Nutritional care needs in elderly residents of long-term care institutions: Potential implications for policies

Abstract Objectives To collect information on actual nutritional intervention requirements in long-term care institutions and on the role of institutional factors in nutritional care. Design A cross-sectional analysis of baseline data (collected between September 2011 and September 2013) within the context of a multicenter prospective cohort study. Setting Nineteen long-term care institutions. Participants: Thirteen hundred and ninety-four resident elderly (age ≥60 years). Measurements The prevalence of nutritional derangements (MNA-Short Form) and the need to introduce nutritional interventions on the residents. Results: Prevalence of malnutrition and risk of malnutrition were 35.2% [95%CI, 32.8–37.8] and 52.6% [95%CI, 50.0–55.2], respectively. Malnutrition was more frequent upon admission and in larger institutions (≥50 beds). Overall, 50% of the residents requiring an individualized nutritional care plan (any type) were not receiving it. Oral diet, the use of fluid thickeners and oral nutritional supplements had to be introduced in 306 (22.5%), 201 (15%) and 175 (13%) residents, respectively. The need to implement the oral diet was mainly due to inadequacy of texture according to chewing and swallowing capabilities. In gender and age-adjusted multivariable logistic regression models, nutritional interventions were associated with worse nutritional status (P<0.001 for all). Moreover, while the duration of stay was unrelated to the need for nutritional interventions, we observed that residents living in larger long-term care institutions (=50 beds) were more likely to require improvement in nutrition care. Conclusions In long-term care elderly residents nutritional derangements are very common, underdiagnosed and undertreated. Nutritional screening should be part of routine care. However, also the systematic involvement of a nutritional care specialist appears to be an urgent need, particularly in larger institutions where the standards of care are likely to be lower.