Interdisciplinary Nutritional Management and Care for Older Adults. An Evidence-Based Practical Guide for Nurses

Foreword from FFN

Professor Paolo Falaschi, Italy
Julie Santy-Tomlinson, United Kingdom
Karen Hertz, United Kingdom

Part I 

Chapter 1: Overview of nutrition care in geriatrics and orthogeriatrics

Setting the scene/awareness

• Description of issues/common nutritional problems, including prevalence, causes, consequences, costs
• Guidelines /consensus on nutritional care 
• Description of geriatric patients and patients with fragility fractures including prevalence, causes, consequences, costs
• Nutritional requirements in old age and in fragility fractures
• Why proactive, multimodal, and multidisciplinary nutrition care is a ‘must do’
• Need to focus on nutrition care across the 3 pillars: acute care, rehabilitation, and primary/secondary prevention in the community
• Shifting the focus of nutrition care with the onset of geriatric conditions, need to shift nutritional care focus from lifestyle disease and obesity prevention to prevention of functional loss and maintain muscle mass, bone integrity, and optimal quality of life. Food choose in heart disease, risk of malnutrition vs heart health & food chooses in diabetes and serum glucose control 

Antony Johansen, Jack Bell, Australia, Julie Santy Tomlinson, United Kingdom, Karen Hertz, United Kingdom, Ólöf Guðný Geirsdóttir, Iceland

Chapter 2: Nutritional requirements in geriatrics

Anne Marie Beck (Dietitian), Denmark, Mette Holst (Nurse), Denmark, 
Key words: nutritional recommendations, change in requirements with age and disease, any specific nuances for orthogeriatrics

Chapter 3: Nutritional assessment, diagnosis and treatment in geriatrics

Anne Marie Beck (Dietitian), Denmark, Mette Holst (Nurse), Denmark
Key words: definitions, assessment, diagnosis and treatment for nutritional problems i.e. malnutrition other problems? Targeting nutritional/dietetic care process principles (including screening, assessment, diagnosis, intervention, monitoring)  

Chapter 4: Best practice in nursing care; role of nutrition

Anita Meehan (Nurse), USA, Satya Jonnalagadda (Dietitian)
Key words: safety, timeliness, effectiveness, efficiency, efficacy and patient-centred geriatric care

Chapter 5: Hydration in orthogeriatrics

Sigrún Sunna Skúladóttir (Nurse), Iceland, Vilborg Kolbrún Vilmundardóttir (clinical nutritionist), Iceland
Key word: recommendations, hydration balance, best practise at the ward

Chapter 6: Untangling aging, malnutrition, frailty, sarcopenia and function decline

Silvia Migliaccio, (Endocrinology), Italy, Lorenzo M Donini, Italy
Key words: definitions, association of malnutrition with frailty, sarcopenia and physical function, falls

Chapter 7: Bone health, fragility and fractures (5000 words)

Helen Wilson, (geriatrician) & co-worker UK
Key words: definitions, association of nutrition with bone health

Chapter 8: How to increase patient motivation and adherence to nutritional care? Overcoming psychological barriers

Stephano Eleuteri, Italy, Maria Eduarda Batista de Lima, Italy

Chapter 9: How to engage treating teams to spread and sustain nutritional care

Celia Laur, Australia, Jack Bell, Australia
Keywords: Embedding, sustaining and spreading nutrition care improvements, SIMPLE model. This should also take into account where nutrition care may best be delivered e.g. community setting vs acute hospitals and the potential role for community based / aged care home-based nurses to be leaders and champions in this space

Chapter 10: Interdisciplinary team and education of professionals

Julie Santy-Tomlinson, United Kingdom, Karen Hertz, United Kingdom
Key words: Importance of interdisciplinary teamwork and interdisciplinary education

PART II Special topics in geriatric nutrition (1000 words)

Chapter 11: Specialist versus generalist nutritional care in aging

Ólöf Guðný Geirsdóttir, Iceland, Jack Bell, Australia

This introduces a “less is more” approach in geriatric nutrition to deliver nutritional care that matters for the patients. Dietary deprescription; working with the whole patient rather than treating specific disease processes; balancing food as a medicine with food for comfort; how to apply codesign, shared decision making, and truth telling.

Chapter 12: Key opportunities for multidisciplinary nutritional care 

Debbie ten Cate / Roelof Ettema, Chrys Pulle / Antony Johansen, Alita Rushton (AU)
Enteral- and parenteral nutrition, supplemental drinks, mealtime assistance, nutritional education etc

Chapter 13: Physical activity, exercise and physical rehabilitation

Monica Rodrigues Perracini, Brasilia
Nutrition and PA and safe PA for old adults

Chapter 14: Pressure ulcer prevention and management

Julie Santy-Tomlinson, United Kingdom, Karen Hertz, United Kingdom
Nutrition, nutritional status and pressure ulcer

Chapter 15: Obesity, Body composition & BMI 

Sari Holmstein, Finland, Alfons Ramel, Austria/Iceland
Obesity paradox in aging

Chapter 16: Fundamentals of nutritional physiology

Saverio Cinti, Italy
Anatomy and physiology of nutritional system overview with a basic overview of the different roles of macro and micronutrients in orthogeriatric

Chapter 17: Nutrition in oropharyngeal dysphagia

Lina Spigiene, Lithuania, Gyte Damulevičiene, Lithuania

Chapter 18 Delirium

Lina Spigiene, Lithuania, Alison Mudge, Australia
Prevention of delirium and risk of malnutrition in delirium

Chapter 19: Drug-food & food-drug interaction - supplements

Þórhallur Ingi Halldórsson, Iceland, Björn Viðar Aðalbjörnsson, Iceland, Alfons Ramel, Iceland
Risk of interactions, supplements bioavailability

Chapter 20:  Food services and systems

Sandra Capra, Mary-Hannan Jones
Nutritional care out of the ward

Chapter 21: End of life, food and water – ethical standards of care

Stephano Eleuteri, Italy
Food is not only energy and nutrients; food has both social and mental affects. Balancing the need for ‘food as medicine’ with food for comfort, especially when the focus of treatment intent changes from rehabilitation to comfort cares / palliation.

This open access book aims to primarily support nurses as leaders and champions of multimodal, Interdisciplinary nutrition care for older adults. A structured approach to fundamentals of nutrition care across Interdisciplinary settings is combined with additional short chapters about special topics in geriatric nutrition. The book is designed to provide highly accessible information on evidence-based management and care for older adults, with a focus on practical guidance and advice across acute, rehabilitation, and primary and secondary malnutrition prevention settings.The cost of malnutrition in England alone has been estimated to be £19.6 billion per year, or more than 15% of the total public expenditure on health and social care. ^65 years. The importance and benefit of specialised nutrition care, delivered by experts in field, is well established for those with complex nutrition care needs. However, despite the substantial adverse impact of malnutrition on patient and healthcare outcomes, specialised management of this condition is often under-resourced, overlooked and under-prioritised by both older adults and their treating teams.

As an alternative, timely, efficient, and effective supportive nutrition care opportunities may be appropriately implemented by nurses and non-specialist Interdisciplinary healthcare team members, working together with nutrition specialists and the older adults they care for. Practical, low-risk opportunities should be considered across nutrition screening, assessment, intervention, and monitoring domains for many patients with, or at risk of malnutrition. Whilst a variety of team members may contribute to supportive nutrition care, the nursing profession provide a clear focal point. Nurses across diverse settings provide the backbone for Interdisciplinary teamwork and essential patient care. The nursing profession should consequently be considered best placed to administer Interdisciplinary, multimodal nutrition care, wherever specialist nutrition care referrals are unlikely to add value or are simply not available. As such, the book is a valuable resource for all healthcare providers dedicated to working with older patients to improve nutrition care.

Dr Ólöf Guðný Geirsdóttir. Dr Geirsdóttir has developed a strong interdisciplinary research focused on gerontological research in several core areas, including nutritional status, physical function, physical activity and active ageing. Dr Geirsdóttir has background broad experience as a clinical nutritionist at several units at the National University of Iceland. She has contributed to clinical guidelines for patient care, a handbook of food and nutrition for older people, and guidelines in prevention of falls for the Landspítali University Hospital. Dr Geirsdóttir led the work, with the Director of Health, on the Icelandic nutritional recommendations (2018) for older adults and healthy and a nutritional recommendation for sick and frail older people. Recent research works have focussed on associations between nutrition and physical activity among community-dwelling older adults, the nutritional status of sick and frail older adults and how to improve outcomes with nutritional care. In addition to contributing to clinical care and peer reviewed international literature, Dr Geirsdóttir advocates for multidisciplinary nutrition care education across administrative, academic leadership, and educational positions promoting ageing research, for example as the Secretary General of the 25th Nordic Congress of Gerontology.   
Dr Jack Bell is a conjoint Principal Research Fellow and Advanced Accredited Practicing Dietitian at The University of Queensland and The Prince Charles Hospital, and is longstanding member of the Queensland Clinical Senate. He has over 20 years’ clinical experience working with older adults and teams to deliver multidisciplinary nutritional care across a variety of settings. Dr Bell is a strong advocate for engaging patients in co-design and shared decision making, and clinicians as co-researchers. As a clinical academic and implementation practitioner, Dr Bell works with patients and diverse players the development, implementation, and evaluation of new models of care directing how malnutrition should be managed in diverse, contemporary settings both in Australia and internationally. Published works are challenging international norms and perceptions regarding how malnutrition care is provided in hospitals, have highlighted the need to adopt systematized, multidisciplinary nutrition care across the continuum to improve outcomes for older adults and those who care for them.