occupational Therapy Education (2006) ACOTE standards and interpretive guidelines Retrieved from
httpwwwaotaorgnonmembersarea13docs acotestandards806pdf Adams NE Bowie AJ Simmance N Murrary M amp Crowe T (2008) Recognition by medical and nursing professionals of malnutrition and risk of malnutrition in elderly hospitalised patients Nutrition and Dietetics (65) 144-150 Amella EJ (2002) Resistance at mealtimes for persons with dementia The Journal of Nutrition Health amp Aging 6 117-122 Amella EJ (2008) Mealtime difficulties In Evidence-Based Geriatric Nursing Protocols for Best Practice 3rd ed (Capezuti E Zwicker D Mezey M Fulmer T Gray-Miceli D amp Kluger M eds) Springer Publishing Company LLC New York p 337-351 American Occupational Therapy Association [AOTA] (2002) Occupational therapy practice framework Domain and process American Journal of Occupational Therapy 56
609ndash639 doi 105014ajot566609 AOTA (2007) Specialized knowledge and skills in feeding eating and swallowing for occupational therapy practice American Journal of Occupational Therapy 61(6) 686-700
doi 105014ajot616686 Asai JL (2004) Nutrition and the geriatric rehabilitation patient Challenges and solutions Topics in Geriatric Rehabilitation 20(1) 34-45 Baier RR Butterfield K Harris Y Gravenstein S (2008) Aiming for star performance the relationship between setting targets and improved nursing home quality of
care Journal of the American Medical Directors Association9(8) 594-9 Epub Dolhi C amp Rogers J (2009) Dementia nutrition and self-feeding A systematic review of the literature Occupational Therapy in Health Care 15(3-4) 59-87 Ferri C Prince M Brayne C Brodaty H Fratiglioni L Ganguli M hellip Landry G (2005) Global prevalence of dementia a delphi consensus study Lancet 366 2112-2217 Frisoni G Fanzoni S Rozzini R Ferrucci L Boffelli S amp Trabucchi M (1994) A nutritional index predicting mortality in the nursing home Journal of the American Geriatric Society 42 1167-1172 Furman EF (2006) Under-nutrition in older adults across the continuum of care Journal of Gerontological Nursing 32(1) 22-27 Groher ME amp Crary MA(2010) Dysphagia Clinical Management in Adults and Children Maryland Heights MO Mosby-Elsevier Harris-Kojetin L Sengupta M Park-Lee E Valverde R Long-term care services in the United States 2013 overview National health care statistics reports no 1 Hyattsville MD National Center for Health Statistics 2013
References
Horner J Alberts MJ Dawson DV Cook GM (1994) Swallowing in Alzheimerrsquos disease Alzheimer Disease Association Disorders 8 177 ndash 19 Kielhofner G (1985) A model of human occupation Baltimore Williams and Wilkins Lammes E amp Akner G (2006) Repeated assessment of energy and nutrient intake in 52 nursing home residents Journal of Nutritional Health and Aging 10(3) 222-30 Lin L-C Watson R amp Wu S-C (2010) What is associated with low food intake in older people with dementia Journal of Clinical Nursing 19 53-59 Doi 101111j1365-2702200902962x Maher D amp Eliad C (2014) Malnutrition in the elderly An unrecognized health issue Journal of Nursing Retrieved from httprnjournalcomjournal-of-nursingmalnutrition-in-the-elderly-an-unrecognized-health-issue Manthorpe J amp Watson R (2003) Poorly served Eating and dementia Journal of Advanced Nursing 41(2) 162-169 Nelson K Coultson A SucherKP amp Tseng R (1992) Prevalence of malnutrition in The elderly admitted to long-term-care facilities Journal of the American Dietetic Association 93(4) 459-460 Ott F Readman T amp Backman C (1990) Mealtimes of the institutionalized elderly A literature review Canadian Journal of Occupational Therapy 57(5) 261-267 Payette H (2002) Know related effects of nutrition on aging muscle function In Nutrition and Aging Vol 6 Ed by LH Rosenberg and A Sastre Nestle Workshop Series Clinical and Performance Program Nestec Ltd Vevey Switzerland P 135-150 Planetree amp Picker Institute (2010) Long term care improvement guide Retrieved from httpplanetreeorgwp-contentuploads201112LTC-Improvement-Guide-For-Downloadpdf Riviere S Gillerte-Guyonnet S Andrieu S Nourhashemi F Laugque S Cantet C hellip Vellas B (2002) Cognitive function and caregiver burden Predictive factors for eating behavior disorders in Alzhiemerrsquos disease International Journal of Geriatric Psychiatry 17 950-955 Schussler S Dassen T amp Lohrmann C (2014) Prevalence of care dependency and nursing care problems in nursing home residents with dementia A literature review International Journal of Caring Sciences 7(2) 339 Retrieved from httpwwwinternationaljournalofcaringsciencesorgdocs120SchC3BCssler-1pdf
References
Scott TM Peter L Tucker KL Arsenault L Bergethon P Bhadelia R hellip Folstein M (2006) The Nutrition Aging and Memory in Elders (NAME) study Design and methods for a study of micronutrients and cognitive function in a homebound elderly population International Journal of Geriatric Psychiatry 21(6) 519-528
doi101002gps1503735 Simmons SF Keeler E Zhuo X Hickey KA Sato HW amp Schnelle JF (2008) Prevention of unintentional weight loss in nursing home residents a controlled trial of feeding assistance Journal of American Geriatric Society 56(8) 1466-1473
Doi101111j1532-5415200801801x Sodderhamn U Backrach-Lindstrom M amp Ek AC (2007) Nutritional screening and perceived health in a group of geriatric rehabilitation patients Journal of Clinical Nursing (16) 1997-2006 Thomas DR Ashmen W Morley JE Evans WJ amp the Council for Nutritional Strategies in Long-Term Care (2000) Nutritional management in long-term care Development of a clinical guideline Journal of Gerontolology Biological Sciences and Medical Sciences 55A(12) M725- doi101093Gerona5512M725 Wu S amp Barker JC (2008) Hot tea and Juk The institutional meaning of food for Chinese elders in an American nursing home Journal of Gerontological Nursing 34(11) 46-45 doi10392800989134-20081101-11
E L I Z A B E T H C B A I R b a i r 0 7 1 2 p a c i f i c u e d u
Thank You
Setting
Intended LTC workshop Skilled nursing facility conference room during weekday
business hours
Pilot Group workshop Large open-plan diningliving space with participants around
large oval table
Outcome of Pilot
What would I do differently
Schedule more convenient time
Include more participants
Ask for feedback
More anonymous feedback option
simplify language
Proposed Changes to Workshop
Provide printed quiz to go with handouts Add video component Rework handouts for comprehension and
application to learners needs
Discussion
After learning more about the problem of malnutrition in long-term care are you considering how you might introduce this topic into your practice or your teaching
Are there other venues where this type of educational program is appropriate and might influence the management of nutritional care for elders
Questions
References
Abbasi AA amp Rudman D (1994) Undernutrition in the nursing home Prevalence consequences cause and prevention Nutrition Reviews 52(4) 113-122 Accreditation Council for Occupational Therapy Education (2006) ACOTE standards and interpretive guidelines Retrieved from
httpwwwaotaorgnonmembersarea13docs acotestandards806pdf Adams NE Bowie AJ Simmance N Murrary M amp Crowe T (2008) Recognition by medical and nursing professionals of malnutrition and risk of malnutrition in elderly hospitalised patients Nutrition and Dietetics (65) 144-150 Amella EJ (2002) Resistance at mealtimes for persons with dementia The Journal of Nutrition Health amp Aging 6 117-122 Amella EJ (2008) Mealtime difficulties In Evidence-Based Geriatric Nursing Protocols for Best Practice 3rd ed (Capezuti E Zwicker D Mezey M Fulmer T Gray-Miceli D amp Kluger M eds) Springer Publishing Company LLC New York p 337-351 American Occupational Therapy Association [AOTA] (2002) Occupational therapy practice framework Domain and process American Journal of Occupational Therapy 56
609ndash639 doi 105014ajot566609 AOTA (2007) Specialized knowledge and skills in feeding eating and swallowing for occupational therapy practice American Journal of Occupational Therapy 61(6) 686-700
doi 105014ajot616686 Asai JL (2004) Nutrition and the geriatric rehabilitation patient Challenges and solutions Topics in Geriatric Rehabilitation 20(1) 34-45 Baier RR Butterfield K Harris Y Gravenstein S (2008) Aiming for star performance the relationship between setting targets and improved nursing home quality of
care Journal of the American Medical Directors Association9(8) 594-9 Epub Dolhi C amp Rogers J (2009) Dementia nutrition and self-feeding A systematic review of the literature Occupational Therapy in Health Care 15(3-4) 59-87 Ferri C Prince M Brayne C Brodaty H Fratiglioni L Ganguli M hellip Landry G (2005) Global prevalence of dementia a delphi consensus study Lancet 366 2112-2217 Frisoni G Fanzoni S Rozzini R Ferrucci L Boffelli S amp Trabucchi M (1994) A nutritional index predicting mortality in the nursing home Journal of the American Geriatric Society 42 1167-1172 Furman EF (2006) Under-nutrition in older adults across the continuum of care Journal of Gerontological Nursing 32(1) 22-27 Groher ME amp Crary MA(2010) Dysphagia Clinical Management in Adults and Children Maryland Heights MO Mosby-Elsevier Harris-Kojetin L Sengupta M Park-Lee E Valverde R Long-term care services in the United States 2013 overview National health care statistics reports no 1 Hyattsville MD National Center for Health Statistics 2013
References
Horner J Alberts MJ Dawson DV Cook GM (1994) Swallowing in Alzheimerrsquos disease Alzheimer Disease Association Disorders 8 177 ndash 19 Kielhofner G (1985) A model of human occupation Baltimore Williams and Wilkins Lammes E amp Akner G (2006) Repeated assessment of energy and nutrient intake in 52 nursing home residents Journal of Nutritional Health and Aging 10(3) 222-30 Lin L-C Watson R amp Wu S-C (2010) What is associated with low food intake in older people with dementia Journal of Clinical Nursing 19 53-59 Doi 101111j1365-2702200902962x Maher D amp Eliad C (2014) Malnutrition in the elderly An unrecognized health issue Journal of Nursing Retrieved from httprnjournalcomjournal-of-nursingmalnutrition-in-the-elderly-an-unrecognized-health-issue Manthorpe J amp Watson R (2003) Poorly served Eating and dementia Journal of Advanced Nursing 41(2) 162-169 Nelson K Coultson A SucherKP amp Tseng R (1992) Prevalence of malnutrition in The elderly admitted to long-term-care facilities Journal of the American Dietetic Association 93(4) 459-460 Ott F Readman T amp Backman C (1990) Mealtimes of the institutionalized elderly A literature review Canadian Journal of Occupational Therapy 57(5) 261-267 Payette H (2002) Know related effects of nutrition on aging muscle function In Nutrition and Aging Vol 6 Ed by LH Rosenberg and A Sastre Nestle Workshop Series Clinical and Performance Program Nestec Ltd Vevey Switzerland P 135-150 Planetree amp Picker Institute (2010) Long term care improvement guide Retrieved from httpplanetreeorgwp-contentuploads201112LTC-Improvement-Guide-For-Downloadpdf Riviere S Gillerte-Guyonnet S Andrieu S Nourhashemi F Laugque S Cantet C hellip Vellas B (2002) Cognitive function and caregiver burden Predictive factors for eating behavior disorders in Alzhiemerrsquos disease International Journal of Geriatric Psychiatry 17 950-955 Schussler S Dassen T amp Lohrmann C (2014) Prevalence of care dependency and nursing care problems in nursing home residents with dementia A literature review International Journal of Caring Sciences 7(2) 339 Retrieved from httpwwwinternationaljournalofcaringsciencesorgdocs120SchC3BCssler-1pdf
References
Scott TM Peter L Tucker KL Arsenault L Bergethon P Bhadelia R hellip Folstein M (2006) The Nutrition Aging and Memory in Elders (NAME) study Design and methods for a study of micronutrients and cognitive function in a homebound elderly population International Journal of Geriatric Psychiatry 21(6) 519-528
doi101002gps1503735 Simmons SF Keeler E Zhuo X Hickey KA Sato HW amp Schnelle JF (2008) Prevention of unintentional weight loss in nursing home residents a controlled trial of feeding assistance Journal of American Geriatric Society 56(8) 1466-1473
Doi101111j1532-5415200801801x Sodderhamn U Backrach-Lindstrom M amp Ek AC (2007) Nutritional screening and perceived health in a group of geriatric rehabilitation patients Journal of Clinical Nursing (16) 1997-2006 Thomas DR Ashmen W Morley JE Evans WJ amp the Council for Nutritional Strategies in Long-Term Care (2000) Nutritional management in long-term care Development of a clinical guideline Journal of Gerontolology Biological Sciences and Medical Sciences 55A(12) M725- doi101093Gerona5512M725 Wu S amp Barker JC (2008) Hot tea and Juk The institutional meaning of food for Chinese elders in an American nursing home Journal of Gerontological Nursing 34(11) 46-45 doi10392800989134-20081101-11
E L I Z A B E T H C B A I R b a i r 0 7 1 2 p a c i f i c u e d u
Thank You
Outcome of Pilot
What would I do differently
Schedule more convenient time
Include more participants
Ask for feedback
More anonymous feedback option
simplify language
Proposed Changes to Workshop
Provide printed quiz to go with handouts Add video component Rework handouts for comprehension and
application to learners needs
Discussion
After learning more about the problem of malnutrition in long-term care are you considering how you might introduce this topic into your practice or your teaching
Are there other venues where this type of educational program is appropriate and might influence the management of nutritional care for elders
Questions
References
Abbasi AA amp Rudman D (1994) Undernutrition in the nursing home Prevalence consequences cause and prevention Nutrition Reviews 52(4) 113-122 Accreditation Council for Occupational Therapy Education (2006) ACOTE standards and interpretive guidelines Retrieved from
httpwwwaotaorgnonmembersarea13docs acotestandards806pdf Adams NE Bowie AJ Simmance N Murrary M amp Crowe T (2008) Recognition by medical and nursing professionals of malnutrition and risk of malnutrition in elderly hospitalised patients Nutrition and Dietetics (65) 144-150 Amella EJ (2002) Resistance at mealtimes for persons with dementia The Journal of Nutrition Health amp Aging 6 117-122 Amella EJ (2008) Mealtime difficulties In Evidence-Based Geriatric Nursing Protocols for Best Practice 3rd ed (Capezuti E Zwicker D Mezey M Fulmer T Gray-Miceli D amp Kluger M eds) Springer Publishing Company LLC New York p 337-351 American Occupational Therapy Association [AOTA] (2002) Occupational therapy practice framework Domain and process American Journal of Occupational Therapy 56
609ndash639 doi 105014ajot566609 AOTA (2007) Specialized knowledge and skills in feeding eating and swallowing for occupational therapy practice American Journal of Occupational Therapy 61(6) 686-700
doi 105014ajot616686 Asai JL (2004) Nutrition and the geriatric rehabilitation patient Challenges and solutions Topics in Geriatric Rehabilitation 20(1) 34-45 Baier RR Butterfield K Harris Y Gravenstein S (2008) Aiming for star performance the relationship between setting targets and improved nursing home quality of
care Journal of the American Medical Directors Association9(8) 594-9 Epub Dolhi C amp Rogers J (2009) Dementia nutrition and self-feeding A systematic review of the literature Occupational Therapy in Health Care 15(3-4) 59-87 Ferri C Prince M Brayne C Brodaty H Fratiglioni L Ganguli M hellip Landry G (2005) Global prevalence of dementia a delphi consensus study Lancet 366 2112-2217 Frisoni G Fanzoni S Rozzini R Ferrucci L Boffelli S amp Trabucchi M (1994) A nutritional index predicting mortality in the nursing home Journal of the American Geriatric Society 42 1167-1172 Furman EF (2006) Under-nutrition in older adults across the continuum of care Journal of Gerontological Nursing 32(1) 22-27 Groher ME amp Crary MA(2010) Dysphagia Clinical Management in Adults and Children Maryland Heights MO Mosby-Elsevier Harris-Kojetin L Sengupta M Park-Lee E Valverde R Long-term care services in the United States 2013 overview National health care statistics reports no 1 Hyattsville MD National Center for Health Statistics 2013
References
Horner J Alberts MJ Dawson DV Cook GM (1994) Swallowing in Alzheimerrsquos disease Alzheimer Disease Association Disorders 8 177 ndash 19 Kielhofner G (1985) A model of human occupation Baltimore Williams and Wilkins Lammes E amp Akner G (2006) Repeated assessment of energy and nutrient intake in 52 nursing home residents Journal of Nutritional Health and Aging 10(3) 222-30 Lin L-C Watson R amp Wu S-C (2010) What is associated with low food intake in older people with dementia Journal of Clinical Nursing 19 53-59 Doi 101111j1365-2702200902962x Maher D amp Eliad C (2014) Malnutrition in the elderly An unrecognized health issue Journal of Nursing Retrieved from httprnjournalcomjournal-of-nursingmalnutrition-in-the-elderly-an-unrecognized-health-issue Manthorpe J amp Watson R (2003) Poorly served Eating and dementia Journal of Advanced Nursing 41(2) 162-169 Nelson K Coultson A SucherKP amp Tseng R (1992) Prevalence of malnutrition in The elderly admitted to long-term-care facilities Journal of the American Dietetic Association 93(4) 459-460 Ott F Readman T amp Backman C (1990) Mealtimes of the institutionalized elderly A literature review Canadian Journal of Occupational Therapy 57(5) 261-267 Payette H (2002) Know related effects of nutrition on aging muscle function In Nutrition and Aging Vol 6 Ed by LH Rosenberg and A Sastre Nestle Workshop Series Clinical and Performance Program Nestec Ltd Vevey Switzerland P 135-150 Planetree amp Picker Institute (2010) Long term care improvement guide Retrieved from httpplanetreeorgwp-contentuploads201112LTC-Improvement-Guide-For-Downloadpdf Riviere S Gillerte-Guyonnet S Andrieu S Nourhashemi F Laugque S Cantet C hellip Vellas B (2002) Cognitive function and caregiver burden Predictive factors for eating behavior disorders in Alzhiemerrsquos disease International Journal of Geriatric Psychiatry 17 950-955 Schussler S Dassen T amp Lohrmann C (2014) Prevalence of care dependency and nursing care problems in nursing home residents with dementia A literature review International Journal of Caring Sciences 7(2) 339 Retrieved from httpwwwinternationaljournalofcaringsciencesorgdocs120SchC3BCssler-1pdf
References
Scott TM Peter L Tucker KL Arsenault L Bergethon P Bhadelia R hellip Folstein M (2006) The Nutrition Aging and Memory in Elders (NAME) study Design and methods for a study of micronutrients and cognitive function in a homebound elderly population International Journal of Geriatric Psychiatry 21(6) 519-528
doi101002gps1503735 Simmons SF Keeler E Zhuo X Hickey KA Sato HW amp Schnelle JF (2008) Prevention of unintentional weight loss in nursing home residents a controlled trial of feeding assistance Journal of American Geriatric Society 56(8) 1466-1473
Doi101111j1532-5415200801801x Sodderhamn U Backrach-Lindstrom M amp Ek AC (2007) Nutritional screening and perceived health in a group of geriatric rehabilitation patients Journal of Clinical Nursing (16) 1997-2006 Thomas DR Ashmen W Morley JE Evans WJ amp the Council for Nutritional Strategies in Long-Term Care (2000) Nutritional management in long-term care Development of a clinical guideline Journal of Gerontolology Biological Sciences and Medical Sciences 55A(12) M725- doi101093Gerona5512M725 Wu S amp Barker JC (2008) Hot tea and Juk The institutional meaning of food for Chinese elders in an American nursing home Journal of Gerontological Nursing 34(11) 46-45 doi10392800989134-20081101-11
E L I Z A B E T H C B A I R b a i r 0 7 1 2 p a c i f i c u e d u
Thank You
What would I do differently
Schedule more convenient time
Include more participants
Ask for feedback
More anonymous feedback option
simplify language
Proposed Changes to Workshop
Provide printed quiz to go with handouts Add video component Rework handouts for comprehension and
application to learners needs
Discussion
After learning more about the problem of malnutrition in long-term care are you considering how you might introduce this topic into your practice or your teaching
Are there other venues where this type of educational program is appropriate and might influence the management of nutritional care for elders
Questions
References
Abbasi AA amp Rudman D (1994) Undernutrition in the nursing home Prevalence consequences cause and prevention Nutrition Reviews 52(4) 113-122 Accreditation Council for Occupational Therapy Education (2006) ACOTE standards and interpretive guidelines Retrieved from
httpwwwaotaorgnonmembersarea13docs acotestandards806pdf Adams NE Bowie AJ Simmance N Murrary M amp Crowe T (2008) Recognition by medical and nursing professionals of malnutrition and risk of malnutrition in elderly hospitalised patients Nutrition and Dietetics (65) 144-150 Amella EJ (2002) Resistance at mealtimes for persons with dementia The Journal of Nutrition Health amp Aging 6 117-122 Amella EJ (2008) Mealtime difficulties In Evidence-Based Geriatric Nursing Protocols for Best Practice 3rd ed (Capezuti E Zwicker D Mezey M Fulmer T Gray-Miceli D amp Kluger M eds) Springer Publishing Company LLC New York p 337-351 American Occupational Therapy Association [AOTA] (2002) Occupational therapy practice framework Domain and process American Journal of Occupational Therapy 56
609ndash639 doi 105014ajot566609 AOTA (2007) Specialized knowledge and skills in feeding eating and swallowing for occupational therapy practice American Journal of Occupational Therapy 61(6) 686-700
doi 105014ajot616686 Asai JL (2004) Nutrition and the geriatric rehabilitation patient Challenges and solutions Topics in Geriatric Rehabilitation 20(1) 34-45 Baier RR Butterfield K Harris Y Gravenstein S (2008) Aiming for star performance the relationship between setting targets and improved nursing home quality of
care Journal of the American Medical Directors Association9(8) 594-9 Epub Dolhi C amp Rogers J (2009) Dementia nutrition and self-feeding A systematic review of the literature Occupational Therapy in Health Care 15(3-4) 59-87 Ferri C Prince M Brayne C Brodaty H Fratiglioni L Ganguli M hellip Landry G (2005) Global prevalence of dementia a delphi consensus study Lancet 366 2112-2217 Frisoni G Fanzoni S Rozzini R Ferrucci L Boffelli S amp Trabucchi M (1994) A nutritional index predicting mortality in the nursing home Journal of the American Geriatric Society 42 1167-1172 Furman EF (2006) Under-nutrition in older adults across the continuum of care Journal of Gerontological Nursing 32(1) 22-27 Groher ME amp Crary MA(2010) Dysphagia Clinical Management in Adults and Children Maryland Heights MO Mosby-Elsevier Harris-Kojetin L Sengupta M Park-Lee E Valverde R Long-term care services in the United States 2013 overview National health care statistics reports no 1 Hyattsville MD National Center for Health Statistics 2013
References
Horner J Alberts MJ Dawson DV Cook GM (1994) Swallowing in Alzheimerrsquos disease Alzheimer Disease Association Disorders 8 177 ndash 19 Kielhofner G (1985) A model of human occupation Baltimore Williams and Wilkins Lammes E amp Akner G (2006) Repeated assessment of energy and nutrient intake in 52 nursing home residents Journal of Nutritional Health and Aging 10(3) 222-30 Lin L-C Watson R amp Wu S-C (2010) What is associated with low food intake in older people with dementia Journal of Clinical Nursing 19 53-59 Doi 101111j1365-2702200902962x Maher D amp Eliad C (2014) Malnutrition in the elderly An unrecognized health issue Journal of Nursing Retrieved from httprnjournalcomjournal-of-nursingmalnutrition-in-the-elderly-an-unrecognized-health-issue Manthorpe J amp Watson R (2003) Poorly served Eating and dementia Journal of Advanced Nursing 41(2) 162-169 Nelson K Coultson A SucherKP amp Tseng R (1992) Prevalence of malnutrition in The elderly admitted to long-term-care facilities Journal of the American Dietetic Association 93(4) 459-460 Ott F Readman T amp Backman C (1990) Mealtimes of the institutionalized elderly A literature review Canadian Journal of Occupational Therapy 57(5) 261-267 Payette H (2002) Know related effects of nutrition on aging muscle function In Nutrition and Aging Vol 6 Ed by LH Rosenberg and A Sastre Nestle Workshop Series Clinical and Performance Program Nestec Ltd Vevey Switzerland P 135-150 Planetree amp Picker Institute (2010) Long term care improvement guide Retrieved from httpplanetreeorgwp-contentuploads201112LTC-Improvement-Guide-For-Downloadpdf Riviere S Gillerte-Guyonnet S Andrieu S Nourhashemi F Laugque S Cantet C hellip Vellas B (2002) Cognitive function and caregiver burden Predictive factors for eating behavior disorders in Alzhiemerrsquos disease International Journal of Geriatric Psychiatry 17 950-955 Schussler S Dassen T amp Lohrmann C (2014) Prevalence of care dependency and nursing care problems in nursing home residents with dementia A literature review International Journal of Caring Sciences 7(2) 339 Retrieved from httpwwwinternationaljournalofcaringsciencesorgdocs120SchC3BCssler-1pdf
References
Scott TM Peter L Tucker KL Arsenault L Bergethon P Bhadelia R hellip Folstein M (2006) The Nutrition Aging and Memory in Elders (NAME) study Design and methods for a study of micronutrients and cognitive function in a homebound elderly population International Journal of Geriatric Psychiatry 21(6) 519-528
doi101002gps1503735 Simmons SF Keeler E Zhuo X Hickey KA Sato HW amp Schnelle JF (2008) Prevention of unintentional weight loss in nursing home residents a controlled trial of feeding assistance Journal of American Geriatric Society 56(8) 1466-1473
Doi101111j1532-5415200801801x Sodderhamn U Backrach-Lindstrom M amp Ek AC (2007) Nutritional screening and perceived health in a group of geriatric rehabilitation patients Journal of Clinical Nursing (16) 1997-2006 Thomas DR Ashmen W Morley JE Evans WJ amp the Council for Nutritional Strategies in Long-Term Care (2000) Nutritional management in long-term care Development of a clinical guideline Journal of Gerontolology Biological Sciences and Medical Sciences 55A(12) M725- doi101093Gerona5512M725 Wu S amp Barker JC (2008) Hot tea and Juk The institutional meaning of food for Chinese elders in an American nursing home Journal of Gerontological Nursing 34(11) 46-45 doi10392800989134-20081101-11
E L I Z A B E T H C B A I R b a i r 0 7 1 2 p a c i f i c u e d u
Thank You
Proposed Changes to Workshop
Provide printed quiz to go with handouts Add video component Rework handouts for comprehension and
application to learners needs
Discussion
After learning more about the problem of malnutrition in long-term care are you considering how you might introduce this topic into your practice or your teaching
Are there other venues where this type of educational program is appropriate and might influence the management of nutritional care for elders
Questions
References
Abbasi AA amp Rudman D (1994) Undernutrition in the nursing home Prevalence consequences cause and prevention Nutrition Reviews 52(4) 113-122 Accreditation Council for Occupational Therapy Education (2006) ACOTE standards and interpretive guidelines Retrieved from
httpwwwaotaorgnonmembersarea13docs acotestandards806pdf Adams NE Bowie AJ Simmance N Murrary M amp Crowe T (2008) Recognition by medical and nursing professionals of malnutrition and risk of malnutrition in elderly hospitalised patients Nutrition and Dietetics (65) 144-150 Amella EJ (2002) Resistance at mealtimes for persons with dementia The Journal of Nutrition Health amp Aging 6 117-122 Amella EJ (2008) Mealtime difficulties In Evidence-Based Geriatric Nursing Protocols for Best Practice 3rd ed (Capezuti E Zwicker D Mezey M Fulmer T Gray-Miceli D amp Kluger M eds) Springer Publishing Company LLC New York p 337-351 American Occupational Therapy Association [AOTA] (2002) Occupational therapy practice framework Domain and process American Journal of Occupational Therapy 56
609ndash639 doi 105014ajot566609 AOTA (2007) Specialized knowledge and skills in feeding eating and swallowing for occupational therapy practice American Journal of Occupational Therapy 61(6) 686-700
doi 105014ajot616686 Asai JL (2004) Nutrition and the geriatric rehabilitation patient Challenges and solutions Topics in Geriatric Rehabilitation 20(1) 34-45 Baier RR Butterfield K Harris Y Gravenstein S (2008) Aiming for star performance the relationship between setting targets and improved nursing home quality of
care Journal of the American Medical Directors Association9(8) 594-9 Epub Dolhi C amp Rogers J (2009) Dementia nutrition and self-feeding A systematic review of the literature Occupational Therapy in Health Care 15(3-4) 59-87 Ferri C Prince M Brayne C Brodaty H Fratiglioni L Ganguli M hellip Landry G (2005) Global prevalence of dementia a delphi consensus study Lancet 366 2112-2217 Frisoni G Fanzoni S Rozzini R Ferrucci L Boffelli S amp Trabucchi M (1994) A nutritional index predicting mortality in the nursing home Journal of the American Geriatric Society 42 1167-1172 Furman EF (2006) Under-nutrition in older adults across the continuum of care Journal of Gerontological Nursing 32(1) 22-27 Groher ME amp Crary MA(2010) Dysphagia Clinical Management in Adults and Children Maryland Heights MO Mosby-Elsevier Harris-Kojetin L Sengupta M Park-Lee E Valverde R Long-term care services in the United States 2013 overview National health care statistics reports no 1 Hyattsville MD National Center for Health Statistics 2013
References
Horner J Alberts MJ Dawson DV Cook GM (1994) Swallowing in Alzheimerrsquos disease Alzheimer Disease Association Disorders 8 177 ndash 19 Kielhofner G (1985) A model of human occupation Baltimore Williams and Wilkins Lammes E amp Akner G (2006) Repeated assessment of energy and nutrient intake in 52 nursing home residents Journal of Nutritional Health and Aging 10(3) 222-30 Lin L-C Watson R amp Wu S-C (2010) What is associated with low food intake in older people with dementia Journal of Clinical Nursing 19 53-59 Doi 101111j1365-2702200902962x Maher D amp Eliad C (2014) Malnutrition in the elderly An unrecognized health issue Journal of Nursing Retrieved from httprnjournalcomjournal-of-nursingmalnutrition-in-the-elderly-an-unrecognized-health-issue Manthorpe J amp Watson R (2003) Poorly served Eating and dementia Journal of Advanced Nursing 41(2) 162-169 Nelson K Coultson A SucherKP amp Tseng R (1992) Prevalence of malnutrition in The elderly admitted to long-term-care facilities Journal of the American Dietetic Association 93(4) 459-460 Ott F Readman T amp Backman C (1990) Mealtimes of the institutionalized elderly A literature review Canadian Journal of Occupational Therapy 57(5) 261-267 Payette H (2002) Know related effects of nutrition on aging muscle function In Nutrition and Aging Vol 6 Ed by LH Rosenberg and A Sastre Nestle Workshop Series Clinical and Performance Program Nestec Ltd Vevey Switzerland P 135-150 Planetree amp Picker Institute (2010) Long term care improvement guide Retrieved from httpplanetreeorgwp-contentuploads201112LTC-Improvement-Guide-For-Downloadpdf Riviere S Gillerte-Guyonnet S Andrieu S Nourhashemi F Laugque S Cantet C hellip Vellas B (2002) Cognitive function and caregiver burden Predictive factors for eating behavior disorders in Alzhiemerrsquos disease International Journal of Geriatric Psychiatry 17 950-955 Schussler S Dassen T amp Lohrmann C (2014) Prevalence of care dependency and nursing care problems in nursing home residents with dementia A literature review International Journal of Caring Sciences 7(2) 339 Retrieved from httpwwwinternationaljournalofcaringsciencesorgdocs120SchC3BCssler-1pdf
References
Scott TM Peter L Tucker KL Arsenault L Bergethon P Bhadelia R hellip Folstein M (2006) The Nutrition Aging and Memory in Elders (NAME) study Design and methods for a study of micronutrients and cognitive function in a homebound elderly population International Journal of Geriatric Psychiatry 21(6) 519-528
doi101002gps1503735 Simmons SF Keeler E Zhuo X Hickey KA Sato HW amp Schnelle JF (2008) Prevention of unintentional weight loss in nursing home residents a controlled trial of feeding assistance Journal of American Geriatric Society 56(8) 1466-1473
Doi101111j1532-5415200801801x Sodderhamn U Backrach-Lindstrom M amp Ek AC (2007) Nutritional screening and perceived health in a group of geriatric rehabilitation patients Journal of Clinical Nursing (16) 1997-2006 Thomas DR Ashmen W Morley JE Evans WJ amp the Council for Nutritional Strategies in Long-Term Care (2000) Nutritional management in long-term care Development of a clinical guideline Journal of Gerontolology Biological Sciences and Medical Sciences 55A(12) M725- doi101093Gerona5512M725 Wu S amp Barker JC (2008) Hot tea and Juk The institutional meaning of food for Chinese elders in an American nursing home Journal of Gerontological Nursing 34(11) 46-45 doi10392800989134-20081101-11
E L I Z A B E T H C B A I R b a i r 0 7 1 2 p a c i f i c u e d u
Thank You
Discussion
After learning more about the problem of malnutrition in long-term care are you considering how you might introduce this topic into your practice or your teaching
Are there other venues where this type of educational program is appropriate and might influence the management of nutritional care for elders
Questions
References
Abbasi AA amp Rudman D (1994) Undernutrition in the nursing home Prevalence consequences cause and prevention Nutrition Reviews 52(4) 113-122 Accreditation Council for Occupational Therapy Education (2006) ACOTE standards and interpretive guidelines Retrieved from
httpwwwaotaorgnonmembersarea13docs acotestandards806pdf Adams NE Bowie AJ Simmance N Murrary M amp Crowe T (2008) Recognition by medical and nursing professionals of malnutrition and risk of malnutrition in elderly hospitalised patients Nutrition and Dietetics (65) 144-150 Amella EJ (2002) Resistance at mealtimes for persons with dementia The Journal of Nutrition Health amp Aging 6 117-122 Amella EJ (2008) Mealtime difficulties In Evidence-Based Geriatric Nursing Protocols for Best Practice 3rd ed (Capezuti E Zwicker D Mezey M Fulmer T Gray-Miceli D amp Kluger M eds) Springer Publishing Company LLC New York p 337-351 American Occupational Therapy Association [AOTA] (2002) Occupational therapy practice framework Domain and process American Journal of Occupational Therapy 56
609ndash639 doi 105014ajot566609 AOTA (2007) Specialized knowledge and skills in feeding eating and swallowing for occupational therapy practice American Journal of Occupational Therapy 61(6) 686-700
doi 105014ajot616686 Asai JL (2004) Nutrition and the geriatric rehabilitation patient Challenges and solutions Topics in Geriatric Rehabilitation 20(1) 34-45 Baier RR Butterfield K Harris Y Gravenstein S (2008) Aiming for star performance the relationship between setting targets and improved nursing home quality of
care Journal of the American Medical Directors Association9(8) 594-9 Epub Dolhi C amp Rogers J (2009) Dementia nutrition and self-feeding A systematic review of the literature Occupational Therapy in Health Care 15(3-4) 59-87 Ferri C Prince M Brayne C Brodaty H Fratiglioni L Ganguli M hellip Landry G (2005) Global prevalence of dementia a delphi consensus study Lancet 366 2112-2217 Frisoni G Fanzoni S Rozzini R Ferrucci L Boffelli S amp Trabucchi M (1994) A nutritional index predicting mortality in the nursing home Journal of the American Geriatric Society 42 1167-1172 Furman EF (2006) Under-nutrition in older adults across the continuum of care Journal of Gerontological Nursing 32(1) 22-27 Groher ME amp Crary MA(2010) Dysphagia Clinical Management in Adults and Children Maryland Heights MO Mosby-Elsevier Harris-Kojetin L Sengupta M Park-Lee E Valverde R Long-term care services in the United States 2013 overview National health care statistics reports no 1 Hyattsville MD National Center for Health Statistics 2013
References
Horner J Alberts MJ Dawson DV Cook GM (1994) Swallowing in Alzheimerrsquos disease Alzheimer Disease Association Disorders 8 177 ndash 19 Kielhofner G (1985) A model of human occupation Baltimore Williams and Wilkins Lammes E amp Akner G (2006) Repeated assessment of energy and nutrient intake in 52 nursing home residents Journal of Nutritional Health and Aging 10(3) 222-30 Lin L-C Watson R amp Wu S-C (2010) What is associated with low food intake in older people with dementia Journal of Clinical Nursing 19 53-59 Doi 101111j1365-2702200902962x Maher D amp Eliad C (2014) Malnutrition in the elderly An unrecognized health issue Journal of Nursing Retrieved from httprnjournalcomjournal-of-nursingmalnutrition-in-the-elderly-an-unrecognized-health-issue Manthorpe J amp Watson R (2003) Poorly served Eating and dementia Journal of Advanced Nursing 41(2) 162-169 Nelson K Coultson A SucherKP amp Tseng R (1992) Prevalence of malnutrition in The elderly admitted to long-term-care facilities Journal of the American Dietetic Association 93(4) 459-460 Ott F Readman T amp Backman C (1990) Mealtimes of the institutionalized elderly A literature review Canadian Journal of Occupational Therapy 57(5) 261-267 Payette H (2002) Know related effects of nutrition on aging muscle function In Nutrition and Aging Vol 6 Ed by LH Rosenberg and A Sastre Nestle Workshop Series Clinical and Performance Program Nestec Ltd Vevey Switzerland P 135-150 Planetree amp Picker Institute (2010) Long term care improvement guide Retrieved from httpplanetreeorgwp-contentuploads201112LTC-Improvement-Guide-For-Downloadpdf Riviere S Gillerte-Guyonnet S Andrieu S Nourhashemi F Laugque S Cantet C hellip Vellas B (2002) Cognitive function and caregiver burden Predictive factors for eating behavior disorders in Alzhiemerrsquos disease International Journal of Geriatric Psychiatry 17 950-955 Schussler S Dassen T amp Lohrmann C (2014) Prevalence of care dependency and nursing care problems in nursing home residents with dementia A literature review International Journal of Caring Sciences 7(2) 339 Retrieved from httpwwwinternationaljournalofcaringsciencesorgdocs120SchC3BCssler-1pdf
References
Scott TM Peter L Tucker KL Arsenault L Bergethon P Bhadelia R hellip Folstein M (2006) The Nutrition Aging and Memory in Elders (NAME) study Design and methods for a study of micronutrients and cognitive function in a homebound elderly population International Journal of Geriatric Psychiatry 21(6) 519-528
doi101002gps1503735 Simmons SF Keeler E Zhuo X Hickey KA Sato HW amp Schnelle JF (2008) Prevention of unintentional weight loss in nursing home residents a controlled trial of feeding assistance Journal of American Geriatric Society 56(8) 1466-1473
Doi101111j1532-5415200801801x Sodderhamn U Backrach-Lindstrom M amp Ek AC (2007) Nutritional screening and perceived health in a group of geriatric rehabilitation patients Journal of Clinical Nursing (16) 1997-2006 Thomas DR Ashmen W Morley JE Evans WJ amp the Council for Nutritional Strategies in Long-Term Care (2000) Nutritional management in long-term care Development of a clinical guideline Journal of Gerontolology Biological Sciences and Medical Sciences 55A(12) M725- doi101093Gerona5512M725 Wu S amp Barker JC (2008) Hot tea and Juk The institutional meaning of food for Chinese elders in an American nursing home Journal of Gerontological Nursing 34(11) 46-45 doi10392800989134-20081101-11
E L I Z A B E T H C B A I R b a i r 0 7 1 2 p a c i f i c u e d u
Thank You
Questions
References
Abbasi AA amp Rudman D (1994) Undernutrition in the nursing home Prevalence consequences cause and prevention Nutrition Reviews 52(4) 113-122 Accreditation Council for Occupational Therapy Education (2006) ACOTE standards and interpretive guidelines Retrieved from
httpwwwaotaorgnonmembersarea13docs acotestandards806pdf Adams NE Bowie AJ Simmance N Murrary M amp Crowe T (2008) Recognition by medical and nursing professionals of malnutrition and risk of malnutrition in elderly hospitalised patients Nutrition and Dietetics (65) 144-150 Amella EJ (2002) Resistance at mealtimes for persons with dementia The Journal of Nutrition Health amp Aging 6 117-122 Amella EJ (2008) Mealtime difficulties In Evidence-Based Geriatric Nursing Protocols for Best Practice 3rd ed (Capezuti E Zwicker D Mezey M Fulmer T Gray-Miceli D amp Kluger M eds) Springer Publishing Company LLC New York p 337-351 American Occupational Therapy Association [AOTA] (2002) Occupational therapy practice framework Domain and process American Journal of Occupational Therapy 56
609ndash639 doi 105014ajot566609 AOTA (2007) Specialized knowledge and skills in feeding eating and swallowing for occupational therapy practice American Journal of Occupational Therapy 61(6) 686-700
doi 105014ajot616686 Asai JL (2004) Nutrition and the geriatric rehabilitation patient Challenges and solutions Topics in Geriatric Rehabilitation 20(1) 34-45 Baier RR Butterfield K Harris Y Gravenstein S (2008) Aiming for star performance the relationship between setting targets and improved nursing home quality of
care Journal of the American Medical Directors Association9(8) 594-9 Epub Dolhi C amp Rogers J (2009) Dementia nutrition and self-feeding A systematic review of the literature Occupational Therapy in Health Care 15(3-4) 59-87 Ferri C Prince M Brayne C Brodaty H Fratiglioni L Ganguli M hellip Landry G (2005) Global prevalence of dementia a delphi consensus study Lancet 366 2112-2217 Frisoni G Fanzoni S Rozzini R Ferrucci L Boffelli S amp Trabucchi M (1994) A nutritional index predicting mortality in the nursing home Journal of the American Geriatric Society 42 1167-1172 Furman EF (2006) Under-nutrition in older adults across the continuum of care Journal of Gerontological Nursing 32(1) 22-27 Groher ME amp Crary MA(2010) Dysphagia Clinical Management in Adults and Children Maryland Heights MO Mosby-Elsevier Harris-Kojetin L Sengupta M Park-Lee E Valverde R Long-term care services in the United States 2013 overview National health care statistics reports no 1 Hyattsville MD National Center for Health Statistics 2013
References
Horner J Alberts MJ Dawson DV Cook GM (1994) Swallowing in Alzheimerrsquos disease Alzheimer Disease Association Disorders 8 177 ndash 19 Kielhofner G (1985) A model of human occupation Baltimore Williams and Wilkins Lammes E amp Akner G (2006) Repeated assessment of energy and nutrient intake in 52 nursing home residents Journal of Nutritional Health and Aging 10(3) 222-30 Lin L-C Watson R amp Wu S-C (2010) What is associated with low food intake in older people with dementia Journal of Clinical Nursing 19 53-59 Doi 101111j1365-2702200902962x Maher D amp Eliad C (2014) Malnutrition in the elderly An unrecognized health issue Journal of Nursing Retrieved from httprnjournalcomjournal-of-nursingmalnutrition-in-the-elderly-an-unrecognized-health-issue Manthorpe J amp Watson R (2003) Poorly served Eating and dementia Journal of Advanced Nursing 41(2) 162-169 Nelson K Coultson A SucherKP amp Tseng R (1992) Prevalence of malnutrition in The elderly admitted to long-term-care facilities Journal of the American Dietetic Association 93(4) 459-460 Ott F Readman T amp Backman C (1990) Mealtimes of the institutionalized elderly A literature review Canadian Journal of Occupational Therapy 57(5) 261-267 Payette H (2002) Know related effects of nutrition on aging muscle function In Nutrition and Aging Vol 6 Ed by LH Rosenberg and A Sastre Nestle Workshop Series Clinical and Performance Program Nestec Ltd Vevey Switzerland P 135-150 Planetree amp Picker Institute (2010) Long term care improvement guide Retrieved from httpplanetreeorgwp-contentuploads201112LTC-Improvement-Guide-For-Downloadpdf Riviere S Gillerte-Guyonnet S Andrieu S Nourhashemi F Laugque S Cantet C hellip Vellas B (2002) Cognitive function and caregiver burden Predictive factors for eating behavior disorders in Alzhiemerrsquos disease International Journal of Geriatric Psychiatry 17 950-955 Schussler S Dassen T amp Lohrmann C (2014) Prevalence of care dependency and nursing care problems in nursing home residents with dementia A literature review International Journal of Caring Sciences 7(2) 339 Retrieved from httpwwwinternationaljournalofcaringsciencesorgdocs120SchC3BCssler-1pdf
References
Scott TM Peter L Tucker KL Arsenault L Bergethon P Bhadelia R hellip Folstein M (2006) The Nutrition Aging and Memory in Elders (NAME) study Design and methods for a study of micronutrients and cognitive function in a homebound elderly population International Journal of Geriatric Psychiatry 21(6) 519-528
doi101002gps1503735 Simmons SF Keeler E Zhuo X Hickey KA Sato HW amp Schnelle JF (2008) Prevention of unintentional weight loss in nursing home residents a controlled trial of feeding assistance Journal of American Geriatric Society 56(8) 1466-1473
Doi101111j1532-5415200801801x Sodderhamn U Backrach-Lindstrom M amp Ek AC (2007) Nutritional screening and perceived health in a group of geriatric rehabilitation patients Journal of Clinical Nursing (16) 1997-2006 Thomas DR Ashmen W Morley JE Evans WJ amp the Council for Nutritional Strategies in Long-Term Care (2000) Nutritional management in long-term care Development of a clinical guideline Journal of Gerontolology Biological Sciences and Medical Sciences 55A(12) M725- doi101093Gerona5512M725 Wu S amp Barker JC (2008) Hot tea and Juk The institutional meaning of food for Chinese elders in an American nursing home Journal of Gerontological Nursing 34(11) 46-45 doi10392800989134-20081101-11
E L I Z A B E T H C B A I R b a i r 0 7 1 2 p a c i f i c u e d u
Thank You
References
Abbasi AA amp Rudman D (1994) Undernutrition in the nursing home Prevalence consequences cause and prevention Nutrition Reviews 52(4) 113-122 Accreditation Council for Occupational Therapy Education (2006) ACOTE standards and interpretive guidelines Retrieved from
httpwwwaotaorgnonmembersarea13docs acotestandards806pdf Adams NE Bowie AJ Simmance N Murrary M amp Crowe T (2008) Recognition by medical and nursing professionals of malnutrition and risk of malnutrition in elderly hospitalised patients Nutrition and Dietetics (65) 144-150 Amella EJ (2002) Resistance at mealtimes for persons with dementia The Journal of Nutrition Health amp Aging 6 117-122 Amella EJ (2008) Mealtime difficulties In Evidence-Based Geriatric Nursing Protocols for Best Practice 3rd ed (Capezuti E Zwicker D Mezey M Fulmer T Gray-Miceli D amp Kluger M eds) Springer Publishing Company LLC New York p 337-351 American Occupational Therapy Association [AOTA] (2002) Occupational therapy practice framework Domain and process American Journal of Occupational Therapy 56
609ndash639 doi 105014ajot566609 AOTA (2007) Specialized knowledge and skills in feeding eating and swallowing for occupational therapy practice American Journal of Occupational Therapy 61(6) 686-700
doi 105014ajot616686 Asai JL (2004) Nutrition and the geriatric rehabilitation patient Challenges and solutions Topics in Geriatric Rehabilitation 20(1) 34-45 Baier RR Butterfield K Harris Y Gravenstein S (2008) Aiming for star performance the relationship between setting targets and improved nursing home quality of
care Journal of the American Medical Directors Association9(8) 594-9 Epub Dolhi C amp Rogers J (2009) Dementia nutrition and self-feeding A systematic review of the literature Occupational Therapy in Health Care 15(3-4) 59-87 Ferri C Prince M Brayne C Brodaty H Fratiglioni L Ganguli M hellip Landry G (2005) Global prevalence of dementia a delphi consensus study Lancet 366 2112-2217 Frisoni G Fanzoni S Rozzini R Ferrucci L Boffelli S amp Trabucchi M (1994) A nutritional index predicting mortality in the nursing home Journal of the American Geriatric Society 42 1167-1172 Furman EF (2006) Under-nutrition in older adults across the continuum of care Journal of Gerontological Nursing 32(1) 22-27 Groher ME amp Crary MA(2010) Dysphagia Clinical Management in Adults and Children Maryland Heights MO Mosby-Elsevier Harris-Kojetin L Sengupta M Park-Lee E Valverde R Long-term care services in the United States 2013 overview National health care statistics reports no 1 Hyattsville MD National Center for Health Statistics 2013
References
Horner J Alberts MJ Dawson DV Cook GM (1994) Swallowing in Alzheimerrsquos disease Alzheimer Disease Association Disorders 8 177 ndash 19 Kielhofner G (1985) A model of human occupation Baltimore Williams and Wilkins Lammes E amp Akner G (2006) Repeated assessment of energy and nutrient intake in 52 nursing home residents Journal of Nutritional Health and Aging 10(3) 222-30 Lin L-C Watson R amp Wu S-C (2010) What is associated with low food intake in older people with dementia Journal of Clinical Nursing 19 53-59 Doi 101111j1365-2702200902962x Maher D amp Eliad C (2014) Malnutrition in the elderly An unrecognized health issue Journal of Nursing Retrieved from httprnjournalcomjournal-of-nursingmalnutrition-in-the-elderly-an-unrecognized-health-issue Manthorpe J amp Watson R (2003) Poorly served Eating and dementia Journal of Advanced Nursing 41(2) 162-169 Nelson K Coultson A SucherKP amp Tseng R (1992) Prevalence of malnutrition in The elderly admitted to long-term-care facilities Journal of the American Dietetic Association 93(4) 459-460 Ott F Readman T amp Backman C (1990) Mealtimes of the institutionalized elderly A literature review Canadian Journal of Occupational Therapy 57(5) 261-267 Payette H (2002) Know related effects of nutrition on aging muscle function In Nutrition and Aging Vol 6 Ed by LH Rosenberg and A Sastre Nestle Workshop Series Clinical and Performance Program Nestec Ltd Vevey Switzerland P 135-150 Planetree amp Picker Institute (2010) Long term care improvement guide Retrieved from httpplanetreeorgwp-contentuploads201112LTC-Improvement-Guide-For-Downloadpdf Riviere S Gillerte-Guyonnet S Andrieu S Nourhashemi F Laugque S Cantet C hellip Vellas B (2002) Cognitive function and caregiver burden Predictive factors for eating behavior disorders in Alzhiemerrsquos disease International Journal of Geriatric Psychiatry 17 950-955 Schussler S Dassen T amp Lohrmann C (2014) Prevalence of care dependency and nursing care problems in nursing home residents with dementia A literature review International Journal of Caring Sciences 7(2) 339 Retrieved from httpwwwinternationaljournalofcaringsciencesorgdocs120SchC3BCssler-1pdf
References
Scott TM Peter L Tucker KL Arsenault L Bergethon P Bhadelia R hellip Folstein M (2006) The Nutrition Aging and Memory in Elders (NAME) study Design and methods for a study of micronutrients and cognitive function in a homebound elderly population International Journal of Geriatric Psychiatry 21(6) 519-528
doi101002gps1503735 Simmons SF Keeler E Zhuo X Hickey KA Sato HW amp Schnelle JF (2008) Prevention of unintentional weight loss in nursing home residents a controlled trial of feeding assistance Journal of American Geriatric Society 56(8) 1466-1473
Doi101111j1532-5415200801801x Sodderhamn U Backrach-Lindstrom M amp Ek AC (2007) Nutritional screening and perceived health in a group of geriatric rehabilitation patients Journal of Clinical Nursing (16) 1997-2006 Thomas DR Ashmen W Morley JE Evans WJ amp the Council for Nutritional Strategies in Long-Term Care (2000) Nutritional management in long-term care Development of a clinical guideline Journal of Gerontolology Biological Sciences and Medical Sciences 55A(12) M725- doi101093Gerona5512M725 Wu S amp Barker JC (2008) Hot tea and Juk The institutional meaning of food for Chinese elders in an American nursing home Journal of Gerontological Nursing 34(11) 46-45 doi10392800989134-20081101-11
E L I Z A B E T H C B A I R b a i r 0 7 1 2 p a c i f i c u e d u
Thank You
References
Horner J Alberts MJ Dawson DV Cook GM (1994) Swallowing in Alzheimerrsquos disease Alzheimer Disease Association Disorders 8 177 ndash 19 Kielhofner G (1985) A model of human occupation Baltimore Williams and Wilkins Lammes E amp Akner G (2006) Repeated assessment of energy and nutrient intake in 52 nursing home residents Journal of Nutritional Health and Aging 10(3) 222-30 Lin L-C Watson R amp Wu S-C (2010) What is associated with low food intake in older people with dementia Journal of Clinical Nursing 19 53-59 Doi 101111j1365-2702200902962x Maher D amp Eliad C (2014) Malnutrition in the elderly An unrecognized health issue Journal of Nursing Retrieved from httprnjournalcomjournal-of-nursingmalnutrition-in-the-elderly-an-unrecognized-health-issue Manthorpe J amp Watson R (2003) Poorly served Eating and dementia Journal of Advanced Nursing 41(2) 162-169 Nelson K Coultson A SucherKP amp Tseng R (1992) Prevalence of malnutrition in The elderly admitted to long-term-care facilities Journal of the American Dietetic Association 93(4) 459-460 Ott F Readman T amp Backman C (1990) Mealtimes of the institutionalized elderly A literature review Canadian Journal of Occupational Therapy 57(5) 261-267 Payette H (2002) Know related effects of nutrition on aging muscle function In Nutrition and Aging Vol 6 Ed by LH Rosenberg and A Sastre Nestle Workshop Series Clinical and Performance Program Nestec Ltd Vevey Switzerland P 135-150 Planetree amp Picker Institute (2010) Long term care improvement guide Retrieved from httpplanetreeorgwp-contentuploads201112LTC-Improvement-Guide-For-Downloadpdf Riviere S Gillerte-Guyonnet S Andrieu S Nourhashemi F Laugque S Cantet C hellip Vellas B (2002) Cognitive function and caregiver burden Predictive factors for eating behavior disorders in Alzhiemerrsquos disease International Journal of Geriatric Psychiatry 17 950-955 Schussler S Dassen T amp Lohrmann C (2014) Prevalence of care dependency and nursing care problems in nursing home residents with dementia A literature review International Journal of Caring Sciences 7(2) 339 Retrieved from httpwwwinternationaljournalofcaringsciencesorgdocs120SchC3BCssler-1pdf
References
Scott TM Peter L Tucker KL Arsenault L Bergethon P Bhadelia R hellip Folstein M (2006) The Nutrition Aging and Memory in Elders (NAME) study Design and methods for a study of micronutrients and cognitive function in a homebound elderly population International Journal of Geriatric Psychiatry 21(6) 519-528
doi101002gps1503735 Simmons SF Keeler E Zhuo X Hickey KA Sato HW amp Schnelle JF (2008) Prevention of unintentional weight loss in nursing home residents a controlled trial of feeding assistance Journal of American Geriatric Society 56(8) 1466-1473
Doi101111j1532-5415200801801x Sodderhamn U Backrach-Lindstrom M amp Ek AC (2007) Nutritional screening and perceived health in a group of geriatric rehabilitation patients Journal of Clinical Nursing (16) 1997-2006 Thomas DR Ashmen W Morley JE Evans WJ amp the Council for Nutritional Strategies in Long-Term Care (2000) Nutritional management in long-term care Development of a clinical guideline Journal of Gerontolology Biological Sciences and Medical Sciences 55A(12) M725- doi101093Gerona5512M725 Wu S amp Barker JC (2008) Hot tea and Juk The institutional meaning of food for Chinese elders in an American nursing home Journal of Gerontological Nursing 34(11) 46-45 doi10392800989134-20081101-11
E L I Z A B E T H C B A I R b a i r 0 7 1 2 p a c i f i c u e d u
Thank You
References
Scott TM Peter L Tucker KL Arsenault L Bergethon P Bhadelia R hellip Folstein M (2006) The Nutrition Aging and Memory in Elders (NAME) study Design and methods for a study of micronutrients and cognitive function in a homebound elderly population International Journal of Geriatric Psychiatry 21(6) 519-528
doi101002gps1503735 Simmons SF Keeler E Zhuo X Hickey KA Sato HW amp Schnelle JF (2008) Prevention of unintentional weight loss in nursing home residents a controlled trial of feeding assistance Journal of American Geriatric Society 56(8) 1466-1473
Doi101111j1532-5415200801801x Sodderhamn U Backrach-Lindstrom M amp Ek AC (2007) Nutritional screening and perceived health in a group of geriatric rehabilitation patients Journal of Clinical Nursing (16) 1997-2006 Thomas DR Ashmen W Morley JE Evans WJ amp the Council for Nutritional Strategies in Long-Term Care (2000) Nutritional management in long-term care Development of a clinical guideline Journal of Gerontolology Biological Sciences and Medical Sciences 55A(12) M725- doi101093Gerona5512M725 Wu S amp Barker JC (2008) Hot tea and Juk The institutional meaning of food for Chinese elders in an American nursing home Journal of Gerontological Nursing 34(11) 46-45 doi10392800989134-20081101-11
E L I Z A B E T H C B A I R b a i r 0 7 1 2 p a c i f i c u e d u
Thank You
E L I Z A B E T H C B A I R b a i r 0 7 1 2 p a c i f i c u e d u
Thank You