O C C U P A T I O N A L T H E R A P Y H E L P S I M P R O V E N U T R I T I O N A L S T A T U S T H R O U G H C U L T U R E

A N D P R O G R A M C H A N G E

P R E S E N T E D B Y E L I Z A B E T H C B A I R P A C I F I C U N I V E R S I T Y

Preventing Malnutrition in Long-term Care

Abstract

This presentation explores the issue of malnutrition among residents of long-term care (LTC) facilities discusses the importance of educating LTC leadership and staff about the far-reaching effects of this problem and clarifies how occupational therapy can facilitate cultural and program changes in LTC facilities

Such changes have been shown to improve residentsrsquo dining experiences decrease risks of malnutrition and secondary health complications increase staff morale and retention and benefit the financial health of the organization

Purpose

This presentation is intended to educate about malnutrition in LTC

introduce elements of a teaching plan and instructional

materials

describe a proposed research project

inspire you to take action

Learning Objectives

By the end of this presentation you should be able to

Identify key signs and symptoms of malnutrition Recall effects of malnutrition on cognition and health Understand how personal institutional and cultural factors

affect an individualrsquos ability to remain nutritionally sound Describe the Role of OT in managing and preventing

malnutrition in LTC residents

Malnutrition in Long-term Care

Malnutrition in LTC is a serious problem Who is at risk Long-term residents Rehabilitation patients

Prevalence

Each day in 2012 there were 1383700 residents in nursing homes (Harris-Kojetin Sengupta Park-Lee amp Valverde 2013)

Between 35 and 85 of older adults in nursing homes experience some level of malnutrition (Furman 2006)

Percentage of adults with dementia and malnutrition in nursing homes range from 14 - 56

Schussler S Dassen T amp Lohrmann C (2014)

Factors in Malnutrition

Natural aging processes Chronic medical conditions Cognitive impairment Disease Injury Frailty Environments

(Scott et al 2006 Thomas Ashmen Morley Evans amp the Council for Nutritional Strategies in Long-Term Care 2000)

Signs and Symptoms

skin breakdown and pressure wounds

anemia fatigue muscle weakness and

wasting dry skin dull dry hair and hair loss conjunctival dryness receding gums or a change in

how their dentures fit

increasing levels of confusion

loss of appetite or interest in mealtimes

loss of sensation (touch taste smell changes in vision)

Consequences of Malnutrition

Secondary health complications Postoperative complications Decreased functional independence Cognitive loss Increased mortality rates Decreased quality of life Increased costs of healthcare

Barriers to Good Nutritional Status

Lack of knowledge about risk factors No formalized screening and assessment Inadequate staff to resident ratios Lack of training in feeding and eating assistance Limited communication between disciplines Lack of understanding of impact of dementia Inattention to the cultural and personal context of

mealtime Lack of social supports

Dementia and Malnutrition

Six factors that predict low food intake Eating difficulty No feeding assistance by caregivers Moderate dependence in activities of daily living Fewer family visits Being female Older age

(Lin Watson amp Wu 2010)

Dementia and Malnutrition

It is estimated that up to 45 of people with dementia living in institutions have swallowing

difficulties (Horner Alberts Dawson amp Cook 1994)

Effects of Increased Assistance

Increases in total daily calorie intake Residents maintain or gain weight Reduced secondary health complications Improved relationship between resident and staff Improved quality of life

Role of Occupational Therapy

OTs and OTAs have foundational skills and knowledge in eating feeding and

swallowing understanding of multidimensional aspects of eating expertise in assessment evaluation and treatment a holistic view to bring to nutritional care

OT Interventions

Attention to psychosocial aspects of dining Environmental modification Adaptive equipment Dysphagia assessment and treatment Positioning Task analysis Residents Staff

Caregiver and dining assistant training Sensory integration issues internal and external

Culture Change

ldquoCulture change is an innovation anchored in values and beliefs that return the locus of control to elders and those who work closest with them Its ultimate vision is to create a culture of aging that is inclusive life-affirming satisfying humane and meaningfulrdquo

(Kantor B amp Planetree amp Picker Institute 2010)

Trends in Culture Change

Emphasis on resident choice and person-centered care as essential components to improve dining experiences

Culture change requires transformation in organizational practices physical environments workplace practices communication and relationships among all stakeholders

Benefits of Culture Change

LTCs who implement cultural changeshellip Improve quality-of-life for residents patients and staff

Increase performance on clinical outcomes

(Planetree amp Picker Institute 2010 Baier Butterfield Harris amp Gravenstei 2008)

Experience positive effects on occupancy rates and the financial bottom line of LTC (Doty Koren amp Sturla 2008 Elliot 2010 LaPorte 2010)

Key Points for Program amp Culture Change

Residents are unique individuals Facility leadership must seek further education Leaders must support the changes in environment Interdisciplinary staff education and training at all

levels Formalize screening and referral process Changes to dining organization and staffing duties Utilize expertise and unique perspective of OT

Future Work

Increase multidisciplinary collaboration

Increase knowledge base for OT through research Design and share educational programs across

disciplines and settings

Future Work

Explore and implement innovative approaches to feeding and eating assistance

Design programs specific to the dining experience of persons with dementia or cognitive impairment

Advocate with government and industry to promote

person centered care in LTC

Education is Key to Change

Industry leaders nursing home administrators and management need to be educated about the extent of malnutrition in nursing homes

There is a need for educational plans and instructional materials on preventing and treating malnutrition in LTC

Healthcare providers must take time to advocate with facilities and present educational workshops

Recognizing and preventing malnutrition in nursing homes

A teaching plan was developed and incorporated into

the coursework for the OTD 610 Practitioner as Educator course at Pacific University

An extensive literature review has been created to provide evidence and foundational knowledge for healthcare providers LTC administrators and stakeholders

Purpose

Educate skilled nursing facility administrators and management about effects of poor nutritional status skilled OT assessment analysis and Interventions improving nutritional status of residents enhancing the dining experience improving staff effectiveness and efficiency

Program Goal

LTC administrators and managers will demonstrate basic knowledge of effects of poor nutritional

status describe barriers to providing excellent nutritional care explain how skilled OT services contribute to proving holistic

nutritional care

Teaching Elements

Teaching Session

Lecture- group instruction Printed educational handouts Printed worksheets Interactive activities among learners Small and whole group discussions Self-reflection and sharing Resource table with additional learning tools Short video (added as a result of feedback to pilot

session)

Targeted learners

professionals in health care provision or administration

extensive experience in the long-term healthcare industry in the area of nutrition and dietary food service

men and women multicultural group 30 ndash 60 years of age

Setting

Intended LTC workshop Skilled nursing facility conference room during weekday

business hours

Pilot Group workshop Large open-plan diningliving space with participants around

large oval table

Outcome of Pilot

What would I do differently

Schedule more convenient time

Include more participants

Ask for feedback

More anonymous feedback option

simplify language

Proposed Changes to Workshop

Provide printed quiz to go with handouts Add video component Rework handouts for comprehension and

application to learners needs

Discussion

After learning more about the problem of malnutrition in long-term care are you considering how you might introduce this topic into your practice or your teaching

Are there other venues where this type of educational program is appropriate and might influence the management of nutritional care for elders

Questions

References

Abbasi AA amp Rudman D (1994) Undernutrition in the nursing home Prevalence consequences cause and prevention Nutrition Reviews 52(4) 113-122 Accreditation Council for Occupational Therapy Education (2006) ACOTE standards and interpretive guidelines Retrieved from

httpwwwaotaorgnonmembersarea13docs acotestandards806pdf Adams NE Bowie AJ Simmance N Murrary M amp Crowe T (2008) Recognition by medical and nursing professionals of malnutrition and risk of malnutrition in elderly hospitalised patients Nutrition and Dietetics (65) 144-150 Amella EJ (2002) Resistance at mealtimes for persons with dementia The Journal of Nutrition Health amp Aging 6 117-122 Amella EJ (2008) Mealtime difficulties In Evidence-Based Geriatric Nursing Protocols for Best Practice 3rd ed (Capezuti E Zwicker D Mezey M Fulmer T Gray-Miceli D amp Kluger M eds) Springer Publishing Company LLC New York p 337-351 American Occupational Therapy Association [AOTA] (2002) Occupational therapy practice framework Domain and process American Journal of Occupational Therapy 56

609ndash639 doi 105014ajot566609 AOTA (2007) Specialized knowledge and skills in feeding eating and swallowing for occupational therapy practice American Journal of Occupational Therapy 61(6) 686-700

doi 105014ajot616686 Asai JL (2004) Nutrition and the geriatric rehabilitation patient Challenges and solutions Topics in Geriatric Rehabilitation 20(1) 34-45 Baier RR Butterfield K Harris Y Gravenstein S (2008) Aiming for star performance the relationship between setting targets and improved nursing home quality of

care Journal of the American Medical Directors Association9(8) 594-9 Epub Dolhi C amp Rogers J (2009) Dementia nutrition and self-feeding A systematic review of the literature Occupational Therapy in Health Care 15(3-4) 59-87 Ferri C Prince M Brayne C Brodaty H Fratiglioni L Ganguli M hellip Landry G (2005) Global prevalence of dementia a delphi consensus study Lancet 366 2112-2217 Frisoni G Fanzoni S Rozzini R Ferrucci L Boffelli S amp Trabucchi M (1994) A nutritional index predicting mortality in the nursing home Journal of the American Geriatric Society 42 1167-1172 Furman EF (2006) Under-nutrition in older adults across the continuum of care Journal of Gerontological Nursing 32(1) 22-27 Groher ME amp Crary MA(2010) Dysphagia Clinical Management in Adults and Children Maryland Heights MO Mosby-Elsevier Harris-Kojetin L Sengupta M Park-Lee E Valverde R Long-term care services in the United States 2013 overview National health care statistics reports no 1 Hyattsville MD National Center for Health Statistics 2013

Abstract

This presentation explores the issue of malnutrition among residents of long-term care (LTC) facilities discusses the importance of educating LTC leadership and staff about the far-reaching effects of this problem and clarifies how occupational therapy can facilitate cultural and program changes in LTC facilities

Such changes have been shown to improve residentsrsquo dining experiences decrease risks of malnutrition and secondary health complications increase staff morale and retention and benefit the financial health of the organization

Purpose

This presentation is intended to educate about malnutrition in LTC

introduce elements of a teaching plan and instructional

materials

describe a proposed research project

inspire you to take action

Learning Objectives

By the end of this presentation you should be able to

Identify key signs and symptoms of malnutrition Recall effects of malnutrition on cognition and health Understand how personal institutional and cultural factors

affect an individualrsquos ability to remain nutritionally sound Describe the Role of OT in managing and preventing

malnutrition in LTC residents

Malnutrition in Long-term Care

Malnutrition in LTC is a serious problem Who is at risk Long-term residents Rehabilitation patients

Prevalence

Each day in 2012 there were 1383700 residents in nursing homes (Harris-Kojetin Sengupta Park-Lee amp Valverde 2013)

Between 35 and 85 of older adults in nursing homes experience some level of malnutrition (Furman 2006)

Percentage of adults with dementia and malnutrition in nursing homes range from 14 - 56

Schussler S Dassen T amp Lohrmann C (2014)

Factors in Malnutrition

Natural aging processes Chronic medical conditions Cognitive impairment Disease Injury Frailty Environments

(Scott et al 2006 Thomas Ashmen Morley Evans amp the Council for Nutritional Strategies in Long-Term Care 2000)

Signs and Symptoms

skin breakdown and pressure wounds

anemia fatigue muscle weakness and

wasting dry skin dull dry hair and hair loss conjunctival dryness receding gums or a change in

how their dentures fit

increasing levels of confusion

loss of appetite or interest in mealtimes

loss of sensation (touch taste smell changes in vision)

Consequences of Malnutrition

Secondary health complications Postoperative complications Decreased functional independence Cognitive loss Increased mortality rates Decreased quality of life Increased costs of healthcare

Barriers to Good Nutritional Status

Lack of knowledge about risk factors No formalized screening and assessment Inadequate staff to resident ratios Lack of training in feeding and eating assistance Limited communication between disciplines Lack of understanding of impact of dementia Inattention to the cultural and personal context of

mealtime Lack of social supports

Dementia and Malnutrition

Six factors that predict low food intake Eating difficulty No feeding assistance by caregivers Moderate dependence in activities of daily living Fewer family visits Being female Older age

(Lin Watson amp Wu 2010)

Dementia and Malnutrition

It is estimated that up to 45 of people with dementia living in institutions have swallowing

difficulties (Horner Alberts Dawson amp Cook 1994)

Effects of Increased Assistance

Increases in total daily calorie intake Residents maintain or gain weight Reduced secondary health complications Improved relationship between resident and staff Improved quality of life

Role of Occupational Therapy

OTs and OTAs have foundational skills and knowledge in eating feeding and

swallowing understanding of multidimensional aspects of eating expertise in assessment evaluation and treatment a holistic view to bring to nutritional care

OT Interventions

Attention to psychosocial aspects of dining Environmental modification Adaptive equipment Dysphagia assessment and treatment Positioning Task analysis Residents Staff

Caregiver and dining assistant training Sensory integration issues internal and external

Culture Change

ldquoCulture change is an innovation anchored in values and beliefs that return the locus of control to elders and those who work closest with them Its ultimate vision is to create a culture of aging that is inclusive life-affirming satisfying humane and meaningfulrdquo

(Kantor B amp Planetree amp Picker Institute 2010)

Trends in Culture Change

Emphasis on resident choice and person-centered care as essential components to improve dining experiences

Culture change requires transformation in organizational practices physical environments workplace practices communication and relationships among all stakeholders

Benefits of Culture Change

LTCs who implement cultural changeshellip Improve quality-of-life for residents patients and staff

Increase performance on clinical outcomes

(Planetree amp Picker Institute 2010 Baier Butterfield Harris amp Gravenstei 2008)

Experience positive effects on occupancy rates and the financial bottom line of LTC (Doty Koren amp Sturla 2008 Elliot 2010 LaPorte 2010)

Key Points for Program amp Culture Change

Residents are unique individuals Facility leadership must seek further education Leaders must support the changes in environment Interdisciplinary staff education and training at all

levels Formalize screening and referral process Changes to dining organization and staffing duties Utilize expertise and unique perspective of OT

Future Work

Increase multidisciplinary collaboration

Increase knowledge base for OT through research Design and share educational programs across

disciplines and settings

Future Work

Explore and implement innovative approaches to feeding and eating assistance

Design programs specific to the dining experience of persons with dementia or cognitive impairment

Advocate with government and industry to promote

person centered care in LTC

Education is Key to Change

Industry leaders nursing home administrators and management need to be educated about the extent of malnutrition in nursing homes

There is a need for educational plans and instructional materials on preventing and treating malnutrition in LTC

Healthcare providers must take time to advocate with facilities and present educational workshops

Recognizing and preventing malnutrition in nursing homes

A teaching plan was developed and incorporated into

the coursework for the OTD 610 Practitioner as Educator course at Pacific University

An extensive literature review has been created to provide evidence and foundational knowledge for healthcare providers LTC administrators and stakeholders

Purpose

Educate skilled nursing facility administrators and management about effects of poor nutritional status skilled OT assessment analysis and Interventions improving nutritional status of residents enhancing the dining experience improving staff effectiveness and efficiency

Program Goal

LTC administrators and managers will demonstrate basic knowledge of effects of poor nutritional

status describe barriers to providing excellent nutritional care explain how skilled OT services contribute to proving holistic

nutritional care

Teaching Elements

Teaching Session

Lecture- group instruction Printed educational handouts Printed worksheets Interactive activities among learners Small and whole group discussions Self-reflection and sharing Resource table with additional learning tools Short video (added as a result of feedback to pilot

session)

Targeted learners

professionals in health care provision or administration

extensive experience in the long-term healthcare industry in the area of nutrition and dietary food service

men and women multicultural group 30 ndash 60 years of age

Setting

Intended LTC workshop Skilled nursing facility conference room during weekday

business hours

Pilot Group workshop Large open-plan diningliving space with participants around

large oval table

Outcome of Pilot

What would I do differently

Schedule more convenient time

Include more participants

Ask for feedback

More anonymous feedback option

simplify language

Proposed Changes to Workshop

Provide printed quiz to go with handouts Add video component Rework handouts for comprehension and

application to learners needs

Discussion

After learning more about the problem of malnutrition in long-term care are you considering how you might introduce this topic into your practice or your teaching

Are there other venues where this type of educational program is appropriate and might influence the management of nutritional care for elders

Questions

References

Abbasi AA amp Rudman D (1994) Undernutrition in the nursing home Prevalence consequences cause and prevention Nutrition Reviews 52(4) 113-122 Accreditation Council for Occupational Therapy Education (2006) ACOTE standards and interpretive guidelines Retrieved from

httpwwwaotaorgnonmembersarea13docs acotestandards806pdf Adams NE Bowie AJ Simmance N Murrary M amp Crowe T (2008) Recognition by medical and nursing professionals of malnutrition and risk of malnutrition in elderly hospitalised patients Nutrition and Dietetics (65) 144-150 Amella EJ (2002) Resistance at mealtimes for persons with dementia The Journal of Nutrition Health amp Aging 6 117-122 Amella EJ (2008) Mealtime difficulties In Evidence-Based Geriatric Nursing Protocols for Best Practice 3rd ed (Capezuti E Zwicker D Mezey M Fulmer T Gray-Miceli D amp Kluger M eds) Springer Publishing Company LLC New York p 337-351 American Occupational Therapy Association [AOTA] (2002) Occupational therapy practice framework Domain and process American Journal of Occupational Therapy 56

609ndash639 doi 105014ajot566609 AOTA (2007) Specialized knowledge and skills in feeding eating and swallowing for occupational therapy practice American Journal of Occupational Therapy 61(6) 686-700

doi 105014ajot616686 Asai JL (2004) Nutrition and the geriatric rehabilitation patient Challenges and solutions Topics in Geriatric Rehabilitation 20(1) 34-45 Baier RR Butterfield K Harris Y Gravenstein S (2008) Aiming for star performance the relationship between setting targets and improved nursing home quality of

care Journal of the American Medical Directors Association9(8) 594-9 Epub Dolhi C amp Rogers J (2009) Dementia nutrition and self-feeding A systematic review of the literature Occupational Therapy in Health Care 15(3-4) 59-87 Ferri C Prince M Brayne C Brodaty H Fratiglioni L Ganguli M hellip Landry G (2005) Global prevalence of dementia a delphi consensus study Lancet 366 2112-2217 Frisoni G Fanzoni S Rozzini R Ferrucci L Boffelli S amp Trabucchi M (1994) A nutritional index predicting mortality in the nursing home Journal of the American Geriatric Society 42 1167-1172 Furman EF (2006) Under-nutrition in older adults across the continuum of care Journal of Gerontological Nursing 32(1) 22-27 Groher ME amp Crary MA(2010) Dysphagia Clinical Management in Adults and Children Maryland Heights MO Mosby-Elsevier Harris-Kojetin L Sengupta M Park-Lee E Valverde R Long-term care services in the United States 2013 overview National health care statistics reports no 1 Hyattsville MD National Center for Health Statistics 2013

Purpose

This presentation is intended to educate about malnutrition in LTC

introduce elements of a teaching plan and instructional

materials

describe a proposed research project

inspire you to take action

Learning Objectives

By the end of this presentation you should be able to

Identify key signs and symptoms of malnutrition Recall effects of malnutrition on cognition and health Understand how personal institutional and cultural factors

affect an individualrsquos ability to remain nutritionally sound Describe the Role of OT in managing and preventing

malnutrition in LTC residents

Malnutrition in Long-term Care

Malnutrition in LTC is a serious problem Who is at risk Long-term residents Rehabilitation patients

Prevalence

Each day in 2012 there were 1383700 residents in nursing homes (Harris-Kojetin Sengupta Park-Lee amp Valverde 2013)

Between 35 and 85 of older adults in nursing homes experience some level of malnutrition (Furman 2006)

Percentage of adults with dementia and malnutrition in nursing homes range from 14 - 56

Schussler S Dassen T amp Lohrmann C (2014)

Factors in Malnutrition

Natural aging processes Chronic medical conditions Cognitive impairment Disease Injury Frailty Environments

(Scott et al 2006 Thomas Ashmen Morley Evans amp the Council for Nutritional Strategies in Long-Term Care 2000)

Signs and Symptoms

skin breakdown and pressure wounds

anemia fatigue muscle weakness and

wasting dry skin dull dry hair and hair loss conjunctival dryness receding gums or a change in

how their dentures fit

increasing levels of confusion

loss of appetite or interest in mealtimes

loss of sensation (touch taste smell changes in vision)

Consequences of Malnutrition

Secondary health complications Postoperative complications Decreased functional independence Cognitive loss Increased mortality rates Decreased quality of life Increased costs of healthcare

Barriers to Good Nutritional Status

Lack of knowledge about risk factors No formalized screening and assessment Inadequate staff to resident ratios Lack of training in feeding and eating assistance Limited communication between disciplines Lack of understanding of impact of dementia Inattention to the cultural and personal context of

mealtime Lack of social supports

Dementia and Malnutrition

Six factors that predict low food intake Eating difficulty No feeding assistance by caregivers Moderate dependence in activities of daily living Fewer family visits Being female Older age

(Lin Watson amp Wu 2010)

Dementia and Malnutrition

It is estimated that up to 45 of people with dementia living in institutions have swallowing

difficulties (Horner Alberts Dawson amp Cook 1994)

Effects of Increased Assistance

Increases in total daily calorie intake Residents maintain or gain weight Reduced secondary health complications Improved relationship between resident and staff Improved quality of life

Role of Occupational Therapy

OTs and OTAs have foundational skills and knowledge in eating feeding and

swallowing understanding of multidimensional aspects of eating expertise in assessment evaluation and treatment a holistic view to bring to nutritional care

OT Interventions

Attention to psychosocial aspects of dining Environmental modification Adaptive equipment Dysphagia assessment and treatment Positioning Task analysis Residents Staff

Caregiver and dining assistant training Sensory integration issues internal and external

Culture Change

ldquoCulture change is an innovation anchored in values and beliefs that return the locus of control to elders and those who work closest with them Its ultimate vision is to create a culture of aging that is inclusive life-affirming satisfying humane and meaningfulrdquo

(Kantor B amp Planetree amp Picker Institute 2010)

Trends in Culture Change

Emphasis on resident choice and person-centered care as essential components to improve dining experiences

Culture change requires transformation in organizational practices physical environments workplace practices communication and relationships among all stakeholders

Benefits of Culture Change

LTCs who implement cultural changeshellip Improve quality-of-life for residents patients and staff

Increase performance on clinical outcomes

(Planetree amp Picker Institute 2010 Baier Butterfield Harris amp Gravenstei 2008)

Experience positive effects on occupancy rates and the financial bottom line of LTC (Doty Koren amp Sturla 2008 Elliot 2010 LaPorte 2010)

Key Points for Program amp Culture Change

Residents are unique individuals Facility leadership must seek further education Leaders must support the changes in environment Interdisciplinary staff education and training at all

levels Formalize screening and referral process Changes to dining organization and staffing duties Utilize expertise and unique perspective of OT

Future Work

Increase multidisciplinary collaboration

Increase knowledge base for OT through research Design and share educational programs across

disciplines and settings

Future Work

Explore and implement innovative approaches to feeding and eating assistance

Design programs specific to the dining experience of persons with dementia or cognitive impairment

Advocate with government and industry to promote

person centered care in LTC

Education is Key to Change

Industry leaders nursing home administrators and management need to be educated about the extent of malnutrition in nursing homes

There is a need for educational plans and instructional materials on preventing and treating malnutrition in LTC

Healthcare providers must take time to advocate with facilities and present educational workshops

Recognizing and preventing malnutrition in nursing homes

A teaching plan was developed and incorporated into

the coursework for the OTD 610 Practitioner as Educator course at Pacific University

An extensive literature review has been created to provide evidence and foundational knowledge for healthcare providers LTC administrators and stakeholders

Purpose

Educate skilled nursing facility administrators and management about effects of poor nutritional status skilled OT assessment analysis and Interventions improving nutritional status of residents enhancing the dining experience improving staff effectiveness and efficiency

Program Goal

LTC administrators and managers will demonstrate basic knowledge of effects of poor nutritional

status describe barriers to providing excellent nutritional care explain how skilled OT services contribute to proving holistic

nutritional care

Teaching Elements

Teaching Session

Lecture- group instruction Printed educational handouts Printed worksheets Interactive activities among learners Small and whole group discussions Self-reflection and sharing Resource table with additional learning tools Short video (added as a result of feedback to pilot

session)

Targeted learners

professionals in health care provision or administration

extensive experience in the long-term healthcare industry in the area of nutrition and dietary food service

men and women multicultural group 30 ndash 60 years of age

Setting

Intended LTC workshop Skilled nursing facility conference room during weekday

business hours

Pilot Group workshop Large open-plan diningliving space with participants around

large oval table

Outcome of Pilot

What would I do differently

Schedule more convenient time

Include more participants

Ask for feedback

More anonymous feedback option

simplify language

Proposed Changes to Workshop

Provide printed quiz to go with handouts Add video component Rework handouts for comprehension and

application to learners needs

Discussion

After learning more about the problem of malnutrition in long-term care are you considering how you might introduce this topic into your practice or your teaching

Are there other venues where this type of educational program is appropriate and might influence the management of nutritional care for elders

Questions

References

Abbasi AA amp Rudman D (1994) Undernutrition in the nursing home Prevalence consequences cause and prevention Nutrition Reviews 52(4) 113-122 Accreditation Council for Occupational Therapy Education (2006) ACOTE standards and interpretive guidelines Retrieved from

httpwwwaotaorgnonmembersarea13docs acotestandards806pdf Adams NE Bowie AJ Simmance N Murrary M amp Crowe T (2008) Recognition by medical and nursing professionals of malnutrition and risk of malnutrition in elderly hospitalised patients Nutrition and Dietetics (65) 144-150 Amella EJ (2002) Resistance at mealtimes for persons with dementia The Journal of Nutrition Health amp Aging 6 117-122 Amella EJ (2008) Mealtime difficulties In Evidence-Based Geriatric Nursing Protocols for Best Practice 3rd ed (Capezuti E Zwicker D Mezey M Fulmer T Gray-Miceli D amp Kluger M eds) Springer Publishing Company LLC New York p 337-351 American Occupational Therapy Association [AOTA] (2002) Occupational therapy practice framework Domain and process American Journal of Occupational Therapy 56

609ndash639 doi 105014ajot566609 AOTA (2007) Specialized knowledge and skills in feeding eating and swallowing for occupational therapy practice American Journal of Occupational Therapy 61(6) 686-700

doi 105014ajot616686 Asai JL (2004) Nutrition and the geriatric rehabilitation patient Challenges and solutions Topics in Geriatric Rehabilitation 20(1) 34-45 Baier RR Butterfield K Harris Y Gravenstein S (2008) Aiming for star performance the relationship between setting targets and improved nursing home quality of

care Journal of the American Medical Directors Association9(8) 594-9 Epub Dolhi C amp Rogers J (2009) Dementia nutrition and self-feeding A systematic review of the literature Occupational Therapy in Health Care 15(3-4) 59-87 Ferri C Prince M Brayne C Brodaty H Fratiglioni L Ganguli M hellip Landry G (2005) Global prevalence of dementia a delphi consensus study Lancet 366 2112-2217 Frisoni G Fanzoni S Rozzini R Ferrucci L Boffelli S amp Trabucchi M (1994) A nutritional index predicting mortality in the nursing home Journal of the American Geriatric Society 42 1167-1172 Furman EF (2006) Under-nutrition in older adults across the continuum of care Journal of Gerontological Nursing 32(1) 22-27 Groher ME amp Crary MA(2010) Dysphagia Clinical Management in Adults and Children Maryland Heights MO Mosby-Elsevier Harris-Kojetin L Sengupta M Park-Lee E Valverde R Long-term care services in the United States 2013 overview National health care statistics reports no 1 Hyattsville MD National Center for Health Statistics 2013

Learning Objectives

By the end of this presentation you should be able to

Identify key signs and symptoms of malnutrition Recall effects of malnutrition on cognition and health Understand how personal institutional and cultural factors

affect an individualrsquos ability to remain nutritionally sound Describe the Role of OT in managing and preventing

malnutrition in LTC residents

Malnutrition in Long-term Care

Malnutrition in LTC is a serious problem Who is at risk Long-term residents Rehabilitation patients

Prevalence

Each day in 2012 there were 1383700 residents in nursing homes (Harris-Kojetin Sengupta Park-Lee amp Valverde 2013)

Between 35 and 85 of older adults in nursing homes experience some level of malnutrition (Furman 2006)

Percentage of adults with dementia and malnutrition in nursing homes range from 14 - 56

Schussler S Dassen T amp Lohrmann C (2014)

Factors in Malnutrition

Natural aging processes Chronic medical conditions Cognitive impairment Disease Injury Frailty Environments

(Scott et al 2006 Thomas Ashmen Morley Evans amp the Council for Nutritional Strategies in Long-Term Care 2000)

Signs and Symptoms

skin breakdown and pressure wounds

anemia fatigue muscle weakness and

wasting dry skin dull dry hair and hair loss conjunctival dryness receding gums or a change in

how their dentures fit

increasing levels of confusion

loss of appetite or interest in mealtimes

loss of sensation (touch taste smell changes in vision)

Consequences of Malnutrition

Secondary health complications Postoperative complications Decreased functional independence Cognitive loss Increased mortality rates Decreased quality of life Increased costs of healthcare

Barriers to Good Nutritional Status

Lack of knowledge about risk factors No formalized screening and assessment Inadequate staff to resident ratios Lack of training in feeding and eating assistance Limited communication between disciplines Lack of understanding of impact of dementia Inattention to the cultural and personal context of

mealtime Lack of social supports

Dementia and Malnutrition

Six factors that predict low food intake Eating difficulty No feeding assistance by caregivers Moderate dependence in activities of daily living Fewer family visits Being female Older age

(Lin Watson amp Wu 2010)

Dementia and Malnutrition

It is estimated that up to 45 of people with dementia living in institutions have swallowing

difficulties (Horner Alberts Dawson amp Cook 1994)

Effects of Increased Assistance

Increases in total daily calorie intake Residents maintain or gain weight Reduced secondary health complications Improved relationship between resident and staff Improved quality of life

Role of Occupational Therapy

OTs and OTAs have foundational skills and knowledge in eating feeding and

swallowing understanding of multidimensional aspects of eating expertise in assessment evaluation and treatment a holistic view to bring to nutritional care

OT Interventions

Attention to psychosocial aspects of dining Environmental modification Adaptive equipment Dysphagia assessment and treatment Positioning Task analysis Residents Staff

Caregiver and dining assistant training Sensory integration issues internal and external

Culture Change

ldquoCulture change is an innovation anchored in values and beliefs that return the locus of control to elders and those who work closest with them Its ultimate vision is to create a culture of aging that is inclusive life-affirming satisfying humane and meaningfulrdquo

(Kantor B amp Planetree amp Picker Institute 2010)

Trends in Culture Change

Emphasis on resident choice and person-centered care as essential components to improve dining experiences

Culture change requires transformation in organizational practices physical environments workplace practices communication and relationships among all stakeholders

Benefits of Culture Change

LTCs who implement cultural changeshellip Improve quality-of-life for residents patients and staff

Increase performance on clinical outcomes

(Planetree amp Picker Institute 2010 Baier Butterfield Harris amp Gravenstei 2008)

Experience positive effects on occupancy rates and the financial bottom line of LTC (Doty Koren amp Sturla 2008 Elliot 2010 LaPorte 2010)

Key Points for Program amp Culture Change

Residents are unique individuals Facility leadership must seek further education Leaders must support the changes in environment Interdisciplinary staff education and training at all

levels Formalize screening and referral process Changes to dining organization and staffing duties Utilize expertise and unique perspective of OT

Future Work

Increase multidisciplinary collaboration

Increase knowledge base for OT through research Design and share educational programs across

disciplines and settings

Future Work

Explore and implement innovative approaches to feeding and eating assistance

Design programs specific to the dining experience of persons with dementia or cognitive impairment

Advocate with government and industry to promote

person centered care in LTC

Education is Key to Change

Industry leaders nursing home administrators and management need to be educated about the extent of malnutrition in nursing homes

There is a need for educational plans and instructional materials on preventing and treating malnutrition in LTC

Healthcare providers must take time to advocate with facilities and present educational workshops

Recognizing and preventing malnutrition in nursing homes

A teaching plan was developed and incorporated into

the coursework for the OTD 610 Practitioner as Educator course at Pacific University

An extensive literature review has been created to provide evidence and foundational knowledge for healthcare providers LTC administrators and stakeholders

Purpose

Educate skilled nursing facility administrators and management about effects of poor nutritional status skilled OT assessment analysis and Interventions improving nutritional status of residents enhancing the dining experience improving staff effectiveness and efficiency

Program Goal

LTC administrators and managers will demonstrate basic knowledge of effects of poor nutritional

status describe barriers to providing excellent nutritional care explain how skilled OT services contribute to proving holistic

nutritional care

Teaching Elements

Teaching Session

Lecture- group instruction Printed educational handouts Printed worksheets Interactive activities among learners Small and whole group discussions Self-reflection and sharing Resource table with additional learning tools Short video (added as a result of feedback to pilot

session)

Targeted learners

professionals in health care provision or administration

extensive experience in the long-term healthcare industry in the area of nutrition and dietary food service

men and women multicultural group 30 ndash 60 years of age

Setting

Intended LTC workshop Skilled nursing facility conference room during weekday

business hours

Pilot Group workshop Large open-plan diningliving space with participants around

large oval table

Outcome of Pilot

What would I do differently

Schedule more convenient time

Include more participants

Ask for feedback

More anonymous feedback option

simplify language

Proposed Changes to Workshop

Provide printed quiz to go with handouts Add video component Rework handouts for comprehension and

application to learners needs

Discussion

After learning more about the problem of malnutrition in long-term care are you considering how you might introduce this topic into your practice or your teaching

Are there other venues where this type of educational program is appropriate and might influence the management of nutritional care for elders

Questions

References

Abbasi AA amp Rudman D (1994) Undernutrition in the nursing home Prevalence consequences cause and prevention Nutrition Reviews 52(4) 113-122 Accreditation Council for Occupational Therapy Education (2006) ACOTE standards and interpretive guidelines Retrieved from

httpwwwaotaorgnonmembersarea13docs acotestandards806pdf Adams NE Bowie AJ Simmance N Murrary M amp Crowe T (2008) Recognition by medical and nursing professionals of malnutrition and risk of malnutrition in elderly hospitalised patients Nutrition and Dietetics (65) 144-150 Amella EJ (2002) Resistance at mealtimes for persons with dementia The Journal of Nutrition Health amp Aging 6 117-122 Amella EJ (2008) Mealtime difficulties In Evidence-Based Geriatric Nursing Protocols for Best Practice 3rd ed (Capezuti E Zwicker D Mezey M Fulmer T Gray-Miceli D amp Kluger M eds) Springer Publishing Company LLC New York p 337-351 American Occupational Therapy Association [AOTA] (2002) Occupational therapy practice framework Domain and process American Journal of Occupational Therapy 56

609ndash639 doi 105014ajot566609 AOTA (2007) Specialized knowledge and skills in feeding eating and swallowing for occupational therapy practice American Journal of Occupational Therapy 61(6) 686-700

doi 105014ajot616686 Asai JL (2004) Nutrition and the geriatric rehabilitation patient Challenges and solutions Topics in Geriatric Rehabilitation 20(1) 34-45 Baier RR Butterfield K Harris Y Gravenstein S (2008) Aiming for star performance the relationship between setting targets and improved nursing home quality of

care Journal of the American Medical Directors Association9(8) 594-9 Epub Dolhi C amp Rogers J (2009) Dementia nutrition and self-feeding A systematic review of the literature Occupational Therapy in Health Care 15(3-4) 59-87 Ferri C Prince M Brayne C Brodaty H Fratiglioni L Ganguli M hellip Landry G (2005) Global prevalence of dementia a delphi consensus study Lancet 366 2112-2217 Frisoni G Fanzoni S Rozzini R Ferrucci L Boffelli S amp Trabucchi M (1994) A nutritional index predicting mortality in the nursing home Journal of the American Geriatric Society 42 1167-1172 Furman EF (2006) Under-nutrition in older adults across the continuum of care Journal of Gerontological Nursing 32(1) 22-27 Groher ME amp Crary MA(2010) Dysphagia Clinical Management in Adults and Children Maryland Heights MO Mosby-Elsevier Harris-Kojetin L Sengupta M Park-Lee E Valverde R Long-term care services in the United States 2013 overview National health care statistics reports no 1 Hyattsville MD National Center for Health Statistics 2013

Malnutrition in Long-term Care

Malnutrition in LTC is a serious problem Who is at risk Long-term residents Rehabilitation patients

Prevalence

Each day in 2012 there were 1383700 residents in nursing homes (Harris-Kojetin Sengupta Park-Lee amp Valverde 2013)

Between 35 and 85 of older adults in nursing homes experience some level of malnutrition (Furman 2006)

Percentage of adults with dementia and malnutrition in nursing homes range from 14 - 56

Schussler S Dassen T amp Lohrmann C (2014)

Factors in Malnutrition

Natural aging processes Chronic medical conditions Cognitive impairment Disease Injury Frailty Environments

(Scott et al 2006 Thomas Ashmen Morley Evans amp the Council for Nutritional Strategies in Long-Term Care 2000)

Signs and Symptoms

skin breakdown and pressure wounds

anemia fatigue muscle weakness and

wasting dry skin dull dry hair and hair loss conjunctival dryness receding gums or a change in

how their dentures fit

increasing levels of confusion

loss of appetite or interest in mealtimes

loss of sensation (touch taste smell changes in vision)

Consequences of Malnutrition

Secondary health complications Postoperative complications Decreased functional independence Cognitive loss Increased mortality rates Decreased quality of life Increased costs of healthcare

Barriers to Good Nutritional Status

Lack of knowledge about risk factors No formalized screening and assessment Inadequate staff to resident ratios Lack of training in feeding and eating assistance Limited communication between disciplines Lack of understanding of impact of dementia Inattention to the cultural and personal context of

mealtime Lack of social supports

Dementia and Malnutrition

Six factors that predict low food intake Eating difficulty No feeding assistance by caregivers Moderate dependence in activities of daily living Fewer family visits Being female Older age

(Lin Watson amp Wu 2010)

Dementia and Malnutrition

It is estimated that up to 45 of people with dementia living in institutions have swallowing

difficulties (Horner Alberts Dawson amp Cook 1994)

Effects of Increased Assistance

Increases in total daily calorie intake Residents maintain or gain weight Reduced secondary health complications Improved relationship between resident and staff Improved quality of life

Role of Occupational Therapy

OTs and OTAs have foundational skills and knowledge in eating feeding and

swallowing understanding of multidimensional aspects of eating expertise in assessment evaluation and treatment a holistic view to bring to nutritional care

OT Interventions

Attention to psychosocial aspects of dining Environmental modification Adaptive equipment Dysphagia assessment and treatment Positioning Task analysis Residents Staff

Caregiver and dining assistant training Sensory integration issues internal and external

Culture Change

ldquoCulture change is an innovation anchored in values and beliefs that return the locus of control to elders and those who work closest with them Its ultimate vision is to create a culture of aging that is inclusive life-affirming satisfying humane and meaningfulrdquo

(Kantor B amp Planetree amp Picker Institute 2010)

Trends in Culture Change

Emphasis on resident choice and person-centered care as essential components to improve dining experiences

Culture change requires transformation in organizational practices physical environments workplace practices communication and relationships among all stakeholders

Benefits of Culture Change

LTCs who implement cultural changeshellip Improve quality-of-life for residents patients and staff

Increase performance on clinical outcomes

(Planetree amp Picker Institute 2010 Baier Butterfield Harris amp Gravenstei 2008)

Experience positive effects on occupancy rates and the financial bottom line of LTC (Doty Koren amp Sturla 2008 Elliot 2010 LaPorte 2010)

Key Points for Program amp Culture Change

Residents are unique individuals Facility leadership must seek further education Leaders must support the changes in environment Interdisciplinary staff education and training at all

levels Formalize screening and referral process Changes to dining organization and staffing duties Utilize expertise and unique perspective of OT

Future Work

Increase multidisciplinary collaboration

Increase knowledge base for OT through research Design and share educational programs across

disciplines and settings

Future Work

Explore and implement innovative approaches to feeding and eating assistance

Design programs specific to the dining experience of persons with dementia or cognitive impairment

Advocate with government and industry to promote

person centered care in LTC

Education is Key to Change

Industry leaders nursing home administrators and management need to be educated about the extent of malnutrition in nursing homes

There is a need for educational plans and instructional materials on preventing and treating malnutrition in LTC

Healthcare providers must take time to advocate with facilities and present educational workshops

Recognizing and preventing malnutrition in nursing homes

A teaching plan was developed and incorporated into

the coursework for the OTD 610 Practitioner as Educator course at Pacific University

An extensive literature review has been created to provide evidence and foundational knowledge for healthcare providers LTC administrators and stakeholders

Purpose

Educate skilled nursing facility administrators and management about effects of poor nutritional status skilled OT assessment analysis and Interventions improving nutritional status of residents enhancing the dining experience improving staff effectiveness and efficiency

Program Goal

LTC administrators and managers will demonstrate basic knowledge of effects of poor nutritional

status describe barriers to providing excellent nutritional care explain how skilled OT services contribute to proving holistic

nutritional care

Teaching Elements

Teaching Session

Lecture- group instruction Printed educational handouts Printed worksheets Interactive activities among learners Small and whole group discussions Self-reflection and sharing Resource table with additional learning tools Short video (added as a result of feedback to pilot

session)

Targeted learners

professionals in health care provision or administration

extensive experience in the long-term healthcare industry in the area of nutrition and dietary food service

men and women multicultural group 30 ndash 60 years of age

Setting

Intended LTC workshop Skilled nursing facility conference room during weekday

business hours

Pilot Group workshop Large open-plan diningliving space with participants around

large oval table

Outcome of Pilot

What would I do differently

Schedule more convenient time

Include more participants

Ask for feedback

More anonymous feedback option

simplify language

Proposed Changes to Workshop

Provide printed quiz to go with handouts Add video component Rework handouts for comprehension and

application to learners needs

Discussion

After learning more about the problem of malnutrition in long-term care are you considering how you might introduce this topic into your practice or your teaching

Are there other venues where this type of educational program is appropriate and might influence the management of nutritional care for elders

Questions

References

Abbasi AA amp Rudman D (1994) Undernutrition in the nursing home Prevalence consequences cause and prevention Nutrition Reviews 52(4) 113-122 Accreditation Council for Occupational Therapy Education (2006) ACOTE standards and interpretive guidelines Retrieved from

httpwwwaotaorgnonmembersarea13docs acotestandards806pdf Adams NE Bowie AJ Simmance N Murrary M amp Crowe T (2008) Recognition by medical and nursing professionals of malnutrition and risk of malnutrition in elderly hospitalised patients Nutrition and Dietetics (65) 144-150 Amella EJ (2002) Resistance at mealtimes for persons with dementia The Journal of Nutrition Health amp Aging 6 117-122 Amella EJ (2008) Mealtime difficulties In Evidence-Based Geriatric Nursing Protocols for Best Practice 3rd ed (Capezuti E Zwicker D Mezey M Fulmer T Gray-Miceli D amp Kluger M eds) Springer Publishing Company LLC New York p 337-351 American Occupational Therapy Association [AOTA] (2002) Occupational therapy practice framework Domain and process American Journal of Occupational Therapy 56

609ndash639 doi 105014ajot566609 AOTA (2007) Specialized knowledge and skills in feeding eating and swallowing for occupational therapy practice American Journal of Occupational Therapy 61(6) 686-700

doi 105014ajot616686 Asai JL (2004) Nutrition and the geriatric rehabilitation patient Challenges and solutions Topics in Geriatric Rehabilitation 20(1) 34-45 Baier RR Butterfield K Harris Y Gravenstein S (2008) Aiming for star performance the relationship between setting targets and improved nursing home quality of

care Journal of the American Medical Directors Association9(8) 594-9 Epub Dolhi C amp Rogers J (2009) Dementia nutrition and self-feeding A systematic review of the literature Occupational Therapy in Health Care 15(3-4) 59-87 Ferri C Prince M Brayne C Brodaty H Fratiglioni L Ganguli M hellip Landry G (2005) Global prevalence of dementia a delphi consensus study Lancet 366 2112-2217 Frisoni G Fanzoni S Rozzini R Ferrucci L Boffelli S amp Trabucchi M (1994) A nutritional index predicting mortality in the nursing home Journal of the American Geriatric Society 42 1167-1172 Furman EF (2006) Under-nutrition in older adults across the continuum of care Journal of Gerontological Nursing 32(1) 22-27 Groher ME amp Crary MA(2010) Dysphagia Clinical Management in Adults and Children Maryland Heights MO Mosby-Elsevier Harris-Kojetin L Sengupta M Park-Lee E Valverde R Long-term care services in the United States 2013 overview National health care statistics reports no 1 Hyattsville MD National Center for Health Statistics 2013

Prevalence

Each day in 2012 there were 1383700 residents in nursing homes (Harris-Kojetin Sengupta Park-Lee amp Valverde 2013)

Between 35 and 85 of older adults in nursing homes experience some level of malnutrition (Furman 2006)

Percentage of adults with dementia and malnutrition in nursing homes range from 14 - 56

Schussler S Dassen T amp Lohrmann C (2014)

Factors in Malnutrition

Natural aging processes Chronic medical conditions Cognitive impairment Disease Injury Frailty Environments

(Scott et al 2006 Thomas Ashmen Morley Evans amp the Council for Nutritional Strategies in Long-Term Care 2000)

Signs and Symptoms

skin breakdown and pressure wounds

anemia fatigue muscle weakness and

wasting dry skin dull dry hair and hair loss conjunctival dryness receding gums or a change in

how their dentures fit

increasing levels of confusion

loss of appetite or interest in mealtimes

loss of sensation (touch taste smell changes in vision)

Consequences of Malnutrition

Secondary health complications Postoperative complications Decreased functional independence Cognitive loss Increased mortality rates Decreased quality of life Increased costs of healthcare

Barriers to Good Nutritional Status

Lack of knowledge about risk factors No formalized screening and assessment Inadequate staff to resident ratios Lack of training in feeding and eating assistance Limited communication between disciplines Lack of understanding of impact of dementia Inattention to the cultural and personal context of

mealtime Lack of social supports

Dementia and Malnutrition

Six factors that predict low food intake Eating difficulty No feeding assistance by caregivers Moderate dependence in activities of daily living Fewer family visits Being female Older age

(Lin Watson amp Wu 2010)

Dementia and Malnutrition

It is estimated that up to 45 of people with dementia living in institutions have swallowing

difficulties (Horner Alberts Dawson amp Cook 1994)

Effects of Increased Assistance

Increases in total daily calorie intake Residents maintain or gain weight Reduced secondary health complications Improved relationship between resident and staff Improved quality of life

Role of Occupational Therapy

OTs and OTAs have foundational skills and knowledge in eating feeding and

swallowing understanding of multidimensional aspects of eating expertise in assessment evaluation and treatment a holistic view to bring to nutritional care

OT Interventions

Attention to psychosocial aspects of dining Environmental modification Adaptive equipment Dysphagia assessment and treatment Positioning Task analysis Residents Staff

Caregiver and dining assistant training Sensory integration issues internal and external

Culture Change

ldquoCulture change is an innovation anchored in values and beliefs that return the locus of control to elders and those who work closest with them Its ultimate vision is to create a culture of aging that is inclusive life-affirming satisfying humane and meaningfulrdquo

(Kantor B amp Planetree amp Picker Institute 2010)

Trends in Culture Change

Emphasis on resident choice and person-centered care as essential components to improve dining experiences

Culture change requires transformation in organizational practices physical environments workplace practices communication and relationships among all stakeholders

Benefits of Culture Change

LTCs who implement cultural changeshellip Improve quality-of-life for residents patients and staff

Increase performance on clinical outcomes

(Planetree amp Picker Institute 2010 Baier Butterfield Harris amp Gravenstei 2008)

Experience positive effects on occupancy rates and the financial bottom line of LTC (Doty Koren amp Sturla 2008 Elliot 2010 LaPorte 2010)

Key Points for Program amp Culture Change

Residents are unique individuals Facility leadership must seek further education Leaders must support the changes in environment Interdisciplinary staff education and training at all

levels Formalize screening and referral process Changes to dining organization and staffing duties Utilize expertise and unique perspective of OT

Future Work

Increase multidisciplinary collaboration

Increase knowledge base for OT through research Design and share educational programs across

disciplines and settings

Future Work

Explore and implement innovative approaches to feeding and eating assistance

Design programs specific to the dining experience of persons with dementia or cognitive impairment

Advocate with government and industry to promote

person centered care in LTC

Education is Key to Change

Industry leaders nursing home administrators and management need to be educated about the extent of malnutrition in nursing homes

There is a need for educational plans and instructional materials on preventing and treating malnutrition in LTC

Healthcare providers must take time to advocate with facilities and present educational workshops

Recognizing and preventing malnutrition in nursing homes

A teaching plan was developed and incorporated into

the coursework for the OTD 610 Practitioner as Educator course at Pacific University

An extensive literature review has been created to provide evidence and foundational knowledge for healthcare providers LTC administrators and stakeholders

Purpose

Educate skilled nursing facility administrators and management about effects of poor nutritional status skilled OT assessment analysis and Interventions improving nutritional status of residents enhancing the dining experience improving staff effectiveness and efficiency

Program Goal

LTC administrators and managers will demonstrate basic knowledge of effects of poor nutritional

status describe barriers to providing excellent nutritional care explain how skilled OT services contribute to proving holistic

nutritional care

Teaching Elements

Teaching Session

Lecture- group instruction Printed educational handouts Printed worksheets Interactive activities among learners Small and whole group discussions Self-reflection and sharing Resource table with additional learning tools Short video (added as a result of feedback to pilot

session)

Targeted learners

professionals in health care provision or administration

extensive experience in the long-term healthcare industry in the area of nutrition and dietary food service

men and women multicultural group 30 ndash 60 years of age

Setting

Intended LTC workshop Skilled nursing facility conference room during weekday

business hours

Pilot Group workshop Large open-plan diningliving space with participants around

large oval table

Outcome of Pilot

What would I do differently

Schedule more convenient time

Include more participants

Ask for feedback

More anonymous feedback option

simplify language

Proposed Changes to Workshop

Provide printed quiz to go with handouts Add video component Rework handouts for comprehension and

application to learners needs

Discussion

After learning more about the problem of malnutrition in long-term care are you considering how you might introduce this topic into your practice or your teaching

Are there other venues where this type of educational program is appropriate and might influence the management of nutritional care for elders

Questions

References

Abbasi AA amp Rudman D (1994) Undernutrition in the nursing home Prevalence consequences cause and prevention Nutrition Reviews 52(4) 113-122 Accreditation Council for Occupational Therapy Education (2006) ACOTE standards and interpretive guidelines Retrieved from

httpwwwaotaorgnonmembersarea13docs acotestandards806pdf Adams NE Bowie AJ Simmance N Murrary M amp Crowe T (2008) Recognition by medical and nursing professionals of malnutrition and risk of malnutrition in elderly hospitalised patients Nutrition and Dietetics (65) 144-150 Amella EJ (2002) Resistance at mealtimes for persons with dementia The Journal of Nutrition Health amp Aging 6 117-122 Amella EJ (2008) Mealtime difficulties In Evidence-Based Geriatric Nursing Protocols for Best Practice 3rd ed (Capezuti E Zwicker D Mezey M Fulmer T Gray-Miceli D amp Kluger M eds) Springer Publishing Company LLC New York p 337-351 American Occupational Therapy Association [AOTA] (2002) Occupational therapy practice framework Domain and process American Journal of Occupational Therapy 56

609ndash639 doi 105014ajot566609 AOTA (2007) Specialized knowledge and skills in feeding eating and swallowing for occupational therapy practice American Journal of Occupational Therapy 61(6) 686-700

doi 105014ajot616686 Asai JL (2004) Nutrition and the geriatric rehabilitation patient Challenges and solutions Topics in Geriatric Rehabilitation 20(1) 34-45 Baier RR Butterfield K Harris Y Gravenstein S (2008) Aiming for star performance the relationship between setting targets and improved nursing home quality of

care Journal of the American Medical Directors Association9(8) 594-9 Epub Dolhi C amp Rogers J (2009) Dementia nutrition and self-feeding A systematic review of the literature Occupational Therapy in Health Care 15(3-4) 59-87 Ferri C Prince M Brayne C Brodaty H Fratiglioni L Ganguli M hellip Landry G (2005) Global prevalence of dementia a delphi consensus study Lancet 366 2112-2217 Frisoni G Fanzoni S Rozzini R Ferrucci L Boffelli S amp Trabucchi M (1994) A nutritional index predicting mortality in the nursing home Journal of the American Geriatric Society 42 1167-1172 Furman EF (2006) Under-nutrition in older adults across the continuum of care Journal of Gerontological Nursing 32(1) 22-27 Groher ME amp Crary MA(2010) Dysphagia Clinical Management in Adults and Children Maryland Heights MO Mosby-Elsevier Harris-Kojetin L Sengupta M Park-Lee E Valverde R Long-term care services in the United States 2013 overview National health care statistics reports no 1 Hyattsville MD National Center for Health Statistics 2013

Factors in Malnutrition

Natural aging processes Chronic medical conditions Cognitive impairment Disease Injury Frailty Environments

(Scott et al 2006 Thomas Ashmen Morley Evans amp the Council for Nutritional Strategies in Long-Term Care 2000)

Signs and Symptoms

skin breakdown and pressure wounds

anemia fatigue muscle weakness and

wasting dry skin dull dry hair and hair loss conjunctival dryness receding gums or a change in

how their dentures fit

increasing levels of confusion

loss of appetite or interest in mealtimes

loss of sensation (touch taste smell changes in vision)

Consequences of Malnutrition

Secondary health complications Postoperative complications Decreased functional independence Cognitive loss Increased mortality rates Decreased quality of life Increased costs of healthcare

Barriers to Good Nutritional Status

Lack of knowledge about risk factors No formalized screening and assessment Inadequate staff to resident ratios Lack of training in feeding and eating assistance Limited communication between disciplines Lack of understanding of impact of dementia Inattention to the cultural and personal context of

mealtime Lack of social supports

Dementia and Malnutrition

Six factors that predict low food intake Eating difficulty No feeding assistance by caregivers Moderate dependence in activities of daily living Fewer family visits Being female Older age

(Lin Watson amp Wu 2010)

Dementia and Malnutrition

It is estimated that up to 45 of people with dementia living in institutions have swallowing

difficulties (Horner Alberts Dawson amp Cook 1994)

Effects of Increased Assistance

Increases in total daily calorie intake Residents maintain or gain weight Reduced secondary health complications Improved relationship between resident and staff Improved quality of life

Role of Occupational Therapy

OTs and OTAs have foundational skills and knowledge in eating feeding and

swallowing understanding of multidimensional aspects of eating expertise in assessment evaluation and treatment a holistic view to bring to nutritional care

OT Interventions

Attention to psychosocial aspects of dining Environmental modification Adaptive equipment Dysphagia assessment and treatment Positioning Task analysis Residents Staff

Caregiver and dining assistant training Sensory integration issues internal and external

Culture Change

ldquoCulture change is an innovation anchored in values and beliefs that return the locus of control to elders and those who work closest with them Its ultimate vision is to create a culture of aging that is inclusive life-affirming satisfying humane and meaningfulrdquo

(Kantor B amp Planetree amp Picker Institute 2010)

Trends in Culture Change

Emphasis on resident choice and person-centered care as essential components to improve dining experiences

Culture change requires transformation in organizational practices physical environments workplace practices communication and relationships among all stakeholders

Benefits of Culture Change

LTCs who implement cultural changeshellip Improve quality-of-life for residents patients and staff

Increase performance on clinical outcomes

(Planetree amp Picker Institute 2010 Baier Butterfield Harris amp Gravenstei 2008)

Experience positive effects on occupancy rates and the financial bottom line of LTC (Doty Koren amp Sturla 2008 Elliot 2010 LaPorte 2010)

Key Points for Program amp Culture Change

Residents are unique individuals Facility leadership must seek further education Leaders must support the changes in environment Interdisciplinary staff education and training at all

levels Formalize screening and referral process Changes to dining organization and staffing duties Utilize expertise and unique perspective of OT

Future Work

Increase multidisciplinary collaboration

Increase knowledge base for OT through research Design and share educational programs across

disciplines and settings

Future Work

Explore and implement innovative approaches to feeding and eating assistance

Design programs specific to the dining experience of persons with dementia or cognitive impairment

Advocate with government and industry to promote

person centered care in LTC

Education is Key to Change

Industry leaders nursing home administrators and management need to be educated about the extent of malnutrition in nursing homes

There is a need for educational plans and instructional materials on preventing and treating malnutrition in LTC

Healthcare providers must take time to advocate with facilities and present educational workshops

Recognizing and preventing malnutrition in nursing homes

A teaching plan was developed and incorporated into

the coursework for the OTD 610 Practitioner as Educator course at Pacific University

An extensive literature review has been created to provide evidence and foundational knowledge for healthcare providers LTC administrators and stakeholders

Purpose

Educate skilled nursing facility administrators and management about effects of poor nutritional status skilled OT assessment analysis and Interventions improving nutritional status of residents enhancing the dining experience improving staff effectiveness and efficiency

Program Goal

LTC administrators and managers will demonstrate basic knowledge of effects of poor nutritional

status describe barriers to providing excellent nutritional care explain how skilled OT services contribute to proving holistic

nutritional care

Teaching Elements

Teaching Session

Lecture- group instruction Printed educational handouts Printed worksheets Interactive activities among learners Small and whole group discussions Self-reflection and sharing Resource table with additional learning tools Short video (added as a result of feedback to pilot

session)

Targeted learners

professionals in health care provision or administration

extensive experience in the long-term healthcare industry in the area of nutrition and dietary food service

men and women multicultural group 30 ndash 60 years of age

Setting

Intended LTC workshop Skilled nursing facility conference room during weekday

business hours

Pilot Group workshop Large open-plan diningliving space with participants around

large oval table

Outcome of Pilot

What would I do differently

Schedule more convenient time

Include more participants

Ask for feedback

More anonymous feedback option

simplify language

Proposed Changes to Workshop

Provide printed quiz to go with handouts Add video component Rework handouts for comprehension and

application to learners needs

Discussion

After learning more about the problem of malnutrition in long-term care are you considering how you might introduce this topic into your practice or your teaching

Are there other venues where this type of educational program is appropriate and might influence the management of nutritional care for elders

Questions

References

Abbasi AA amp Rudman D (1994) Undernutrition in the nursing home Prevalence consequences cause and prevention Nutrition Reviews 52(4) 113-122 Accreditation Council for Occupational Therapy Education (2006) ACOTE standards and interpretive guidelines Retrieved from

httpwwwaotaorgnonmembersarea13docs acotestandards806pdf Adams NE Bowie AJ Simmance N Murrary M amp Crowe T (2008) Recognition by medical and nursing professionals of malnutrition and risk of malnutrition in elderly hospitalised patients Nutrition and Dietetics (65) 144-150 Amella EJ (2002) Resistance at mealtimes for persons with dementia The Journal of Nutrition Health amp Aging 6 117-122 Amella EJ (2008) Mealtime difficulties In Evidence-Based Geriatric Nursing Protocols for Best Practice 3rd ed (Capezuti E Zwicker D Mezey M Fulmer T Gray-Miceli D amp Kluger M eds) Springer Publishing Company LLC New York p 337-351 American Occupational Therapy Association [AOTA] (2002) Occupational therapy practice framework Domain and process American Journal of Occupational Therapy 56

609ndash639 doi 105014ajot566609 AOTA (2007) Specialized knowledge and skills in feeding eating and swallowing for occupational therapy practice American Journal of Occupational Therapy 61(6) 686-700

doi 105014ajot616686 Asai JL (2004) Nutrition and the geriatric rehabilitation patient Challenges and solutions Topics in Geriatric Rehabilitation 20(1) 34-45 Baier RR Butterfield K Harris Y Gravenstein S (2008) Aiming for star performance the relationship between setting targets and improved nursing home quality of

care Journal of the American Medical Directors Association9(8) 594-9 Epub Dolhi C amp Rogers J (2009) Dementia nutrition and self-feeding A systematic review of the literature Occupational Therapy in Health Care 15(3-4) 59-87 Ferri C Prince M Brayne C Brodaty H Fratiglioni L Ganguli M hellip Landry G (2005) Global prevalence of dementia a delphi consensus study Lancet 366 2112-2217 Frisoni G Fanzoni S Rozzini R Ferrucci L Boffelli S amp Trabucchi M (1994) A nutritional index predicting mortality in the nursing home Journal of the American Geriatric Society 42 1167-1172 Furman EF (2006) Under-nutrition in older adults across the continuum of care Journal of Gerontological Nursing 32(1) 22-27 Groher ME amp Crary MA(2010) Dysphagia Clinical Management in Adults and Children Maryland Heights MO Mosby-Elsevier Harris-Kojetin L Sengupta M Park-Lee E Valverde R Long-term care services in the United States 2013 overview National health care statistics reports no 1 Hyattsville MD National Center for Health Statistics 2013

Signs and Symptoms

skin breakdown and pressure wounds

anemia fatigue muscle weakness and

wasting dry skin dull dry hair and hair loss conjunctival dryness receding gums or a change in

how their dentures fit

increasing levels of confusion

loss of appetite or interest in mealtimes

loss of sensation (touch taste smell changes in vision)

Consequences of Malnutrition

Secondary health complications Postoperative complications Decreased functional independence Cognitive loss Increased mortality rates Decreased quality of life Increased costs of healthcare

Barriers to Good Nutritional Status

Lack of knowledge about risk factors No formalized screening and assessment Inadequate staff to resident ratios Lack of training in feeding and eating assistance Limited communication between disciplines Lack of understanding of impact of dementia Inattention to the cultural and personal context of

mealtime Lack of social supports

Dementia and Malnutrition

Six factors that predict low food intake Eating difficulty No feeding assistance by caregivers Moderate dependence in activities of daily living Fewer family visits Being female Older age

(Lin Watson amp Wu 2010)

Dementia and Malnutrition

It is estimated that up to 45 of people with dementia living in institutions have swallowing

difficulties (Horner Alberts Dawson amp Cook 1994)

Effects of Increased Assistance

Increases in total daily calorie intake Residents maintain or gain weight Reduced secondary health complications Improved relationship between resident and staff Improved quality of life

Role of Occupational Therapy

OTs and OTAs have foundational skills and knowledge in eating feeding and

swallowing understanding of multidimensional aspects of eating expertise in assessment evaluation and treatment a holistic view to bring to nutritional care

OT Interventions

Attention to psychosocial aspects of dining Environmental modification Adaptive equipment Dysphagia assessment and treatment Positioning Task analysis Residents Staff

Caregiver and dining assistant training Sensory integration issues internal and external

Culture Change

ldquoCulture change is an innovation anchored in values and beliefs that return the locus of control to elders and those who work closest with them Its ultimate vision is to create a culture of aging that is inclusive life-affirming satisfying humane and meaningfulrdquo

(Kantor B amp Planetree amp Picker Institute 2010)

Trends in Culture Change

Emphasis on resident choice and person-centered care as essential components to improve dining experiences

Culture change requires transformation in organizational practices physical environments workplace practices communication and relationships among all stakeholders

Benefits of Culture Change

LTCs who implement cultural changeshellip Improve quality-of-life for residents patients and staff

Increase performance on clinical outcomes

(Planetree amp Picker Institute 2010 Baier Butterfield Harris amp Gravenstei 2008)

Experience positive effects on occupancy rates and the financial bottom line of LTC (Doty Koren amp Sturla 2008 Elliot 2010 LaPorte 2010)

Key Points for Program amp Culture Change

Residents are unique individuals Facility leadership must seek further education Leaders must support the changes in environment Interdisciplinary staff education and training at all

levels Formalize screening and referral process Changes to dining organization and staffing duties Utilize expertise and unique perspective of OT

Future Work

Increase multidisciplinary collaboration

Increase knowledge base for OT through research Design and share educational programs across

disciplines and settings

Future Work

Explore and implement innovative approaches to feeding and eating assistance

Design programs specific to the dining experience of persons with dementia or cognitive impairment

Advocate with government and industry to promote

person centered care in LTC

Education is Key to Change

Industry leaders nursing home administrators and management need to be educated about the extent of malnutrition in nursing homes

There is a need for educational plans and instructional materials on preventing and treating malnutrition in LTC

Healthcare providers must take time to advocate with facilities and present educational workshops

Recognizing and preventing malnutrition in nursing homes

A teaching plan was developed and incorporated into

the coursework for the OTD 610 Practitioner as Educator course at Pacific University

An extensive literature review has been created to provide evidence and foundational knowledge for healthcare providers LTC administrators and stakeholders

Purpose

Educate skilled nursing facility administrators and management about effects of poor nutritional status skilled OT assessment analysis and Interventions improving nutritional status of residents enhancing the dining experience improving staff effectiveness and efficiency

Program Goal

LTC administrators and managers will demonstrate basic knowledge of effects of poor nutritional

status describe barriers to providing excellent nutritional care explain how skilled OT services contribute to proving holistic

nutritional care

Teaching Elements

Teaching Session

Lecture- group instruction Printed educational handouts Printed worksheets Interactive activities among learners Small and whole group discussions Self-reflection and sharing Resource table with additional learning tools Short video (added as a result of feedback to pilot

session)

Targeted learners

professionals in health care provision or administration

extensive experience in the long-term healthcare industry in the area of nutrition and dietary food service

men and women multicultural group 30 ndash 60 years of age

Setting

Intended LTC workshop Skilled nursing facility conference room during weekday

business hours

Pilot Group workshop Large open-plan diningliving space with participants around

large oval table

Outcome of Pilot

What would I do differently

Schedule more convenient time

Include more participants

Ask for feedback

More anonymous feedback option

simplify language

Proposed Changes to Workshop

Provide printed quiz to go with handouts Add video component Rework handouts for comprehension and

application to learners needs

Discussion

After learning more about the problem of malnutrition in long-term care are you considering how you might introduce this topic into your practice or your teaching

Are there other venues where this type of educational program is appropriate and might influence the management of nutritional care for elders

Questions

References

Abbasi AA amp Rudman D (1994) Undernutrition in the nursing home Prevalence consequences cause and prevention Nutrition Reviews 52(4) 113-122 Accreditation Council for Occupational Therapy Education (2006) ACOTE standards and interpretive guidelines Retrieved from

httpwwwaotaorgnonmembersarea13docs acotestandards806pdf Adams NE Bowie AJ Simmance N Murrary M amp Crowe T (2008) Recognition by medical and nursing professionals of malnutrition and risk of malnutrition in elderly hospitalised patients Nutrition and Dietetics (65) 144-150 Amella EJ (2002) Resistance at mealtimes for persons with dementia The Journal of Nutrition Health amp Aging 6 117-122 Amella EJ (2008) Mealtime difficulties In Evidence-Based Geriatric Nursing Protocols for Best Practice 3rd ed (Capezuti E Zwicker D Mezey M Fulmer T Gray-Miceli D amp Kluger M eds) Springer Publishing Company LLC New York p 337-351 American Occupational Therapy Association [AOTA] (2002) Occupational therapy practice framework Domain and process American Journal of Occupational Therapy 56

609ndash639 doi 105014ajot566609 AOTA (2007) Specialized knowledge and skills in feeding eating and swallowing for occupational therapy practice American Journal of Occupational Therapy 61(6) 686-700

doi 105014ajot616686 Asai JL (2004) Nutrition and the geriatric rehabilitation patient Challenges and solutions Topics in Geriatric Rehabilitation 20(1) 34-45 Baier RR Butterfield K Harris Y Gravenstein S (2008) Aiming for star performance the relationship between setting targets and improved nursing home quality of

care Journal of the American Medical Directors Association9(8) 594-9 Epub Dolhi C amp Rogers J (2009) Dementia nutrition and self-feeding A systematic review of the literature Occupational Therapy in Health Care 15(3-4) 59-87 Ferri C Prince M Brayne C Brodaty H Fratiglioni L Ganguli M hellip Landry G (2005) Global prevalence of dementia a delphi consensus study Lancet 366 2112-2217 Frisoni G Fanzoni S Rozzini R Ferrucci L Boffelli S amp Trabucchi M (1994) A nutritional index predicting mortality in the nursing home Journal of the American Geriatric Society 42 1167-1172 Furman EF (2006) Under-nutrition in older adults across the continuum of care Journal of Gerontological Nursing 32(1) 22-27 Groher ME amp Crary MA(2010) Dysphagia Clinical Management in Adults and Children Maryland Heights MO Mosby-Elsevier Harris-Kojetin L Sengupta M Park-Lee E Valverde R Long-term care services in the United States 2013 overview National health care statistics reports no 1 Hyattsville MD National Center for Health Statistics 2013

Consequences of Malnutrition

Secondary health complications Postoperative complications Decreased functional independence Cognitive loss Increased mortality rates Decreased quality of life Increased costs of healthcare

Barriers to Good Nutritional Status

Lack of knowledge about risk factors No formalized screening and assessment Inadequate staff to resident ratios Lack of training in feeding and eating assistance Limited communication between disciplines Lack of understanding of impact of dementia Inattention to the cultural and personal context of

mealtime Lack of social supports

Dementia and Malnutrition

Six factors that predict low food intake Eating difficulty No feeding assistance by caregivers Moderate dependence in activities of daily living Fewer family visits Being female Older age

(Lin Watson amp Wu 2010)

Dementia and Malnutrition

It is estimated that up to 45 of people with dementia living in institutions have swallowing

difficulties (Horner Alberts Dawson amp Cook 1994)

Effects of Increased Assistance

Increases in total daily calorie intake Residents maintain or gain weight Reduced secondary health complications Improved relationship between resident and staff Improved quality of life

Role of Occupational Therapy

OTs and OTAs have foundational skills and knowledge in eating feeding and

swallowing understanding of multidimensional aspects of eating expertise in assessment evaluation and treatment a holistic view to bring to nutritional care

OT Interventions

Attention to psychosocial aspects of dining Environmental modification Adaptive equipment Dysphagia assessment and treatment Positioning Task analysis Residents Staff

Caregiver and dining assistant training Sensory integration issues internal and external

Culture Change

ldquoCulture change is an innovation anchored in values and beliefs that return the locus of control to elders and those who work closest with them Its ultimate vision is to create a culture of aging that is inclusive life-affirming satisfying humane and meaningfulrdquo

(Kantor B amp Planetree amp Picker Institute 2010)

Trends in Culture Change

Emphasis on resident choice and person-centered care as essential components to improve dining experiences

Culture change requires transformation in organizational practices physical environments workplace practices communication and relationships among all stakeholders

Benefits of Culture Change

LTCs who implement cultural changeshellip Improve quality-of-life for residents patients and staff

Increase performance on clinical outcomes

(Planetree amp Picker Institute 2010 Baier Butterfield Harris amp Gravenstei 2008)

Experience positive effects on occupancy rates and the financial bottom line of LTC (Doty Koren amp Sturla 2008 Elliot 2010 LaPorte 2010)

Key Points for Program amp Culture Change

Residents are unique individuals Facility leadership must seek further education Leaders must support the changes in environment Interdisciplinary staff education and training at all

levels Formalize screening and referral process Changes to dining organization and staffing duties Utilize expertise and unique perspective of OT

Future Work

Increase multidisciplinary collaboration

Increase knowledge base for OT through research Design and share educational programs across

disciplines and settings

Future Work

Explore and implement innovative approaches to feeding and eating assistance

Design programs specific to the dining experience of persons with dementia or cognitive impairment

Advocate with government and industry to promote

person centered care in LTC

Education is Key to Change

Industry leaders nursing home administrators and management need to be educated about the extent of malnutrition in nursing homes

There is a need for educational plans and instructional materials on preventing and treating malnutrition in LTC

Healthcare providers must take time to advocate with facilities and present educational workshops

Recognizing and preventing malnutrition in nursing homes

A teaching plan was developed and incorporated into

the coursework for the OTD 610 Practitioner as Educator course at Pacific University

An extensive literature review has been created to provide evidence and foundational knowledge for healthcare providers LTC administrators and stakeholders

Purpose

Educate skilled nursing facility administrators and management about effects of poor nutritional status skilled OT assessment analysis and Interventions improving nutritional status of residents enhancing the dining experience improving staff effectiveness and efficiency

Program Goal

LTC administrators and managers will demonstrate basic knowledge of effects of poor nutritional

status describe barriers to providing excellent nutritional care explain how skilled OT services contribute to proving holistic

nutritional care

Teaching Elements

Teaching Session

Lecture- group instruction Printed educational handouts Printed worksheets Interactive activities among learners Small and whole group discussions Self-reflection and sharing Resource table with additional learning tools Short video (added as a result of feedback to pilot

session)

Targeted learners

professionals in health care provision or administration

extensive experience in the long-term healthcare industry in the area of nutrition and dietary food service

men and women multicultural group 30 ndash 60 years of age

Setting

Intended LTC workshop Skilled nursing facility conference room during weekday

business hours

Pilot Group workshop Large open-plan diningliving space with participants around

large oval table

Outcome of Pilot

What would I do differently

Schedule more convenient time

Include more participants

Ask for feedback

More anonymous feedback option

simplify language

Proposed Changes to Workshop

Provide printed quiz to go with handouts Add video component Rework handouts for comprehension and

application to learners needs

Discussion

After learning more about the problem of malnutrition in long-term care are you considering how you might introduce this topic into your practice or your teaching

Are there other venues where this type of educational program is appropriate and might influence the management of nutritional care for elders

Questions

References

Abbasi AA amp Rudman D (1994) Undernutrition in the nursing home Prevalence consequences cause and prevention Nutrition Reviews 52(4) 113-122 Accreditation Council for Occupational Therapy Education (2006) ACOTE standards and interpretive guidelines Retrieved from

httpwwwaotaorgnonmembersarea13docs acotestandards806pdf Adams NE Bowie AJ Simmance N Murrary M amp Crowe T (2008) Recognition by medical and nursing professionals of malnutrition and risk of malnutrition in elderly hospitalised patients Nutrition and Dietetics (65) 144-150 Amella EJ (2002) Resistance at mealtimes for persons with dementia The Journal of Nutrition Health amp Aging 6 117-122 Amella EJ (2008) Mealtime difficulties In Evidence-Based Geriatric Nursing Protocols for Best Practice 3rd ed (Capezuti E Zwicker D Mezey M Fulmer T Gray-Miceli D amp Kluger M eds) Springer Publishing Company LLC New York p 337-351 American Occupational Therapy Association [AOTA] (2002) Occupational therapy practice framework Domain and process American Journal of Occupational Therapy 56

609ndash639 doi 105014ajot566609 AOTA (2007) Specialized knowledge and skills in feeding eating and swallowing for occupational therapy practice American Journal of Occupational Therapy 61(6) 686-700

doi 105014ajot616686 Asai JL (2004) Nutrition and the geriatric rehabilitation patient Challenges and solutions Topics in Geriatric Rehabilitation 20(1) 34-45 Baier RR Butterfield K Harris Y Gravenstein S (2008) Aiming for star performance the relationship between setting targets and improved nursing home quality of

care Journal of the American Medical Directors Association9(8) 594-9 Epub Dolhi C amp Rogers J (2009) Dementia nutrition and self-feeding A systematic review of the literature Occupational Therapy in Health Care 15(3-4) 59-87 Ferri C Prince M Brayne C Brodaty H Fratiglioni L Ganguli M hellip Landry G (2005) Global prevalence of dementia a delphi consensus study Lancet 366 2112-2217 Frisoni G Fanzoni S Rozzini R Ferrucci L Boffelli S amp Trabucchi M (1994) A nutritional index predicting mortality in the nursing home Journal of the American Geriatric Society 42 1167-1172 Furman EF (2006) Under-nutrition in older adults across the continuum of care Journal of Gerontological Nursing 32(1) 22-27 Groher ME amp Crary MA(2010) Dysphagia Clinical Management in Adults and Children Maryland Heights MO Mosby-Elsevier Harris-Kojetin L Sengupta M Park-Lee E Valverde R Long-term care services in the United States 2013 overview National health care statistics reports no 1 Hyattsville MD National Center for Health Statistics 2013

Barriers to Good Nutritional Status

Lack of knowledge about risk factors No formalized screening and assessment Inadequate staff to resident ratios Lack of training in feeding and eating assistance Limited communication between disciplines Lack of understanding of impact of dementia Inattention to the cultural and personal context of

mealtime Lack of social supports

Dementia and Malnutrition

Six factors that predict low food intake Eating difficulty No feeding assistance by caregivers Moderate dependence in activities of daily living Fewer family visits Being female Older age

(Lin Watson amp Wu 2010)

Dementia and Malnutrition

It is estimated that up to 45 of people with dementia living in institutions have swallowing

difficulties (Horner Alberts Dawson amp Cook 1994)

Effects of Increased Assistance

Increases in total daily calorie intake Residents maintain or gain weight Reduced secondary health complications Improved relationship between resident and staff Improved quality of life

Role of Occupational Therapy

OTs and OTAs have foundational skills and knowledge in eating feeding and

swallowing understanding of multidimensional aspects of eating expertise in assessment evaluation and treatment a holistic view to bring to nutritional care

OT Interventions

Attention to psychosocial aspects of dining Environmental modification Adaptive equipment Dysphagia assessment and treatment Positioning Task analysis Residents Staff

Caregiver and dining assistant training Sensory integration issues internal and external

Culture Change

ldquoCulture change is an innovation anchored in values and beliefs that return the locus of control to elders and those who work closest with them Its ultimate vision is to create a culture of aging that is inclusive life-affirming satisfying humane and meaningfulrdquo

(Kantor B amp Planetree amp Picker Institute 2010)

Trends in Culture Change

Emphasis on resident choice and person-centered care as essential components to improve dining experiences

Culture change requires transformation in organizational practices physical environments workplace practices communication and relationships among all stakeholders

Benefits of Culture Change

LTCs who implement cultural changeshellip Improve quality-of-life for residents patients and staff

Increase performance on clinical outcomes

(Planetree amp Picker Institute 2010 Baier Butterfield Harris amp Gravenstei 2008)

Experience positive effects on occupancy rates and the financial bottom line of LTC (Doty Koren amp Sturla 2008 Elliot 2010 LaPorte 2010)

Key Points for Program amp Culture Change

Residents are unique individuals Facility leadership must seek further education Leaders must support the changes in environment Interdisciplinary staff education and training at all

levels Formalize screening and referral process Changes to dining organization and staffing duties Utilize expertise and unique perspective of OT

Future Work

Increase multidisciplinary collaboration

Increase knowledge base for OT through research Design and share educational programs across

disciplines and settings

Future Work

Explore and implement innovative approaches to feeding and eating assistance

Design programs specific to the dining experience of persons with dementia or cognitive impairment

Advocate with government and industry to promote

person centered care in LTC

Education is Key to Change

Industry leaders nursing home administrators and management need to be educated about the extent of malnutrition in nursing homes

There is a need for educational plans and instructional materials on preventing and treating malnutrition in LTC

Healthcare providers must take time to advocate with facilities and present educational workshops

Recognizing and preventing malnutrition in nursing homes

A teaching plan was developed and incorporated into

the coursework for the OTD 610 Practitioner as Educator course at Pacific University

An extensive literature review has been created to provide evidence and foundational knowledge for healthcare providers LTC administrators and stakeholders

Purpose

Educate skilled nursing facility administrators and management about effects of poor nutritional status skilled OT assessment analysis and Interventions improving nutritional status of residents enhancing the dining experience improving staff effectiveness and efficiency

Program Goal

LTC administrators and managers will demonstrate basic knowledge of effects of poor nutritional

status describe barriers to providing excellent nutritional care explain how skilled OT services contribute to proving holistic

nutritional care

Teaching Elements

Teaching Session

Lecture- group instruction Printed educational handouts Printed worksheets Interactive activities among learners Small and whole group discussions Self-reflection and sharing Resource table with additional learning tools Short video (added as a result of feedback to pilot

session)

Targeted learners

professionals in health care provision or administration

extensive experience in the long-term healthcare industry in the area of nutrition and dietary food service

men and women multicultural group 30 ndash 60 years of age

Setting

Intended LTC workshop Skilled nursing facility conference room during weekday

business hours

Pilot Group workshop Large open-plan diningliving space with participants around

large oval table

Outcome of Pilot

What would I do differently

Schedule more convenient time

Include more participants

Ask for feedback

More anonymous feedback option

simplify language

Proposed Changes to Workshop

Provide printed quiz to go with handouts Add video component Rework handouts for comprehension and

application to learners needs

Discussion

After learning more about the problem of malnutrition in long-term care are you considering how you might introduce this topic into your practice or your teaching

Are there other venues where this type of educational program is appropriate and might influence the management of nutritional care for elders

Questions

References

Abbasi AA amp Rudman D (1994) Undernutrition in the nursing home Prevalence consequences cause and prevention Nutrition Reviews 52(4) 113-122 Accreditation Council for Occupational Therapy Education (2006) ACOTE standards and interpretive guidelines Retrieved from

httpwwwaotaorgnonmembersarea13docs acotestandards806pdf Adams NE Bowie AJ Simmance N Murrary M amp Crowe T (2008) Recognition by medical and nursing professionals of malnutrition and risk of malnutrition in elderly hospitalised patients Nutrition and Dietetics (65) 144-150 Amella EJ (2002) Resistance at mealtimes for persons with dementia The Journal of Nutrition Health amp Aging 6 117-122 Amella EJ (2008) Mealtime difficulties In Evidence-Based Geriatric Nursing Protocols for Best Practice 3rd ed (Capezuti E Zwicker D Mezey M Fulmer T Gray-Miceli D amp Kluger M eds) Springer Publishing Company LLC New York p 337-351 American Occupational Therapy Association [AOTA] (2002) Occupational therapy practice framework Domain and process American Journal of Occupational Therapy 56

609ndash639 doi 105014ajot566609 AOTA (2007) Specialized knowledge and skills in feeding eating and swallowing for occupational therapy practice American Journal of Occupational Therapy 61(6) 686-700

doi 105014ajot616686 Asai JL (2004) Nutrition and the geriatric rehabilitation patient Challenges and solutions Topics in Geriatric Rehabilitation 20(1) 34-45 Baier RR Butterfield K Harris Y Gravenstein S (2008) Aiming for star performance the relationship between setting targets and improved nursing home quality of

care Journal of the American Medical Directors Association9(8) 594-9 Epub Dolhi C amp Rogers J (2009) Dementia nutrition and self-feeding A systematic review of the literature Occupational Therapy in Health Care 15(3-4) 59-87 Ferri C Prince M Brayne C Brodaty H Fratiglioni L Ganguli M hellip Landry G (2005) Global prevalence of dementia a delphi consensus study Lancet 366 2112-2217 Frisoni G Fanzoni S Rozzini R Ferrucci L Boffelli S amp Trabucchi M (1994) A nutritional index predicting mortality in the nursing home Journal of the American Geriatric Society 42 1167-1172 Furman EF (2006) Under-nutrition in older adults across the continuum of care Journal of Gerontological Nursing 32(1) 22-27 Groher ME amp Crary MA(2010) Dysphagia Clinical Management in Adults and Children Maryland Heights MO Mosby-Elsevier Harris-Kojetin L Sengupta M Park-Lee E Valverde R Long-term care services in the United States 2013 overview National health care statistics reports no 1 Hyattsville MD National Center for Health Statistics 2013

Dementia and Malnutrition

Six factors that predict low food intake Eating difficulty No feeding assistance by caregivers Moderate dependence in activities of daily living Fewer family visits Being female Older age

(Lin Watson amp Wu 2010)

Dementia and Malnutrition

It is estimated that up to 45 of people with dementia living in institutions have swallowing

difficulties (Horner Alberts Dawson amp Cook 1994)

Effects of Increased Assistance

Increases in total daily calorie intake Residents maintain or gain weight Reduced secondary health complications Improved relationship between resident and staff Improved quality of life

Role of Occupational Therapy

OTs and OTAs have foundational skills and knowledge in eating feeding and

swallowing understanding of multidimensional aspects of eating expertise in assessment evaluation and treatment a holistic view to bring to nutritional care

OT Interventions

Attention to psychosocial aspects of dining Environmental modification Adaptive equipment Dysphagia assessment and treatment Positioning Task analysis Residents Staff

Caregiver and dining assistant training Sensory integration issues internal and external

Culture Change

ldquoCulture change is an innovation anchored in values and beliefs that return the locus of control to elders and those who work closest with them Its ultimate vision is to create a culture of aging that is inclusive life-affirming satisfying humane and meaningfulrdquo

(Kantor B amp Planetree amp Picker Institute 2010)

Trends in Culture Change

Emphasis on resident choice and person-centered care as essential components to improve dining experiences

Culture change requires transformation in organizational practices physical environments workplace practices communication and relationships among all stakeholders

Benefits of Culture Change

LTCs who implement cultural changeshellip Improve quality-of-life for residents patients and staff

Increase performance on clinical outcomes

(Planetree amp Picker Institute 2010 Baier Butterfield Harris amp Gravenstei 2008)

Experience positive effects on occupancy rates and the financial bottom line of LTC (Doty Koren amp Sturla 2008 Elliot 2010 LaPorte 2010)

Key Points for Program amp Culture Change

Residents are unique individuals Facility leadership must seek further education Leaders must support the changes in environment Interdisciplinary staff education and training at all

levels Formalize screening and referral process Changes to dining organization and staffing duties Utilize expertise and unique perspective of OT

Future Work

Increase multidisciplinary collaboration

Increase knowledge base for OT through research Design and share educational programs across

disciplines and settings

Future Work

Explore and implement innovative approaches to feeding and eating assistance

Design programs specific to the dining experience of persons with dementia or cognitive impairment

Advocate with government and industry to promote

person centered care in LTC

Education is Key to Change

Industry leaders nursing home administrators and management need to be educated about the extent of malnutrition in nursing homes

There is a need for educational plans and instructional materials on preventing and treating malnutrition in LTC

Healthcare providers must take time to advocate with facilities and present educational workshops

Recognizing and preventing malnutrition in nursing homes

A teaching plan was developed and incorporated into

the coursework for the OTD 610 Practitioner as Educator course at Pacific University

An extensive literature review has been created to provide evidence and foundational knowledge for healthcare providers LTC administrators and stakeholders

Purpose

Educate skilled nursing facility administrators and management about effects of poor nutritional status skilled OT assessment analysis and Interventions improving nutritional status of residents enhancing the dining experience improving staff effectiveness and efficiency

Program Goal

LTC administrators and managers will demonstrate basic knowledge of effects of poor nutritional

status describe barriers to providing excellent nutritional care explain how skilled OT services contribute to proving holistic

nutritional care

Teaching Elements

Teaching Session

Lecture- group instruction Printed educational handouts Printed worksheets Interactive activities among learners Small and whole group discussions Self-reflection and sharing Resource table with additional learning tools Short video (added as a result of feedback to pilot

session)

Targeted learners

professionals in health care provision or administration

extensive experience in the long-term healthcare industry in the area of nutrition and dietary food service

men and women multicultural group 30 ndash 60 years of age

Setting

Intended LTC workshop Skilled nursing facility conference room during weekday

business hours

Pilot Group workshop Large open-plan diningliving space with participants around

large oval table

Outcome of Pilot

What would I do differently

Schedule more convenient time

Include more participants

Ask for feedback

More anonymous feedback option

simplify language

Proposed Changes to Workshop

Provide printed quiz to go with handouts Add video component Rework handouts for comprehension and

application to learners needs

Discussion

After learning more about the problem of malnutrition in long-term care are you considering how you might introduce this topic into your practice or your teaching

Are there other venues where this type of educational program is appropriate and might influence the management of nutritional care for elders

Questions

References

Abbasi AA amp Rudman D (1994) Undernutrition in the nursing home Prevalence consequences cause and prevention Nutrition Reviews 52(4) 113-122 Accreditation Council for Occupational Therapy Education (2006) ACOTE standards and interpretive guidelines Retrieved from

httpwwwaotaorgnonmembersarea13docs acotestandards806pdf Adams NE Bowie AJ Simmance N Murrary M amp Crowe T (2008) Recognition by medical and nursing professionals of malnutrition and risk of malnutrition in elderly hospitalised patients Nutrition and Dietetics (65) 144-150 Amella EJ (2002) Resistance at mealtimes for persons with dementia The Journal of Nutrition Health amp Aging 6 117-122 Amella EJ (2008) Mealtime difficulties In Evidence-Based Geriatric Nursing Protocols for Best Practice 3rd ed (Capezuti E Zwicker D Mezey M Fulmer T Gray-Miceli D amp Kluger M eds) Springer Publishing Company LLC New York p 337-351 American Occupational Therapy Association [AOTA] (2002) Occupational therapy practice framework Domain and process American Journal of Occupational Therapy 56

609ndash639 doi 105014ajot566609 AOTA (2007) Specialized knowledge and skills in feeding eating and swallowing for occupational therapy practice American Journal of Occupational Therapy 61(6) 686-700

doi 105014ajot616686 Asai JL (2004) Nutrition and the geriatric rehabilitation patient Challenges and solutions Topics in Geriatric Rehabilitation 20(1) 34-45 Baier RR Butterfield K Harris Y Gravenstein S (2008) Aiming for star performance the relationship between setting targets and improved nursing home quality of

care Journal of the American Medical Directors Association9(8) 594-9 Epub Dolhi C amp Rogers J (2009) Dementia nutrition and self-feeding A systematic review of the literature Occupational Therapy in Health Care 15(3-4) 59-87 Ferri C Prince M Brayne C Brodaty H Fratiglioni L Ganguli M hellip Landry G (2005) Global prevalence of dementia a delphi consensus study Lancet 366 2112-2217 Frisoni G Fanzoni S Rozzini R Ferrucci L Boffelli S amp Trabucchi M (1994) A nutritional index predicting mortality in the nursing home Journal of the American Geriatric Society 42 1167-1172 Furman EF (2006) Under-nutrition in older adults across the continuum of care Journal of Gerontological Nursing 32(1) 22-27 Groher ME amp Crary MA(2010) Dysphagia Clinical Management in Adults and Children Maryland Heights MO Mosby-Elsevier Harris-Kojetin L Sengupta M Park-Lee E Valverde R Long-term care services in the United States 2013 overview National health care statistics reports no 1 Hyattsville MD National Center for Health Statistics 2013

Dementia and Malnutrition

It is estimated that up to 45 of people with dementia living in institutions have swallowing

difficulties (Horner Alberts Dawson amp Cook 1994)

Effects of Increased Assistance

Increases in total daily calorie intake Residents maintain or gain weight Reduced secondary health complications Improved relationship between resident and staff Improved quality of life

Role of Occupational Therapy

OTs and OTAs have foundational skills and knowledge in eating feeding and

swallowing understanding of multidimensional aspects of eating expertise in assessment evaluation and treatment a holistic view to bring to nutritional care

OT Interventions

Attention to psychosocial aspects of dining Environmental modification Adaptive equipment Dysphagia assessment and treatment Positioning Task analysis Residents Staff

Caregiver and dining assistant training Sensory integration issues internal and external

Culture Change

ldquoCulture change is an innovation anchored in values and beliefs that return the locus of control to elders and those who work closest with them Its ultimate vision is to create a culture of aging that is inclusive life-affirming satisfying humane and meaningfulrdquo

(Kantor B amp Planetree amp Picker Institute 2010)

Trends in Culture Change

Emphasis on resident choice and person-centered care as essential components to improve dining experiences

Culture change requires transformation in organizational practices physical environments workplace practices communication and relationships among all stakeholders

Benefits of Culture Change

LTCs who implement cultural changeshellip Improve quality-of-life for residents patients and staff

Increase performance on clinical outcomes

(Planetree amp Picker Institute 2010 Baier Butterfield Harris amp Gravenstei 2008)

Experience positive effects on occupancy rates and the financial bottom line of LTC (Doty Koren amp Sturla 2008 Elliot 2010 LaPorte 2010)

Key Points for Program amp Culture Change

Residents are unique individuals Facility leadership must seek further education Leaders must support the changes in environment Interdisciplinary staff education and training at all

levels Formalize screening and referral process Changes to dining organization and staffing duties Utilize expertise and unique perspective of OT

Future Work

Increase multidisciplinary collaboration

Increase knowledge base for OT through research Design and share educational programs across

disciplines and settings

Future Work

Explore and implement innovative approaches to feeding and eating assistance

Design programs specific to the dining experience of persons with dementia or cognitive impairment

Advocate with government and industry to promote

person centered care in LTC

Education is Key to Change

Industry leaders nursing home administrators and management need to be educated about the extent of malnutrition in nursing homes

There is a need for educational plans and instructional materials on preventing and treating malnutrition in LTC

Healthcare providers must take time to advocate with facilities and present educational workshops

Recognizing and preventing malnutrition in nursing homes

A teaching plan was developed and incorporated into

the coursework for the OTD 610 Practitioner as Educator course at Pacific University

An extensive literature review has been created to provide evidence and foundational knowledge for healthcare providers LTC administrators and stakeholders

Purpose

Educate skilled nursing facility administrators and management about effects of poor nutritional status skilled OT assessment analysis and Interventions improving nutritional status of residents enhancing the dining experience improving staff effectiveness and efficiency

Program Goal

LTC administrators and managers will demonstrate basic knowledge of effects of poor nutritional

status describe barriers to providing excellent nutritional care explain how skilled OT services contribute to proving holistic

nutritional care

Teaching Elements

Teaching Session

Lecture- group instruction Printed educational handouts Printed worksheets Interactive activities among learners Small and whole group discussions Self-reflection and sharing Resource table with additional learning tools Short video (added as a result of feedback to pilot

session)

Targeted learners

professionals in health care provision or administration

extensive experience in the long-term healthcare industry in the area of nutrition and dietary food service

men and women multicultural group 30 ndash 60 years of age

Setting

Intended LTC workshop Skilled nursing facility conference room during weekday

business hours

Pilot Group workshop Large open-plan diningliving space with participants around

large oval table

Outcome of Pilot

What would I do differently

Schedule more convenient time

Include more participants

Ask for feedback

More anonymous feedback option

simplify language

Proposed Changes to Workshop

Provide printed quiz to go with handouts Add video component Rework handouts for comprehension and

application to learners needs

Discussion

After learning more about the problem of malnutrition in long-term care are you considering how you might introduce this topic into your practice or your teaching

Are there other venues where this type of educational program is appropriate and might influence the management of nutritional care for elders

Questions

References

Abbasi AA amp Rudman D (1994) Undernutrition in the nursing home Prevalence consequences cause and prevention Nutrition Reviews 52(4) 113-122 Accreditation Council for Occupational Therapy Education (2006) ACOTE standards and interpretive guidelines Retrieved from

httpwwwaotaorgnonmembersarea13docs acotestandards806pdf Adams NE Bowie AJ Simmance N Murrary M amp Crowe T (2008) Recognition by medical and nursing professionals of malnutrition and risk of malnutrition in elderly hospitalised patients Nutrition and Dietetics (65) 144-150 Amella EJ (2002) Resistance at mealtimes for persons with dementia The Journal of Nutrition Health amp Aging 6 117-122 Amella EJ (2008) Mealtime difficulties In Evidence-Based Geriatric Nursing Protocols for Best Practice 3rd ed (Capezuti E Zwicker D Mezey M Fulmer T Gray-Miceli D amp Kluger M eds) Springer Publishing Company LLC New York p 337-351 American Occupational Therapy Association [AOTA] (2002) Occupational therapy practice framework Domain and process American Journal of Occupational Therapy 56

609ndash639 doi 105014ajot566609 AOTA (2007) Specialized knowledge and skills in feeding eating and swallowing for occupational therapy practice American Journal of Occupational Therapy 61(6) 686-700

doi 105014ajot616686 Asai JL (2004) Nutrition and the geriatric rehabilitation patient Challenges and solutions Topics in Geriatric Rehabilitation 20(1) 34-45 Baier RR Butterfield K Harris Y Gravenstein S (2008) Aiming for star performance the relationship between setting targets and improved nursing home quality of

care Journal of the American Medical Directors Association9(8) 594-9 Epub Dolhi C amp Rogers J (2009) Dementia nutrition and self-feeding A systematic review of the literature Occupational Therapy in Health Care 15(3-4) 59-87 Ferri C Prince M Brayne C Brodaty H Fratiglioni L Ganguli M hellip Landry G (2005) Global prevalence of dementia a delphi consensus study Lancet 366 2112-2217 Frisoni G Fanzoni S Rozzini R Ferrucci L Boffelli S amp Trabucchi M (1994) A nutritional index predicting mortality in the nursing home Journal of the American Geriatric Society 42 1167-1172 Furman EF (2006) Under-nutrition in older adults across the continuum of care Journal of Gerontological Nursing 32(1) 22-27 Groher ME amp Crary MA(2010) Dysphagia Clinical Management in Adults and Children Maryland Heights MO Mosby-Elsevier Harris-Kojetin L Sengupta M Park-Lee E Valverde R Long-term care services in the United States 2013 overview National health care statistics reports no 1 Hyattsville MD National Center for Health Statistics 2013

Effects of Increased Assistance

Increases in total daily calorie intake Residents maintain or gain weight Reduced secondary health complications Improved relationship between resident and staff Improved quality of life

Role of Occupational Therapy

OTs and OTAs have foundational skills and knowledge in eating feeding and

swallowing understanding of multidimensional aspects of eating expertise in assessment evaluation and treatment a holistic view to bring to nutritional care

OT Interventions

Attention to psychosocial aspects of dining Environmental modification Adaptive equipment Dysphagia assessment and treatment Positioning Task analysis Residents Staff

Caregiver and dining assistant training Sensory integration issues internal and external

Culture Change

ldquoCulture change is an innovation anchored in values and beliefs that return the locus of control to elders and those who work closest with them Its ultimate vision is to create a culture of aging that is inclusive life-affirming satisfying humane and meaningfulrdquo

(Kantor B amp Planetree amp Picker Institute 2010)

Trends in Culture Change

Emphasis on resident choice and person-centered care as essential components to improve dining experiences

Culture change requires transformation in organizational practices physical environments workplace practices communication and relationships among all stakeholders

Benefits of Culture Change

LTCs who implement cultural changeshellip Improve quality-of-life for residents patients and staff

Increase performance on clinical outcomes

(Planetree amp Picker Institute 2010 Baier Butterfield Harris amp Gravenstei 2008)

Experience positive effects on occupancy rates and the financial bottom line of LTC (Doty Koren amp Sturla 2008 Elliot 2010 LaPorte 2010)

Key Points for Program amp Culture Change

Residents are unique individuals Facility leadership must seek further education Leaders must support the changes in environment Interdisciplinary staff education and training at all

levels Formalize screening and referral process Changes to dining organization and staffing duties Utilize expertise and unique perspective of OT

Future Work

Increase multidisciplinary collaboration

Increase knowledge base for OT through research Design and share educational programs across

disciplines and settings

Future Work

Explore and implement innovative approaches to feeding and eating assistance

Design programs specific to the dining experience of persons with dementia or cognitive impairment

Advocate with government and industry to promote

person centered care in LTC

Education is Key to Change

Industry leaders nursing home administrators and management need to be educated about the extent of malnutrition in nursing homes

There is a need for educational plans and instructional materials on preventing and treating malnutrition in LTC

Healthcare providers must take time to advocate with facilities and present educational workshops

Recognizing and preventing malnutrition in nursing homes

A teaching plan was developed and incorporated into

the coursework for the OTD 610 Practitioner as Educator course at Pacific University

An extensive literature review has been created to provide evidence and foundational knowledge for healthcare providers LTC administrators and stakeholders

Purpose

Educate skilled nursing facility administrators and management about effects of poor nutritional status skilled OT assessment analysis and Interventions improving nutritional status of residents enhancing the dining experience improving staff effectiveness and efficiency

Program Goal

LTC administrators and managers will demonstrate basic knowledge of effects of poor nutritional

status describe barriers to providing excellent nutritional care explain how skilled OT services contribute to proving holistic

nutritional care

Teaching Elements

Teaching Session

Lecture- group instruction Printed educational handouts Printed worksheets Interactive activities among learners Small and whole group discussions Self-reflection and sharing Resource table with additional learning tools Short video (added as a result of feedback to pilot

session)

Targeted learners

professionals in health care provision or administration

extensive experience in the long-term healthcare industry in the area of nutrition and dietary food service

men and women multicultural group 30 ndash 60 years of age

Setting

Intended LTC workshop Skilled nursing facility conference room during weekday

business hours

Pilot Group workshop Large open-plan diningliving space with participants around

large oval table

Outcome of Pilot

What would I do differently

Schedule more convenient time

Include more participants

Ask for feedback

More anonymous feedback option

simplify language

Proposed Changes to Workshop

Provide printed quiz to go with handouts Add video component Rework handouts for comprehension and

application to learners needs

Discussion

After learning more about the problem of malnutrition in long-term care are you considering how you might introduce this topic into your practice or your teaching

Are there other venues where this type of educational program is appropriate and might influence the management of nutritional care for elders

Questions

References

Abbasi AA amp Rudman D (1994) Undernutrition in the nursing home Prevalence consequences cause and prevention Nutrition Reviews 52(4) 113-122 Accreditation Council for Occupational Therapy Education (2006) ACOTE standards and interpretive guidelines Retrieved from

httpwwwaotaorgnonmembersarea13docs acotestandards806pdf Adams NE Bowie AJ Simmance N Murrary M amp Crowe T (2008) Recognition by medical and nursing professionals of malnutrition and risk of malnutrition in elderly hospitalised patients Nutrition and Dietetics (65) 144-150 Amella EJ (2002) Resistance at mealtimes for persons with dementia The Journal of Nutrition Health amp Aging 6 117-122 Amella EJ (2008) Mealtime difficulties In Evidence-Based Geriatric Nursing Protocols for Best Practice 3rd ed (Capezuti E Zwicker D Mezey M Fulmer T Gray-Miceli D amp Kluger M eds) Springer Publishing Company LLC New York p 337-351 American Occupational Therapy Association [AOTA] (2002) Occupational therapy practice framework Domain and process American Journal of Occupational Therapy 56

609ndash639 doi 105014ajot566609 AOTA (2007) Specialized knowledge and skills in feeding eating and swallowing for occupational therapy practice American Journal of Occupational Therapy 61(6) 686-700

doi 105014ajot616686 Asai JL (2004) Nutrition and the geriatric rehabilitation patient Challenges and solutions Topics in Geriatric Rehabilitation 20(1) 34-45 Baier RR Butterfield K Harris Y Gravenstein S (2008) Aiming for star performance the relationship between setting targets and improved nursing home quality of

care Journal of the American Medical Directors Association9(8) 594-9 Epub Dolhi C amp Rogers J (2009) Dementia nutrition and self-feeding A systematic review of the literature Occupational Therapy in Health Care 15(3-4) 59-87 Ferri C Prince M Brayne C Brodaty H Fratiglioni L Ganguli M hellip Landry G (2005) Global prevalence of dementia a delphi consensus study Lancet 366 2112-2217 Frisoni G Fanzoni S Rozzini R Ferrucci L Boffelli S amp Trabucchi M (1994) A nutritional index predicting mortality in the nursing home Journal of the American Geriatric Society 42 1167-1172 Furman EF (2006) Under-nutrition in older adults across the continuum of care Journal of Gerontological Nursing 32(1) 22-27 Groher ME amp Crary MA(2010) Dysphagia Clinical Management in Adults and Children Maryland Heights MO Mosby-Elsevier Harris-Kojetin L Sengupta M Park-Lee E Valverde R Long-term care services in the United States 2013 overview National health care statistics reports no 1 Hyattsville MD National Center for Health Statistics 2013

Role of Occupational Therapy

OTs and OTAs have foundational skills and knowledge in eating feeding and

swallowing understanding of multidimensional aspects of eating expertise in assessment evaluation and treatment a holistic view to bring to nutritional care

OT Interventions

Attention to psychosocial aspects of dining Environmental modification Adaptive equipment Dysphagia assessment and treatment Positioning Task analysis Residents Staff

Caregiver and dining assistant training Sensory integration issues internal and external

Culture Change

ldquoCulture change is an innovation anchored in values and beliefs that return the locus of control to elders and those who work closest with them Its ultimate vision is to create a culture of aging that is inclusive life-affirming satisfying humane and meaningfulrdquo

(Kantor B amp Planetree amp Picker Institute 2010)

Trends in Culture Change

Emphasis on resident choice and person-centered care as essential components to improve dining experiences

Culture change requires transformation in organizational practices physical environments workplace practices communication and relationships among all stakeholders

Benefits of Culture Change

LTCs who implement cultural changeshellip Improve quality-of-life for residents patients and staff

Increase performance on clinical outcomes

(Planetree amp Picker Institute 2010 Baier Butterfield Harris amp Gravenstei 2008)

Experience positive effects on occupancy rates and the financial bottom line of LTC (Doty Koren amp Sturla 2008 Elliot 2010 LaPorte 2010)

Key Points for Program amp Culture Change

Residents are unique individuals Facility leadership must seek further education Leaders must support the changes in environment Interdisciplinary staff education and training at all

levels Formalize screening and referral process Changes to dining organization and staffing duties Utilize expertise and unique perspective of OT

Future Work

Increase multidisciplinary collaboration

Increase knowledge base for OT through research Design and share educational programs across

disciplines and settings

Future Work

Explore and implement innovative approaches to feeding and eating assistance

Design programs specific to the dining experience of persons with dementia or cognitive impairment

Advocate with government and industry to promote

person centered care in LTC

Education is Key to Change

Industry leaders nursing home administrators and management need to be educated about the extent of malnutrition in nursing homes

There is a need for educational plans and instructional materials on preventing and treating malnutrition in LTC

Healthcare providers must take time to advocate with facilities and present educational workshops

Recognizing and preventing malnutrition in nursing homes

A teaching plan was developed and incorporated into

the coursework for the OTD 610 Practitioner as Educator course at Pacific University

An extensive literature review has been created to provide evidence and foundational knowledge for healthcare providers LTC administrators and stakeholders

Purpose

Educate skilled nursing facility administrators and management about effects of poor nutritional status skilled OT assessment analysis and Interventions improving nutritional status of residents enhancing the dining experience improving staff effectiveness and efficiency

Program Goal

LTC administrators and managers will demonstrate basic knowledge of effects of poor nutritional

status describe barriers to providing excellent nutritional care explain how skilled OT services contribute to proving holistic

nutritional care

Teaching Elements

Teaching Session

Lecture- group instruction Printed educational handouts Printed worksheets Interactive activities among learners Small and whole group discussions Self-reflection and sharing Resource table with additional learning tools Short video (added as a result of feedback to pilot

session)

Targeted learners

professionals in health care provision or administration

extensive experience in the long-term healthcare industry in the area of nutrition and dietary food service

men and women multicultural group 30 ndash 60 years of age

Setting

Intended LTC workshop Skilled nursing facility conference room during weekday

business hours

Pilot Group workshop Large open-plan diningliving space with participants around

large oval table

Outcome of Pilot

What would I do differently

Schedule more convenient time

Include more participants

Ask for feedback

More anonymous feedback option

simplify language

Proposed Changes to Workshop

Provide printed quiz to go with handouts Add video component Rework handouts for comprehension and

application to learners needs

Discussion

After learning more about the problem of malnutrition in long-term care are you considering how you might introduce this topic into your practice or your teaching

Are there other venues where this type of educational program is appropriate and might influence the management of nutritional care for elders

Questions

References

Abbasi AA amp Rudman D (1994) Undernutrition in the nursing home Prevalence consequences cause and prevention Nutrition Reviews 52(4) 113-122 Accreditation Council for Occupational Therapy Education (2006) ACOTE standards and interpretive guidelines Retrieved from

httpwwwaotaorgnonmembersarea13docs acotestandards806pdf Adams NE Bowie AJ Simmance N Murrary M amp Crowe T (2008) Recognition by medical and nursing professionals of malnutrition and risk of malnutrition in elderly hospitalised patients Nutrition and Dietetics (65) 144-150 Amella EJ (2002) Resistance at mealtimes for persons with dementia The Journal of Nutrition Health amp Aging 6 117-122 Amella EJ (2008) Mealtime difficulties In Evidence-Based Geriatric Nursing Protocols for Best Practice 3rd ed (Capezuti E Zwicker D Mezey M Fulmer T Gray-Miceli D amp Kluger M eds) Springer Publishing Company LLC New York p 337-351 American Occupational Therapy Association [AOTA] (2002) Occupational therapy practice framework Domain and process American Journal of Occupational Therapy 56

609ndash639 doi 105014ajot566609 AOTA (2007) Specialized knowledge and skills in feeding eating and swallowing for occupational therapy practice American Journal of Occupational Therapy 61(6) 686-700

doi 105014ajot616686 Asai JL (2004) Nutrition and the geriatric rehabilitation patient Challenges and solutions Topics in Geriatric Rehabilitation 20(1) 34-45 Baier RR Butterfield K Harris Y Gravenstein S (2008) Aiming for star performance the relationship between setting targets and improved nursing home quality of

care Journal of the American Medical Directors Association9(8) 594-9 Epub Dolhi C amp Rogers J (2009) Dementia nutrition and self-feeding A systematic review of the literature Occupational Therapy in Health Care 15(3-4) 59-87 Ferri C Prince M Brayne C Brodaty H Fratiglioni L Ganguli M hellip Landry G (2005) Global prevalence of dementia a delphi consensus study Lancet 366 2112-2217 Frisoni G Fanzoni S Rozzini R Ferrucci L Boffelli S amp Trabucchi M (1994) A nutritional index predicting mortality in the nursing home Journal of the American Geriatric Society 42 1167-1172 Furman EF (2006) Under-nutrition in older adults across the continuum of care Journal of Gerontological Nursing 32(1) 22-27 Groher ME amp Crary MA(2010) Dysphagia Clinical Management in Adults and Children Maryland Heights MO Mosby-Elsevier Harris-Kojetin L Sengupta M Park-Lee E Valverde R Long-term care services in the United States 2013 overview National health care statistics reports no 1 Hyattsville MD National Center for Health Statistics 2013

OT Interventions

Attention to psychosocial aspects of dining Environmental modification Adaptive equipment Dysphagia assessment and treatment Positioning Task analysis Residents Staff

Caregiver and dining assistant training Sensory integration issues internal and external

Culture Change

ldquoCulture change is an innovation anchored in values and beliefs that return the locus of control to elders and those who work closest with them Its ultimate vision is to create a culture of aging that is inclusive life-affirming satisfying humane and meaningfulrdquo

(Kantor B amp Planetree amp Picker Institute 2010)

Trends in Culture Change

Emphasis on resident choice and person-centered care as essential components to improve dining experiences

Culture change requires transformation in organizational practices physical environments workplace practices communication and relationships among all stakeholders

Benefits of Culture Change

LTCs who implement cultural changeshellip Improve quality-of-life for residents patients and staff

Increase performance on clinical outcomes

(Planetree amp Picker Institute 2010 Baier Butterfield Harris amp Gravenstei 2008)

Experience positive effects on occupancy rates and the financial bottom line of LTC (Doty Koren amp Sturla 2008 Elliot 2010 LaPorte 2010)

Key Points for Program amp Culture Change

Residents are unique individuals Facility leadership must seek further education Leaders must support the changes in environment Interdisciplinary staff education and training at all

levels Formalize screening and referral process Changes to dining organization and staffing duties Utilize expertise and unique perspective of OT

Future Work

Increase multidisciplinary collaboration

Increase knowledge base for OT through research Design and share educational programs across

disciplines and settings

Future Work

Explore and implement innovative approaches to feeding and eating assistance

Design programs specific to the dining experience of persons with dementia or cognitive impairment

Advocate with government and industry to promote

person centered care in LTC

Education is Key to Change

Industry leaders nursing home administrators and management need to be educated about the extent of malnutrition in nursing homes

There is a need for educational plans and instructional materials on preventing and treating malnutrition in LTC

Healthcare providers must take time to advocate with facilities and present educational workshops

Recognizing and preventing malnutrition in nursing homes

A teaching plan was developed and incorporated into

the coursework for the OTD 610 Practitioner as Educator course at Pacific University

An extensive literature review has been created to provide evidence and foundational knowledge for healthcare providers LTC administrators and stakeholders

Purpose

Educate skilled nursing facility administrators and management about effects of poor nutritional status skilled OT assessment analysis and Interventions improving nutritional status of residents enhancing the dining experience improving staff effectiveness and efficiency

Program Goal

LTC administrators and managers will demonstrate basic knowledge of effects of poor nutritional

status describe barriers to providing excellent nutritional care explain how skilled OT services contribute to proving holistic

nutritional care

Teaching Elements

Teaching Session

Lecture- group instruction Printed educational handouts Printed worksheets Interactive activities among learners Small and whole group discussions Self-reflection and sharing Resource table with additional learning tools Short video (added as a result of feedback to pilot

session)

Targeted learners

professionals in health care provision or administration

extensive experience in the long-term healthcare industry in the area of nutrition and dietary food service

men and women multicultural group 30 ndash 60 years of age

Setting

Intended LTC workshop Skilled nursing facility conference room during weekday

business hours

Pilot Group workshop Large open-plan diningliving space with participants around

large oval table

Outcome of Pilot

What would I do differently

Schedule more convenient time

Include more participants

Ask for feedback

More anonymous feedback option

simplify language

Proposed Changes to Workshop

Provide printed quiz to go with handouts Add video component Rework handouts for comprehension and

application to learners needs

Discussion

After learning more about the problem of malnutrition in long-term care are you considering how you might introduce this topic into your practice or your teaching

Are there other venues where this type of educational program is appropriate and might influence the management of nutritional care for elders

Questions

References

Abbasi AA amp Rudman D (1994) Undernutrition in the nursing home Prevalence consequences cause and prevention Nutrition Reviews 52(4) 113-122 Accreditation Council for Occupational Therapy Education (2006) ACOTE standards and interpretive guidelines Retrieved from

httpwwwaotaorgnonmembersarea13docs acotestandards806pdf Adams NE Bowie AJ Simmance N Murrary M amp Crowe T (2008) Recognition by medical and nursing professionals of malnutrition and risk of malnutrition in elderly hospitalised patients Nutrition and Dietetics (65) 144-150 Amella EJ (2002) Resistance at mealtimes for persons with dementia The Journal of Nutrition Health amp Aging 6 117-122 Amella EJ (2008) Mealtime difficulties In Evidence-Based Geriatric Nursing Protocols for Best Practice 3rd ed (Capezuti E Zwicker D Mezey M Fulmer T Gray-Miceli D amp Kluger M eds) Springer Publishing Company LLC New York p 337-351 American Occupational Therapy Association [AOTA] (2002) Occupational therapy practice framework Domain and process American Journal of Occupational Therapy 56

609ndash639 doi 105014ajot566609 AOTA (2007) Specialized knowledge and skills in feeding eating and swallowing for occupational therapy practice American Journal of Occupational Therapy 61(6) 686-700

doi 105014ajot616686 Asai JL (2004) Nutrition and the geriatric rehabilitation patient Challenges and solutions Topics in Geriatric Rehabilitation 20(1) 34-45 Baier RR Butterfield K Harris Y Gravenstein S (2008) Aiming for star performance the relationship between setting targets and improved nursing home quality of

care Journal of the American Medical Directors Association9(8) 594-9 Epub Dolhi C amp Rogers J (2009) Dementia nutrition and self-feeding A systematic review of the literature Occupational Therapy in Health Care 15(3-4) 59-87 Ferri C Prince M Brayne C Brodaty H Fratiglioni L Ganguli M hellip Landry G (2005) Global prevalence of dementia a delphi consensus study Lancet 366 2112-2217 Frisoni G Fanzoni S Rozzini R Ferrucci L Boffelli S amp Trabucchi M (1994) A nutritional index predicting mortality in the nursing home Journal of the American Geriatric Society 42 1167-1172 Furman EF (2006) Under-nutrition in older adults across the continuum of care Journal of Gerontological Nursing 32(1) 22-27 Groher ME amp Crary MA(2010) Dysphagia Clinical Management in Adults and Children Maryland Heights MO Mosby-Elsevier Harris-Kojetin L Sengupta M Park-Lee E Valverde R Long-term care services in the United States 2013 overview National health care statistics reports no 1 Hyattsville MD National Center for Health Statistics 2013

Culture Change

ldquoCulture change is an innovation anchored in values and beliefs that return the locus of control to elders and those who work closest with them Its ultimate vision is to create a culture of aging that is inclusive life-affirming satisfying humane and meaningfulrdquo

(Kantor B amp Planetree amp Picker Institute 2010)

Trends in Culture Change

Emphasis on resident choice and person-centered care as essential components to improve dining experiences

Culture change requires transformation in organizational practices physical environments workplace practices communication and relationships among all stakeholders

Benefits of Culture Change

LTCs who implement cultural changeshellip Improve quality-of-life for residents patients and staff

Increase performance on clinical outcomes

(Planetree amp Picker Institute 2010 Baier Butterfield Harris amp Gravenstei 2008)

Experience positive effects on occupancy rates and the financial bottom line of LTC (Doty Koren amp Sturla 2008 Elliot 2010 LaPorte 2010)

Key Points for Program amp Culture Change

Residents are unique individuals Facility leadership must seek further education Leaders must support the changes in environment Interdisciplinary staff education and training at all

levels Formalize screening and referral process Changes to dining organization and staffing duties Utilize expertise and unique perspective of OT

Future Work

Increase multidisciplinary collaboration

Increase knowledge base for OT through research Design and share educational programs across

disciplines and settings

Future Work

Explore and implement innovative approaches to feeding and eating assistance

Design programs specific to the dining experience of persons with dementia or cognitive impairment

Advocate with government and industry to promote

person centered care in LTC

Education is Key to Change

Industry leaders nursing home administrators and management need to be educated about the extent of malnutrition in nursing homes

There is a need for educational plans and instructional materials on preventing and treating malnutrition in LTC

Healthcare providers must take time to advocate with facilities and present educational workshops

Recognizing and preventing malnutrition in nursing homes

A teaching plan was developed and incorporated into

the coursework for the OTD 610 Practitioner as Educator course at Pacific University

An extensive literature review has been created to provide evidence and foundational knowledge for healthcare providers LTC administrators and stakeholders

Purpose

Educate skilled nursing facility administrators and management about effects of poor nutritional status skilled OT assessment analysis and Interventions improving nutritional status of residents enhancing the dining experience improving staff effectiveness and efficiency

Program Goal

LTC administrators and managers will demonstrate basic knowledge of effects of poor nutritional

status describe barriers to providing excellent nutritional care explain how skilled OT services contribute to proving holistic

nutritional care

Teaching Elements

Teaching Session

Lecture- group instruction Printed educational handouts Printed worksheets Interactive activities among learners Small and whole group discussions Self-reflection and sharing Resource table with additional learning tools Short video (added as a result of feedback to pilot

session)

Targeted learners

professionals in health care provision or administration

extensive experience in the long-term healthcare industry in the area of nutrition and dietary food service

men and women multicultural group 30 ndash 60 years of age

Setting

Intended LTC workshop Skilled nursing facility conference room during weekday

business hours

Pilot Group workshop Large open-plan diningliving space with participants around

large oval table

Outcome of Pilot

What would I do differently

Schedule more convenient time

Include more participants

Ask for feedback

More anonymous feedback option

simplify language

Proposed Changes to Workshop

Provide printed quiz to go with handouts Add video component Rework handouts for comprehension and

application to learners needs

Discussion

After learning more about the problem of malnutrition in long-term care are you considering how you might introduce this topic into your practice or your teaching

Are there other venues where this type of educational program is appropriate and might influence the management of nutritional care for elders

Questions

References

Abbasi AA amp Rudman D (1994) Undernutrition in the nursing home Prevalence consequences cause and prevention Nutrition Reviews 52(4) 113-122 Accreditation Council for Occupational Therapy Education (2006) ACOTE standards and interpretive guidelines Retrieved from

httpwwwaotaorgnonmembersarea13docs acotestandards806pdf Adams NE Bowie AJ Simmance N Murrary M amp Crowe T (2008) Recognition by medical and nursing professionals of malnutrition and risk of malnutrition in elderly hospitalised patients Nutrition and Dietetics (65) 144-150 Amella EJ (2002) Resistance at mealtimes for persons with dementia The Journal of Nutrition Health amp Aging 6 117-122 Amella EJ (2008) Mealtime difficulties In Evidence-Based Geriatric Nursing Protocols for Best Practice 3rd ed (Capezuti E Zwicker D Mezey M Fulmer T Gray-Miceli D amp Kluger M eds) Springer Publishing Company LLC New York p 337-351 American Occupational Therapy Association [AOTA] (2002) Occupational therapy practice framework Domain and process American Journal of Occupational Therapy 56

609ndash639 doi 105014ajot566609 AOTA (2007) Specialized knowledge and skills in feeding eating and swallowing for occupational therapy practice American Journal of Occupational Therapy 61(6) 686-700

doi 105014ajot616686 Asai JL (2004) Nutrition and the geriatric rehabilitation patient Challenges and solutions Topics in Geriatric Rehabilitation 20(1) 34-45 Baier RR Butterfield K Harris Y Gravenstein S (2008) Aiming for star performance the relationship between setting targets and improved nursing home quality of

care Journal of the American Medical Directors Association9(8) 594-9 Epub Dolhi C amp Rogers J (2009) Dementia nutrition and self-feeding A systematic review of the literature Occupational Therapy in Health Care 15(3-4) 59-87 Ferri C Prince M Brayne C Brodaty H Fratiglioni L Ganguli M hellip Landry G (2005) Global prevalence of dementia a delphi consensus study Lancet 366 2112-2217 Frisoni G Fanzoni S Rozzini R Ferrucci L Boffelli S amp Trabucchi M (1994) A nutritional index predicting mortality in the nursing home Journal of the American Geriatric Society 42 1167-1172 Furman EF (2006) Under-nutrition in older adults across the continuum of care Journal of Gerontological Nursing 32(1) 22-27 Groher ME amp Crary MA(2010) Dysphagia Clinical Management in Adults and Children Maryland Heights MO Mosby-Elsevier Harris-Kojetin L Sengupta M Park-Lee E Valverde R Long-term care services in the United States 2013 overview National health care statistics reports no 1 Hyattsville MD National Center for Health Statistics 2013

Trends in Culture Change

Emphasis on resident choice and person-centered care as essential components to improve dining experiences

Culture change requires transformation in organizational practices physical environments workplace practices communication and relationships among all stakeholders

Benefits of Culture Change

LTCs who implement cultural changeshellip Improve quality-of-life for residents patients and staff

Increase performance on clinical outcomes

(Planetree amp Picker Institute 2010 Baier Butterfield Harris amp Gravenstei 2008)

Experience positive effects on occupancy rates and the financial bottom line of LTC (Doty Koren amp Sturla 2008 Elliot 2010 LaPorte 2010)

Key Points for Program amp Culture Change

Residents are unique individuals Facility leadership must seek further education Leaders must support the changes in environment Interdisciplinary staff education and training at all

levels Formalize screening and referral process Changes to dining organization and staffing duties Utilize expertise and unique perspective of OT

Future Work

Increase multidisciplinary collaboration

Increase knowledge base for OT through research Design and share educational programs across

disciplines and settings

Future Work

Explore and implement innovative approaches to feeding and eating assistance

Design programs specific to the dining experience of persons with dementia or cognitive impairment

Advocate with government and industry to promote

person centered care in LTC

Education is Key to Change

Industry leaders nursing home administrators and management need to be educated about the extent of malnutrition in nursing homes

There is a need for educational plans and instructional materials on preventing and treating malnutrition in LTC

Healthcare providers must take time to advocate with facilities and present educational workshops

Recognizing and preventing malnutrition in nursing homes

A teaching plan was developed and incorporated into

the coursework for the OTD 610 Practitioner as Educator course at Pacific University

An extensive literature review has been created to provide evidence and foundational knowledge for healthcare providers LTC administrators and stakeholders

Purpose

Educate skilled nursing facility administrators and management about effects of poor nutritional status skilled OT assessment analysis and Interventions improving nutritional status of residents enhancing the dining experience improving staff effectiveness and efficiency

Program Goal

LTC administrators and managers will demonstrate basic knowledge of effects of poor nutritional

status describe barriers to providing excellent nutritional care explain how skilled OT services contribute to proving holistic

nutritional care

Teaching Elements

Teaching Session

Lecture- group instruction Printed educational handouts Printed worksheets Interactive activities among learners Small and whole group discussions Self-reflection and sharing Resource table with additional learning tools Short video (added as a result of feedback to pilot

session)

Targeted learners

professionals in health care provision or administration

extensive experience in the long-term healthcare industry in the area of nutrition and dietary food service

men and women multicultural group 30 ndash 60 years of age

Setting

Intended LTC workshop Skilled nursing facility conference room during weekday

business hours

Pilot Group workshop Large open-plan diningliving space with participants around

large oval table

Outcome of Pilot

What would I do differently

Schedule more convenient time

Include more participants

Ask for feedback

More anonymous feedback option

simplify language

Proposed Changes to Workshop

Provide printed quiz to go with handouts Add video component Rework handouts for comprehension and

application to learners needs

Discussion

After learning more about the problem of malnutrition in long-term care are you considering how you might introduce this topic into your practice or your teaching

Are there other venues where this type of educational program is appropriate and might influence the management of nutritional care for elders

Questions

References

Abbasi AA amp Rudman D (1994) Undernutrition in the nursing home Prevalence consequences cause and prevention Nutrition Reviews 52(4) 113-122 Accreditation Council for Occupational Therapy Education (2006) ACOTE standards and interpretive guidelines Retrieved from

httpwwwaotaorgnonmembersarea13docs acotestandards806pdf Adams NE Bowie AJ Simmance N Murrary M amp Crowe T (2008) Recognition by medical and nursing professionals of malnutrition and risk of malnutrition in elderly hospitalised patients Nutrition and Dietetics (65) 144-150 Amella EJ (2002) Resistance at mealtimes for persons with dementia The Journal of Nutrition Health amp Aging 6 117-122 Amella EJ (2008) Mealtime difficulties In Evidence-Based Geriatric Nursing Protocols for Best Practice 3rd ed (Capezuti E Zwicker D Mezey M Fulmer T Gray-Miceli D amp Kluger M eds) Springer Publishing Company LLC New York p 337-351 American Occupational Therapy Association [AOTA] (2002) Occupational therapy practice framework Domain and process American Journal of Occupational Therapy 56

609ndash639 doi 105014ajot566609 AOTA (2007) Specialized knowledge and skills in feeding eating and swallowing for occupational therapy practice American Journal of Occupational Therapy 61(6) 686-700

doi 105014ajot616686 Asai JL (2004) Nutrition and the geriatric rehabilitation patient Challenges and solutions Topics in Geriatric Rehabilitation 20(1) 34-45 Baier RR Butterfield K Harris Y Gravenstein S (2008) Aiming for star performance the relationship between setting targets and improved nursing home quality of

care Journal of the American Medical Directors Association9(8) 594-9 Epub Dolhi C amp Rogers J (2009) Dementia nutrition and self-feeding A systematic review of the literature Occupational Therapy in Health Care 15(3-4) 59-87 Ferri C Prince M Brayne C Brodaty H Fratiglioni L Ganguli M hellip Landry G (2005) Global prevalence of dementia a delphi consensus study Lancet 366 2112-2217 Frisoni G Fanzoni S Rozzini R Ferrucci L Boffelli S amp Trabucchi M (1994) A nutritional index predicting mortality in the nursing home Journal of the American Geriatric Society 42 1167-1172 Furman EF (2006) Under-nutrition in older adults across the continuum of care Journal of Gerontological Nursing 32(1) 22-27 Groher ME amp Crary MA(2010) Dysphagia Clinical Management in Adults and Children Maryland Heights MO Mosby-Elsevier Harris-Kojetin L Sengupta M Park-Lee E Valverde R Long-term care services in the United States 2013 overview National health care statistics reports no 1 Hyattsville MD National Center for Health Statistics 2013

Benefits of Culture Change

LTCs who implement cultural changeshellip Improve quality-of-life for residents patients and staff

Increase performance on clinical outcomes

(Planetree amp Picker Institute 2010 Baier Butterfield Harris amp Gravenstei 2008)

Experience positive effects on occupancy rates and the financial bottom line of LTC (Doty Koren amp Sturla 2008 Elliot 2010 LaPorte 2010)

Key Points for Program amp Culture Change

Residents are unique individuals Facility leadership must seek further education Leaders must support the changes in environment Interdisciplinary staff education and training at all

levels Formalize screening and referral process Changes to dining organization and staffing duties Utilize expertise and unique perspective of OT

Future Work

Increase multidisciplinary collaboration

Increase knowledge base for OT through research Design and share educational programs across

disciplines and settings

Future Work

Explore and implement innovative approaches to feeding and eating assistance

Design programs specific to the dining experience of persons with dementia or cognitive impairment

Advocate with government and industry to promote

person centered care in LTC

Education is Key to Change

Industry leaders nursing home administrators and management need to be educated about the extent of malnutrition in nursing homes

There is a need for educational plans and instructional materials on preventing and treating malnutrition in LTC

Healthcare providers must take time to advocate with facilities and present educational workshops

Recognizing and preventing malnutrition in nursing homes

A teaching plan was developed and incorporated into

the coursework for the OTD 610 Practitioner as Educator course at Pacific University

An extensive literature review has been created to provide evidence and foundational knowledge for healthcare providers LTC administrators and stakeholders

Purpose

Educate skilled nursing facility administrators and management about effects of poor nutritional status skilled OT assessment analysis and Interventions improving nutritional status of residents enhancing the dining experience improving staff effectiveness and efficiency

Program Goal

LTC administrators and managers will demonstrate basic knowledge of effects of poor nutritional

status describe barriers to providing excellent nutritional care explain how skilled OT services contribute to proving holistic

nutritional care

Teaching Elements

Teaching Session

Lecture- group instruction Printed educational handouts Printed worksheets Interactive activities among learners Small and whole group discussions Self-reflection and sharing Resource table with additional learning tools Short video (added as a result of feedback to pilot

session)

Targeted learners

professionals in health care provision or administration

extensive experience in the long-term healthcare industry in the area of nutrition and dietary food service

men and women multicultural group 30 ndash 60 years of age

Setting

Intended LTC workshop Skilled nursing facility conference room during weekday

business hours

Pilot Group workshop Large open-plan diningliving space with participants around

large oval table

Outcome of Pilot

What would I do differently

Schedule more convenient time

Include more participants

Ask for feedback

More anonymous feedback option

simplify language

Proposed Changes to Workshop

Provide printed quiz to go with handouts Add video component Rework handouts for comprehension and

application to learners needs

Discussion

After learning more about the problem of malnutrition in long-term care are you considering how you might introduce this topic into your practice or your teaching

Are there other venues where this type of educational program is appropriate and might influence the management of nutritional care for elders

Questions

References

Abbasi AA amp Rudman D (1994) Undernutrition in the nursing home Prevalence consequences cause and prevention Nutrition Reviews 52(4) 113-122 Accreditation Council for Occupational Therapy Education (2006) ACOTE standards and interpretive guidelines Retrieved from

httpwwwaotaorgnonmembersarea13docs acotestandards806pdf Adams NE Bowie AJ Simmance N Murrary M amp Crowe T (2008) Recognition by medical and nursing professionals of malnutrition and risk of malnutrition in elderly hospitalised patients Nutrition and Dietetics (65) 144-150 Amella EJ (2002) Resistance at mealtimes for persons with dementia The Journal of Nutrition Health amp Aging 6 117-122 Amella EJ (2008) Mealtime difficulties In Evidence-Based Geriatric Nursing Protocols for Best Practice 3rd ed (Capezuti E Zwicker D Mezey M Fulmer T Gray-Miceli D amp Kluger M eds) Springer Publishing Company LLC New York p 337-351 American Occupational Therapy Association [AOTA] (2002) Occupational therapy practice framework Domain and process American Journal of Occupational Therapy 56

609ndash639 doi 105014ajot566609 AOTA (2007) Specialized knowledge and skills in feeding eating and swallowing for occupational therapy practice American Journal of Occupational Therapy 61(6) 686-700

doi 105014ajot616686 Asai JL (2004) Nutrition and the geriatric rehabilitation patient Challenges and solutions Topics in Geriatric Rehabilitation 20(1) 34-45 Baier RR Butterfield K Harris Y Gravenstein S (2008) Aiming for star performance the relationship between setting targets and improved nursing home quality of

care Journal of the American Medical Directors Association9(8) 594-9 Epub Dolhi C amp Rogers J (2009) Dementia nutrition and self-feeding A systematic review of the literature Occupational Therapy in Health Care 15(3-4) 59-87 Ferri C Prince M Brayne C Brodaty H Fratiglioni L Ganguli M hellip Landry G (2005) Global prevalence of dementia a delphi consensus study Lancet 366 2112-2217 Frisoni G Fanzoni S Rozzini R Ferrucci L Boffelli S amp Trabucchi M (1994) A nutritional index predicting mortality in the nursing home Journal of the American Geriatric Society 42 1167-1172 Furman EF (2006) Under-nutrition in older adults across the continuum of care Journal of Gerontological Nursing 32(1) 22-27 Groher ME amp Crary MA(2010) Dysphagia Clinical Management in Adults and Children Maryland Heights MO Mosby-Elsevier Harris-Kojetin L Sengupta M Park-Lee E Valverde R Long-term care services in the United States 2013 overview National health care statistics reports no 1 Hyattsville MD National Center for Health Statistics 2013

Key Points for Program amp Culture Change

Residents are unique individuals Facility leadership must seek further education Leaders must support the changes in environment Interdisciplinary staff education and training at all

levels Formalize screening and referral process Changes to dining organization and staffing duties Utilize expertise and unique perspective of OT

Future Work

Increase multidisciplinary collaboration

Increase knowledge base for OT through research Design and share educational programs across

disciplines and settings

Future Work

Explore and implement innovative approaches to feeding and eating assistance

Design programs specific to the dining experience of persons with dementia or cognitive impairment

Advocate with government and industry to promote

person centered care in LTC

Education is Key to Change

Industry leaders nursing home administrators and management need to be educated about the extent of malnutrition in nursing homes

There is a need for educational plans and instructional materials on preventing and treating malnutrition in LTC

Healthcare providers must take time to advocate with facilities and present educational workshops

Recognizing and preventing malnutrition in nursing homes

A teaching plan was developed and incorporated into

the coursework for the OTD 610 Practitioner as Educator course at Pacific University

An extensive literature review has been created to provide evidence and foundational knowledge for healthcare providers LTC administrators and stakeholders

Purpose

Educate skilled nursing facility administrators and management about effects of poor nutritional status skilled OT assessment analysis and Interventions improving nutritional status of residents enhancing the dining experience improving staff effectiveness and efficiency

Program Goal

LTC administrators and managers will demonstrate basic knowledge of effects of poor nutritional

status describe barriers to providing excellent nutritional care explain how skilled OT services contribute to proving holistic

nutritional care

Teaching Elements

Teaching Session

Lecture- group instruction Printed educational handouts Printed worksheets Interactive activities among learners Small and whole group discussions Self-reflection and sharing Resource table with additional learning tools Short video (added as a result of feedback to pilot

session)

Targeted learners

professionals in health care provision or administration

extensive experience in the long-term healthcare industry in the area of nutrition and dietary food service

men and women multicultural group 30 ndash 60 years of age

Setting

Intended LTC workshop Skilled nursing facility conference room during weekday

business hours

Pilot Group workshop Large open-plan diningliving space with participants around

large oval table

Outcome of Pilot

What would I do differently

Schedule more convenient time

Include more participants

Ask for feedback

More anonymous feedback option

simplify language

Proposed Changes to Workshop

Provide printed quiz to go with handouts Add video component Rework handouts for comprehension and

application to learners needs

Discussion

After learning more about the problem of malnutrition in long-term care are you considering how you might introduce this topic into your practice or your teaching

Are there other venues where this type of educational program is appropriate and might influence the management of nutritional care for elders

Questions

References

Abbasi AA amp Rudman D (1994) Undernutrition in the nursing home Prevalence consequences cause and prevention Nutrition Reviews 52(4) 113-122 Accreditation Council for Occupational Therapy Education (2006) ACOTE standards and interpretive guidelines Retrieved from

httpwwwaotaorgnonmembersarea13docs acotestandards806pdf Adams NE Bowie AJ Simmance N Murrary M amp Crowe T (2008) Recognition by medical and nursing professionals of malnutrition and risk of malnutrition in elderly hospitalised patients Nutrition and Dietetics (65) 144-150 Amella EJ (2002) Resistance at mealtimes for persons with dementia The Journal of Nutrition Health amp Aging 6 117-122 Amella EJ (2008) Mealtime difficulties In Evidence-Based Geriatric Nursing Protocols for Best Practice 3rd ed (Capezuti E Zwicker D Mezey M Fulmer T Gray-Miceli D amp Kluger M eds) Springer Publishing Company LLC New York p 337-351 American Occupational Therapy Association [AOTA] (2002) Occupational therapy practice framework Domain and process American Journal of Occupational Therapy 56

609ndash639 doi 105014ajot566609 AOTA (2007) Specialized knowledge and skills in feeding eating and swallowing for occupational therapy practice American Journal of Occupational Therapy 61(6) 686-700

doi 105014ajot616686 Asai JL (2004) Nutrition and the geriatric rehabilitation patient Challenges and solutions Topics in Geriatric Rehabilitation 20(1) 34-45 Baier RR Butterfield K Harris Y Gravenstein S (2008) Aiming for star performance the relationship between setting targets and improved nursing home quality of

care Journal of the American Medical Directors Association9(8) 594-9 Epub Dolhi C amp Rogers J (2009) Dementia nutrition and self-feeding A systematic review of the literature Occupational Therapy in Health Care 15(3-4) 59-87 Ferri C Prince M Brayne C Brodaty H Fratiglioni L Ganguli M hellip Landry G (2005) Global prevalence of dementia a delphi consensus study Lancet 366 2112-2217 Frisoni G Fanzoni S Rozzini R Ferrucci L Boffelli S amp Trabucchi M (1994) A nutritional index predicting mortality in the nursing home Journal of the American Geriatric Society 42 1167-1172 Furman EF (2006) Under-nutrition in older adults across the continuum of care Journal of Gerontological Nursing 32(1) 22-27 Groher ME amp Crary MA(2010) Dysphagia Clinical Management in Adults and Children Maryland Heights MO Mosby-Elsevier Harris-Kojetin L Sengupta M Park-Lee E Valverde R Long-term care services in the United States 2013 overview National health care statistics reports no 1 Hyattsville MD National Center for Health Statistics 2013

Future Work

Increase multidisciplinary collaboration

Increase knowledge base for OT through research Design and share educational programs across

disciplines and settings

Future Work

Explore and implement innovative approaches to feeding and eating assistance

Design programs specific to the dining experience of persons with dementia or cognitive impairment

Advocate with government and industry to promote

person centered care in LTC

Education is Key to Change

Industry leaders nursing home administrators and management need to be educated about the extent of malnutrition in nursing homes

There is a need for educational plans and instructional materials on preventing and treating malnutrition in LTC

Healthcare providers must take time to advocate with facilities and present educational workshops

Recognizing and preventing malnutrition in nursing homes

A teaching plan was developed and incorporated into

the coursework for the OTD 610 Practitioner as Educator course at Pacific University

An extensive literature review has been created to provide evidence and foundational knowledge for healthcare providers LTC administrators and stakeholders

Purpose

Educate skilled nursing facility administrators and management about effects of poor nutritional status skilled OT assessment analysis and Interventions improving nutritional status of residents enhancing the dining experience improving staff effectiveness and efficiency

Program Goal

LTC administrators and managers will demonstrate basic knowledge of effects of poor nutritional

status describe barriers to providing excellent nutritional care explain how skilled OT services contribute to proving holistic

nutritional care

Teaching Elements

Teaching Session

Lecture- group instruction Printed educational handouts Printed worksheets Interactive activities among learners Small and whole group discussions Self-reflection and sharing Resource table with additional learning tools Short video (added as a result of feedback to pilot

session)

Targeted learners

professionals in health care provision or administration

extensive experience in the long-term healthcare industry in the area of nutrition and dietary food service

men and women multicultural group 30 ndash 60 years of age

Setting

Intended LTC workshop Skilled nursing facility conference room during weekday

business hours

Pilot Group workshop Large open-plan diningliving space with participants around

large oval table

Outcome of Pilot

What would I do differently

Schedule more convenient time

Include more participants

Ask for feedback

More anonymous feedback option

simplify language

Proposed Changes to Workshop

Provide printed quiz to go with handouts Add video component Rework handouts for comprehension and

application to learners needs

Discussion

After learning more about the problem of malnutrition in long-term care are you considering how you might introduce this topic into your practice or your teaching

Are there other venues where this type of educational program is appropriate and might influence the management of nutritional care for elders

Questions

References

Abbasi AA amp Rudman D (1994) Undernutrition in the nursing home Prevalence consequences cause and prevention Nutrition Reviews 52(4) 113-122 Accreditation Council for Occupational Therapy Education (2006) ACOTE standards and interpretive guidelines Retrieved from

httpwwwaotaorgnonmembersarea13docs acotestandards806pdf Adams NE Bowie AJ Simmance N Murrary M amp Crowe T (2008) Recognition by medical and nursing professionals of malnutrition and risk of malnutrition in elderly hospitalised patients Nutrition and Dietetics (65) 144-150 Amella EJ (2002) Resistance at mealtimes for persons with dementia The Journal of Nutrition Health amp Aging 6 117-122 Amella EJ (2008) Mealtime difficulties In Evidence-Based Geriatric Nursing Protocols for Best Practice 3rd ed (Capezuti E Zwicker D Mezey M Fulmer T Gray-Miceli D amp Kluger M eds) Springer Publishing Company LLC New York p 337-351 American Occupational Therapy Association [AOTA] (2002) Occupational therapy practice framework Domain and process American Journal of Occupational Therapy 56

609ndash639 doi 105014ajot566609 AOTA (2007) Specialized knowledge and skills in feeding eating and swallowing for occupational therapy practice American Journal of Occupational Therapy 61(6) 686-700

doi 105014ajot616686 Asai JL (2004) Nutrition and the geriatric rehabilitation patient Challenges and solutions Topics in Geriatric Rehabilitation 20(1) 34-45 Baier RR Butterfield K Harris Y Gravenstein S (2008) Aiming for star performance the relationship between setting targets and improved nursing home quality of

care Journal of the American Medical Directors Association9(8) 594-9 Epub Dolhi C amp Rogers J (2009) Dementia nutrition and self-feeding A systematic review of the literature Occupational Therapy in Health Care 15(3-4) 59-87 Ferri C Prince M Brayne C Brodaty H Fratiglioni L Ganguli M hellip Landry G (2005) Global prevalence of dementia a delphi consensus study Lancet 366 2112-2217 Frisoni G Fanzoni S Rozzini R Ferrucci L Boffelli S amp Trabucchi M (1994) A nutritional index predicting mortality in the nursing home Journal of the American Geriatric Society 42 1167-1172 Furman EF (2006) Under-nutrition in older adults across the continuum of care Journal of Gerontological Nursing 32(1) 22-27 Groher ME amp Crary MA(2010) Dysphagia Clinical Management in Adults and Children Maryland Heights MO Mosby-Elsevier Harris-Kojetin L Sengupta M Park-Lee E Valverde R Long-term care services in the United States 2013 overview National health care statistics reports no 1 Hyattsville MD National Center for Health Statistics 2013

Future Work

Explore and implement innovative approaches to feeding and eating assistance

Design programs specific to the dining experience of persons with dementia or cognitive impairment

Advocate with government and industry to promote

person centered care in LTC

Education is Key to Change

Industry leaders nursing home administrators and management need to be educated about the extent of malnutrition in nursing homes

There is a need for educational plans and instructional materials on preventing and treating malnutrition in LTC

Healthcare providers must take time to advocate with facilities and present educational workshops

Recognizing and preventing malnutrition in nursing homes

A teaching plan was developed and incorporated into

the coursework for the OTD 610 Practitioner as Educator course at Pacific University

An extensive literature review has been created to provide evidence and foundational knowledge for healthcare providers LTC administrators and stakeholders

Purpose

Educate skilled nursing facility administrators and management about effects of poor nutritional status skilled OT assessment analysis and Interventions improving nutritional status of residents enhancing the dining experience improving staff effectiveness and efficiency

Program Goal

LTC administrators and managers will demonstrate basic knowledge of effects of poor nutritional

status describe barriers to providing excellent nutritional care explain how skilled OT services contribute to proving holistic

nutritional care

Teaching Elements

Teaching Session

Lecture- group instruction Printed educational handouts Printed worksheets Interactive activities among learners Small and whole group discussions Self-reflection and sharing Resource table with additional learning tools Short video (added as a result of feedback to pilot

session)

Targeted learners

professionals in health care provision or administration

extensive experience in the long-term healthcare industry in the area of nutrition and dietary food service

men and women multicultural group 30 ndash 60 years of age

Setting

Intended LTC workshop Skilled nursing facility conference room during weekday

business hours

Pilot Group workshop Large open-plan diningliving space with participants around

large oval table

Outcome of Pilot

What would I do differently

Schedule more convenient time

Include more participants

Ask for feedback

More anonymous feedback option

simplify language

Proposed Changes to Workshop

Provide printed quiz to go with handouts Add video component Rework handouts for comprehension and

application to learners needs

Discussion

After learning more about the problem of malnutrition in long-term care are you considering how you might introduce this topic into your practice or your teaching

Are there other venues where this type of educational program is appropriate and might influence the management of nutritional care for elders

Questions

References

Abbasi AA amp Rudman D (1994) Undernutrition in the nursing home Prevalence consequences cause and prevention Nutrition Reviews 52(4) 113-122 Accreditation Council for Occupational Therapy Education (2006) ACOTE standards and interpretive guidelines Retrieved from

httpwwwaotaorgnonmembersarea13docs acotestandards806pdf Adams NE Bowie AJ Simmance N Murrary M amp Crowe T (2008) Recognition by medical and nursing professionals of malnutrition and risk of malnutrition in elderly hospitalised patients Nutrition and Dietetics (65) 144-150 Amella EJ (2002) Resistance at mealtimes for persons with dementia The Journal of Nutrition Health amp Aging 6 117-122 Amella EJ (2008) Mealtime difficulties In Evidence-Based Geriatric Nursing Protocols for Best Practice 3rd ed (Capezuti E Zwicker D Mezey M Fulmer T Gray-Miceli D amp Kluger M eds) Springer Publishing Company LLC New York p 337-351 American Occupational Therapy Association [AOTA] (2002) Occupational therapy practice framework Domain and process American Journal of Occupational Therapy 56

609ndash639 doi 105014ajot566609 AOTA (2007) Specialized knowledge and skills in feeding eating and swallowing for occupational therapy practice American Journal of Occupational Therapy 61(6) 686-700

doi 105014ajot616686 Asai JL (2004) Nutrition and the geriatric rehabilitation patient Challenges and solutions Topics in Geriatric Rehabilitation 20(1) 34-45 Baier RR Butterfield K Harris Y Gravenstein S (2008) Aiming for star performance the relationship between setting targets and improved nursing home quality of

care Journal of the American Medical Directors Association9(8) 594-9 Epub Dolhi C amp Rogers J (2009) Dementia nutrition and self-feeding A systematic review of the literature Occupational Therapy in Health Care 15(3-4) 59-87 Ferri C Prince M Brayne C Brodaty H Fratiglioni L Ganguli M hellip Landry G (2005) Global prevalence of dementia a delphi consensus study Lancet 366 2112-2217 Frisoni G Fanzoni S Rozzini R Ferrucci L Boffelli S amp Trabucchi M (1994) A nutritional index predicting mortality in the nursing home Journal of the American Geriatric Society 42 1167-1172 Furman EF (2006) Under-nutrition in older adults across the continuum of care Journal of Gerontological Nursing 32(1) 22-27 Groher ME amp Crary MA(2010) Dysphagia Clinical Management in Adults and Children Maryland Heights MO Mosby-Elsevier Harris-Kojetin L Sengupta M Park-Lee E Valverde R Long-term care services in the United States 2013 overview National health care statistics reports no 1 Hyattsville MD National Center for Health Statistics 2013

Education is Key to Change

Industry leaders nursing home administrators and management need to be educated about the extent of malnutrition in nursing homes

There is a need for educational plans and instructional materials on preventing and treating malnutrition in LTC

Healthcare providers must take time to advocate with facilities and present educational workshops

Recognizing and preventing malnutrition in nursing homes

A teaching plan was developed and incorporated into

the coursework for the OTD 610 Practitioner as Educator course at Pacific University

An extensive literature review has been created to provide evidence and foundational knowledge for healthcare providers LTC administrators and stakeholders

Purpose

Educate skilled nursing facility administrators and management about effects of poor nutritional status skilled OT assessment analysis and Interventions improving nutritional status of residents enhancing the dining experience improving staff effectiveness and efficiency

Program Goal

LTC administrators and managers will demonstrate basic knowledge of effects of poor nutritional

status describe barriers to providing excellent nutritional care explain how skilled OT services contribute to proving holistic

nutritional care

Teaching Elements

Teaching Session

Lecture- group instruction Printed educational handouts Printed worksheets Interactive activities among learners Small and whole group discussions Self-reflection and sharing Resource table with additional learning tools Short video (added as a result of feedback to pilot

session)

Targeted learners

professionals in health care provision or administration

extensive experience in the long-term healthcare industry in the area of nutrition and dietary food service

men and women multicultural group 30 ndash 60 years of age

Setting

Intended LTC workshop Skilled nursing facility conference room during weekday

business hours

Pilot Group workshop Large open-plan diningliving space with participants around

large oval table

Outcome of Pilot

What would I do differently

Schedule more convenient time

Include more participants

Ask for feedback

More anonymous feedback option

simplify language

Proposed Changes to Workshop

Provide printed quiz to go with handouts Add video component Rework handouts for comprehension and

application to learners needs

Discussion

After learning more about the problem of malnutrition in long-term care are you considering how you might introduce this topic into your practice or your teaching

Are there other venues where this type of educational program is appropriate and might influence the management of nutritional care for elders

Questions

References

Abbasi AA amp Rudman D (1994) Undernutrition in the nursing home Prevalence consequences cause and prevention Nutrition Reviews 52(4) 113-122 Accreditation Council for Occupational Therapy Education (2006) ACOTE standards and interpretive guidelines Retrieved from

httpwwwaotaorgnonmembersarea13docs acotestandards806pdf Adams NE Bowie AJ Simmance N Murrary M amp Crowe T (2008) Recognition by medical and nursing professionals of malnutrition and risk of malnutrition in elderly hospitalised patients Nutrition and Dietetics (65) 144-150 Amella EJ (2002) Resistance at mealtimes for persons with dementia The Journal of Nutrition Health amp Aging 6 117-122 Amella EJ (2008) Mealtime difficulties In Evidence-Based Geriatric Nursing Protocols for Best Practice 3rd ed (Capezuti E Zwicker D Mezey M Fulmer T Gray-Miceli D amp Kluger M eds) Springer Publishing Company LLC New York p 337-351 American Occupational Therapy Association [AOTA] (2002) Occupational therapy practice framework Domain and process American Journal of Occupational Therapy 56

609ndash639 doi 105014ajot566609 AOTA (2007) Specialized knowledge and skills in feeding eating and swallowing for occupational therapy practice American Journal of Occupational Therapy 61(6) 686-700

doi 105014ajot616686 Asai JL (2004) Nutrition and the geriatric rehabilitation patient Challenges and solutions Topics in Geriatric Rehabilitation 20(1) 34-45 Baier RR Butterfield K Harris Y Gravenstein S (2008) Aiming for star performance the relationship between setting targets and improved nursing home quality of

care Journal of the American Medical Directors Association9(8) 594-9 Epub Dolhi C amp Rogers J (2009) Dementia nutrition and self-feeding A systematic review of the literature Occupational Therapy in Health Care 15(3-4) 59-87 Ferri C Prince M Brayne C Brodaty H Fratiglioni L Ganguli M hellip Landry G (2005) Global prevalence of dementia a delphi consensus study Lancet 366 2112-2217 Frisoni G Fanzoni S Rozzini R Ferrucci L Boffelli S amp Trabucchi M (1994) A nutritional index predicting mortality in the nursing home Journal of the American Geriatric Society 42 1167-1172 Furman EF (2006) Under-nutrition in older adults across the continuum of care Journal of Gerontological Nursing 32(1) 22-27 Groher ME amp Crary MA(2010) Dysphagia Clinical Management in Adults and Children Maryland Heights MO Mosby-Elsevier Harris-Kojetin L Sengupta M Park-Lee E Valverde R Long-term care services in the United States 2013 overview National health care statistics reports no 1 Hyattsville MD National Center for Health Statistics 2013

Recognizing and preventing malnutrition in nursing homes

A teaching plan was developed and incorporated into

the coursework for the OTD 610 Practitioner as Educator course at Pacific University

An extensive literature review has been created to provide evidence and foundational knowledge for healthcare providers LTC administrators and stakeholders

Purpose

Educate skilled nursing facility administrators and management about effects of poor nutritional status skilled OT assessment analysis and Interventions improving nutritional status of residents enhancing the dining experience improving staff effectiveness and efficiency

Program Goal

LTC administrators and managers will demonstrate basic knowledge of effects of poor nutritional

status describe barriers to providing excellent nutritional care explain how skilled OT services contribute to proving holistic

nutritional care

Teaching Elements

Teaching Session

Lecture- group instruction Printed educational handouts Printed worksheets Interactive activities among learners Small and whole group discussions Self-reflection and sharing Resource table with additional learning tools Short video (added as a result of feedback to pilot

session)

Targeted learners

professionals in health care provision or administration

extensive experience in the long-term healthcare industry in the area of nutrition and dietary food service

men and women multicultural group 30 ndash 60 years of age

Setting

Intended LTC workshop Skilled nursing facility conference room during weekday

business hours

Pilot Group workshop Large open-plan diningliving space with participants around

large oval table

Outcome of Pilot

What would I do differently

Schedule more convenient time

Include more participants

Ask for feedback

More anonymous feedback option

simplify language

Proposed Changes to Workshop

Provide printed quiz to go with handouts Add video component Rework handouts for comprehension and

application to learners needs

Discussion

After learning more about the problem of malnutrition in long-term care are you considering how you might introduce this topic into your practice or your teaching

Are there other venues where this type of educational program is appropriate and might influence the management of nutritional care for elders

Questions

References

Abbasi AA amp Rudman D (1994) Undernutrition in the nursing home Prevalence consequences cause and prevention Nutrition Reviews 52(4) 113-122 Accreditation Council for Occupational Therapy Education (2006) ACOTE standards and interpretive guidelines Retrieved from

httpwwwaotaorgnonmembersarea13docs acotestandards806pdf Adams NE Bowie AJ Simmance N Murrary M amp Crowe T (2008) Recognition by medical and nursing professionals of malnutrition and risk of malnutrition in elderly hospitalised patients Nutrition and Dietetics (65) 144-150 Amella EJ (2002) Resistance at mealtimes for persons with dementia The Journal of Nutrition Health amp Aging 6 117-122 Amella EJ (2008) Mealtime difficulties In Evidence-Based Geriatric Nursing Protocols for Best Practice 3rd ed (Capezuti E Zwicker D Mezey M Fulmer T Gray-Miceli D amp Kluger M eds) Springer Publishing Company LLC New York p 337-351 American Occupational Therapy Association [AOTA] (2002) Occupational therapy practice framework Domain and process American Journal of Occupational Therapy 56

609ndash639 doi 105014ajot566609 AOTA (2007) Specialized knowledge and skills in feeding eating and swallowing for occupational therapy practice American Journal of Occupational Therapy 61(6) 686-700

doi 105014ajot616686 Asai JL (2004) Nutrition and the geriatric rehabilitation patient Challenges and solutions Topics in Geriatric Rehabilitation 20(1) 34-45 Baier RR Butterfield K Harris Y Gravenstein S (2008) Aiming for star performance the relationship between setting targets and improved nursing home quality of

care Journal of the American Medical Directors Association9(8) 594-9 Epub Dolhi C amp Rogers J (2009) Dementia nutrition and self-feeding A systematic review of the literature Occupational Therapy in Health Care 15(3-4) 59-87 Ferri C Prince M Brayne C Brodaty H Fratiglioni L Ganguli M hellip Landry G (2005) Global prevalence of dementia a delphi consensus study Lancet 366 2112-2217 Frisoni G Fanzoni S Rozzini R Ferrucci L Boffelli S amp Trabucchi M (1994) A nutritional index predicting mortality in the nursing home Journal of the American Geriatric Society 42 1167-1172 Furman EF (2006) Under-nutrition in older adults across the continuum of care Journal of Gerontological Nursing 32(1) 22-27 Groher ME amp Crary MA(2010) Dysphagia Clinical Management in Adults and Children Maryland Heights MO Mosby-Elsevier Harris-Kojetin L Sengupta M Park-Lee E Valverde R Long-term care services in the United States 2013 overview National health care statistics reports no 1 Hyattsville MD National Center for Health Statistics 2013

Purpose

Educate skilled nursing facility administrators and management about effects of poor nutritional status skilled OT assessment analysis and Interventions improving nutritional status of residents enhancing the dining experience improving staff effectiveness and efficiency

Program Goal

LTC administrators and managers will demonstrate basic knowledge of effects of poor nutritional

status describe barriers to providing excellent nutritional care explain how skilled OT services contribute to proving holistic

nutritional care

Teaching Elements

Teaching Session

Lecture- group instruction Printed educational handouts Printed worksheets Interactive activities among learners Small and whole group discussions Self-reflection and sharing Resource table with additional learning tools Short video (added as a result of feedback to pilot

session)

Targeted learners

professionals in health care provision or administration

extensive experience in the long-term healthcare industry in the area of nutrition and dietary food service

men and women multicultural group 30 ndash 60 years of age

Setting

Intended LTC workshop Skilled nursing facility conference room during weekday

business hours

Pilot Group workshop Large open-plan diningliving space with participants around

large oval table

Outcome of Pilot

What would I do differently

Schedule more convenient time

Include more participants

Ask for feedback

More anonymous feedback option

simplify language

Proposed Changes to Workshop

Provide printed quiz to go with handouts Add video component Rework handouts for comprehension and

application to learners needs

Discussion

After learning more about the problem of malnutrition in long-term care are you considering how you might introduce this topic into your practice or your teaching

Are there other venues where this type of educational program is appropriate and might influence the management of nutritional care for elders

Questions

References

Abbasi AA amp Rudman D (1994) Undernutrition in the nursing home Prevalence consequences cause and prevention Nutrition Reviews 52(4) 113-122 Accreditation Council for Occupational Therapy Education (2006) ACOTE standards and interpretive guidelines Retrieved from

httpwwwaotaorgnonmembersarea13docs acotestandards806pdf Adams NE Bowie AJ Simmance N Murrary M amp Crowe T (2008) Recognition by medical and nursing professionals of malnutrition and risk of malnutrition in elderly hospitalised patients Nutrition and Dietetics (65) 144-150 Amella EJ (2002) Resistance at mealtimes for persons with dementia The Journal of Nutrition Health amp Aging 6 117-122 Amella EJ (2008) Mealtime difficulties In Evidence-Based Geriatric Nursing Protocols for Best Practice 3rd ed (Capezuti E Zwicker D Mezey M Fulmer T Gray-Miceli D amp Kluger M eds) Springer Publishing Company LLC New York p 337-351 American Occupational Therapy Association [AOTA] (2002) Occupational therapy practice framework Domain and process American Journal of Occupational Therapy 56

609ndash639 doi 105014ajot566609 AOTA (2007) Specialized knowledge and skills in feeding eating and swallowing for occupational therapy practice American Journal of Occupational Therapy 61(6) 686-700

doi 105014ajot616686 Asai JL (2004) Nutrition and the geriatric rehabilitation patient Challenges and solutions Topics in Geriatric Rehabilitation 20(1) 34-45 Baier RR Butterfield K Harris Y Gravenstein S (2008) Aiming for star performance the relationship between setting targets and improved nursing home quality of

care Journal of the American Medical Directors Association9(8) 594-9 Epub Dolhi C amp Rogers J (2009) Dementia nutrition and self-feeding A systematic review of the literature Occupational Therapy in Health Care 15(3-4) 59-87 Ferri C Prince M Brayne C Brodaty H Fratiglioni L Ganguli M hellip Landry G (2005) Global prevalence of dementia a delphi consensus study Lancet 366 2112-2217 Frisoni G Fanzoni S Rozzini R Ferrucci L Boffelli S amp Trabucchi M (1994) A nutritional index predicting mortality in the nursing home Journal of the American Geriatric Society 42 1167-1172 Furman EF (2006) Under-nutrition in older adults across the continuum of care Journal of Gerontological Nursing 32(1) 22-27 Groher ME amp Crary MA(2010) Dysphagia Clinical Management in Adults and Children Maryland Heights MO Mosby-Elsevier Harris-Kojetin L Sengupta M Park-Lee E Valverde R Long-term care services in the United States 2013 overview National health care statistics reports no 1 Hyattsville MD National Center for Health Statistics 2013

Program Goal

LTC administrators and managers will demonstrate basic knowledge of effects of poor nutritional

status describe barriers to providing excellent nutritional care explain how skilled OT services contribute to proving holistic

nutritional care

Teaching Elements

Teaching Session

Lecture- group instruction Printed educational handouts Printed worksheets Interactive activities among learners Small and whole group discussions Self-reflection and sharing Resource table with additional learning tools Short video (added as a result of feedback to pilot

session)

Targeted learners

professionals in health care provision or administration

extensive experience in the long-term healthcare industry in the area of nutrition and dietary food service

men and women multicultural group 30 ndash 60 years of age

Setting

Intended LTC workshop Skilled nursing facility conference room during weekday

business hours

Pilot Group workshop Large open-plan diningliving space with participants around

large oval table

Outcome of Pilot

What would I do differently

Schedule more convenient time

Include more participants

Ask for feedback

More anonymous feedback option

simplify language

Proposed Changes to Workshop

Provide printed quiz to go with handouts Add video component Rework handouts for comprehension and

application to learners needs

Discussion

After learning more about the problem of malnutrition in long-term care are you considering how you might introduce this topic into your practice or your teaching

Are there other venues where this type of educational program is appropriate and might influence the management of nutritional care for elders

Questions

References

Abbasi AA amp Rudman D (1994) Undernutrition in the nursing home Prevalence consequences cause and prevention Nutrition Reviews 52(4) 113-122 Accreditation Council for Occupational Therapy Education (2006) ACOTE standards and interpretive guidelines Retrieved from

httpwwwaotaorgnonmembersarea13docs acotestandards806pdf Adams NE Bowie AJ Simmance N Murrary M amp Crowe T (2008) Recognition by medical and nursing professionals of malnutrition and risk of malnutrition in elderly hospitalised patients Nutrition and Dietetics (65) 144-150 Amella EJ (2002) Resistance at mealtimes for persons with dementia The Journal of Nutrition Health amp Aging 6 117-122 Amella EJ (2008) Mealtime difficulties In Evidence-Based Geriatric Nursing Protocols for Best Practice 3rd ed (Capezuti E Zwicker D Mezey M Fulmer T Gray-Miceli D amp Kluger M eds) Springer Publishing Company LLC New York p 337-351 American Occupational Therapy Association [AOTA] (2002) Occupational therapy practice framework Domain and process American Journal of Occupational Therapy 56

609ndash639 doi 105014ajot566609 AOTA (2007) Specialized knowledge and skills in feeding eating and swallowing for occupational therapy practice American Journal of Occupational Therapy 61(6) 686-700

doi 105014ajot616686 Asai JL (2004) Nutrition and the geriatric rehabilitation patient Challenges and solutions Topics in Geriatric Rehabilitation 20(1) 34-45 Baier RR Butterfield K Harris Y Gravenstein S (2008) Aiming for star performance the relationship between setting targets and improved nursing home quality of

care Journal of the American Medical Directors Association9(8) 594-9 Epub Dolhi C amp Rogers J (2009) Dementia nutrition and self-feeding A systematic review of the literature Occupational Therapy in Health Care 15(3-4) 59-87 Ferri C Prince M Brayne C Brodaty H Fratiglioni L Ganguli M hellip Landry G (2005) Global prevalence of dementia a delphi consensus study Lancet 366 2112-2217 Frisoni G Fanzoni S Rozzini R Ferrucci L Boffelli S amp Trabucchi M (1994) A nutritional index predicting mortality in the nursing home Journal of the American Geriatric Society 42 1167-1172 Furman EF (2006) Under-nutrition in older adults across the continuum of care Journal of Gerontological Nursing 32(1) 22-27 Groher ME amp Crary MA(2010) Dysphagia Clinical Management in Adults and Children Maryland Heights MO Mosby-Elsevier Harris-Kojetin L Sengupta M Park-Lee E Valverde R Long-term care services in the United States 2013 overview National health care statistics reports no 1 Hyattsville MD National Center for Health Statistics 2013

Teaching Elements

Teaching Session

Lecture- group instruction Printed educational handouts Printed worksheets Interactive activities among learners Small and whole group discussions Self-reflection and sharing Resource table with additional learning tools Short video (added as a result of feedback to pilot

session)

Targeted learners

professionals in health care provision or administration

extensive experience in the long-term healthcare industry in the area of nutrition and dietary food service

men and women multicultural group 30 ndash 60 years of age

Setting

Intended LTC workshop Skilled nursing facility conference room during weekday

business hours

Pilot Group workshop Large open-plan diningliving space with participants around

large oval table

Outcome of Pilot

What would I do differently

Schedule more convenient time

Include more participants

Ask for feedback

More anonymous feedback option

simplify language

Proposed Changes to Workshop

Provide printed quiz to go with handouts Add video component Rework handouts for comprehension and

application to learners needs

Discussion

After learning more about the problem of malnutrition in long-term care are you considering how you might introduce this topic into your practice or your teaching

Are there other venues where this type of educational program is appropriate and might influence the management of nutritional care for elders

Questions

References

Abbasi AA amp Rudman D (1994) Undernutrition in the nursing home Prevalence consequences cause and prevention Nutrition Reviews 52(4) 113-122 Accreditation Council for Occupational Therapy Education (2006) ACOTE standards and interpretive guidelines Retrieved from

httpwwwaotaorgnonmembersarea13docs acotestandards806pdf Adams NE Bowie AJ Simmance N Murrary M amp Crowe T (2008) Recognition by medical and nursing professionals of malnutrition and risk of malnutrition in elderly hospitalised patients Nutrition and Dietetics (65) 144-150 Amella EJ (2002) Resistance at mealtimes for persons with dementia The Journal of Nutrition Health amp Aging 6 117-122 Amella EJ (2008) Mealtime difficulties In Evidence-Based Geriatric Nursing Protocols for Best Practice 3rd ed (Capezuti E Zwicker D Mezey M Fulmer T Gray-Miceli D amp Kluger M eds) Springer Publishing Company LLC New York p 337-351 American Occupational Therapy Association [AOTA] (2002) Occupational therapy practice framework Domain and process American Journal of Occupational Therapy 56

609ndash639 doi 105014ajot566609 AOTA (2007) Specialized knowledge and skills in feeding eating and swallowing for occupational therapy practice American Journal of Occupational Therapy 61(6) 686-700

doi 105014ajot616686 Asai JL (2004) Nutrition and the geriatric rehabilitation patient Challenges and solutions Topics in Geriatric Rehabilitation 20(1) 34-45 Baier RR Butterfield K Harris Y Gravenstein S (2008) Aiming for star performance the relationship between setting targets and improved nursing home quality of

care Journal of the American Medical Directors Association9(8) 594-9 Epub Dolhi C amp Rogers J (2009) Dementia nutrition and self-feeding A systematic review of the literature Occupational Therapy in Health Care 15(3-4) 59-87 Ferri C Prince M Brayne C Brodaty H Fratiglioni L Ganguli M hellip Landry G (2005) Global prevalence of dementia a delphi consensus study Lancet 366 2112-2217 Frisoni G Fanzoni S Rozzini R Ferrucci L Boffelli S amp Trabucchi M (1994) A nutritional index predicting mortality in the nursing home Journal of the American Geriatric Society 42 1167-1172 Furman EF (2006) Under-nutrition in older adults across the continuum of care Journal of Gerontological Nursing 32(1) 22-27 Groher ME amp Crary MA(2010) Dysphagia Clinical Management in Adults and Children Maryland Heights MO Mosby-Elsevier Harris-Kojetin L Sengupta M Park-Lee E Valverde R Long-term care services in the United States 2013 overview National health care statistics reports no 1 Hyattsville MD National Center for Health Statistics 2013

Teaching Session

Lecture- group instruction Printed educational handouts Printed worksheets Interactive activities among learners Small and whole group discussions Self-reflection and sharing Resource table with additional learning tools Short video (added as a result of feedback to pilot

session)

Targeted learners

professionals in health care provision or administration

extensive experience in the long-term healthcare industry in the area of nutrition and dietary food service

men and women multicultural group 30 ndash 60 years of age

Setting

Intended LTC workshop Skilled nursing facility conference room during weekday

business hours

Pilot Group workshop Large open-plan diningliving space with participants around

large oval table

Outcome of Pilot

What would I do differently

Schedule more convenient time

Include more participants

Ask for feedback

More anonymous feedback option

simplify language

Proposed Changes to Workshop

Provide printed quiz to go with handouts Add video component Rework handouts for comprehension and

application to learners needs

Discussion

After learning more about the problem of malnutrition in long-term care are you considering how you might introduce this topic into your practice or your teaching

Are there other venues where this type of educational program is appropriate and might influence the management of nutritional care for elders

Questions

References

Abbasi AA amp Rudman D (1994) Undernutrition in the nursing home Prevalence consequences cause and prevention Nutrition Reviews 52(4) 113-122 Accreditation Council for Occupational Therapy Education (2006) ACOTE standards and interpretive guidelines Retrieved from

httpwwwaotaorgnonmembersarea13docs acotestandards806pdf Adams NE Bowie AJ Simmance N Murrary M amp Crowe T (2008) Recognition by medical and nursing professionals of malnutrition and risk of malnutrition in elderly hospitalised patients Nutrition and Dietetics (65) 144-150 Amella EJ (2002) Resistance at mealtimes for persons with dementia The Journal of Nutrition Health amp Aging 6 117-122 Amella EJ (2008) Mealtime difficulties In Evidence-Based Geriatric Nursing Protocols for Best Practice 3rd ed (Capezuti E Zwicker D Mezey M Fulmer T Gray-Miceli D amp Kluger M eds) Springer Publishing Company LLC New York p 337-351 American Occupational Therapy Association [AOTA] (2002) Occupational therapy practice framework Domain and process American Journal of Occupational Therapy 56

609ndash639 doi 105014ajot566609 AOTA (2007) Specialized knowledge and skills in feeding eating and swallowing for occupational therapy practice American Journal of Occupational Therapy 61(6) 686-700

doi 105014ajot616686 Asai JL (2004) Nutrition and the geriatric rehabilitation patient Challenges and solutions Topics in Geriatric Rehabilitation 20(1) 34-45 Baier RR Butterfield K Harris Y Gravenstein S (2008) Aiming for star performance the relationship between setting targets and improved nursing home quality of

care Journal of the American Medical Directors Association9(8) 594-9 Epub Dolhi C amp Rogers J (2009) Dementia nutrition and self-feeding A systematic review of the literature Occupational Therapy in Health Care 15(3-4) 59-87 Ferri C Prince M Brayne C Brodaty H Fratiglioni L Ganguli M hellip Landry G (2005) Global prevalence of dementia a delphi consensus study Lancet 366 2112-2217 Frisoni G Fanzoni S Rozzini R Ferrucci L Boffelli S amp Trabucchi M (1994) A nutritional index predicting mortality in the nursing home Journal of the American Geriatric Society 42 1167-1172 Furman EF (2006) Under-nutrition in older adults across the continuum of care Journal of Gerontological Nursing 32(1) 22-27 Groher ME amp Crary MA(2010) Dysphagia Clinical Management in Adults and Children Maryland Heights MO Mosby-Elsevier Harris-Kojetin L Sengupta M Park-Lee E Valverde R Long-term care services in the United States 2013 overview National health care statistics reports no 1 Hyattsville MD National Center for Health Statistics 2013

Targeted learners

professionals in health care provision or administration

extensive experience in the long-term healthcare industry in the area of nutrition and dietary food service

men and women multicultural group 30 ndash 60 years of age

Setting

Intended LTC workshop Skilled nursing facility conference room during weekday

business hours

Pilot Group workshop Large open-plan diningliving space with participants around

large oval table

Outcome of Pilot

What would I do differently

Schedule more convenient time

Include more participants

Ask for feedback

More anonymous feedback option

simplify language

Proposed Changes to Workshop

Provide printed quiz to go with handouts Add video component Rework handouts for comprehension and

application to learners needs

Discussion

After learning more about the problem of malnutrition in long-term care are you considering how you might introduce this topic into your practice or your teaching

Are there other venues where this type of educational program is appropriate and might influence the management of nutritional care for elders

Questions

References

Abbasi AA amp Rudman D (1994) Undernutrition in the nursing home Prevalence consequences cause and prevention Nutrition Reviews 52(4) 113-122 Accreditation Council for Occupational Therapy Education (2006) ACOTE standards and interpretive guidelines Retrieved from

httpwwwaotaorgnonmembersarea13docs acotestandards806pdf Adams NE Bowie AJ Simmance N Murrary M amp Crowe T (2008) Recognition by medical and nursing professionals of malnutrition and risk of malnutrition in elderly hospitalised patients Nutrition and Dietetics (65) 144-150 Amella EJ (2002) Resistance at mealtimes for persons with dementia The Journal of Nutrition Health amp Aging 6 117-122 Amella EJ (2008) Mealtime difficulties In Evidence-Based Geriatric Nursing Protocols for Best Practice 3rd ed (Capezuti E Zwicker D Mezey M Fulmer T Gray-Miceli D amp Kluger M eds) Springer Publishing Company LLC New York p 337-351 American Occupational Therapy Association [AOTA] (2002) Occupational therapy practice framework Domain and process American Journal of Occupational Therapy 56

609ndash639 doi 105014ajot566609 AOTA (2007) Specialized knowledge and skills in feeding eating and swallowing for occupational therapy practice American Journal of Occupational Therapy 61(6) 686-700

doi 105014ajot616686 Asai JL (2004) Nutrition and the geriatric rehabilitation patient Challenges and solutions Topics in Geriatric Rehabilitation 20(1) 34-45 Baier RR Butterfield K Harris Y Gravenstein S (2008) Aiming for star performance the relationship between setting targets and improved nursing home quality of

care Journal of the American Medical Directors Association9(8) 594-9 Epub Dolhi C amp Rogers J (2009) Dementia nutrition and self-feeding A systematic review of the literature Occupational Therapy in Health Care 15(3-4) 59-87 Ferri C Prince M Brayne C Brodaty H Fratiglioni L Ganguli M hellip Landry G (2005) Global prevalence of dementia a delphi consensus study Lancet 366 2112-2217 Frisoni G Fanzoni S Rozzini R Ferrucci L Boffelli S amp Trabucchi M (1994) A nutritional index predicting mortality in the nursing home Journal of the American Geriatric Society 42 1167-1172 Furman EF (2006) Under-nutrition in older adults across the continuum of care Journal of Gerontological Nursing 32(1) 22-27 Groher ME amp Crary MA(2010) Dysphagia Clinical Management in Adults and Children Maryland Heights MO Mosby-Elsevier Harris-Kojetin L Sengupta M Park-Lee E Valverde R Long-term care services in the United States 2013 overview National health care statistics reports no 1 Hyattsville MD National Center for Health Statistics 2013

Setting

Intended LTC workshop Skilled nursing facility conference room during weekday

business hours

Pilot Group workshop Large open-plan diningliving space with participants around

large oval table

Outcome of Pilot

What would I do differently

Schedule more convenient time

Include more participants

Ask for feedback

More anonymous feedback option

simplify language

Proposed Changes to Workshop

Provide printed quiz to go with handouts Add video component Rework handouts for comprehension and

application to learners needs

Discussion

After learning more about the problem of malnutrition in long-term care are you considering how you might introduce this topic into your practice or your teaching

Are there other venues where this type of educational program is appropriate and might influence the management of nutritional care for elders

Questions

References

Abbasi AA amp Rudman D (1994) Undernutrition in the nursing home Prevalence consequences cause and prevention Nutrition Reviews 52(4) 113-122 Accreditation Council for Occupational Therapy Education (2006) ACOTE standards and interpretive guidelines Retrieved from

httpwwwaotaorgnonmembersarea13docs acotestandards806pdf Adams NE Bowie AJ Simmance N Murrary M amp Crowe T (2008) Recognition by medical and nursing professionals of malnutrition and risk of malnutrition in elderly hospitalised patients Nutrition and Dietetics (65) 144-150 Amella EJ (2002) Resistance at mealtimes for persons with dementia The Journal of Nutrition Health amp Aging 6 117-122 Amella EJ (2008) Mealtime difficulties In Evidence-Based Geriatric Nursing Protocols for Best Practice 3rd ed (Capezuti E Zwicker D Mezey M Fulmer T Gray-Miceli D amp Kluger M eds) Springer Publishing Company LLC New York p 337-351 American Occupational Therapy Association [AOTA] (2002) Occupational therapy practice framework Domain and process American Journal of Occupational Therapy 56

609ndash639 doi 105014ajot566609 AOTA (2007) Specialized knowledge and skills in feeding eating and swallowing for occupational therapy practice American Journal of Occupational Therapy 61(6) 686-700

doi 105014ajot616686 Asai JL (2004) Nutrition and the geriatric rehabilitation patient Challenges and solutions Topics in Geriatric Rehabilitation 20(1) 34-45 Baier RR Butterfield K Harris Y Gravenstein S (2008) Aiming for star performance the relationship between setting targets and improved nursing home quality of

care Journal of the American Medical Directors Association9(8) 594-9 Epub Dolhi C amp Rogers J (2009) Dementia nutrition and self-feeding A systematic review of the literature Occupational Therapy in Health Care 15(3-4) 59-87 Ferri C Prince M Brayne C Brodaty H Fratiglioni L Ganguli M hellip Landry G (2005) Global prevalence of dementia a delphi consensus study Lancet 366 2112-2217 Frisoni G Fanzoni S Rozzini R Ferrucci L Boffelli S amp Trabucchi M (1994) A nutritional index predicting mortality in the nursing home Journal of the American Geriatric Society 42 1167-1172 Furman EF (2006) Under-nutrition in older adults across the continuum of care Journal of Gerontological Nursing 32(1) 22-27 Groher ME amp Crary MA(2010) Dysphagia Clinical Management in Adults and Children Maryland Heights MO Mosby-Elsevier Harris-Kojetin L Sengupta M Park-Lee E Valverde R Long-term care services in the United States 2013 overview National health care statistics reports no 1 Hyattsville MD National Center for Health Statistics 2013

Outcome of Pilot

What would I do differently

Schedule more convenient time

Include more participants

Ask for feedback

More anonymous feedback option

simplify language

Proposed Changes to Workshop

Provide printed quiz to go with handouts Add video component Rework handouts for comprehension and

application to learners needs

Discussion

After learning more about the problem of malnutrition in long-term care are you considering how you might introduce this topic into your practice or your teaching

Are there other venues where this type of educational program is appropriate and might influence the management of nutritional care for elders

Questions

References

Abbasi AA amp Rudman D (1994) Undernutrition in the nursing home Prevalence consequences cause and prevention Nutrition Reviews 52(4) 113-122 Accreditation Council for Occupational Therapy Education (2006) ACOTE standards and interpretive guidelines Retrieved from

httpwwwaotaorgnonmembersarea13docs acotestandards806pdf Adams NE Bowie AJ Simmance N Murrary M amp Crowe T (2008) Recognition by medical and nursing professionals of malnutrition and risk of malnutrition in elderly hospitalised patients Nutrition and Dietetics (65) 144-150 Amella EJ (2002) Resistance at mealtimes for persons with dementia The Journal of Nutrition Health amp Aging 6 117-122 Amella EJ (2008) Mealtime difficulties In Evidence-Based Geriatric Nursing Protocols for Best Practice 3rd ed (Capezuti E Zwicker D Mezey M Fulmer T Gray-Miceli D amp Kluger M eds) Springer Publishing Company LLC New York p 337-351 American Occupational Therapy Association [AOTA] (2002) Occupational therapy practice framework Domain and process American Journal of Occupational Therapy 56

609ndash639 doi 105014ajot566609 AOTA (2007) Specialized knowledge and skills in feeding eating and swallowing for occupational therapy practice American Journal of Occupational Therapy 61(6) 686-700

doi 105014ajot616686 Asai JL (2004) Nutrition and the geriatric rehabilitation patient Challenges and solutions Topics in Geriatric Rehabilitation 20(1) 34-45 Baier RR Butterfield K Harris Y Gravenstein S (2008) Aiming for star performance the relationship between setting targets and improved nursing home quality of

care Journal of the American Medical Directors Association9(8) 594-9 Epub Dolhi C amp Rogers J (2009) Dementia nutrition and self-feeding A systematic review of the literature Occupational Therapy in Health Care 15(3-4) 59-87 Ferri C Prince M Brayne C Brodaty H Fratiglioni L Ganguli M hellip Landry G (2005) Global prevalence of dementia a delphi consensus study Lancet 366 2112-2217 Frisoni G Fanzoni S Rozzini R Ferrucci L Boffelli S amp Trabucchi M (1994) A nutritional index predicting mortality in the nursing home Journal of the American Geriatric Society 42 1167-1172 Furman EF (2006) Under-nutrition in older adults across the continuum of care Journal of Gerontological Nursing 32(1) 22-27 Groher ME amp Crary MA(2010) Dysphagia Clinical Management in Adults and Children Maryland Heights MO Mosby-Elsevier Harris-Kojetin L Sengupta M Park-Lee E Valverde R Long-term care services in the United States 2013 overview National health care statistics reports no 1 Hyattsville MD National Center for Health Statistics 2013

What would I do differently

Schedule more convenient time

Include more participants

Ask for feedback

More anonymous feedback option

simplify language

Proposed Changes to Workshop

Provide printed quiz to go with handouts Add video component Rework handouts for comprehension and

application to learners needs

Discussion

After learning more about the problem of malnutrition in long-term care are you considering how you might introduce this topic into your practice or your teaching

Are there other venues where this type of educational program is appropriate and might influence the management of nutritional care for elders

Questions

References

Abbasi AA amp Rudman D (1994) Undernutrition in the nursing home Prevalence consequences cause and prevention Nutrition Reviews 52(4) 113-122 Accreditation Council for Occupational Therapy Education (2006) ACOTE standards and interpretive guidelines Retrieved from

httpwwwaotaorgnonmembersarea13docs acotestandards806pdf Adams NE Bowie AJ Simmance N Murrary M amp Crowe T (2008) Recognition by medical and nursing professionals of malnutrition and risk of malnutrition in elderly hospitalised patients Nutrition and Dietetics (65) 144-150 Amella EJ (2002) Resistance at mealtimes for persons with dementia The Journal of Nutrition Health amp Aging 6 117-122 Amella EJ (2008) Mealtime difficulties In Evidence-Based Geriatric Nursing Protocols for Best Practice 3rd ed (Capezuti E Zwicker D Mezey M Fulmer T Gray-Miceli D amp Kluger M eds) Springer Publishing Company LLC New York p 337-351 American Occupational Therapy Association [AOTA] (2002) Occupational therapy practice framework Domain and process American Journal of Occupational Therapy 56

609ndash639 doi 105014ajot566609 AOTA (2007) Specialized knowledge and skills in feeding eating and swallowing for occupational therapy practice American Journal of Occupational Therapy 61(6) 686-700

doi 105014ajot616686 Asai JL (2004) Nutrition and the geriatric rehabilitation patient Challenges and solutions Topics in Geriatric Rehabilitation 20(1) 34-45 Baier RR Butterfield K Harris Y Gravenstein S (2008) Aiming for star performance the relationship between setting targets and improved nursing home quality of

care Journal of the American Medical Directors Association9(8) 594-9 Epub Dolhi C amp Rogers J (2009) Dementia nutrition and self-feeding A systematic review of the literature Occupational Therapy in Health Care 15(3-4) 59-87 Ferri C Prince M Brayne C Brodaty H Fratiglioni L Ganguli M hellip Landry G (2005) Global prevalence of dementia a delphi consensus study Lancet 366 2112-2217 Frisoni G Fanzoni S Rozzini R Ferrucci L Boffelli S amp Trabucchi M (1994) A nutritional index predicting mortality in the nursing home Journal of the American Geriatric Society 42 1167-1172 Furman EF (2006) Under-nutrition in older adults across the continuum of care Journal of Gerontological Nursing 32(1) 22-27 Groher ME amp Crary MA(2010) Dysphagia Clinical Management in Adults and Children Maryland Heights MO Mosby-Elsevier Harris-Kojetin L Sengupta M Park-Lee E Valverde R Long-term care services in the United States 2013 overview National health care statistics reports no 1 Hyattsville MD National Center for Health Statistics 2013

Proposed Changes to Workshop

Provide printed quiz to go with handouts Add video component Rework handouts for comprehension and

application to learners needs

Discussion

After learning more about the problem of malnutrition in long-term care are you considering how you might introduce this topic into your practice or your teaching

Are there other venues where this type of educational program is appropriate and might influence the management of nutritional care for elders

Questions

References

Abbasi AA amp Rudman D (1994) Undernutrition in the nursing home Prevalence consequences cause and prevention Nutrition Reviews 52(4) 113-122 Accreditation Council for Occupational Therapy Education (2006) ACOTE standards and interpretive guidelines Retrieved from

httpwwwaotaorgnonmembersarea13docs acotestandards806pdf Adams NE Bowie AJ Simmance N Murrary M amp Crowe T (2008) Recognition by medical and nursing professionals of malnutrition and risk of malnutrition in elderly hospitalised patients Nutrition and Dietetics (65) 144-150 Amella EJ (2002) Resistance at mealtimes for persons with dementia The Journal of Nutrition Health amp Aging 6 117-122 Amella EJ (2008) Mealtime difficulties In Evidence-Based Geriatric Nursing Protocols for Best Practice 3rd ed (Capezuti E Zwicker D Mezey M Fulmer T Gray-Miceli D amp Kluger M eds) Springer Publishing Company LLC New York p 337-351 American Occupational Therapy Association [AOTA] (2002) Occupational therapy practice framework Domain and process American Journal of Occupational Therapy 56

609ndash639 doi 105014ajot566609 AOTA (2007) Specialized knowledge and skills in feeding eating and swallowing for occupational therapy practice American Journal of Occupational Therapy 61(6) 686-700

doi 105014ajot616686 Asai JL (2004) Nutrition and the geriatric rehabilitation patient Challenges and solutions Topics in Geriatric Rehabilitation 20(1) 34-45 Baier RR Butterfield K Harris Y Gravenstein S (2008) Aiming for star performance the relationship between setting targets and improved nursing home quality of

care Journal of the American Medical Directors Association9(8) 594-9 Epub Dolhi C amp Rogers J (2009) Dementia nutrition and self-feeding A systematic review of the literature Occupational Therapy in Health Care 15(3-4) 59-87 Ferri C Prince M Brayne C Brodaty H Fratiglioni L Ganguli M hellip Landry G (2005) Global prevalence of dementia a delphi consensus study Lancet 366 2112-2217 Frisoni G Fanzoni S Rozzini R Ferrucci L Boffelli S amp Trabucchi M (1994) A nutritional index predicting mortality in the nursing home Journal of the American Geriatric Society 42 1167-1172 Furman EF (2006) Under-nutrition in older adults across the continuum of care Journal of Gerontological Nursing 32(1) 22-27 Groher ME amp Crary MA(2010) Dysphagia Clinical Management in Adults and Children Maryland Heights MO Mosby-Elsevier Harris-Kojetin L Sengupta M Park-Lee E Valverde R Long-term care services in the United States 2013 overview National health care statistics reports no 1 Hyattsville MD National Center for Health Statistics 2013

Discussion

After learning more about the problem of malnutrition in long-term care are you considering how you might introduce this topic into your practice or your teaching

Are there other venues where this type of educational program is appropriate and might influence the management of nutritional care for elders

Questions

References

Abbasi AA amp Rudman D (1994) Undernutrition in the nursing home Prevalence consequences cause and prevention Nutrition Reviews 52(4) 113-122 Accreditation Council for Occupational Therapy Education (2006) ACOTE standards and interpretive guidelines Retrieved from

httpwwwaotaorgnonmembersarea13docs acotestandards806pdf Adams NE Bowie AJ Simmance N Murrary M amp Crowe T (2008) Recognition by medical and nursing professionals of malnutrition and risk of malnutrition in elderly hospitalised patients Nutrition and Dietetics (65) 144-150 Amella EJ (2002) Resistance at mealtimes for persons with dementia The Journal of Nutrition Health amp Aging 6 117-122 Amella EJ (2008) Mealtime difficulties In Evidence-Based Geriatric Nursing Protocols for Best Practice 3rd ed (Capezuti E Zwicker D Mezey M Fulmer T Gray-Miceli D amp Kluger M eds) Springer Publishing Company LLC New York p 337-351 American Occupational Therapy Association [AOTA] (2002) Occupational therapy practice framework Domain and process American Journal of Occupational Therapy 56

609ndash639 doi 105014ajot566609 AOTA (2007) Specialized knowledge and skills in feeding eating and swallowing for occupational therapy practice American Journal of Occupational Therapy 61(6) 686-700

doi 105014ajot616686 Asai JL (2004) Nutrition and the geriatric rehabilitation patient Challenges and solutions Topics in Geriatric Rehabilitation 20(1) 34-45 Baier RR Butterfield K Harris Y Gravenstein S (2008) Aiming for star performance the relationship between setting targets and improved nursing home quality of

care Journal of the American Medical Directors Association9(8) 594-9 Epub Dolhi C amp Rogers J (2009) Dementia nutrition and self-feeding A systematic review of the literature Occupational Therapy in Health Care 15(3-4) 59-87 Ferri C Prince M Brayne C Brodaty H Fratiglioni L Ganguli M hellip Landry G (2005) Global prevalence of dementia a delphi consensus study Lancet 366 2112-2217 Frisoni G Fanzoni S Rozzini R Ferrucci L Boffelli S amp Trabucchi M (1994) A nutritional index predicting mortality in the nursing home Journal of the American Geriatric Society 42 1167-1172 Furman EF (2006) Under-nutrition in older adults across the continuum of care Journal of Gerontological Nursing 32(1) 22-27 Groher ME amp Crary MA(2010) Dysphagia Clinical Management in Adults and Children Maryland Heights MO Mosby-Elsevier Harris-Kojetin L Sengupta M Park-Lee E Valverde R Long-term care services in the United States 2013 overview National health care statistics reports no 1 Hyattsville MD National Center for Health Statistics 2013

Questions

References

Abbasi AA amp Rudman D (1994) Undernutrition in the nursing home Prevalence consequences cause and prevention Nutrition Reviews 52(4) 113-122 Accreditation Council for Occupational Therapy Education (2006) ACOTE standards and interpretive guidelines Retrieved from

httpwwwaotaorgnonmembersarea13docs acotestandards806pdf Adams NE Bowie AJ Simmance N Murrary M amp Crowe T (2008) Recognition by medical and nursing professionals of malnutrition and risk of malnutrition in elderly hospitalised patients Nutrition and Dietetics (65) 144-150 Amella EJ (2002) Resistance at mealtimes for persons with dementia The Journal of Nutrition Health amp Aging 6 117-122 Amella EJ (2008) Mealtime difficulties In Evidence-Based Geriatric Nursing Protocols for Best Practice 3rd ed (Capezuti E Zwicker D Mezey M Fulmer T Gray-Miceli D amp Kluger M eds) Springer Publishing Company LLC New York p 337-351 American Occupational Therapy Association [AOTA] (2002) Occupational therapy practice framework Domain and process American Journal of Occupational Therapy 56

609ndash639 doi 105014ajot566609 AOTA (2007) Specialized knowledge and skills in feeding eating and swallowing for occupational therapy practice American Journal of Occupational Therapy 61(6) 686-700

doi 105014ajot616686 Asai JL (2004) Nutrition and the geriatric rehabilitation patient Challenges and solutions Topics in Geriatric Rehabilitation 20(1) 34-45 Baier RR Butterfield K Harris Y Gravenstein S (2008) Aiming for star performance the relationship between setting targets and improved nursing home quality of

care Journal of the American Medical Directors Association9(8) 594-9 Epub Dolhi C amp Rogers J (2009) Dementia nutrition and self-feeding A systematic review of the literature Occupational Therapy in Health Care 15(3-4) 59-87 Ferri C Prince M Brayne C Brodaty H Fratiglioni L Ganguli M hellip Landry G (2005) Global prevalence of dementia a delphi consensus study Lancet 366 2112-2217 Frisoni G Fanzoni S Rozzini R Ferrucci L Boffelli S amp Trabucchi M (1994) A nutritional index predicting mortality in the nursing home Journal of the American Geriatric Society 42 1167-1172 Furman EF (2006) Under-nutrition in older adults across the continuum of care Journal of Gerontological Nursing 32(1) 22-27 Groher ME amp Crary MA(2010) Dysphagia Clinical Management in Adults and Children Maryland Heights MO Mosby-Elsevier Harris-Kojetin L Sengupta M Park-Lee E Valverde R Long-term care services in the United States 2013 overview National health care statistics reports no 1 Hyattsville MD National Center for Health Statistics 2013

References

Abbasi AA amp Rudman D (1994) Undernutrition in the nursing home Prevalence consequences cause and prevention Nutrition Reviews 52(4) 113-122 Accreditation Council for Occupational Therapy Education (2006) ACOTE standards and interpretive guidelines Retrieved from

httpwwwaotaorgnonmembersarea13docs acotestandards806pdf Adams NE Bowie AJ Simmance N Murrary M amp Crowe T (2008) Recognition by medical and nursing professionals of malnutrition and risk of malnutrition in elderly hospitalised patients Nutrition and Dietetics (65) 144-150 Amella EJ (2002) Resistance at mealtimes for persons with dementia The Journal of Nutrition Health amp Aging 6 117-122 Amella EJ (2008) Mealtime difficulties In Evidence-Based Geriatric Nursing Protocols for Best Practice 3rd ed (Capezuti E Zwicker D Mezey M Fulmer T Gray-Miceli D amp Kluger M eds) Springer Publishing Company LLC New York p 337-351 American Occupational Therapy Association [AOTA] (2002) Occupational therapy practice framework Domain and process American Journal of Occupational Therapy 56

609ndash639 doi 105014ajot566609 AOTA (2007) Specialized knowledge and skills in feeding eating and swallowing for occupational therapy practice American Journal of Occupational Therapy 61(6) 686-700

doi 105014ajot616686 Asai JL (2004) Nutrition and the geriatric rehabilitation patient Challenges and solutions Topics in Geriatric Rehabilitation 20(1) 34-45 Baier RR Butterfield K Harris Y Gravenstein S (2008) Aiming for star performance the relationship between setting targets and improved nursing home quality of

care Journal of the American Medical Directors Association9(8) 594-9 Epub Dolhi C amp Rogers J (2009) Dementia nutrition and self-feeding A systematic review of the literature Occupational Therapy in Health Care 15(3-4) 59-87 Ferri C Prince M Brayne C Brodaty H Fratiglioni L Ganguli M hellip Landry G (2005) Global prevalence of dementia a delphi consensus study Lancet 366 2112-2217 Frisoni G Fanzoni S Rozzini R Ferrucci L Boffelli S amp Trabucchi M (1994) A nutritional index predicting mortality in the nursing home Journal of the American Geriatric Society 42 1167-1172 Furman EF (2006) Under-nutrition in older adults across the continuum of care Journal of Gerontological Nursing 32(1) 22-27 Groher ME amp Crary MA(2010) Dysphagia Clinical Management in Adults and Children Maryland Heights MO Mosby-Elsevier Harris-Kojetin L Sengupta M Park-Lee E Valverde R Long-term care services in the United States 2013 overview National health care statistics reports no 1 Hyattsville MD National Center for Health Statistics 2013

References

Horner J Alberts MJ Dawson DV Cook GM (1994) Swallowing in Alzheimerrsquos disease Alzheimer Disease Association Disorders 8 177 ndash 19 Kielhofner G (1985) A model of human occupation Baltimore Williams and Wilkins Lammes E amp Akner G (2006) Repeated assessment of energy and nutrient intake in 52 nursing home residents Journal of Nutritional Health and Aging 10(3) 222-30 Lin L-C Watson R amp Wu S-C (2010) What is associated with low food intake in older people with dementia Journal of Clinical Nursing 19 53-59 Doi 101111j1365-2702200902962x Maher D amp Eliad C (2014) Malnutrition in the elderly An unrecognized health issue Journal of Nursing Retrieved from httprnjournalcomjournal-of-nursingmalnutrition-in-the-elderly-an-unrecognized-health-issue Manthorpe J amp Watson R (2003) Poorly served Eating and dementia Journal of Advanced Nursing 41(2) 162-169 Nelson K Coultson A SucherKP amp Tseng R (1992) Prevalence of malnutrition in The elderly admitted to long-term-care facilities Journal of the American Dietetic Association 93(4) 459-460 Ott F Readman T amp Backman C (1990) Mealtimes of the institutionalized elderly A literature review Canadian Journal of Occupational Therapy 57(5) 261-267 Payette H (2002) Know related effects of nutrition on aging muscle function In Nutrition and Aging Vol 6 Ed by LH Rosenberg and A Sastre Nestle Workshop Series Clinical and Performance Program Nestec Ltd Vevey Switzerland P 135-150 Planetree amp Picker Institute (2010) Long term care improvement guide Retrieved from httpplanetreeorgwp-contentuploads201112LTC-Improvement-Guide-For-Downloadpdf Riviere S Gillerte-Guyonnet S Andrieu S Nourhashemi F Laugque S Cantet C hellip Vellas B (2002) Cognitive function and caregiver burden Predictive factors for eating behavior disorders in Alzhiemerrsquos disease International Journal of Geriatric Psychiatry 17 950-955 Schussler S Dassen T amp Lohrmann C (2014) Prevalence of care dependency and nursing care problems in nursing home residents with dementia A literature review International Journal of Caring Sciences 7(2) 339 Retrieved from httpwwwinternationaljournalofcaringsciencesorgdocs120SchC3BCssler-1pdf

References

Scott TM Peter L Tucker KL Arsenault L Bergethon P Bhadelia R hellip Folstein M (2006) The Nutrition Aging and Memory in Elders (NAME) study Design and methods for a study of micronutrients and cognitive function in a homebound elderly population International Journal of Geriatric Psychiatry 21(6) 519-528

doi101002gps1503735 Simmons SF Keeler E Zhuo X Hickey KA Sato HW amp Schnelle JF (2008) Prevention of unintentional weight loss in nursing home residents a controlled trial of feeding assistance Journal of American Geriatric Society 56(8) 1466-1473

Doi101111j1532-5415200801801x Sodderhamn U Backrach-Lindstrom M amp Ek AC (2007) Nutritional screening and perceived health in a group of geriatric rehabilitation patients Journal of Clinical Nursing (16) 1997-2006 Thomas DR Ashmen W Morley JE Evans WJ amp the Council for Nutritional Strategies in Long-Term Care (2000) Nutritional management in long-term care Development of a clinical guideline Journal of Gerontolology Biological Sciences and Medical Sciences 55A(12) M725- doi101093Gerona5512M725 Wu S amp Barker JC (2008) Hot tea and Juk The institutional meaning of food for Chinese elders in an American nursing home Journal of Gerontological Nursing 34(11) 46-45 doi10392800989134-20081101-11

E L I Z A B E T H C B A I R b a i r 0 7 1 2 p a c i f i c u e d u

Thank You

• Preventing Malnutrition in Long-term Care
• Abstract
• Purpose
• Learning Objectives
• Malnutrition in Long-term Care
• Prevalence
• Factors in Malnutrition
• Signs and Symptoms
• Consequences of Malnutrition
• Barriers to Good Nutritional Status
• Dementia and Malnutrition
• Dementia and Malnutrition
• Effects of Increased Assistance
• Role of Occupational Therapy
• OT Interventions
• Culture Change
• Trends in Culture Change
• Benefits of Culture Change
• Key Points for Program amp Culture Change
• Future Work
• Future Work
• Education is Key to Change
• Recognizing and preventing malnutrition in nursing homes
• Purpose
• Program Goal
• Teaching Elements
• Teaching Session
• Targeted learners
• Setting
• Outcome of Pilot
• What would I do differently
• Proposed Changes to Workshop
• Discussion
• Questions
• References
• References
• References
• Thank You

E L I Z A B E T H C B A I R b a i r 0 7 1 2 p a c i f i c u e d u

Thank You

• Preventing Malnutrition in Long-term Care
• Abstract
• Purpose
• Learning Objectives
• Malnutrition in Long-term Care
• Prevalence
• Factors in Malnutrition
• Signs and Symptoms
• Consequences of Malnutrition
• Barriers to Good Nutritional Status
• Dementia and Malnutrition
• Dementia and Malnutrition
• Effects of Increased Assistance
• Role of Occupational Therapy
• OT Interventions
• Culture Change
• Trends in Culture Change
• Benefits of Culture Change
• Key Points for Program amp Culture Change
• Future Work
• Future Work
• Education is Key to Change
• Recognizing and preventing malnutrition in nursing homes
• Purpose
• Program Goal
• Teaching Elements
• Teaching Session
• Targeted learners
• Setting
• Outcome of Pilot
• What would I do differently
• Proposed Changes to Workshop
• Discussion
• Questions
• References
• References
• References
• Thank You