nutritionday Overview of ESPEN European Project Dorothee Volkert Institute for Biomedicine of Aging Friedrich-Alexander-Universität Erlangen-Nürnberg
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1 nutritionday Overview of ESPEN European Project Dorothee Volkert Institute for Biomedicine of Aging Friedrich-Alexander-Universität Erlangen-Nürnberg
2 nutritionday worldwide Save the date! 7. November 2013
3 nutritionday Overview of ESPEN European Project Project What is nutritionday? History Why nutritionday? Participation Recent Activities Limitations & Strengths
4 nutritionday worldwide 51 Countries 30 Languages Hospital / nursing home units Participants Coordination Central Michael Hiesmayr, Karin Schindler Medical University Vienna Nursing home Dorothee Volkert Cornel Sieber University Erlangen-Nürnberg
5 2006 nd in Hopitals 2007 nd in ICU nd in Nursing Homes 2012 nd in Oncology nutritionday IN EUROPE nutritionday WORLDWIDE
6 nutritionday concept 1-day cross-sectional data collection in yearly intervals by questionnaire in hospitals and nursing homes actively involving staff without need of specialist knowledge with individual feedback to each unit Increase awareness of malnutrition Benchmarking with other institutions
7 nutritionday concept Registration Code-Order Download of questionnaires Data input Download of feedback report Certificate for successful participation
8 Certificate This unit has contributed information to maintain and improve the quality of nutritional care in nutritionday in hospitals worldwide nutritionday
9 nutritionday contents Questionnaires Sheet I Sheet II a Sheet II b Sheet III a Sheet III b Sheet IV Institutional characteristics Main characteristics of patients / residents Mini Nutritional Assessment (SF) Nutritional characteristics of participants: Body weight weight loss intake last week Particpant at nd: plate diagramm at lunch Follow-up after 30 days / 6 months Detailed instructions and explanations dv nutritionday 2013
10 nutritionday Patient / Resident age, health, mobility, need of care Institution unit size, staff, nutritional care Patient s / Resident s nutritional status BMI, weight loss, malnutrition, intake last week, intake at nd All 1/2 1/4 nothing don t know Outcome Mortality, place of residence, hospitalisations, weight loss
11 Patient s journey Determinants Risk faktors What will be? mh/dv nutritionday 2013
12 nutritionday Overview of ESPEN European Project Project What is nutritionday? History Why nutritionday? Participation Recent Activities Limitations & Strengths
13 Situation before ND (2003) Experts had identified hospital malnutrition disease related undernutrition as a major problem in institutional health care 15-40% of hospitalised patients malnourished Neither systematic assessment nor treatment of MN Lack of nutritional awareness & education Lack of clearly defined responsibilities mh/dv nutritionday 2013
14 18 countries within the European Council signed up for hospital nutrition as future political priority mh/dv nutritionday 2013 Austria Belgium Cyprus Denmark Finland France Germany Ireland Italy Luxembourg The Netherlands Norway Portugal Slovenia Spain Sweden Switzerland United Kingdom
15 Why nutritionday? Increase awareness Create a community that speaks a similar language and may produce together new evidence Have up-to-date local, regional, national data that can be compared Increase understanding and knowledge Determinants of malnutrition and relation to outcome Variability between institutions Risk groups mh/dv nutritionday 2013
16 nutritionday Overview of ESPEN European Project Project What is nutritionday? History Why nutritionday? Participation Recent Activities Limitations & Strengths
17 nd total participation worldwide Centers Units Participants Hospital ICU NH Total Countries ( )
18 nutritionday Participants per year Hospital ICU Nursing home Oncology nd-06 nd-07 nd-08 nd-09 nd-10 nd-11 nd nutritionday
19 Participation 2013 ND: 6084 ICU: 558 onco: 951
20 nutritionday in nursing homes Participation 2013 DK 80 DE 224 AT 389 CH 135 US
21 Albania Australia Austria Belgium Bosnia and Herzegovina Brazil Bulgaria Canada Chile China Colombia Croatia Czech Republic Denmark El Salvador Estonia Finland France Germany Great Britain Greece Hungary India Iran Israel Italy Japan Kuwait Latvia Lithuania Luxembourg Mexico Netherlands Norway Oman Paraguay Poland Portugal Romania Russia Serbia & Montenegro Singapure Slovakia Slovenia Spain Sweden Switzerland Thailand Turkey United Arab Emirates USA nutritionday Participants per country per year
22
23 nutritionday Overview of ESPEN European Project Project What is nutritionday? History Why nutritionday? Participation Recent Activities Limitations & Strengths
24 New nd Flyers
25 nutritionday in NHs New nd Feedback Reports
26 nutritionday in NHs Styria Initiative Residents / proxies complaints and benchmarking need nd 2012: 61 NHs 104 units 3125 residents Discussion at political level Nursing home law will be revised in order to improve nutritional care
27 nutritionday Overview of ESPEN European Project Project What is nutritionday? History Why nutritionday? Participation Recent Activities Strengths & Limitations
28 nutritionday Strengths Worldwide, well-known, exciting project Large and growing database Yearly repetition continuous data collection Data at individual, unit, country level Limitations Data assessment by numerous persons limited quality Limited number of fixed parameters Hypothesis generating
29 nutritionday worldwide Save the date! 6. November 2014
30 nutritionday Overview of ESPEN European Project Thank you for your attention!
31 nd in NHs particpants per country HU AT DE NO CA PT CH IT CZ ES SE TR US FR GB JP FI PL DK
32 nd in NHs particpants per country HU AT DE NO CA PT CH IT CZ ES SE TR US FR GB JP FI PL DK
33 nutritionday in NHs Feedback Reports New structure: Results on one page Results in detail: - unit level including 5 quality indicators - individual level: characteristics & nutritional status Results presented in figures, graphics and text Results presented at unit level Unit results compared to national and international nd data from last 3 years Definition of quality indicators of nutritional care
34 nd in NHs Challenges Time constraints of coordination teams Decreasing participation low interest of NHs - time constraints - regulatory constraints - many other obligations besides nutritional care Different health care systems in different countries To improve network of stakeholders
35
36
37 nd in NHs New Feedback Reports Quality indicators of nutritional care at unit level Body weight measurement at least once a month Screening for malnutrition at least once a month Person responsible for nutritional care Dietitian available Written procedures for nutritional care
38 nd in NHs Future strategies Modification of questionnaires - shorten more focused - additional questions, e.g. end of life situation, type of NH More focused - geriatric nursing homes (age >65 y) - few countries Inclusion of students for nd data assessment Assessment of NH structures and needs in different countries Competition Europeans best nutritional care concept
39 nd in NHs Our interests Increase awareness for nutrition improve nutritional care avoid malnutrition improve quality of life of residents Identification of determinants of dietary intake and nutritional status - individual level - institutional level Identification of effective measures at different levels to avoid malnutrition
40 nd in NHs Results at unit level (n=658) Mean SD P5 Median P95 Unit characteristics Mean number of occupied beds 45,8 47,9 12,0 35,0 102,1 Mean number of participants 31,3 27,8 5,0 26,0 71,0 Participant characteristics Mean age (years) 78,7 13,0 46,0 82,9 89,9 Females (%) 71,4 22,1 21,4 75,0 100,0 Cognitive impairment (%) 70,0 25,2 19,9 73,6 100,0 Mobility impairment (%) 57,6 27,8 5,5 62,5 100,0 Dysphagia (%) 14,2 16,4 0,0 9,7 47,4 Chewing problems (%) 26,8 24,4 0,0 20,1 80,7 Nutritional status Mean BMI (kg/m²) 25,0 2,3 21,5 25,0 28,5 MNA: at risk of MN (%) (n=156) 42,6 21,0 10,8 41,7 80,3 MNA: MN (%) (n=156) 16,5 15,0 0,0 12,5 46,2 Weight loss within last year (%) 33,8 18,9 1,7 33,3 62,5 Weight loss > 5 kg within last year (%) 11,8 13,0 0,0 8,3 35,0
41 patient recruitment per country ( ) nd-06 nd-07 nd-08 nd-09 nd-10 nd-11 nd-12 United Arab Emirates USA Thailand Switzerland Sweden Spain Slovenia Slovakia Singapure Serbia & Montenegro Russia Romania Portugal Poland Paraguay Oman Mexico Netherlands Norway Luxembourg Lithuania Latvia Kuwait Iran India Finland Estonia El Salvador Denmark China Chile Greece Albania Australia Israel France Czech Croatia Columbia Canada Bulgaria Brasil Bosnia Herzegovina Italy Great Britain Japan Belgium Turkey Hungary Germany Austria
42 USA United Arab Emirates Turkey Thailand Switzerland Sweden Spain Slovenia Slovakia Singapure Serbia & Montenegro Russia Romania Portugal Poland Paraguay Oman Norway Netherlands Mexico Luxembourg Lithuania Latvia Kuwait Japan Italy Israel Iran India Hungary Greece Great Britain Germany France Finland Estonia El Salvador Denmark Czech Republic Croatia Colombia China Chile Canada Bulgaria Brazil Bosnia and Herzegovina Belgium Austria Australia
43 nd in NH Teilnahme Jahr Länder Heime Wohn- Bewohner bereiche Länder (Dänemark, Deutschland, Finnland, Frankreich, Großbritannien, Italien, Japan, Kanada, Norwegen, Österreich, Polen, Portugal, Schweden, Schweiz, Spanien, Ungarn, USA, Tschechien, Türkei)
44 nd in NHs units per country AT HU GE NO CA CH ES SE IT CZ US PT FR GB FI JP TR DK PL
45 nd in NHs units per country AT HU DE NO CA CH ES SE IT CZ US PT FR GB FI JP TR DK PL
46 nd in NHs pariticpants per country AT HU DE NO CA PT CH IT CZ ES SE TR US FR GB JP FI PL DK
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