Nutritional Status and Duration of Overnight Fast among Elderly Residents in Municipal Nursing Homes in Oslo

Abstract

Aim:

To examine the duration of overnight fast and the significance of having an overnight fast below or above 11 hrs with respect to nutritional status among elderly nursing home residents.

Background:

Elderly nursing home residents are in high risk of malnutrition. In Norway it is recommended that the overnight fast should not exceed 11 hrs for elderly nursing home residents.

Methods:

Overnight fast and nutritional status was examined for 342 long-term nursing home residents. Nutritional status was evaluated by the Malnutrition Universal Screening Tool, body mass index (BMI), weight loss during the last 3–6 months, triceps skinfold thickness, upper arm muscle circumference, and hand-grip strength.

Findings:

For 98.5% of the participants the overnight fast was > 11 hrs. Median overnight fast was 15 hrs. Among the participants for whom the overnight fast exceeded 11 hrs, 35.6% were in middle or high risk of malnutrition, and 20% were underweight with BMI < 20 kg/m². No differences in overnight fast were observed between the different categories of nutritional status in this group.

Conclusion:

For many participants the overnight fast exceeded recommended length. Future studies should further examine the significance of having an overnight fast below or above 11 hrs with respect to nutritional status for elderly nursing home residents.

Keywords

Overnight fast malnutrition elderly nursing home Norway

References

Mørk

. Seniorer i Norge 2010. Statistiske analyser nr. 120/2011. Oslo: Statistisk sentralbyrå, 2011.

Stratton

Elia

Green

. Disease-related malnutrition; an evidence-based approach to treatment. Wallingford: CABI, 2003.

Morley

. Anorexia of aging: Physiologic and pathologic. Am J Clin Nutr. 1997; 66: 760–773.

Larsson

Unosson

Nilsson

Thorslund

Bjurulf

. Effect of dietary supplement on nutritional status and clinical outcome in 501 geriatric patients-a randomised study. Clin Nutr. 1990; 9: 179–184.

Roberts

Fuss

Heyman

Evans

Tsay

Rasmussen

. Control of food intake in older men. JAMA. 1994; 272: 1601–1606.

Nordic nutrition recommendations 2004 (NNR 2004): Integrating nutrition and physical activity. Copenhagen: Nordic Council of Ministers, 2004.

Helsevernetaten. Måltider i alders- og sykehjem; oppsummering av kartlegging våren 2001. Oslo: Oslo kommune, 2001.

Aagaard

. «Ærlig talt» mat og måltider i sykehjem: En undersøkelse blant beboere i somatiske sykehjem i Østfold. Halden: Høgskolen i Østfold, 2010.

Beck

Ovesen

. Skipping of meals has a significant impact on dietary intake and nutritional status of old (65+ y) nursing home residents. J Nutr Health Aging. 2004; 8: 390–394.

10.

Persson

. Aspects of nutrition in geriatric patients, especially dietary assessment, intake and requirements. Malmö: Medicinska fakulteten, Lund University, 2002.

11.

Saletti

Lindgren

Johansson

Cederholm

. Nutritional status according to mini nutritional assessment in an institutionalized elderly population in Sweden. Gerontology. 2000; 46: 139–145.

12.

Suominen

Muurinen

Routasalo

Soini

Suur-Uski

Peiponen

. Malnutrition and associated factors among aged residents in all nursing homes in Helsinki. Eur J Clin Nutr. 2005; 59: 578–583.

13.

Beck

Ovesen

. Body mass index, weight loss and energy intake of old Danish nursing home residents and home-care clients. Scand J Caring Sci. 2002; 16: 86–90.

14.

Sullivan

Walls

Bopp

. Protein-energy undernutrition and the risk of mortality within one year of hospital discharge: A follow-up study. J Am Geriatr Soc. 1995; 43: 507–512.

15.

Mowe

Bohmer

. The prevalence of undiagnosed protein-calorie undernutrition in a population of hospitalized elderly patients. J Am Geriatr Soc. 1991; 39: 1089–1092.

16.

Crogan

Pasvogel

. The influence of protein-calorie malnutrition on quality of life in nursing homes. J Gerontol A Biol Sci Med Sci. 2003; 58: 159–164.

17.

Mowe

Bohmer

. Reduced appetite. A predictor for undernutrition in aged people. J Nutr Health Aging. 2002; 6: 81–83.

18.

Sullivan

Martin

Flaxman

Hagen

. Oral health problems and involuntary weight loss in a population of frail elderly. J Am Geriatr Soc. 1993; 41: 725–731.

19.

Sosialstyrelsen. Näringsproblem i vård och omsorg; prevention och behandling. Sos rapport nr.11/2000. Stockholm: Socialstyrelsen, 2000.

20.

Expertgruppen för samordning av sjukhuskosten. Mat på sjukhus; råd och riktlinjer från ESS-gruppen. Uppsala: Statens Livsmedelsverk; 1991.

21.

Engelheart

Lammes

Akner

. Elderly peoples' meals. A comparative study between elderly living in a nursing home and frail, self-managing elderly. J Nutr Health Aging. 2006; 10: 96–102.

22.

Odlund

Koochek

Ljungqvist

Cederholm

. Nutritional status, well-being and functional ability in frail elderly service flat residents. Eur J Clin Nutr. 2005; 59: 263–270.

23.

Odlund

Koochek

Cederholm

Ljungqvist

. Minimal effect on energy intake by additional evening meal for frail elderly service flat residents—a pilot study. J Nutr Health Aging. 2008; 12: 295–301.

24.

Ebrahimi

Helle

. Kartläggning av nattfastans längd, underernäring och hälsorelaterad livskvalitet hos personer på äldreboende. Vård i Norden. 2009; 29: 45–48.

25.

Helse- og velferdsetaten. Objektive kvalitetsindikatorer i sykehjem i Oslo kommune. Rapport 2/2005. Oslo: Oslo kommune, 2005.

26.

Kondrup

Allison

Elia

Vellas

Plauth

. ESPEN guidelines for nutrition screening 2002. Clin Nutr. 2003; 22: 415–421.

27.

Stratton

King

Stroud

Jackson

Elia

. ‘Malnutrition Universal Screening Tool’ predicts mortality and length of hospital stay in acutely ill elderly. Br J Nutr. 2006; 95: 325–330.

28.

Stratton

Hackston

Longmore

Dixon

Price

Stroud

. Malnutrition in hospital outpatients and inpatients: Prevalence, concurrent validity and ease of use of the ‘malnutrition universal screening tool’ (‘MUST’) for adults. Br J Nutr. 2004; 92: 799–808.

29.

Helsedirektoratet. Nasjonale faglige retningslinjer for forebygging og behandling av underernæring. Oslo: Helsedirektoratet; 2009.

30.

Bapen

MAG

. MUST-brosjyren. En veiledning til «Mini Underernæring-Screeningverk Toy»(MUST) for voksne. 2003. Accessed by: http://nutricia.no/upload_dir/docs/MUST-brosjyre-32-sider.pdf

31.

Omran

Morley

. Assessment of protein energy malnutrition in older persons, part I: History, examination, body composition, and screening tools. Nutrition. 2000; 16: 50–63.

32.

Nhanes III . National health and nutrition Examination Survey III. Body measurements (anthropometry). 2011/1/15. Accessed by: http://www.cdc.gov/nchs/data/nhanes/nhanes3/cdrom/nchs/manuals/anthro.pdf

33.

Symreng

. Arm anthropometry in a large reference population and in surgical patients. Clin Nutr. 1982; 1: 211–219.

34.

Hauge

Spenning

Iversen

. Individual, nutritional support prevents undernutrition, increases muscle strength and improves QoL among elderly at nutritional risk hospitalized for acute stroke: A randomized, controlled trial. Clin Nutr. 2010; 29: 567–573.

35.

Luna-Heredia

Martin-Pena

Ruiz-Galiana

. Handgrip dynamometry in healthy adults. Clin Nutr. 2005; 24: 250–258.

36.

Budziareck

Duarte

Pureza RR

Barbosa-Silva

. Reference values and determinants for handgrip strength in healthy subjects. Clin Nutr. 2008; 27: 357–362.

37.

Sellevold

Skulberg

. Nok mat, rett mat og trivelige måltider for eldre sykehjemspasienter: Et kvalitetssikringsprosjekt. Bergen: Nasjonalt formidlingssenter i geriatri, 2005.

38.

SPRI-rapport 173. Dags att äta; måltidsordningen i långtidssjukvården. Stockholm: 1984.

39.

Steen

. Preventive nutrition in old age — a review. J Nutr Health Aging. 2000; 4: 114–119.

40.

Gibney

Wolever

. Periodicity of eating and human health: Present perspective and future directions. Br J Nutr. 1997; 77 Suppl 1: S3–S5.

41.

Beck

Ovesen

. At which body mass index and degree of weight loss should hospitalized elderly patients be considered at nutritional risk? Clin Nutr. 1998; 17: 195–198.

42.

Burden

Stoppard

Shaffer

Makin

Todd

. Can we use mid upper arm anthropometry to detect malnutrition in medical inpatients? A validation study. J Hum Nutr Diet. 2005; 18: 287–294.

43.

Jensen

Dudrick

Johnston

. A comparison of triceps skinfold and upper arm circumference measurements taken in standard and supine positions. JPEN J Parenter Enteral Nutr. 1981; 5: 519–521.

44.

Watanabe

Owashi

Kanauchi

Mura

Takahara

Ogino

. The short-term reliability of grip strength measurement and the effects of posture and grip span. J Hand Surg Am. 2005; 30: 603–609.

45.

Norman

Stobaus

Gonzalez

Schulzke

Pirlich

. Hand grip strength: Outcome predictor and marker of nutritional status. Clin Nutr. 2011; 30: 135–142.

46.

Shechtman

Mann

Justiss

Tomita

. Grip strength in the frail elderly. Am J Phys Med Rehabil. 2004; 83: 819–826.