Prevention of Weight Loss in Long Term Care Veterans
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Purpose
Background:
Numerous studies have shown that many LTC residents receive inadequate staff assistance with eating, which places them at risk for under-nutrition, dehydration and weight loss. Moreover, improvements in feeding assistance care have been shown to improve residents' daily food and fluid consumption and weight loss outcomes. However, these improvements have only been achieved through the use of research staff as opposed to indigenous LTC staff due to staffing resource limitations that exist in most LTC facilities. The purpose of this program evaluation project is to train indigenous LTC staff how to improve nutritional care within the constraints of existing staffing resources.
Objectives: The PI of this proposal has developed standardized assessment, monitoring and staffing needs projection tools that can be used by LTC providers to improve feeding assistance care delivery and unintentional weight loss outcomes. The primary objective of this project is to train indigenous LTC staff how to (1) identify residents in need of feeding assistance, (2) effectively monitor daily care delivery; and, (3) utilize existing, non-nursing staff for some mealtime tasks to improve care.
Methods: A multiple baseline design will be used to evaluate the effectiveness of the program in one federal and one state VA LTC facility. Research staff will collect baseline measures related to organizational characteristics, including staffing, nutritional care processes and resident outcomes including oral food and fluid intake and weight status. All LTC units in each of the two sites will be divided into two groups for program implementation purposes (for a total of 4 groups across the 2 sites) based on the proximity of a unit to other units, resident and staff characteristics. The program will be implemented with staff and residents on the units in the first site/group; while, the second site/group remain in usual care and continue to be monitored monthly for all care process and resident outcome measures. Research staff will train LTC staff in the implementation of program protocols during a 12-week intervention period. Research staff will then monitor LTC staff implementation of the program independent of research staff monthly following intervention to determine the sustainability of the program in the absence of research staff. All staff training and monitoring will be repeated for the units in groups three and four. This 3-year program evaluation study will determine the effectiveness and cost of translating efficacious research protocols into care practice to improve the nutritional status of LTC veterans.
Status: All recruitment and data collection are complete. We are currently conducting final data analyses and manuscript preparation for this project.
| Condition | Intervention |
|---|---|
|
Malnutrition |
Behavioral: Nutrition Assessment and Management |
| Study Type: | Interventional |
| Study Design: | Allocation: Randomized Endpoint Classification: Efficacy Study Intervention Model: Single Group Assignment Masking: Open Label Primary Purpose: Treatment |
| Official Title: | Prevention of Weight Loss in Long-Term Care Veterans |
- feeding assistance care processes and weight status [ Time Frame: 3 month intervention and 3 month follow up periods ] [ Designated as safety issue: No ]amount and quality of feeding assistance provided during mealtimes for nutritionally at-risk residents and frequency and timeliness of staff offers of additional foods, fluids and supplements between meals for those with low meal intake.
| Enrollment: | 222 |
| Study Start Date: | February 2009 |
| Estimated Study Completion Date: | January 2013 |
| Primary Completion Date: | October 2011 (Final data collection date for primary outcome measure) |
| Arms | Assigned Interventions |
|---|---|
|
Experimental: Arm 1
Intervention units will receive staff training and management to improve nutritional care processes.
|
Behavioral: Nutrition Assessment and Management
Long term care staff will receive a staff training and management intervention to improve the quality of daily nutritional care processes.
|
|
No Intervention: Arm 2
Usual care control group will be monitored by research staff under usual care conditions.
|
Detailed Description:
Background:
Numerous studies have shown that many long term care (LTC) residents receive inadequate staff assistance with eating, which places them at risk for under-nutrition, dehydration and weight loss. Moreover, improvements in feeding assistance care have been shown to improve residents' daily food and fluid consumption and weight loss outcomes. However, these improvements have only been achieved through the use of research staff as opposed to indigenous LTC staff due to staffing resource limitations that exist in most LTC facilities. The purpose of this program evaluation project is to train indigenous LTC staff how to improve nutritional care within the constraints of existing staffing resources.
Objectives:
The PI of this proposal has developed standardized assessment, monitoring and staffing needs projection tools that can be used by long-term care (LTC) providers to improve feeding assistance care delivery and unintentional weight loss outcomes. The primary objective of this project is to train indigenous LTC staff how to (1) identify residents in need of feeding assistance, (2) effectively monitor daily care delivery; and, (3) utilize existing, non-nursing staff for some mealtime tasks to improve care.
Methods:
A multiple baseline design will be used to evaluate the effectiveness of the program in one federal and one state VA long-term care (LTC) facility. Research staff will collect baseline measures related to organizational characteristics, including staffing, nutritional care processes and resident outcomes including oral food and fluid intake and weight status. All LTC units in each of the two sites will be divided into two groups for program implementation purposes (for a total of 4 groups across the 2 sites) based on the proximity of a unit to other units, resident and staff characteristics. The program will be implemented with staff and residents on the units in the first site/group; while, the second site/group remain in usual care and continue to be monitored monthly for all care process and resident outcome measures. Research staff will train LTC staff in the implementation of program protocols during a 12-week intervention period. Research staff will then monitor LTC staff implementation of the program monthly following intervention to determine the sustainability of the program in the absence of research staff. All staff training and monitoring will be repeated for the LTC units in groups three and four. This 3-year program evaluation study will determine the effectiveness and cost of translating efficacious research protocols into care practice to improve the nutritional status of LTC veterans.
Status:
Final analysis and manuscript preparation of findings.
Eligibility| Ages Eligible for Study: | 65 Years and older |
| Genders Eligible for Study: | Both |
| Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- Long-stay,
- free of feeding tube,
- not receiving hospice care,
- not on a planned weight loss diet,
- able to speak English
Exclusion Criteria:
- short stay/rehab only
- feeding tube
- hospice
- planned weight loss diet
Contacts and Locations| United States, Tennessee | |
| VA Medical Center, Nashville | |
| Nashville, Tennessee, United States, 37212-2637 | |
| Principal Investigator: | Sandra F Simmons, BA MA PhD | Vanderbilt University |
More Information
No publications provided
| Responsible Party: | Department of Veterans Affairs |
| ClinicalTrials.gov Identifier: | NCT00841412 History of Changes |
| Other Study ID Numbers: | IIR 07-250 |
| Study First Received: | February 9, 2009 |
| Last Updated: | October 4, 2012 |
| Health Authority: | United States: Federal Government |
Keywords provided by Department of Veterans Affairs:
|
Usual Care Control Group |
Additional relevant MeSH terms:
|
Weight Loss Malnutrition Body Weight Changes |
Body Weight Signs and Symptoms Nutrition Disorders |
ClinicalTrials.gov processed this record on May 21, 2013