172 / 210
S164
Symposia / European Geriatric Medicine 6S1 (2015) S157
–
S176
S-09
“nutritionDay in nursing homes”
–
present state and future
prospects
D. Volkert
1
, R. Roller-Wirnsberger
2
, M. Maggio
3
1
Friedrich-Alexander-Universit¨at Erlangen-N¨urnerg, N¨urnberg,
Germany;
2
Medical University of Graz, Graz, Austria;
3
Italy
Introduction:
Nursing home residents are at high risk of
malnutrition for various reasons, and malnutrition is widespread in
this mostly very old and frail population group. This is of relevance
since malnutrition is related to many unfavourable health outcomes
and increased healthcare costs.
Effective measures for nutritional therapy are available, prerequisite
is, however that nutritional problems and malnutrition are
recognized. Currently the significance of the problem is not very
well perceived and in many institutions prevention and treatment
of malnutrition do not receive appropriate attention.
Thus, the aim of the nutritionDay project is to improve knowledge
and awareness of malnutrition in health care institutions and to
overall enhance the quality of nutritional care. The initiative started
in 2006 in the hospital setting in a few countries and meanwhile
developed to a worldwide project
(www.nutritionDay.org). On one
specific day every year (“nutritionDay”) hospital wards and nursing
homes around the world have the opportunity to participate and
thus to monitor and benchmark the institutions’ nutritional care at
an international level.
At the same time, a continuously growing database develops
containing information about the nutritional situation of nursing
home residents all over the world. This database is available to
scientists who contribute to the project. Analysing these data
provides the opportunity to better understand differences between
institutions within one country as well as cultural differences
between countries.
The vision of the organizers is that nutritionDay can be developed
further and will be adopted as a surveillance tool to monitor
malnutrition at national levels and at the same time helps to
better understand the role of various structural and individual
determinants of malnutrition and to develop strategies to improve
nutritional care.
Objectives:
After participating in this symposium, participants are
aware of the problem of malnutrition in institutionalised older
persons and the importance of adequate nutritional care to prevent
and treat malnutrition.
Participants are informed about the nDay project as a tool
to increase awareness of malnutrition and know about the
opportunity to participate and make nutritional care a subject of
discussion in their own institutions.
Participants will also get an idea how to promote and implement
the project in their country and know about the possibility to
become part of the project as a country representative, who will
also have access to the scientific database.
Finally participants will learn about the dynamic nature of the
project and possible future strategies and developments.
Presentations:
1. The nutritionDay project
–
an overview and update of findings
(Dorothee Volkert): This presentation will give a review of the
project and will report latest results of the database evaluation.
In 2007 nutritionDay was performed for the first time in nursing
homes with the overall aim to evaluate the current state of the
nutritional status of nursing home residents using easy to complete
questionnaires. Meanwhile the project is well established in nursing
homes around the world. Up to now more than 700 nursing home
units with more than 28,000 residents from 21 countries have
participated.
nutritionDay data document a great heterogeneity in units’ as
well as in residents’ characteristics between different countries.
Malnutrition according to BMI, MNA, weight loss and low food
intake is widespread in all countries with great variance in
the prevalence between countries and also within countries
between participating units. Malnutrition is more prevalent in frail,
functionally impaired residents than in functionally unimpaired
and is clearly related to a poor outcome after 6 months. The
role of institutional factors, like regular weighing or screening for
malnutrition or the presence of a dietitian is presently unclear and
subject of current analyses.
2. nutritionDay initiative in Styria
–
best practice
–
experience
from Styria
(Regina Roller-Wirnsberger, MD, Medizinische
Universit¨at Graz, Austria): In 2012 a low awareness of the impact
of nutrition on individual outcome and wellbeing of nursing home
residents and a lack of data regarding nutritional care was noticed
in the province of Styria in Austria. Furthermore, documentation
and nursing concepts for nutritional care used within long term
care varied significantly and a lack of guidelines was recognized.
It was therefore of interest to get information about the nutritional
situation of nursing home residents as a basis for political decisions
regarding quality assurance of nutritional care. A multi-stakeholder
partnership was raised between nursing homes, universities and
members of the provincial government which allowed training
of nursing home staff about malnutrition, facilitated nutritionDay
participation by support from students and allowed political
commitment.
As a result 61 Styrian institutions (about one third of all nursing
homes in Styria) participated in nutritionDay in nursing homes on
November 8th, 2012. In 104 units 3106 residents were screened
for malnutrition on that day. Results were made available for each
institution and a comprehensive report about the Styrian results in
comparison to Austria and other European countries was produced.
As a result, national guidelines for nutritional care were developed
and quality of nutritional care is now checked in all nursing homes
on a regular basis by legal officers.
In summary, the multi-stakeholder approach makes the Styrian
initiative innovative as it reaches out to political decision makers
on the one hand and to health care professionals, who are working
in the field, on the other. This approach led to changes on structural
and political level as well as increased awareness of health care
professionals which finally results in improved quality of nutritional
care.
3. Future needs and developments: targeting malnutrition and
mobility disability
(Marcello Maggio, MD, Geriatric Clinic Unit
University Hospital of Parma, Italy): The nutritionDay pursues
the goal of improving the awareness of malnutrition in nursing
homes (NH) and other settings. The instruments actually used in
this initiative to screen malnutrition and the food consumption
in NH residents participating at ND include the Mini Nutritional
Assessment short-form and qualitative and quantitative evaluation
forms of food consumption. This information is useful to
generate predictors of outcomes at 6 months such as mortality
and hospitalizations. However, one the main consequences of
malnutrition in nursing homes is the deterioration of physical
function and the onset of disability. This phenomenon has a
huge impact on NH organization, by increasing the costs and
decreasing the quality of life of participants. The chair stand test is a
simple objective test of physical function which deserves particular
attention for a number of reasons: 1) It is an independent risk
factor of mortality. 2) It can be more easily performed than other
tests such as gait speed because the space necessary to complete
the walking test is often not available. 3) It is a mirror of muscle
mass and function more than other physical tests. 4) Recent data
coming from randomised intervention trials suggest that it is a
sensitive marker of nutritional intervention in older persons.
In summary, the inclusion of a simple objective test of physical
function sensitive to nutritional interventions might be of
enormous importance to increase the significance of information