Geriatrics Malnutrition prevention in nursing homes Sarah Hallaj November 16th, 2009

The goal of the proposal The goal of this project is to prevent malnutrition in long term care facilities by hiring dietitians and retraining health care providers to detect early signs and symptoms of malnutrition and promote adequate nutrient intake

Project timeline The implementation of the project will start in March 2010 to allow time for nursing home managers to hire dietitians Evaluation will be conducted after 6 months, September 2010

Some statistics: There are 1.5 million nursing homes residents nationwide As part of Oregon Health Care Association, there are 620 nursing homes represented in Oregon. This is the largest private non-profit association in Oregon; its facility members serve 40,000 Oregonians each day

Objective and activity #1: Objective: Dietitians will identify macronutrient and micronutrient deficiencies and promote adequate nutrient intake Activity: Dietitians will look at monthly biochemical laboratory results and interpret values indicating deficiencies that lead to malnutrition. The dietitian will then dedicate counseling time with each resident to address the problem, find the constraints and try to solve them

Objective and activity #2 Objective: Monitor and prevent resident’s weight loss of 5% or more during a month period Activity: Each dietitian and nurse will have certain number of residents to measure and record their weights on the charts. Reminders will be installed in patient’s charts to remind the staff to record those weights

Objective and activity #3 Objective: Each full time dietitian will spend at least 20 hours per month with residents at meal time Activity: Every working day, the dietitian and nurse will spend lunch hour with residents

Retraining kitchen staff Create a dining area Retrain the server the difference between “serve” versus “offer” “Serving” food is when a resident doesn’t choose what they would like to eat but rather are expected to eat what is on the tray “Offering” is when a resident has the freedom to choose what they would like to eat and how much

This activity will: Increase resident’s freedom of choice and intake Increase communication between residents, nurse and dietitian Create a social time that supports de Castro’s social facilitation theory which is defined as: “the enhancement of a behavior owing to the sheer presence of others.”

Objective and activity #4 Objective: Highlight and reinforce the critical importance of the nutrition care process to nursing home managers and nurses in Oregon Activity: Different dietitians serving nursing homes in Oregon will offer seminars/webinars 4 times a year

Evaluation Evaluations will be conducted after 6 months except for resident’s weights will be monitored weekly and monthly Evaluations will include nursing home managers, dietitians, and residents

Funding and conclusion Each nursing home will partner with a nearby hospital in the area to offer funding, hire a dietitian and provide resources to implement the program (such as: weight scale, dining table…) After two years of executing, testing and evaluating the program, other states can follow and install the program adjusting it as required. With implementing this program in Oregon, the state can be the lead and champion in improving the nutritional status and quality of service to the 1.5 nursing home residents nationwide

References: "The National Nursing Home Survey: 2004 Overview." Centers for Disease Control and Prevention. U.S. Department of Health and Human Services, June 2009. Web. 25 Oct. 2009. <http://www.cdc.gov/nchs/data/series/sr_13/sr13_167.pdf>. "About OHCA." Oregon Health Care Association. 2004. Web. 1 Nov. 2009. <http://www.ohca.com/aboutus.htm>. Nijs, Kristel, Cees Graaf, Wija A. Staveren, and Lisette Groot. "Malnutrition and Mealtime Ambiance in Nursing Homes." Journal of the American Medical Directors Association 10.4 (May 2009): 226-29. Science Direct. Web. 07 Oct. 2009. <http://www.sciencedirect.com.liboff.ohsu.edu/science?_>.