Abstract
Background: Disease-related malnutrition is a major health problem in the elderly population and management issues are under-explored.
Objectives: What is the prevalence of undernutrition-risk (UN-risk), underweight, and overweight in special accommodations (SAs)? Do study circles and a nutritional care policy (NCP) improve the precision in nutritional care (NC) and decrease the prevalence of under- and overweight in a short- and/or long-term perspective?
Design: Quasi-experimental pre- and post-intervention design with three experimental groups and one control group (CG).
Setting: SAs.
Participants: In 2005 (Time 1 – T1), 1726 (90.4%) residents agreed to participate; in 2007 (Time 2 – T2), 1,526 (81.8%); and in 2009 (Time 3 – T3), 1,459 (81.3%) residents participated.
Interventions: Experimental groups: between T1 and T2 the first period of study circles was conducted in one municipality; between T2 and T3 a second period of study circles in another municipality was conducted; after T1 a NCP was implemented in one municipality. CG: residents in three municipalities.
Measurements: Under- and overweight were defined based on BMI. Risk of undernutrition was defined as involving any of: involuntary weight loss, low BMI, and/or eating difficulties. The ‘precision in NC’ describes the relationship between nutritional treatment (protein- and energy-enriched food (PE-food) and/or oral supplements) and UN-risk.
Results: The prevalence of UN-risk varied between 64 and 66%, underweight between 25 and 30%, and overweight between 30 and 33% in T1–T3. At T2 the prevalence of underweight was significantly lower in the first period study circle municipality, and at T3 in the second period study circle municipality compared to in the CG. The precision in NC was higher in a short-term perspective in the study circle municipalities and both in a short- and long-term perspective in the NCP municipality. At T3 between 54 and 70% of residents at UN-risk did not receive PE-food or oral supplements.
Conclusions: Study circles give positive short-term effects and a NCP gives positive short- and long-term effects on NC. Whether a combination of study circles and the implementation of a NCP can give even better results is an area for future studies.
Acknowledgements
The first author (AW) is supported by the Swedish Research Council and the Skåne County Council's research and development foundation. The study circle intervention was supported by the ‘competence ladder’, a government investment in competence improvement for staff in social service. We especially thank The Swedish Institute for Health Sciences (Vårdalinstitutet) for support in the development of the study circle manual focusing on eating and nutrition. The study sponsors were not involved in any parts of the study.
We thank the residents and staff, teachers and students for their cooperation. We are especially grateful to Christina Lindholm, Kerstin Ulander (deceased), and Carolina Axelsson for their contribution to the first part of the study, in 2005–2007. We also thank Karin Petersson, Anita Persson, and Liselotte Svensson for their work with implementing the interventions. The study was conducted in cooperation with the Network for Eating and Nutrition in North-East Skåne (NEN-NES) and the Clinical Research Group within the Knowledge Group for Clinical Nursing Science at Kristianstad University.
