Tài liệu Nutrition and Nutritional Care of Elderly People in Finnish Nursing Homes and Hospitals

Nutrition and Nutritional Care

of Elderly People

in Finnish Nursing Homes

and Hospitals

Helsinki 2007

Merja Suominen

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Nutrition and Nutritional Care

of Elderly People

in Finnish Nursing Homes

and Hospitals

Department of Applied Chemistry and Microbiology (Nutrition)

University of Helsinki, Finland

Department of General Practice and Primary Health Care

University of Helsinki, Finland

Merja Suominen

ACADEMIC DISSERTATION

To be publicly discussed,

with permission of the Faculty of Agriculture and Forestry

of the University of Helsinki,

Helsinki University Museum Arppeanum,

on November 30th, 2007, at 12 noon

Helsinki 2007

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Merja Suominen, tekijä

Vanhuksen silmissä

hymyilee lapsi.

Kurtturuusu kukkii

pakkasiin asti.

Helena Anhava

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Supervised by Professor Kaisu Pitkälä

Department of General Practice

and Primary Health Care

University of Helsinki

Finland

Reviewed by Professor (emeritus) Antti Aro

National Public Health Institute

Finland

and

Professor Tommy Cederholm

Department of Public Care and Caring Sciences/

Clinical Nutrition and Metabolism

Uppsala University

Sweden

Opponent Professor Cornel Sieber

Director of the Chair of Internal Medicine-Geriatrics

University of Erlangen-Nürnberg

Germany

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CONTENTS

LIST OF ABBREVIATIONS 8

LIST OF THE ORIGINAL PUBLICATIONS 9

ABSTRACT 10

TIIVISTELMÄ 11

1. INTRODUCTION 13

2. LITERATURE REVIEW 14

2.1 Diet in elderly populations 14

2.2 Vitamin D 15

2.2.1 Vitamin D and the risk of fractures in the elderly 15

2.2.2 Vitamin D supplementation in institutions 15

2.3 Nutrition studies of Finnish elderly people 16

2.4 Nutrition of elderly subjects in institutions 16

2.4.1 Energy and nutrient intake 16

2.4.2 Meals in institutions 17

2.5 Nutrition guidelines and recommendations for elderly people 17

2.6 Physiological changes related to the nutrition and age 19

2.6.1 Reasons behind the negative energy balance of elderly individuals 19

2.6.2 Body mass index and weight loss 21

2.6.3 Obesity 21

2.7 Nutritional assessment of elderly people 22

2.7.1 Tools for nutritional assessment 22

2.7.2 Mini Nutritional Assessment 22

2.8 Malnutrition in elderly people 23

2.8.1 The risk for malnutrition 25

2.8.2 The prevalence of malnutrition 25

2.8.3 Finnish studies using the MNA 26

2.9 Nutritional support of elderly people 28

2.9.1 Oral nutritional supplements 29

2.9.2 Enriched food and menu planning 30

2.9.3 Meal time and meal ambiance in nursing homes 31

3. THE AIMS OF THIS STUDY AND RESEARCH QUESTIONS 33

4. SUBJECTS AND METHODS 34

4.1 Subjects 34

4.2 Methods 36

4.2.1. Background information of the residents and patients 36

4.2.2 Nutrition related information 37

4.2.3 Educational process 39

4.2.4 Data analysis 41

4.2.5 Ethical questions 41

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5 RESULTS 42

5.1 The nutritional status of elderly nursing home residents

and long term care patients 42

5.2 The energy and nutrient intake of elderly residents in dementia wards 43

5.3 Nursing and nutritional care factors 44

5.4 The recognition of malnutrition 44

5.5 Education of professionals 45

5.5.1 Professionals 45

5.5.2 Residents 45

6. DISCUSSION 46

6.1 Methods 46

6.2 Malnutrition and nutritional care 48

7. CONCLUSIONS 53

8. IMPLICATIONS FOR THE FUTURE 54

9. ACKNOWLEDGEMENTS 57

10. REFERENCES 58

APPENDICES 72

ORIGINAL PUBLICATIONS 74

Article I 74

Article II 79

Article III 85

Article VI 90

Article V 95