MEER AANDACHT VOOR ONDERVOEDING Marian de van der … · Interpersonal Social Living arrangements,...
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MEER AANDACHT VOOR ONDERVOEDING Marian de van der Schueren DGO, 5 oktober 2018
Transcript of MEER AANDACHT VOOR ONDERVOEDING Marian de van der … · Interpersonal Social Living arrangements,...
MEER AANDACHT VOOR ONDERVOEDING
Marian de van der Schueren
DGO, 5 oktober 2018
Exton-Smith AN, Proc Roy Soc Med 1977
Kane & Ouslander: Essentials of clinical geriatrics. 1994
Cited in Amarya et al, J Clin Gerontol Geriatr 2015
Factors that can contribute to malnutrition in older persons
www.dedipac.eu
Stok M et al, Plos One 2017
https://www.uni-konstanz.de/DONE/
Meta-model DONE: Determinants Of Nutrition and Eating
Individual Biological Gender, age, health, oral function, ...
Psychological Food beliefs, mood, personality ...
Situational Hunger, time constraints, ...
Socio-economic Personal socio-economic status
Interpersonal Social Living arrangements, social network
Cultural Traditions, relegion, ...
Socio-economic Houshold socio-economic status
Environment Product Intrinsic, extrinsic product attributes ...
Micro Eating environment, food availablility ...
Meso / macro Living environment, prices, ...
Policy Industry Regulations, lobbying, advertisement,
Government Policies, campaigns, regulations, ...
Model examples
Framework / Model
Determinants of Malnutrition in Aged Persons
DoMAP
Diarrhea
MalabsorptionGastro-
intestinal disease
Hyperactivity
Inflammation
Metabolic rate ↑
Poor appetite
Mobilitylimitations
Forgetting to eat
Poverty
COPD
Breathing ↑
Dysphagia
Chewingproblems
InfectionCancer
CongestiveHeart failure
Dementia
Depression
Stroke
LonelinessLiving aloneEating alone
Difficulties with- shopping
- preparing meals- eating
Cognitiveimpairment
Dry mouth
Parkinson´sdisease
Medication
Poor qualityof meals
Oral pain
Smoking
Physical inactivity
Pain
Surgery
Psychological distress
Low physicalperformance
Restrictive diet
Lowintake
Reducednutrient
bioavailability
Highrequirements
MN
Unwillingto eat
Sensoryimpair-ment
Nausea Vomiting
Poor quality of care
Tremor
Delirium
Lackof food
Not allowed to eat
Poor dental state
Anorexia of aging
Inflamm-Aging
Age-relatedfunctional decline
Frailty
Female sex
Low education
Multimorbidity
Poly-pharmacy
Older age
Hospitali-zation
Diarrhea
MalabsorptionGastro-
intestinal disease
Hyperactivity
Inflammation
Metabolic rate ↑
Poor appetite
Mobilitylimitations
Forgetting to eat
Poverty
COPD
Breathing ↑
Dysphagia
Chewingproblems
InfectionCancer
CongestiveHeart failure
Dementia
Depression
Stroke
LonelinessLiving aloneEating alone
Difficulties with- shopping
- preparing meals- eating
Cognitiveimpairment
Dry mouth
Parkinson´sdisease
Medication
Poor qualityof meals
Oral pain
Smoking
Physical inactivity
Pain
Surgery
Psychological distress
Low physicalperformance
Restrictive diet
Lowintake
Reducednutrient
bioavailability
Highrequirements
MN
Unwillingto eat
Sensoryimpair-ment
Nausea Vomiting
Poor quality of care
DoMAP
Tremor
Delirium
Lackof food
Not allowed to eat
Poor dental state
Anorexia of aging
Inflamm-Aging
Age-relatedfunctional decline
Frailty
Female sex
Low education
Multimorbidity
Poly-pharmacy
Older age
Diarrhea
MalabsorptionGastro-
intestinal disease
Hyperactivity
Inflammation
Metabolic rate ↑
Poor appetite
Mobilitylimitations
Forgetting to eat
Poverty
COPD
Breathing ↑
Dysphagia
Chewingproblems
InfectionCancer
CongestiveHeart failure
Dementia
Depression
Stroke
LonelinessLiving aloneEating alone
Difficulties with- shopping
- preparing meals- eating
Cognitiveimpairment
Anorexia of aging
Inflamm-Aging
Age-relatedfunctional decline
Dry mouth
Parkinson´sdisease
Medication
Poor qualityof meals
Oral pain
Smoking
Physical inactivity
Pain
Surgery
Psychological distress
Low physicalperformance
Restrictive diet
Lowintake
Reducednutrient
bioavailability
Highrequirements
MN
Unwillingto eat
Sensoryimpair-ment
Nausea Vomiting
Poor quality of care
Frailty
Tremor
Delirium
Lackof food
Not allowed to eat
Poor dental state
Female sex
Low education
Multimorbidity
Poly-pharmacy
Older age
DoMAP
Diarrhea
MalabsorptionGastro-
intestinal disease
Hyperactivity
Inflammation
Metabolic rate ↑
Poor appetite
Mobilitylimitations
Forgetting to eat
Poverty
COPD
Breathing ↑
Dysphagia
Chewingproblems
InfectionCancer
CongestiveHeart failure
Dementia
Depression
Stroke
LonelinessLiving aloneEating alone
Difficulties with- shopping
- preparing meals- eating
Cognitiveimpairment
Anorexia of aging
Inflamm-Aging
Age-relatedfunctional decline
Dry mouth
Parkinson´sdisease
Medication
Poor qualityof meals
Oral pain
Smoking
Physical inactivity
Pain
Surgery
Psychological distress
Low physicalperformance
Restrictive diet
Lowintake
Reducednutrient
bioavailability
Highrequirements
MN
Unwillingto eat
Sensoryimpair-ment
Nausea Vomiting
Poor quality of care
Frailty
Tremor
Delirium
Lackof food
Not allowed to eat
Poor dental state
Female sex
Low education
Multimorbidity
Poly-pharmacy
Older age
DoMAP
Diarrhea
MalabsorptionGastro-
intestinal disease
Hyperactivity
Inflammation
Metabolic rate ↑
Poor appetite
Mobilitylimitations
Forgetting to eat
Poverty
COPD
Breathing ↑
Dysphagia
Chewingproblems
InfectionCancer
CongestiveHeart failure
Dementia
Depression
Stroke
LonelinessLiving aloneEating alone
Difficulties with- shopping
- preparing meals- eating
Cognitiveimpairment
Anorexia of aging
Inflamm-Aging
Age-relatedfunctional decline
Dry mouth
Parkinson´sdisease
Medication
Poor qualityof meals
Oral pain
Smoking
Physical inactivity
Pain
Surgery
Psychological distress
Low physicalperformance
Restrictive diet
Lowintake
Reducednutrient
bioavailability
Highrequirements
MN
Unwillingto eat
Sensoryimpair-ment
Nausea Vomiting
Poor quality of care
Frailty
Tremor
Delirium
Lackof food
Not allowed to eat
Poor dental state
Female sex
Low education
Multimorbidity
Poly-pharmacy
Older age
DoMAP
Diarrhea
MalabsorptionGastro-
intestinal disease
Hyperactivity
Inflammation
Metabolic rate ↑
Poor appetite
Mobilitylimitations
Forgetting to eat
Poverty
COPD
Breathing ↑
Dysphagia
Chewingproblems
InfectionCancer
CongestiveHeart failure
Dementia
Depression
Stroke
LonelinessLiving aloneEating alone
Difficulties with- shopping
- preparing meals- eating
Cognitiveimpairment
Anorexia of aging
Inflamm-Aging
Age-relatedfunctional decline
Dry mouth
Parkinson´sdisease
Medication
Poor qualityof meals
Oral pain
Smoking
Physical inactivity
Pain
Surgery
Psychological distress
Low physicalperformance
Restrictive diet
Lowintake
Reducednutrient
bioavailability
Highrequirements
MN
Unwillingto eat
Sensoryimpair-ment
Nausea Vomiting
Poor quality of care
Frailty
Tremor
Delirium
Lackof food
Not allowed to eat
Poor dental state
Female sex
Low education
Multimorbidity
Poly-pharmacy
Older age
DoMAP
Diarrhea
MalabsorptionGastro-
intestinal disease
Hyperactivity
Inflammation
Metabolic rate ↑
Poor appetite
Mobilitylimitations
Forgetting to eat
Poverty
COPD
Breathing ↑
Dysphagia
Chewingproblems
InfectionCancer
CongestiveHeart failure
Dementia
Depression
Stroke
LonelinessLiving aloneEating alone
Difficulties with- shopping
- preparing meals- eating
Cognitiveimpairment
Anorexia of aging
Inflamm-Aging
Age-relatedfunctional decline
Dry mouth
Parkinson´sdisease
Medication
Poor qualityof meals
Oral pain
Smoking
Physical inactivity
Pain
Surgery
Psychological distress
Low physicalperformance
Restrictive diet
Lowintake
Reducednutrient
bioavailability
Highrequirements
MN
Unwillingto eat
Sensoryimpair-ment
Nausea Vomiting
Poor quality of care
Frailty
Tremor
Delirium
Lackof food
Not allowed to eat
Poor dental state
Female sex
Low education
Multimorbidity
Poly-pharmacy
Older age
DoMAP
Diarrhea
MalabsorptionGastro-
intestinal disease
Hyperactivity
Inflammation
Metabolic rate ↑
Poor appetite
Mobilitylimitations
Forgetting to eat
Poverty
COPD
Breathing ↑
Dysphagia
Chewingproblems
InfectionCancer
CongestiveHeart failure
Dementia
Depression
Stroke
LonelinessLiving aloneEating alone
Difficulties with- shopping
- preparing meals- eating
Cognitiveimpairment
Anorexia of aging
Inflamm-Aging
Age-relatedfunctional decline
Dry mouth
Parkinson´sdisease
Medication
Poor qualityof meals
Oral pain
Smoking
Physical inactivity
Pain
Surgery
Psychological distress
Low physicalperformance
Restrictive diet
Lowintake
Reducednutrient
bioavailability
Highrequirements
MN
Unwillingto eat
Sensoryimpair-ment
Nausea Vomiting
Poor quality of care
Frailty
Tremor
Delirium
Lackof food
Not allowed to eat
Poor dental state
Female sex
Low education
Multimorbidity
Poly-pharmacy
Older age
DoMAP
Diarrhea
MalabsorptionGastro-
intestinal disease
Hyperactivity
Inflammation
Metabolic rate ↑
Poor appetite
Mobilitylimitations
Forgetting to eat
Poverty
COPD
Breathing ↑
Dysphagia
Chewingproblems
InfectionCancer
CongestiveHeart failure
Dementia
Depression
Stroke
LonelinessLiving aloneEating alone
Difficulties with- shopping
- preparing meals- eating
Cognitiveimpairment
Anorexia of aging
Inflamm-Aging
Age-relatedfunctional decline
Dry mouth
Parkinson´sdisease
Medication
Poor qualityof meals
Oral pain
Smoking
Physical inactivity
Pain
Surgery
Psychological distress
Low physicalperformance
Restrictive diet
Lowintake
Reducednutrient
bioavailability
Highrequirements
MN
Unwillingto eat
Sensoryimpair-ment
Nausea Vomiting
Poor quality of care
Frailty
Tremor
Delirium
Lackof food
Not allowed to eat
Poor dental state
Female sex
Low education
Multimorbidity
Poly-pharmacy
Older age
DoMAP
Open questions
Which factors trigger the development of malnutrition?
How to categorize these factors?
How do these factors provoke malnutrition?
Relevance of each factor?
How are the factors interrelated?
Model of determinants of malnutrition in older persons
Keller H, JAMDA 2014
Making the Most of Mealtimes (M3) conceptual model
Model examples
Taskforce Gezond eten met ouderen, 2018
https://www.denieuwepraktijk.nl
Actieplan
19,00%
28,00%
30,00%
30,00%
31,00%
31,00%
38,00%
39,00%
45,00%
48,00%
51,00%
51,00%
53,00%
59,00%
60,00%
88,00%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
ONTWIKKELEN VAN PROTOCOLLEN
EXTRA FINANCIELE MIDDELEN
BESCHIKBAARHEID MEETAPPARATUUR
DIEETBEHANDELING ONDERVOEDING
DIAGNOSTIEK VAN ONDERVOEDING
INZET VAN PROTOCOLLEN
PRAKTISCHE VAARDIGHEDEN (SCREENING/BIA)
INZICHTELIJK MAKEN VAN DATA
EXTRA MANUREN
BEWEGING BIJ ONDERVOEDING
DOORVERWIJZEN NAAR DIETIST
COMMUNICATIE
TOENAME MULTIDISCIPLINAIR SAMENWERKEN
SCREENING VAN ONDERVOEDING
MONITORING VAN ONDERVOEDING
KENNIS VAN ONDERVOEDING
Gewenste verbeterpunten
Enquête DGO leden
Taskforce Gezond eten met ouderen, 2018
Wat willen wij als beroepsgroep doen?
- Workshop vanmiddag; wat kunnen en willen wij gezamenlijk aanpakken?
