Care problems and nursing interventions related to oral intake in German nursing homes and hospitals: a descriptive mulitcentre study

Abstract

Background: Reduced nutritional intake in care-dependent patients is a risk factor for malnutrition. The prevalence of malnutrition has been extensively reported, but there is little empirical data on the prevalence of the underlying causes of reduced oral intake and the extent of nursing interventions that address malnutrition.

Objectives: To report the prevalence of problems that potentially led to decreased nutritional intake. To investigate the association between these problems and body mass index (BMI). To investigate the association between increased care dependency and BMI. To document nutrition-related interventions.

Design: Cross-sectional multicentre study.

Setting: A total of 15 hospitals (H) and 76 nursing homes (NH) in Germany were included.

Participants: A total of 2930 hospital patients and 5521 nursing home residents were included in the study. The mean age was 66.6 ± 16.7 years (in H) and 84.9 ± 9.8 years (in NH); 14.7% (in H) and 50.4% (in NH) were almost or completely care dependent. A BMI ≤ 20kg/m² was found in 8.5% (in H) and 16.7% (in NH).

Results: Most hospital patients were eating and drinking independently (72.2%), whereas 58.4% of the nursing home residents needed assistance. Major problems in hospitals were polypharmacy (18.6%), loss of appetite (14.6%) and pain (7.8%); in nursing home common problems were functional problems of the upper extremities (17%), loss of appetite (15.5%) and polypharmacy (15.5%). Patients with a high level of care dependency had higher rates of BMI ≤ 20kg/m². In both settings (H and NH), BMI ≤ 20kg/m² was significantly associated with loss of appetite (odds ratio (OR) 2.6, 95%CI 1.9-3.5 and OR 7.0, 95%CI 5.9-8.3), nausea (OR 2.1, 95%CI 1.3-3.3 and OR 2.8, 95%CI 1.9-4.1), chewing problems (OR 2.1, 95%CI 1.2-3.4 and OR 2.5, 95%CI 2.1-3.1) and swallowing problems (OR 2.3, 95%CI 1.4-3.6 and OR 2.3, 95%CI 1.9-2.8). Nutrition-related nursing interventions were employed more frequently in nursing homes than in hospitals.

Conclusion: A high care dependency in general and in terms of eating and drinking should be addressed in daily care to ensure sufficient nutritional intake. Additional problems, such as loss of appetite, should also be addressed with suitable interventions to prevent malnutrition. Nutrition-related interventions need to be increased in German health care facilities.