Unintentional weight loss in older adults : nutrition-related knowledge, perceptions and practices of nursing staff working in long-term care facilities in the Cape Metropole

[摘要] ENGLISH SUMMARY : Introduction: Unintentional weight loss (UWL) is common in older adults, with a 50-60% prevalence in long-term care facilities (LTCFs). UWL negatively impacts on quality of life and leads to increased morbidity, increased mortality and higher cost of care. Nursing staff are the primary care providers for older adults in LTCFs and key in the early identification and management of UWL.Objectives: The study aims to determine the knowledge, perceptions and practices of nursing staff regarding the identification and management of UWL in older adults residing in LTCFs in the Cape Metropole. Data from different categories of nursing staff and facilities types were compared, and barriers to managing UWL were identified.Methods: A cross-sectional, descriptive study design with an analytical component was used and simple random sampling applied to select LTCFs in the Cape Metropole. A self-administered questionnaire was designed and pilot tested as a research instrument to investigate the knowledge, practices and perceptions of nursing staff with regards to the study objectives. An interviewer-administered facility questionnaire was completed with management staff of facilities to obtain background information and for cross-control purposes.Results: Nursing staff (N=108) from eight subsidised and seven non-subsidised LTCFs (n=60 and n=48 staff respectively) consented to participate and included professional nurses (n=27), staff nurses (n=20), nursing auxiliaries (n=27) and caregivers (n=34). Nursing staff obtained a mean knowledge score of 62%. Even though sub-categories of nursing staff with higher qualifications levels scored statistically significantly better (p=<0.001), all nursing staff categories had insufficient knowledge (38%) regarding weight loss. Most nursing staff (73.2-100%) had positive perceptions regarding the identification and management of UWL, although almost half had misperceptions that malnutrition is uncommon in institutionalised older adults (45.8%) and that it is normal for older adults to have a poor appetite (45.4%). Poor practices that do not support the identification and management of UWL were identified. Half of participants reported that residents had limited choices with regards to meals and that plate waste was reported only once more than ½ or ¾ of a meal was not consumed. Although 87% of participants indicated that residents were weighed, it was only done regularly by 60.6% of those nursing staff and only 22.2% could correctly identify a significant weight loss. Nutrition screening and assessment tools were rarely used (3.8-16.8%). There was no statistically significant difference between knowledge scores of nursing staff working at different facility types and only a significant difference (p<0.05) in a minority of perception statements among the different categories of nursing staff, and nursing staff working at different facility types.Conclusion: Overall, nursing staff had positive perceptions regarding UWL, but many did not show sufficient knowledge, nor did facilities apply necessary procedures to support best practices for the effective identification and management of UWL in older adults residing in LTCFs in the Cape Metropole. Nursing staff must be empowered through continuous education and supported with applied standard procedures to enable early identification and addressing of UWL and malnutrition in older adults residing in LTCFs.

[发布机构] Stellenbosch University