| 1. |
- Fielding, R. A., et al.
(author)
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Effect of structured physical activity and nutritional supplementation on physical function in mobility-limited older adults : Results from the VIVE2 randomized trial
- 2017
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In: The Journal of Nutrition, Health & Aging. - : Springer Science and Business Media LLC. - 1279-7707 .- 1760-4788. ; 21:9, s. 936-942
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Journal article (peer-reviewed)abstract
- The interactions between nutritional supplementation and physical activity on changes in physical function among older adults remain unclear. The primary objective of this study was to examine the impact of nutritional supplementation plus structured physical activity on 400M walk capacity in mobility-limited older adults across two sites (Boston, USA and Stockholm, Sweden). All subjects participated in a physical activity program (3x/week for 24 weeks), involving walking, strength, balance, and flexibility exercises. Subjects were randomized to a daily nutritional supplement (150kcal, 20g whey protein, 800 IU vitamin D) or placebo (30kcal, non-nutritive). Participants were recruited from urban communities at 2 field centers in Boston MA USA and Stockholm SWE. Mobility-limited (Short Physical Performance Battery (SPPB) ae9) and vitamin D insufficient (serum 25(OH) D 9 - 24 ng/ml) older adults were recruited for this study. Primary outcome was gait speed assessed by the 400M walk. Results: 149 subjects were randomized into the study (mean age=77.5 +/- 5.4; female=46.3%; mean SPPB= 7.9 +/- 1.2; mean 25(OH)D=18.7 +/- 6.4 ng/ml). Adherence across supplement and placebo groups was similar (86% and 88%, respectively), and was also similar across groups for the physical activity intervention (75% and 72%, respectively). Both groups demonstrated an improvement in gait speed with no significant difference between those who received the nutritional supplement compared to the placebo (0.071 and 0.108 m/s, respectively (p=0.06)). Similar effects in physical function were observed using the SPPB. Serum 25(OH)D increased in supplemented group compared to placebo 7.4 ng/ml versus 1.3 ng/ml respectively. Results suggest improved gait speed following physical activity program with no further improvement with added nutritional supplementation.
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| 2. |
- Hedman, Sanna, et al.
(author)
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Individually prescribed diet is fundamental to optimize nutritional treatment in geriatric patients
- 2016
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In: Clinical Nutrition. - : Elsevier BV. - 0261-5614 .- 1532-1983. ; 35:3, s. 692-698
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Journal article (peer-reviewed)abstract
- Background & aimsMalnutrition is a well-recognized problem in geriatric patients. Individually prescribed diet is fundamental to optimize nutritional treatment in geriatric patients. The objective of this study was to investigate routines regarding dietary prescriptions and monitoring of food intake in geriatric patients and to see how well the prescribed diet conforms to the patients' nutritional status and ability to eat. A further aim was to identify the most common reasons and factors interacting with patients not finishing a complete meal.MethodsThis study combines two methods using both qualitative and quantitative analysis. Patients (n = 43; 82.5 ± 7.5 yrs; 60% females) at four geriatric wards performed a two-day dietary record, assisted by a dietician. Nurses and assistant nurses at each ward participated in a semi-structured interview regarding prescription of diets and portion size for the patients.ResultsThe prescribed diet differed significantly (P < 0.01) from a diet based upon the patient's nutritional status and ability to eat. Only 30% of the patients were prescribed an energy-enriched diet in contrast to 60% that was in need of it. The most common reason for not finishing the meal was lack of appetite. Diet prescription for the patient was based upon information about eating difficulties identified in the Mini Nutritional Assessment-Short Form (MNA-SF) at admission and the type of diet that was prescribed on a previous ward. Monitoring of the patients' food intake was described as a continuous process discussed daily between the staff.ConclusionPatients' nutritional status and to what extent they were able to eat a complete meal was not routinely considered when prescribing food and monitoring food intake in this study. By making use of this information the diet could be tailored to the patients' needs, thereby improving their nutritional treatment.
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| 3. |
- Kirn, Dylan R., et al.
(author)
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The Vitality, Independence, and Vigor in the Elderly 2 Study (VIVE2) : Design and methods
- 2015
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In: Contemporary Clinical Trials. - : Elsevier BV. - 1551-7144 .- 1559-2030. ; 43, s. 164-171
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Journal article (peer-reviewed)abstract
- Background: Nutritional supplementation may potentiate the increase in skeletal muscle protein synthesis following exercise in healthy older individuals. Whether exercise and nutrition act synergistically to produce sustained changes in physical functioning and body composition has not been well studied, particularly in mobility-limited older adults. Methods: The VIVE2 study was a multi-center, randomized controlled trial, conducted in the United States and Sweden. This study was designed to compare the effects of a 6-month intervention with a once daily, experimental, 4 fl. oz. liquid nutritional supplement providing 150 kcal, whey protein (20 g), and vitamin D (800 IU) (Nestle Health Science, Vevey, Switzerland), to a low calorie placebo drink (30 kcal, non-nutritive; identical format) when combined with group-based exercise in 150 community-dwelling, mobility-limited older adults. All participants participated in a structured exercise program (3 sessions/week for 6 months), which included aerobic, strength, flexibility, and balance exercises. Results: The primary outcome was 6-month change in 400 m walk performance (m/s) between supplement and placebo groups. Secondary outcomes included 6 month change in: body composition, muscle cross-sectional area, leg strength, grip strength, stair climb time, quality of life, physical performance, mood/depressive symptoms and nutritional status. These outcomes were selected based on their applicability to the health and wellbeing of older adults. Conclusions: The results of this study will further define the role of nutritional supplementation on physical functioning and restoration of skeletal muscle mass in older adults. Additionally, these results will help refine the current physical activity and nutritional recommendations for mobility-limited older adults.
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| 4. |
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| 5. |
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| 6. |
- Liljeberg, Evelina, 1985-, et al.
(author)
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High adherence to oral nutrition supplements prescribed by dietitians : A cross‐sectional study on hospital outpatients
- 2019
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In: Nutrition in clinical practice. - : John Wiley & Sons. - 0884-5336. ; 34:6, s. 887-898
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Journal article (peer-reviewed)abstract
- Background: This study aimed to assess adherence to oral nutrition supplements (ONS) among hospital outpatients and to assess patient characteristics, experiences of ONS, and the characteristics of ONS prescriptions in clinical practice.Methods: Hospital outpatients aged 18 years and prescribed ONS by a dietitian at a Swedish hospital were referred to the study from September 2016 to February 2017. Data were collected from structured telephone interviews, medical records, and a register of ONS delivered. Adherence to ONS was measured by dividing self-reported intake of ONS (frequency question and 24-hour recall question) by the amount prescribed and using the medication possession ratio (MPR).Results: Of the 96 patients included (mean age 67±13 years), 52% were male. The 2 most frequent medical diagnoses were malignancy and digestive system disease. Mean adherence to ONS was 93% measured by the frequency question, 87% measured by the 24-hour recall question, and 76% according to MPR. The majority of the patients (83%) were prescribed 1–3 bottles of ONS/day. The average number of flavors of ONS delivered was 4.2. Before prescription, 69% of the patients had been allowed to taste the ONS and 92% had chosen the flavors to be prescribed. Over 75% liked the taste of the ONS and considered them to be good for their health.Conclusions: Adherence to ONS was high in this population, which might be explained by the individual tailoring of ONS prescriptions by a dietitian, positive experiences of ONS, and the relatively young mean age of the participants.
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| 7. |
- Liljeberg, Evelina, 1985-, et al.
(author)
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Incomplete descriptions of oral nutritional supplement interventions in reports of randomised controlled trials
- 2018
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In: Clinical Nutrition. - : Elsevier. - 0261-5614 .- 1532-1983. ; 37:1, s. 61-71
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Journal article (peer-reviewed)abstract
- Background & aimsThe effects of oral nutritional supplements (ONS) have been evaluated in several clinical trials and more studies have been requested. To facilitate replication, support accurate evaluations of research results and avoid research waste, high quality reporting of interventions in clinical trials is needed. The aim of this study is to assess the quality of reporting of interventions in publications describing randomised controlled trials of ONS in populations with malnutrition or at nutritional risk.MethodsThe PubMed database was searched for articles describing ONS trials published between January 2002 and December 2015. The quality of intervention descriptions was evaluated using the Template for Intervention Description and Replication (TIDieR) checklist and guide, which contains twelve items. Articles published before and after 2011 were compared.ResultsOf 76 articles identified, only 3% reported all TIDieR items in sufficient detail. The most frequently missing elements were descriptions of the intervention procedures (e.g. how the ONS were to be taken and if participants were given a choice of flavours), which were adequately presented in only 26% of the articles. Less than half of the articles included a description of the intervention provider and sufficient information about the location(s) for the intervention. Information about adherence and mode of delivery was reported in 60–65% of the articles. Most frequently reported, in >70% of the articles, were items regarding the brief name of the intervention, the rationale for the intervention and the materials used (i.e. information about the specific ONS product(s) administered). The reporting quality for two of the items (materials and provider) was higher in articles published after 2011.ConclusionsThe quality of reporting of ONS interventions was found to be poor. The descriptions mostly lacked information about intervention procedures, provider and location(s). A moderately higher reporting quality was observed in articles published after 2011. These findings imply that an improvement in the descriptions of ONS interventions is required in future clinical trials of malnutrition treatment.
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| 8. |
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| 9. |
- Sandvik, Pernilla, et al.
(author)
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Characterization of Commercial Rye Bread Based on Sensory Properties, Fluidity Index and Chemical Acidity
- 2016
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In: Journal of sensory studies. - : Wiley. - 0887-8250 .- 1745-459X. ; 31:4, s. 283-295
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Journal article (peer-reviewed)abstract
- Rye bread is often considered healthy, especially regarding its potential beneficial effect on blood glucose and insulin regulation, but the characteristics of Swedish rye bread have not previously been described. The aim was to characterize commercial rye bread (n = 24) using sensory descriptive analysis (11 panelists, 15 attributes, 2 replicates), fluidity index (FI; an in vitromeasurement to predict glycemic properties), chemical acidity and selected package information. The associations between sensory and chemical measurements were explored to identify the opportunities and challenges of increased consumption of rye bread with potential health benefits.Six categories of rye bread were identified on the basis of their sensory profiles. The FI indicated that bread from three of the categories possessed beneficial glycemic properties (FI 50–75). These categories contained 31–100% rye, displaying pH 4.3–4.8. Sensory attributes, foremost textural (e.g., chewiness), but also flavor (e.g., sourness), were highly correlated with FI values, thereby revealing their potential to aid consumers, in that they can serve as quality indicators of the glycemic properties of commercial rye bread. However, this also highlights potential sensory barriers to consumption. Front-of-package rye and sourdough labels on some samples could potentially mislead consumers given the low content of rye/sourdough, despite the labels.
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| 10. |
- Sandvik, Pernilla, et al.
(author)
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Consumers' health-related perceptions of bread - Implications for labeling and health communication
- 2018
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In: Appetite. - : Elsevier BV. - 0195-6663 .- 1095-8304. ; 121, s. 285-293
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Journal article (peer-reviewed)abstract
- There is a wide variety of commercial bread types and the present study identifies potential pitfalls in consumer evaluations of bread from a health perspective. The aim is to describe consumers' health related perceptions of bread by exploring which health-related quality attributes consumers associate with bread and whether there are differences with regard to age, gender and education level. A postal and web-based sequential mixed-mode survey (n = 1134, 62% responded online and 38% by paper) with open-ended questions and an elicitation task with pictures of commercial breads were used. Responses were content analyzed and inductively categorized. Three fourths (n = 844) knew of breads they considered healthy; these were most commonly described using terms such as "coarse," "whole grain," "fiber rich," "sourdough," "crisp," "less sugar," "dark," "rye," "seeds," "a commercial brand," "homemade" and "kernels." The breads were perceived as healthy mainly because they "contain fiber," are "good for the stomach," have good "satiation" and beneficial "glycemic properties." The frequency of several elicited attributes and health effects differed as a function of age group (18-44 vs. 45-80 years), gender and education level group (up to secondary education vs. university). Difficulties identifying healthy bread were perceived as a barrier for consumption especially among consumers with a lower education level. Several of the health effects important to consumers cannot be communicated on food packages and consumers must therefore use their own cues to identify these properties. This may lead to consumers being misled especially if a bread is labeled e.g., as a sourdough bread or a rye bread, despite a low content.
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| 11. |
- Sandvik, Pernilla, et al.
(author)
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Different liking but similar healthiness perceptions of rye bread among younger and older consumers in Sweden
- 2017
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In: Food Quality and Preference. - Uppsala : Elsevier BV. - 0950-3293 .- 1873-6343. ; 61, s. 26-37
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Journal article (peer-reviewed)abstract
- Rye breads, especially those with a chewy texture and sour flavor, have shown several health benefits but their consumption is lower among younger consumers than older. This study explores liking of commercial rye bread in younger and older consumers in relation to socio-demographics, childhood bread-eating habits and food choice motives. Further, sensory attributes are explored in relation to the consumers’ concepts of a rye bread and healthiness in bread.Nine commercial rye breads, previously profiled by descriptive sensory analysis were tasted by 225 younger (18–44 years) and 173 older (45–80 years) consumers. Internal preference mappings by principal component regression for each age group showed low liking for rye bread with a chewy texture and sour flavor in the younger consumer group. Based on the preference mappings, the age groups were separately clustered. Associations between clusters and background variables were studied using discriminant partial least squares regression. Liking of rye bread with a chewy texture and sour flavor in the younger consumer group was associated with e.g., more education, females, childhood bread consumption and the food choice motive health. In the older consumer group, it was related to e.g., more education and childhood bread consumption. Partial least squares regression 1 showed that the combination of sensory attributes such as a light color and soft texture led to the perception of bread being less healthy and not a rye bread, and a dark brown color, chewy texture, sour and bitter flavor to the perception of a healthier bread and rye bread.
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| 12. |
- Sandvik, Pernilla, et al.
(author)
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Healthiness mapping The sensory quality of healthy bread according to consumers
- 2015
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Conference paper (peer-reviewed)abstract
- Healthiness is a central credence consumer quality dimension that needs to be communicated, but the use of health claims is highly controlled. The present study explores how sensory attributes influence consumer perceptions of bread healthiness. Sensory and health-related properties of rye bread (n=24) on the Swedish market were described and a representative subset of 9 samples (varying in whole-grain, rye flour, added sugar and sourdough content) were included in a consumer test. Consumers (n=401) tasted the samples blindly in random order and rated their perceived healthiness by indicating degree of agreement with the statement “This bread seems healthy” on a 9-point scale. Background questions regarding socio-demographics and bread consumption habits were also included.Overall, the consumers classified the breads into four groups with significantly different perceived healthiness. This classification corresponded well with the objective health-related measurements of the samples. Healthiness mapping was performed using Principal Component Regression. Perceived healthiness were positively correlated to brown colour, sourness, rye flavour and texture, such as heterogeneity and chewiness while negatively correlated to sweetness, deformability and plasticity. Hierarchical cluster analysis followed by K-means clustering identified three consumer clusters, with different healthiness perceptions. Internal healthiness mapping by Principal component analysis showed that cluster 1 (36%, n=156) clearly and correctly differentiated between the samples while cluster 2 (37%, n=167) discriminated less between the samples and mainly used colour as a cue, cluster 3 (20%, n=78) rated healthiness lower for all samples. Cluster 2 displayed a lower educational level, ate mainly white bread and was more interested in general information about a breads health effects. This study can help facilitate identification of healthy bread in different consumer segments. Based on only intrinsic sensory information 36% discriminated well between the samples while in other segments, the discrimination could be improved by comprehensible extrinsic health-related cues.
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| 13. |
- Sandvik, Pernilla
(author)
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Rye bread in Sweden : Health-related and sensory qualities, consumer perceptions and consumption patterns
- 2017
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Doctoral thesis (other academic/artistic)abstract
- Rye bread has shown potential as a health-beneficial component in the diet, especially in relation to non-communicable diseases. To have a beneficial effect in reality, however, it also needs to be available, chosen and eaten. Less research has focused on rye bread from a consumer perspective. The main aim was to investigate consumption patterns, health-related and sensory qualities and consumer perceptions of bread, more specifically commercial rye bread. In Study I, secondary analysis was performed on bread consumption data from a national dietary survey (n=1,435, 18-80 years). In Study II, commercial rye breads (n=24) were characterized by sensory descriptive analysis; the in vitro measurement fluidity index (FI) was used to predict glycemic properties, and chemical acidity was measured. Study III was a consumer test (n=398, 18-80 years), where acceptance and perceptions of nine rye breads were investigated. Study IV was a web-based and postal sequential mixed-mode survey (n=1,134, 18-80 years) with open-ended items covering health-related perceptions of bread. Consumers with the lowest intake of whole grain and rye bread were from younger age groups, families with children and groups with lower educational levels. Health-related and sensory properties of commercial rye bread varied widely. The FI indicated more beneficial glycemic properties in half of the samples and this was associated with a chewy, dry texture and sour flavor. The younger consumer group (18-44 years) differed in their liking compared to the older group (45-80 years) and displayed a preference toward bread with less whole grain and rye, although different clusters were identified. Rye bread liking was associated with bread type consumed in childhood, food choice motives and educational level. Most (75%) knew of bread they considered healthy. Coarse, whole grain, fiber, sourdough and rye were perceived to be good for the stomach, bowel and, to have good satiation and glycemic properties. Few health claims have been authorized, making it challenging for consumers to identify bread with these properties. Front-of-package label indicating rye bread was sometimes found on breads with very little rye flour. Sensory attributes, foremost textural and flavor, e.g., sourness, correlated with beneficial FI values and could thereby help guide consumers.
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| 14. |
- Skinnars Josefsson, Malin, 1966-, et al.
(author)
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Adherence to a regulation that aims to prevent and treat malnutrition : the case of Swedish elderly care
- 2019
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In: Health Policy. - : Elsevier BV. - 0168-8510 .- 1872-6054. ; 123:7, s. 688-694
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Journal article (peer-reviewed)abstract
- Malnutrition constitutes a serious and challenging problem in elderly care. In 2015, a Swedish regulation that aims to prevent and treat malnutrition came into effect. This study set out to explore associations between level of adoption of the regulation reported as: no, started, yes, in a previous survey, and registrations in a national quality registry. Registry data on screening and actions extracted from the first trimester in 2014 (n=18967), 2016 (n=20318) and 2017 (n= 25669) represented 209, 197 and 199 of 290 Swedish municipalities respectively. A repeated measures ANOVA showed that there was no effect on screened nutritional status, Pearson's chi-square that there were minor differences in types of actions, and regression analysis that the number of actions increased on average by 0.3 due to a higher level of adoption of the regulation. Over the years studied, five actions were prominent regardless of level of adoption or screened nutritional status. Hence, to date, no firm conclusions regarding effects of the regulation can be drawn. Despite the regulatory nature, it appear as if the regulation and the level of adoption reported so far is routine in theory, although not yet leveraged to an implemented practice visible in the quality registry but instead decoupled from practice.
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| 15. |
- Skinnars Josefsson, Malin, 1966-
(author)
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Food Service and Nutritional Care in Swedish Elderly Care : The Progress of National Actions and their Local Interpretations
- 2018
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Doctoral thesis (other academic/artistic)abstract
- The main aim of this thesis is to study local level outcomes regarding food service and nutritional care in Swedish elderly care in relation to the progress of national actions. Study I compared results from a repeated national survey using a questionnaire investigating the general structure and organisation of food service in elderly care. Study II built on data merged from a questionnaire, open comparison survey data and records from the quality registry Senior Alert to investigate nutritional care practice, focusing on quality indicators related to food service. Study III was a web-based questionnaire that described perceived facilitators in the process of adopting a national regulation that aims to prevent and treat malnutrition. Study IV explored associations between the level of adoption of the regulation and registrations in Senior Alert using registry data and results from a questionnaire. Differences were found primarily between rural and city municipality groups. The predominant food service organisation was public, but city municipalities reported a higher and increased use of private providers, chilled production and meal choices. The number of clinical/community dietitians had declined significantly between the surveys. Access to this profession was associated with being well-nourished. Food service dietitians and private providers were positively associated with meal satisfaction, while the food production system cook-chill was negatively associated. One year after the launch of the regulation, 50% of municipalities had adopted new routines. The odds for adoption were higher in municipalities where preventive work was already in progress, the regulation was considered helpful, and where facilitators had long experience of working in elderly care. The most important support factors for the adoption of new routines were cooperation between professions and well-defined goals. There was no significant difference in nutritional screening scores associated with adoption rate, but, in general, the number of individuals registered in Senior Alert increased after the entry into force of the regulation. In conclusion, this thesis contributes increased knowledge about the different outcomes in local level practices in relation to central actions. The results indicate a strong local autonomy and the importance of local access to sufficient capacity and knowledge.
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| 16. |
- Skinnars Josefsson, Malin, et al.
(author)
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Municipal differences decisive for provision of food and meals in Swedish eldercare
- 2016
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Conference paper (peer-reviewed)abstract
- Introduction: In Sweden, provision of food and meals to older people is a welfare service within eldercare, grounded on national frame laws but in practice affected by high local autonomy. The aim of this study was to explore municipality-based steering, organization and practice of the provision of food and meals within Swedish eldercare in terms of trends and local uniformity or differences. To our knowledge, no prior studies have investigated this.Material and methods: A national study on Swedish municipalities (n=290) based on a repeated questionnaire conducted in 2006 and 2013/14. Municipalities were divided into groups based on population density: rural, urban, and city. The response rate was 80% in 2006 and 56% in 2013/14.Results: Overall, provision of food and meals in Swedish eldercare is dominated by a traditional organization still relying on the public food service organization as the main provider. Conventional food technology is still practiced, but with increased use of private food service organizations and changing practice of food technology led by city municipalities. Large discrepancies in modes of provision were found between rural and city municipalities. City municipalities had progressed further in terms of private food service organization (p<0.001), reduced use of cook-serve (p=0.039) in favour for chilled food technology systems (p=0.022), and extensive practice of menu choices (p<0.001).Conclusion: Different conditions in municipalities seem to be decisive for the provision of food and meals, with benchmarking devices and New Public Management as incentives for steering and efficiency appearing to be more achievable for city municipalities.
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| 17. |
- Skinnars Josefsson, Malin, 1966-, et al.
(author)
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National survey in elderly care on the process of adopting a new regulation aiming to prevent and treat malnutrition in Sweden
- 2018
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In: Health & Social Care in the Community. - : John Wiley & Sons. - 0966-0410 .- 1365-2524. ; 26:6, s. 960-969
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Journal article (peer-reviewed)abstract
- Guided by the i-PARIHS framework, this study investigates perceived facilitators in the process of adopting a new regulation launched in 2015 which aims to prevent and treat malnutrition. In May 2016, a national web-based questionnaire was emailed to chief medical nurses in elderly care in all Swedish municipalities (n = 290). The response rate in this cross-sectional study was 75% (n = 217). Fifty per cent of the municipalities had adopted new routines, 42% had started and 8% had not. One third of the respondents considered malnutrition to be a major problem in elderly care and about half considered the new national regulation to have strengthened local work. A logistic regression showed that the odds for having adopted new routines were higher for CMNs with long experience in elderly care and who had previously worked to prevent malnutrition, and for those who considered the new national regulation helpful. To extract underlying factors in the adoption process, two principal component analyses were performed for key actors and support. For key actors, the analysis yielded four factors, explaining 67% of the total variance; (a) first line team, (b) expert team, (c) management team and (d) surrounding resources. For support, the analysis yielded three factors, which explained 65% of the total variance; (a) agile teamwork, (b) management and leadership and (c) acceptance. The slow adoption rate of the regulation raises questions about its impact; this might be an effect of the general trend of decentralisation in the Swedish welfare sector, and in elderly care in particular, making it hard to attain change that is steered centrally. However, malnutrition is a pronounced problem in elderly care and the mandatory nature of the new regulation therefore warrants further investigation of whether its launch has contributed to a reduction of malnutrition by investigating outcomes and preventive actions carried out in practice.
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| 18. |
- Skinnars Josefsson, Malin, 1966-, et al.
(author)
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Quality indicators of nutritional care practice in elderly care
- 2017
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In: The Journal of Nutrition, Health & Aging. - : Springer Science and Business Media LLC. - 1279-7707 .- 1760-4788. ; 21:9, s. 1057-1064
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Journal article (peer-reviewed)abstract
- Objectives: The aim is to explore the effects of antecedent, structural and process quality indicators of nutritional care practice on meal satisfaction and screened nutritional status among older adults in residential care homes. Design: Data for this Swedish cross-sectional study regarding older adults living in residential care homes were collected by i) a national questionnaire, ii) records from the quality registry Senior Alert, iii) data from an Open Comparison survey of elderly care in 2013/2014. The data represented 1154 individuals in 117 of 290 Swedish municipalities. Measurements: Meal satisfaction (%) and adequate nutritional status, screened by the Mini Nutritional Assessment Short Form (MNA-SF), were the two outcome variables assessed through their association with population density of municipalities and residents’ age, together with 12 quality indicators pertaining to structure and process domains in the Donabedian model of care. Results: Meal satisfaction was associated with rural and urban municipalities, with the structure quality indicators: local food policies, private meal providers, on-site cooking, availability of clinical/community dietitians, foodservice dietitians, and with the process quality indicators: meal choice, satisfaction surveys, and ‘meal councils’. Adequate nutritional status was positively associated with availability of clinical/community dietitians, and energy and nutrient calculated menus, and negatively associated with chilled food production systems. Conclusion: Municipality characteristics and structure quality indicators had the strongest associations with meal satisfaction, and quality indicators with local characteristics emerge as important for meal satisfaction. Nutritional competence appears vital for residents to be well-nourished.
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| 19. |
- Skinnars Josefsson, Malin, et al.
(author)
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Quality Indicators Related to Meal Satisfaction and Adequate Nutritional Status in Elderly Care
- 2017
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Conference paper (peer-reviewed)abstract
- Studies of organizational prerequisites for nutritional care practice and their effect on meal satisfaction and nutritional status of older adults in residential care homes are scarce. Guided by Donabedians’ model of quality of care, the aim was to explore structure and process quality indicators of nutritional care practice that predict residents’ meal satisfaction and adequate nutritional status according to MNA-SF, in Swedish elderly care. Data at municipal level from i) a national questionnaire, ii) records from a quality registry and iii) a benchmarking survey, were merged. Logistic and multiple regression analyses included 117 municipalities (of 290 in Sweden). Residence in rural and urban municipalities predicted meal satisfaction over city municipalities. Independent structure indicators of meal satisfaction were local food policy, cooking on-site and private meal providers, and independent process indicators were choice of meals and residents’ possibility to influence the menu. Adequate nutritional status was positively predicted by the structure indicator availability of clinical/community dietitian and the process indicator calculation of nutritional content of meals. To conclude, a locally adapted organization adjusted to residents’ choices, and availability of dietitians, benefit meal satisfaction and nutritional status among older adults in residential care homes.This study provides insights into:quality indicators for nutritional care practice significant for older adults’ well-beingthe significance of dietitiansThe results from this study can benefit future interventions aiming to improve nutritional care practice and serve as guidance for leaders in elderly care organizations.
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| 20. |
- Skinnars Josefsson, Malin, 1966-, et al.
(author)
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Reforming Foodservice in Elderly Care : National Actions and Local Outcomes
- 2018
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In: Nutrition & Dietetics. - : John Wiley & Sons. - 1446-6368 .- 1747-0080. ; 75:1, s. 79-86
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Journal article (peer-reviewed)abstract
- Aim: The aim was to explore the outcome, on a local level, of steering, organisation and practices of elderly care foodservice by Swedish municipalities, and changes relative to national actions. Methods: A survey using a web-based questionnaire about elderly care foodservice targeting all Swedish municipalities (n=290) was conducted in 2006 and 2013/14. The questionnaire included the topics: organisation of foodservice, its practice in elderly care, and steering devices such as guidelines and policies. Based on the share of a rural population, municipalities were divided into groups: rural (≥50%), urban (<50%) and city (≤20%).Results: The response rate from municipalities was 80% in 2006 and 56% in 2013/14; 45% participated in both surveys. The results showed increased use of local food policies (P=0.03) and meal choice (P<0.001), while access to clinical/community dietitians declined (P=0.01) between the surveys. In home-help services, daily delivered cook-serve meals declined (P<0.001) and chilled meals delivered three times a week increased (P=0.002) between the surveys. City municipalities used private foodservice organisations the most, (P<0.001) and reported reduced use of cook-serve systems in favour of chilled. In rural municipalities, the use of public providers (98%) and a cook-serve system (94%) were firmly established. Urban municipalities were placed between the other groups.Conclusions: National actions such as soft governance and benchmarking appear largely to determine local level outcomes. However, conditions for adapting these measures vary between municipality groups. While efficiency enhancing trends were prominent, questions remain whether national actions should be expanded beyond performance to also examine their consequences.
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| 21. |
- von Berens, Åsa, et al.
(author)
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Effect of exercise and nutritional supplementation on health-related quality of life and mood in older adults : the VIVE2 randomized controlled trial
- 2018
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In: BMC Geriatrics. - : Springer Science and Business Media LLC. - 1471-2318. ; 18
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Journal article (peer-reviewed)abstract
- Background: Health-related quality of life (HRQoL) and absence of depressive symptoms are of great importance for older people, which may be achieved through lifestyle interventions, e.g., exercise and nutrition interventions. The aim of this investigation was to analyze the effects of a physical activity program in combination with protein supplementation on HRQoL and depressive symptoms in community-dwelling, mobility-limited older adults. Methods: In the Vitality, Independence, and Vigor 2 Study (VIVE2), community-dwelling men and women with an average age of 77.55.4 years, some mobility limitations and low serum vitamin D levels (25(OH)Vit D 22.5-60 nmol/l) from two study sites (Stockholm, Sweden and Boston, USA) were randomized to receive a nutritional supplement or a placebo for 6 months. All took part in a physical activity program 2-3 times/week. The primary outcome examined in VIVE2 was 400 M walk capacity. HRQoL was measured using the Medical Outcomes Study 36-item Short Form Health Survey (SF36), consisting of the Physical Component Summary (PCS) and Mental Component Summary (MCS), and depressive symptoms were measured using The Centre for Epidemiologic Studies Depression Scale (CES-D). In the sensitivity analyses, the sample was divided into sub-groups based on body measures and function (body mass index (BMI), appendicular lean mass index (ALMI), handgrip strength and gait speed). Results: For the whole sample, there was a significant improvement in both MCS, mean (95% CI) 2.68 (0.5, 4.9) (p 0.02), and CES-D -2.7 (-4.5, -0.9) (p 0.003) during the intervention, but no difference was detected between those who received the nutritional supplement and those who received the placebo. The results revealed no significant change in PCS or variation in effects across the sub-categories. Conclusions: This study demonstrates that a six-month intervention using a physical activity program had positive effects on mental status. No additional effects from nutritional supplementation were detected.
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- von Berens, Åsa
(author)
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Nutrition, exercise and body composition in community-dwelling older adults : Effects on function, wellbeing and mortality
- 2019
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Doctoral thesis (other academic/artistic)abstract
- Background: The demographic shift in society with more people reaching a high age provides new challenges for both society and the healthcare system.Aim: The overall aim of this thesis was to examine the impact of nutrition, exercise and body composition on function, wellbeing and mortality in community-dwelling older adults.The thesis is based on 1) data from the Vitality, Independence and Vigor in the Elderly 2 study (VIVE2) (Papers I-III), i.e. 149 community-dwelling participants >70 years who took part in an exercise program, and were randomized to take either a protein- and vitamin D-rich supplement or a placebo for 6 months and 2) three cohorts from two Swedish population studies on older adults (Paper IV). Quantitative (Papers I, II and IV) and qualitative methods (Paper III) were used. Results: Paper I reports cross-sectional data showing that there was no clear association between serum levels of serum 25(OH)D and physical performance in mobility-limited adults.In Paper II, the results of the VIVE2 study indicated positive effects on mental health from exercise but no additional effect from supplementation was detected.In Paper III, the qualitative interview investigation indicated that the VIVE2 intervention had positive effects, both psychologically and physically. Another finding was that weight loss was a main reason for participants wanting to take part in the study, whereas the aim of the study was to improve muscle function.Paper IV shows from prospective observational data that 75-year-old women with sarcopenic obesity had an increased mortality risk within 10 years, while a similar result could not be found among 75-year-old or 88-year-old men.Conclusion: The exercise intervention improved the mental status of the participants based on both quantitative and qualitative studies. No effect could be attributed to the protein- and vitamin D-rich nutritional supplement, a finding that needs to be evaluated in light of the participants’ good nutritional status. No clear association was revealed between physical function and serum 25(OH)D. Sarcopenic obesity may be associated with mortality but such associations may depend on age and gender.
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- von Berens, Åsa, et al.
(author)
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Physical performance and serum 25(OH)vitamin D status in community dwelling old mobility limited adults : A cross-sectional study
- 2018
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In: The Journal of Nutrition, Health & Aging. - : Springer Science and Business Media LLC. - 1279-7707 .- 1760-4788. ; 22:1, s. 1-7
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Journal article (peer-reviewed)abstract
- Objectives:To examine the potential association between serum 25(OH) vitamin D and theperformance on the Short Physical Performance Battery (SPPB) including the sub-components; five repeatedchair stands test, 4 meters walk test and balance in older mobility-limited community-dwelling men and women.Design:A cross sectional study was performed in American and Swedish subjects who were examined forpotential participation in a combined exercise and nutrition intervention trial. Logistic regression analysis andlinear regression analyses were performed to evaluate the association for 25(OH)D with the overall score onthe SBBP, chair stand, gait speed and balance.Participants:Community-dwelling (mean age 77.6 ± 5.3 years)mobility limited American (n=494) and Swedish (n=116) females (59%) and males.Measurements:The SPPB(0-12 points) includes chair stand (s), gait speed (m/s) and a balance test. Mobility limitation i.e., SPPB score ≤9 was an inclusion criterion. A blood sample was obtained to measure serum 25(OH)vitamin D concentrations.Results:No clear association of 25(OH)D with SPPB scores was detected either when 25(OH)D was assessedas a continuous variable or when categorized according to serum concentrations of <50, 50-75 or <75 nmol/L.However, when analyzing the relationship between 25(OH)D and seconds to perform the chair stands, asignificant quadratic relationship was observed. Thus, at serum levels of 25(OH)D above 74 nmol/L, higherconcentrations appeared to be advantageous for the chair stand test, whereas for serum levels below 74 nmol/Lthis association was not observed.Conclusion: This cross- sectional study lacked clear association betweenserum 25(OH)D and physical performance in mobility limited adults. A potentially interesting observation wasthat at higher serum levels of 25(OH)D a better performance on the chair stand test was indicated.
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