Observations of Mealtimes in Hospital Aged Care Rehabilitation Wards.

Observations of mealtimes in hospital aged care rehabilitation wards.

Appetite. 2013 Mar 21;
Walton K, Williams P, Tapsell L, Hoyle M, Shen ZW, Gladman L, Nurka M

Malnutrition is common in long-stay elderly hospitalized patients and their dietary intakes are often poor, despite the provision of adequate quantities of food to meet patient needs. The aim of this study was to identify environmental factors that were associated with achieving adequate food consumption in a hospital context. This study observed the daily routines of 30 elderly patients over two days in rehabilitation wards in three Australian hospitals. All activities associated with mealtimes were recorded, from the commencement of breakfast to the conclusion of supper at the end of the day. Four key themes emerged: the eating location; assistance given at meals; negative and positive interruptions. The time taken to eat meals averaged 22 minutes, ranging from 3 to 55 minutes. Food intakes appeared to be better when meals were consumed communally in a dining room. There were many occasions when patients needed more assistance to eat than was available. The most common factors negatively affecting meal consumption were medication rounds, inappropriate placement of trays, packaging being hard to open, and patient showering. The presence of visitors, dietitians and nutrition assistants appeared to improve dietary intakes. A trial of the protected mealtime concept would be worthwhile in the Australian hospital context. HubMed – eating


Nursing Home Residents Dying With Dementia in Flanders, Belgium: A Nationwide Postmortem Study on Clinical Characteristics and Quality of Dying.

J Am Med Dir Assoc. 2013 Mar 20;
Vandervoort A, Van den Block L, van der Steen JT, Volicer L, Stichele RV, Houttekier D, Deliens L

OBJECTIVES: There is a lack of large-scale, nationwide data describing clinical characteristics and quality of dying of nursing home residents dying with dementia. We set out to investigate quality of end-of-life care and quality of dying of nursing home residents with dementia in Flanders, Belgium. DESIGN/SETTING/PARTICIPANTS: To obtain representativity, we conducted a postmortem study (2010) using random cluster sampling. In selected nursing homes, all deceased residents with dementia in a period of 3 months were reported. For each case, a structured questionnaire was filled in by the nurse most involved in care, the family physician, and the nursing home administrator. We used the Cognitive Performance Scale and Global Deterioration Scale to assess dementia. Main outcome measures were health status, clinical complications, symptoms at the end of life, and quality of dying. MEASUREMENTS: Health status, clinical complications, symptoms at the end of life, and quality of dying. RESULTS: We identified 198 deceased residents with dementia in 69 nursing homes (58% response rate). Age distribution was the same as all deceased residents with dementia in Flanders, 2010. Fifty-four percent had advanced dementia. In the last month of life, 95.5% had 1 or more sentinel events (eg, eating/drinking problems, febrile episodes, or pneumonia); most frequently reported symptoms were pain, fear, anxiety, agitation, and resistance to care. In the last week, difficulty swallowing and pain were reported most frequently. Pressure sores were present in 26.9%, incontinence in 89.2%, and cachexia in 45.8%. Physical restraints were used in 21.4% of cases, and 10.0% died outside the home. Comparing stages of dementia revealed few differences between groups regarding clinical complications, symptoms, or quality of dying. CONCLUSION: Regardless of the dementia stage, many nursing home residents develop serious clinical complications and symptoms in the last phase of life, posing major challenges to the provision of optimum end-of-life care. HubMed – eating


Diabetes related amputations in Pacific Islands countries: A root cause analysis of precipitating events.

Diabetes Res Clin Pract. 2013 Mar 21;
Win Tin ST, Gadabu E, Iro G, Tasserei J, Colagiuri R

AIM: To identify precipitating events and factors preceding diabetes related amputations in Pacific Islands countries (PICs). METHODS: Using a root cause analysis approach, a questionnaire seeking information on events leading up to amputation was administered to a convenience sample of 85 people with diabetes in three PICs (Solomon Islands, Nauru and Vanuatu) who had a lower limb amputation in the previous five years. RESULTS: There were 85 participants (36% females) with a mean age of 54.1 years and a mean diabetes duration of 10.5years prior to amputation. The first event was trauma and an infected wound in 55% and a blister in another 41%. Half (51%) did take any action soon after the initial trigger event. The major reasons leading to the amputation included delaying treatment (42%), use of traditional treatments (18%) and insufficient knowledge about foot care (11%). 36% of participants had not received foot care information prior to the amputation and 19% did not attend anywhere for regular treatment. CONCLUSIONS: This study identified key precipitating events and underlying factors which contribute to diabetes related amputations and which, if addressed successfully, have the potential to reduce amputations rates. HubMed – eating



One Minute Wellness – Eating Disorders – David Banas, MD, FAAFP, of the ProMedica Toledo Hospital Family Medicine Residency, discusses the causes, signs and treatment of eating disorders like anorex…