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Objectives: To explore how oral problems, chewing problems, dry mouth, and swallowing difficulties cluster and whether their burden is associated with nutritional status, eating habits, gastrointestinal symptoms, psychological well-being, and mortality among institutionalized residents., Design: Cross-sectional study with 1-year mortality., Setting and Participants: 3123 residents living in assisted facilities and nursing homes in Helsinki, Finland., Measures: Trained nurses assessed residents in all nursing homes and assisted living facilities in Helsinki in 2011. A personal interview, the Mini Nutritional Assessment (MNA), oral symptoms, questions about eating habits, and psychological well-being were used to assess each resident. We divided the subjects first according to the number of oral symptoms into 4 groups: no oral symptoms (G0), 1 oral symptom (G1), 2 oral symptoms (G2), and all 3 symptoms (G3); and second according to the symptoms: dry mouth, chewing problems, and swallowing difficulties. The diagnoses and medications were retrieved from medical records, and mortality data were obtained from central registers., Results: In all, 26% of the subjects had 1 oral problem (G1), 11% had 2 oral problems (G2), and 4% had all 3 oral problems (G3), whereas 60% (n = 1870) had no oral symptoms. Thus, the oral symptoms moderately overlapped. The burden of oral symptoms was linearly associated with malnutrition, higher numbers of comorbidities, dependency in physical functioning, gastrointestinal symptoms, and eating less and more often alone. The higher the burden of oral symptoms, the lower the self-rated health and psychological well-being. Mortality increased along with the higher oral symptoms burden. Among residents having 1 or more symptoms, 26% had chewing problems, 18% swallowing difficulties, and 15% dry mouth., Conclusions/implications: The burden of oral health problems was associated in a stepwise fashion with poor health and psychological well-being, malnutrition, and mortality. Clinicians should routinely assess older institutionalized residents' oral health status to improve residents' well-being., (Copyright © 2018 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)

Background: While nutritional problems have been recognized as common in institutional settings for several decades, less is known about how nutritional care and nutrition has changed in these settings over time., Objectives: To describe and compare the nutritional problems and nutritional care of residents in all nursing homes (NH) in 2003 and 2011 and residents in all assisted living facilities (ALF) in 2007 and 2011, in Helsinki, Finland., Methods: We combined four cross-sectional datasets of (1) residents from all NHs in 2003 (N=1987), (2) residents from all ALFs in 2007 (N=1377), (3) residents from all NHs in 2011 (N=1576) and (4) residents from all ALFs in 2011 (N=1585). All participants at each time point were assessed using identical methods, including the Mini Nutritional Assessment (MNA)., Results: The mean age of both samples from 2011 was higher and a larger proportion suffered from dementia, compared to earlier collected samples. A larger proportion of the residents in 2011 were assessed either malnourished or at-risk for malnutrition, according to the MNA, than in 2003 (NH: 93.5% vs. 88.9%, p<0.001) and in 2007 (ALF: 82.1% vs. 78.1%, p=0.007). The use of nutritional, vitamin D and calcium supplements, and snacks between meals was significantly more common in the 2011 residents, compared to the respective earlier samples., Conclusions: In 2011, institutionalized residents were more disabled and more prone to malnourishment than in 2003 or 2007. Institutions do seem to be more aware of good nutritional care for vulnerable older people, although there is still room for improvement., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Objective: The aim of this study is to explore the prevalence of swallowing difficulties (SWD) and their associations with nutritional status, eating habits, nutritional care, and mortality among older people in assisted living., Design: A cross-sectional study with interviews and nutritional assessments at baseline and 3-year follow-up for mortality., Setting: Assisted living facilities in the Helsinki metropolitan area, Finland., Participants: All residents (N=1466) in assisted living facilities., Measurements: Personal interviews yielded information on demographics, medical history, functional status, SWDs and eating habits. Residents' nutritional status was assessed with the Mini Nutritional Assessment (MNA). Three-year mortality data were retrieved from central registers., Results: SWDs were common; 11.8% of subjects suffered from them. Those with SWDs were older, more often female, and more frequently had Parkinson's disease, chronic obstructive pulmonary disease (COPD), and chronic/ recurrent infections than those without SWDs. No differences were present between the groups in prevalence of stroke or dementia, but more severe cognitive decline occurred among those with SWDs. According to the MNA, 30.6% of those with SWDs were malnourished (<17 points), whereas the respective figure for those without SWDs was 11.0% (p < .001). Those with SWDs ate more often fluid or puréed food (27.8% vs. 3.8%, p < .001), ate more often little or quite little of their food portion (32.6% vs. 23.5%, p < .010), and consumed less fluids (< 5 cups/day 51.7% vs. 35.6%, p< .001) than those without SWDs. Of those with SWDs, 55.0% died by the end of follow-up, whereas the respective figure for those without SWDs was 41.5%. In logistic regression analysis using age, sex, comorbidities, and MNA as covariates, SWDs continued to predict mortality (OR=1.49, 95% CI=1.04 -2.12)., Conclusions: SWDs are common and associated with poor nutrition and risk of death of patients in assisted living facilities. Nurses should be trained to assess SWDs and nutritional problems in order to take optimal care of these residents.

Background: Aged residents in nursing homes are at particularly high risk of fractures. Vitamin D and calcium have a preventative role., Objective: To describe the use of vitamin D and calcium supplementations, and their association with nutritional factors among nursing home residents., Methods: Our study is a cross-sectional assessment of long-term residents in all nursing homes in Helsinki during February 2003. We collected residents' background information, nutritional status (Mini Nutritional Assessment, MNA), and data on daily nursing routines in institutions, including nutritional care. Vitamin D and calcium supplementations were inquired after in the questionnaire and retrieved from residents' medication lists., Results: 2,114 (87%) of all 2,424 eligible residents had available data on the use of vitamin D and calcium supplementation. Their mean age was 83 years, and 80.7% were female. Of all participants, 32.9% received vitamin D supplementation and 27.7% calcium supplementation. Altogether 20.0% received both. However, only 21.3% received vitamin D in the therapeutic dose of 10 mg (400 IU) or more, and 3.6% in the recommended dose of 20 microg (800 IU) or more. In logistic regression analysis, residents who received vitamin D supplementation also had better nutritional status (MNA), ate snacks between meals, did not have constipation and their weight was checked more frequently., Conclusions: Regardless of the known benefit and recommendation of vitamin D supplementation for the elderly residing mostly indoors, the proportion of nursing home residents receiving vitamin D and calcium was surprisingly low.

Background and Objective: Constipation and, as a consequence, the use of laxatives are common among frail older people. The causes of and factors associated with laxative use, however, have undergone surprisingly little study. The objectives of our study were to (i) assess the prevalence of regularly administered laxatives, (ii) identify factors associated with regular use of laxatives, and (iii) determine which drug classes or medications are associated with regular laxative use in an older nursing home population in Helsinki., Methods: This study was a cross-sectional assessment of all long-term nursing home residents aged >/=65 years in Helsinki, Finland. In February 2003, the health status of these residents was assessed and data on their demographic characteristics, health and medication use were collected from medical charts., Results: Of all nursing home residents in Helsinki, 82% (n = 1987, mean age 83.7 years) participated in the study. Of all residents, 55.3% received laxatives regularly. Factors associated with regular laxative use in univariate analysis included age >80 years, stroke, Parkinson's disease, inability to move independently, poor Mini Nutritional Assessment (MNA) score (<17), fluid intake less than five glasses per day, and chewing problems. Drugs associated with laxative use included opioids, antacids, diuretics, tricyclic antidepressants, lipid-lowering drugs other than HMG-CoA reductase inhibitors (statins), histamine H(2) receptor antagonists, nonselective NSAIDs, anticholinergic drugs for urine incontinence, and calcium channel antagonists other than verapamil and nifedipine. In logistic regression analysis, age >80 years (odds ratio [OR] 1.29; 95% CI 1.03, 1.60), inability to move independently (OR 1.80; 95% CI 1.42, 2.28), poor MNA score (<17) [OR 1.51; 95% CI 1.19, 1.93], chewing problems (OR 1.27; CI 95% 1.00, 1.61), Parkinson's disease (OR 1.63; 95% CI 1.01, 2.64), and concomitant use of a high number (>7) of drugs other than laxatives and constipation-inducing drugs found in univariate analysis (OR 1.06; 95% CI 1.03, 1.09) were associated with use of laxatives. Having snacks between meals (OR 0.74; 95% CI 0.60, 0.90) was associated with lower risk of laxative use., Conclusions: Regular laxative use in older nursing home residents in Helsinki is very common. Offering snacks between meals and regular evaluation of medication use may influence laxative use.

Objectives: To determine the oral status of elderly residents in nursing homes (NH) and long term care wards (LT) and to describe associations between oral status and nutritional status among institutionalized elderly residents., Design: Descriptive, cross-sectional study., Setting: All elderly residents in all NH and LT in Helsinki, the capital of Finland., Participants: The study included 2036 out of 2424 (84 %) eligible subjects in NH, 1052 out of 1444 (73%) eligible subjects in LT, and all wards in NH (N = 92) and LT (N = 53)., Measurements: A structured questionnaire, oral examination, and Mini Nutritional Assessment (MNA) were completed by ward nurses for all participating residents. The structured questionnaire included information on oral status and oral health problems, demographic characteristics, functional status, diseases and medication. One questionnaire for each ward was used to evaluate the daily ward routines related to nutritional care and meal management., Results: 11 % of the NH residents and 3 % of LH patients were well nourished. Of NH residents 60 % were at risk of malnutrition and 29 % were malnourished. The respective figures for LT patients were 40 % and 57 %. Nutritional status was significantly associated with oral status and with the number of oral health problems. Those with mixed dentition or complete dentures tended to have better nutritional status than those totally edentulous without prosthesis. Malnutrition increased consistently with the increasing number of oral health problems (including chewing problems, swallowing difficulties, pain in mouth and xerostomia)., Conclusion: In the population of institutionalized frail elderly, malnutrition was related to both poor oral status and oral health problems.

Objective: To acquire information about nutritional problems and factors associated with them in all nursing homes in Helsinki, Finland., Design: Descriptive, cross-sectional study. The residents were assessed by the Mini Nutritional Assessment test (MNA) and information was gathered about residents' backgrounds, functional status, diseases and about daily routines in institutions providing nutritional care., Setting: All nursing homes in Helsinki community, the capital of Finland., Subjects: Of 2424 eligible subjects, 2114 (87%) aged residents, mean age 82 y, were examined., Results: One-third (29%) of the studied residents suffered from malnutrition (MNA < 17), and 60% were at risk (MNA 17-23.5). Malnutrition was associated with the female gender, a longer stay in the nursing home, functional impairment, dementia, stroke, constipation and difficulties in swallowing. In addition, eating less than half of the offered food portion, not eating snacks and resident's weight control at long intervals were associated with malnutrition. In logistic regression analysis mainly patient-related factors predicted malnutrition: impaired functioning (OR 3.71, 95% CI 2.76-4.99), swallowing difficulties (OR 3.03, 95% CI 2.10-4.37), dementia (OR 2.06, 95% CI 1.45-2.93), constipation (OR 1.84, 95% CI 1.38-2.47), but also eating less than half of the offered food portion (OR 3.03, 95% CI 2.21-4.15)., Conclusions: Although internal factors explain most about the poor nutritional status of aged residents in nursing homes, the factors related to nutritional care need further investigation to clarify their role in maintaining the nutritional status of aged residents.

This study was designed to gain information on the quality of nursing care based on the comments in nursing records. The specific aims of the study were to find out if the patients' (i) individual needs are assessed, the goals for nursing care are set, and the nursing interventions are determined; (ii) if the patients' needs are met and (iii) if goal achievement is regularly evaluated by including comments in nursing documents. In addition, the study aimed to describe the up-to-dateness of nursing care plans as well as the frequency of making daily notes. The data were collected on 36 wards of four residential homes. A 30% sample of the nursing documents on each ward was collected (n=332) using the Senior Monitor instrument. The documents studied were mainly nursing care plans and daily note sheets. Seventy-three per cent of the nursing home residents had an up-to-date nursing care plan at the time of data collection. The main results demonstrated that a written statement on the patient's mental ability was lacking in every fourth document although 75% of the patients suffer from at least moderate dementia in Finnish long-term care institutions. Development activities should also be targeted to the documentation of clear and concrete means by which patients' independent functioning is supported. In addition, evaluation was the area that warranted attention and development activities since only every fourth record included information on changes in the patients' functional capability. Although a lot of in-service training has been focused on improving the documentation practices, there is still a need for development. The means by which knowledge is transferred to guide the practice should be carefully considered. Also forms should be developed to meet the special requirements for recording nursing care in long-term care settings.