Hostname: page-component-78c5997874-94fs2 Total loading time: 0 Render date: 2024-11-15T11:16:39.795Z Has data issue: false hasContentIssue false

Nutrition Risk in Home-Bound Older Adults: Using Dietician-Trained and Supervised Nutrition Volunteers for Screening and Intervention*

Published online by Cambridge University Press:  31 March 2010

Sophie Laforest*
Affiliation:
Department of Kinesiology, Université de Montréal Groupe de recherche interdisciplinaire en santé (GRIS), Université de Montréal CSSS Cavendish, Centre de recherche et d'expertise en gérontologie sociale (CREGES)-CAU
Benita Goldin
Affiliation:
Cummings Jewish Centre for Seniors
Kareen Nour
Affiliation:
Groupe de recherche interdisciplinaire en santé (GRIS), Université de Montréal CSSS Cavendish, Centre de recherche et d'expertise en gérontologie sociale (CREGES)-CAU
Marie-Andrée Roy
Affiliation:
Research Centre on Aging, Health and Social Services Centre–University Institute of Geriatrics of Sherbrooke
Hélène Payette
Affiliation:
Research Centre on Aging, Health and Social Services Centre–University Institute of Geriatrics of Sherbrooke Université de Sherbrooke
*
Requests for offprints should be sent to: / Les demandes de tirés-à-part doivent être adressées à : Sophie Laforest, Ph.D., Université de Montréal, Department of Kinesiology, C.P. 6128, succ. Centre-Ville, Montreal, QC H3C 3J7. ([email protected])

Abstract

Nutrition screening and early intervention in home-bound older adults are key to preventing unfavourable health outcomes and functional decline. This pilot study's objectives were (a) to test the reliability of the Elderly Nutrition Screening Tool (ENS©) when administered by dietician-trained and supervised nutrition volunteers, and (b) to explore the feasibility of volunteers' doing nutrition screening and intervention for home-bound older adults receiving home care services. Both participating clients (n = 29) and volunteers (n = 15) were community-dwelling older adults. Volunteers met with participating clients, assessed nutritional risk with the ENS©, provided nutritional education, and developed and helped implement intervention plans. To assess ENS© inter-rater reliability, we compared results obtained by nutrition volunteers and a dietician. Agreement was high (≥80%) for most items but was higher among volunteers than between volunteers and the dietician. We conclude that nutrition volunteers can assist in screening and educating older adults regarding nutritional risks, but intervention is best left to professionals.

Résumé

Le dépistage du risque nutritionnel et l'intervention hâtive en nutrition auprès de la population âgée confinée à domicile sont des déterminants clés de la prévention de divers problèmes de santé et d'incapacités physiques chez cette population. Cette étude pilote avait pour objectifs: (a) de mesurer la fidélité de l'instrument de mesure « Questionnaire de dépistage nutritionnel des aînés » (ENS©) lorsqu'administré par une nutritionniste et par un bénévole formé; et (b) d'explorer la faisabilité pour un bénévole de faire du dépistage et de l'intervention en nutrition auprès d'une population âgée confinée recevant des services de soutien à domicile. Les participants (n = 29) et les bénévoles (n = 15) étaient des personnes âgées vivant dans la communauté. Les bénévoles ont rencontré les participants, ont évalué leur risque nutritionnel à partir de l'échelle de dépistage ENS©, ont offert de l'éducation nutritionnelle, et ont développé et aidé à l'implantation des plans d'intervention nutritionnelle. Afin de calculer la fidélité inter juges du ENS©, les résultats obtenus à partir de cet instrument par les bénévoles et par la nutritionniste ont été comparés. Le pourcentage de concordance était élevé (≥80 %) pour la plupart des items, mais plus élevé parmi les bénévoles qu'entre les bénévoles et la nutritionniste. Nous croyons que des bénévoles formés au sujet de la nutrition peuvent épauler les nutritionnistes pour le dépistage et l'éducation des risques nutritionnels, mais que l'intervention nutritionnelle devrait être réservée aux professionnels.

Type
Articles
Copyright
Copyright © Canadian Association on Gerontology 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

*

This project was made possible by a financial contribution from Health Canada and Canadian Heritage. We also wish to thank the CSSS Cavendish, Centre de recherche et d'expertise en gerontologie sociale (CREGES)-CAU for its support of this project. Appreciation is also extended to Richard Goudreault of the Montreal Public Health Department for his technical assistance with the data and to Silvia Straka for her general comments and recommendations in the writing of the paper. All the older adult nutrition volunteers who donated their time and expertise are also to be commended for their immeasurable contribution to the intervention's success. We further thank the members of the Advisory Committee for their invaluable input and direction regarding the intervention development and evaluation: Colleen Reavell, Miriam Hopmeyer, Debbie Ungar, Rona Maisel (CJCS); Cathy Rigas (CLSC René-Cassin); Katherine Gray-Donald (McGill University); and Phyllis Leebosh (CJCS seniors' volunteers).

References

Abbasi, A.A., Basu, S., & Rudman, D. (1992). Caloric requirement for weight gain in malnourished nursing home patients. Journal of the American Geriatrics Society, 40(SA)24.Google Scholar
Abbasi, A.A., & Rudman, D. (1993). Observations on the prevalence of protein-calorie undernutrition in VA nursing homes. Journal of the American Geriatrics Society, 41, 117121.CrossRefGoogle ScholarPubMed
Alibhai, S.M., Greenwood, C., & Payette, H. (2005). An approach to the management of unintentional weight loss in elderly people. Canadian Medical Association Journal, 172(6), 773780.CrossRefGoogle Scholar
Bravo, G., & Potvin, L. (1991). Estimating the reliability of continuous measures with Cronbach's alpha or the intraclass correlation coefficient: Toward the integration of two traditions. Journal of Clinical Epidemiology, 44(4–5)381390.CrossRefGoogle ScholarPubMed
Byrt, T., Bishop, J., & Carlin, J.B. (1993). Bias, prevalence and kappa. Journal of Clinical Epidemiology, 46(5), 423429.CrossRefGoogle ScholarPubMed
Cohen, J. (1968). Weighted kappa: Nominal scale agreement with provision for scaled disagreement or partial credit. Psychological Bulletin, 70, 213220.CrossRefGoogle ScholarPubMed
Cornoni-Huntley, J.C., Harris, T.B., Everett, D.F., Albanes, D., Micozzi, M.S., Miles, T.P., et al. (1991). An overview of body weight of older persons, including the impact on mortality (National Health and Nutrition Examination Survey I—Epidemiologic Follow-up Study). Journal of Clinical Epidemiology, 44(8), 743753.CrossRefGoogle ScholarPubMed
Fleiss, J.L. (1986). The design and analysis of clinical experiments. New York: John Wiley.Google Scholar
Frongillo, E.A., Rauschenbach, B.S., Roe, D.A., & Williamson, D.F. (1992). Characteristics related to elderly persons' not eating for 1 or more days: Implications for meal programs. American Journal of Public Health, 82(4), 600602.CrossRefGoogle ScholarPubMed
Jensen, G.L., Friedmann, J.M., Coleman, C.D., & Smiciklas-Wright, H. (2001). Screening for hospitalization and nutritional risks among community-dwelling older persons. American Journal of Clinical Nutrition, 74(2), 201205.CrossRefGoogle ScholarPubMed
Kerstetter, J.E., Holthausen, B.A., & Fitz, P.A. (1992). Malnutrition in the institutionalized older adult. Journal of the American Dietetic Association, 92, 11091116.CrossRefGoogle ScholarPubMed
Landis, J.R., & Koch, G.G. (1977). The measurement of observer agreement for categorical data. Biometrics, 33, 159174.CrossRefGoogle ScholarPubMed
Langlois, J.A., Visser, M., Davidovic, L.S., Maggi, S., Li, G., & Harris, T.B. (1998). Hip fracture risk in older white men is associated with change in body weight from age 50 years to old age. Archives of Internal Medicine, 158(9), 990996.CrossRefGoogle ScholarPubMed
Liu, L., Bopp, M.M., Roberson, P.K., & Sullivan, D.H. (2002). Undernutrition and risk of mortality in elderly patients within 1 year of hospital discharge. Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 57(11), M741M746.CrossRefGoogle ScholarPubMed
McIntosh, W.A., Kubena, K.S., Walker, J., Smith, D., & Landmann, W.A. (1990). The relationship between beliefs about nutrition and dietary practices of the elderly. Journal of the American Dietetic Association, 90, 671676.CrossRefGoogle ScholarPubMed
Millen, B.E., Silliman, R.A., Cantey-Kiser, J., Copenhafer, D.L., Ewart, C.V., Ritchie, C.S., et al. (2001). Nutritional risk in an urban homebound older population: The Nutrition and Healthy Aging Project. Journal of Nutrition, Health and Aging, 5(4), 269277.Google Scholar
Newman, A.B., Lee, J.S., Visser, M., Goodpaster, B.H., Kritchevsky, S.B., Tylavsky, F.A., et al. (2005). Weight change and the conservation of lean mass in old age: The Health, Aging and Body Composition Study. American Journal of Clinical Nutrition, 82(4), 872878915916.CrossRefGoogle ScholarPubMed
Payette, H. (1996). Stratégies de prévention de la malnutrition chez les personnes âgées en perte d'autonomie à domicile [Strategies for the prevention of malnutrition in older adults who are losing independence living at home]. Age and Nutrition, 7(1), 69.Google Scholar
Payette, H. (2005). Nutrition as a determinant of functional autonomy and quality of life in aging: A research program. Canadian Journal of Physiology and Pharmacology, 83, 10611070.CrossRefGoogle ScholarPubMed
Payette, H., Coulombe, C., Boutier, V., & Gray-Donald, K. (1999). Weight loss and mortality among free-living frail elders: A prospective study. Journals of Gerontology Series A: Biological Sciences & Medical Sciences, 54(9), M440M445.CrossRefGoogle ScholarPubMed
Payette, H., Coulombe, C., Boutier, V., & Gray-Donald, K. (2000). Nutrition risk factors for institutionalization in a free-living functionally dependent elderly population. Journal of Clinical Epidemiology, 53(6), 579587.CrossRefGoogle Scholar
Payette, H., Gray-Donald, K., Cyr, R., & Boutier, V. (1995). Predictors of dietary intake in a functionally dependent elderly population in the community. American Journal of Public Health, 85(5), 677683.CrossRefGoogle Scholar
Payette, H., Gray-Donald, K., Cyr, R., & Boutier, V. (1996). Efficacy of a nutritional screening tool in free-living frail elderly (Abstract). Age and Nutrition, 7(3), 168.Google Scholar
Payette, H., Guigoz, Y., & Vellas, B.J. (1999). Study design for nutritional assessments in the elderly. In Yu, B.P. (Ed.), Methods in aging research (pp. 301320). Boca Raton, FL: CRC Press.Google Scholar
Payette, H., Hébert, R., Bouthier, V., & Voyer, L. (1997, July). Efficacy of a nutrition screening program among community-dwelling elderly people at risk of functional decline. Paper presented at the 16th International Congress of Nutrition, Montreal, QC.Google Scholar
Payette, H., & Shatenstein, B. (2005). Determinants of healthy eating in community-dwelling elderly people. Canadian Journal of Public Health, 96(Suppl. 3)S27S31S30S35.Google ScholarPubMed
Posner, B.M., Jette, A.M., Smith, K.W., & Miller, D.R. (1993). Nutrition and health risks in the elderly: The Nutrition Screening Initiative. American Journal of Public Health, 83(7), 972978.CrossRefGoogle ScholarPubMed
Roy, M.A., & Payette, H. (2006). Meals-on-Wheels improves energy and nutrient intake in a frail free-living elderly population. Journal of Nutrition, Health and Aging, 10(6), 554560.Google Scholar
Saffel-Shrier, S., & Athas, B.M. (1993). Effective provision of comprehensive nutrition case management for the elderly. Journal of the American Dietetic Association, 93, 439444.CrossRefGoogle ScholarPubMed
Sharkey, J.R. (2002). The interrelationship of nutritional risk factors, indicators of nutritional risk, and severity of disability among home-delivered meal participants. Gerontologist, 42(3), 373380.CrossRefGoogle ScholarPubMed
Sharkey, J.R. (2003). Risk and presence of food insufficiency are associated with low nutrient intakes and multimorbidity among homebound older women who receive home-delivered meals. Journal of Nutrition, 133(11), 34853491.CrossRefGoogle ScholarPubMed
Shatenstein, B., Nadon, S., & Ferland, G. (2004). Determinants of diet quality among Quebecers aged 55–74. Journal of Nutrition, Health and Aging, 8(2), 8391.Google ScholarPubMed
Shizgal, H.M., Martin, M.F., & Gimmon, Z. (1992). The effect of age on the caloric requirement of malnourished individuals. American Journal of Clinical Nutrition, 55(4), 783789.CrossRefGoogle ScholarPubMed
Stuck, A.E., Walthert, J.M., Nikolaus, T., Bula, C.J., Hohmann, C., & Beck, J.C. (1999). Risk factors for functional status decline in community-living elderly people: A systematic literature review. Social Science and Medicine, 48(4), 445469.CrossRefGoogle ScholarPubMed
Sullivan, D.H., & Walls, R.C. (1994). Impact of nutritional status on morbidity in a population of geriatric rehabilitation patients. Journal of the American Geriatrics Society, 42, 471477.CrossRefGoogle Scholar
Sullivan, D.H., & Walls, R.C. (1998). Protein-energy undernutrition and the risk of mortality within six years of hospital discharge. Journal of the American College of Nutrition, 17(6), 571578.CrossRefGoogle ScholarPubMed
Wellman, N.S., Weddle, D.O., Kranz, S., & Brain, C.T. (1997). Elder insecurities: Poverty, hunger and malnutrition. Journal of the American Dietetic Association, 10(Suppl. 2)S120S122.CrossRefGoogle Scholar