Environment, attitude, assessment can improve nutrition.

ARLINGTON, VA. -- Poor nutrition remains a chronic problem for individuals in long-term care and stems from environmental factors as well as personal factors, Dr. Philip Sloane said at a meeting sponsored by the American Medical Directors Association.

"In most of long-term care, when we want to change behaviors, we have to look at the environment and what the environment does," said Dr. Sloane, a family medicine physician at the University of North Carolina, Chapel Hill.

Dr. Sloane shared results of an observational study at a meeting on Evidence-Based Clinical Management and Leadership for Experienced Medical Directors and Attending Physicians.

The study outlined contributing factors to poor eating in long-term care residents. Observations of 421 residents at 35 assisted-living facilities and 10 nursing homes revealed that the prevalence of low food intake (defined as less than 75% of food consumed during a meal) was 50% in the assisted-living homes and 62% in the nursing homes.

Similarly, the prevalence of low fluid intake (defined as less than 8 ounces consumed during a meal) was 46% in the assisted-living homes and 63% in the nursing homes.

Factors significantly associated with low food intake included eating in one's room rather than in a dining area, fewer supervisory staff during meals, nonresponsiveness or sleepiness, and living in a larger facility.

To improve nutrition, staff should consider the following issues that may affect appetite:

* Personal factors. Residents in pain, or who have physical or mental illness or a need for control, may have problems eating enough. Also, disease and medications may blunt the appetite.

* Interpersonal factors. Residents who have a consistent caregiver are more likely to eat enough.

* Physical environment. Dining rooms are often noisy, which can distract residents from eating.

* Organizational environment. Some residents may have trouble navigating a buffet and choosing foods, versus having a served meal.

Dr. Sloane said the following have been shown to encourage better eating habits in long-term care residents:

* A homelike setting. Anecdotal evidence suggests that long-term care residents eat better in a dining room that is quieter, carpeted, and more homelike, supplied with table linens and china and silverware.

* Family-style meals. Place serving bowls on the tables to facilitate second helpings.

* Caregiver actions that match resident behaviors. Be sure that staff members on duty pay attention to residents' cues. Some residents may need reminders to swallow. Others may need adaptive utensils.

* Positive interactions. Remind staff to talk to the residents during mealtime, rather than simply talking to other staff members.

In addition, try to identify new residents who may be at risk for malnutrition, Dr. Sloane said. Several items from the Minimum Data Set that have been shown to significantly predict malnutrition among newly admitted residents include living alone before admission, depression or other psychiatric problems, missing teeth, antidepressant use, diuretic use, and better function in the morning versus the evening (Geriatric Nursing 2002;23:224-6).

BY HEIDI SPLETE

Senior Writer