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Biomedical subjects

Nancy S Wellman

Publications and source records attributed to Nancy S Wellman.

14 recordsLinked to original sources
PubMed2005

Nutrition concerns in discharge planning for older adults: a need for multidisciplinary collaboration.

This survey of 84 case managers (CMs) (88% response rate) in 11 south Florida hospitals, in one for-profit health care system, sought to identify their discharge planning concerns regarding the food and nutrition needs of older patients, how they addressed these concerns, and the degree to which registered dietitians (RDs) were involved. Most CMs were female (82 of 84, 98%), older than age 40 (59 of 84, 70%), and were registered nurses (51 of 84, 61%). Almost all (82 of 84, 98%) reported job barriers, including excessive patient loads and responsibilities and limited community services. Almost all said that nutrition-related diseases and factors (eg, chewing/swallowing problems, poor appetite, modified diets, poor dentition) strongly influenced discharge planning. Many perceived community nutrition resources (eg, congregate meals, food stamps, shopping assistance, outpatient dietitians) as not readily available. While physicians, nurses, social workers, and physical therapists were identified as very important in discharge planning, RDs were not; almost half of CMs consulted them infrequently, if at all. Strategies for the six nutrition-related case scenarios were inconsistent. Home-health agencies were chosen most often and outpatient RDs least often. Comprehensive discharge planning must include more attention to nutrition with greater input from clinical, outpatient, home health, and community RDs through, for example, attendance at hospital discharge planning rounds, inservices for CMs, and better marketing of RD services. More RDs can and should become CMs to help serve the number of older adults with nutrition-related chronic conditions.

Adult↗
PubMed2005

Aging in community nutrition, diet therapy, and nutrition and aging textbooks.

Using content analysis, this study evaluated the aging content and context in 11 nutrition sub-specialty textbooks: community nutrition (n = 3), diet therapy (n = 4), and nutrition and aging (n = 4). Pages with paragraphs on aging were identified in community nutrition and diet therapy textbooks, and 10% random samples of pages were evaluated in nutrition and aging textbooks. Paragraphs were assigned to one of four categories: gerontology, nutrition as primary, nutrition as secondary, or tertiary prevention. A total of 310 pages was qualitatively analyzed using NUD*IST 5 software and quantitatively with percentages. Only 7% of community nutrition and 2% of diet therapy pages were devoted to aging. There was little integration of aging beyond the chapters on aging. Community nutrition had the most gerontology (30%) and primary prevention (43%) content. Diet therapy and nutrition and aging had more secondary prevention (33% and 42%, respectively) and tertiary prevention (27% each) content. Some important databases and studies were absent. Of the 1,239 ageism words, 10% were positive, 53% neutral, and 36% negative. Photographs were generally positive. Women, but not minorities, reflected current older adult demographics. Future textbook editions should address aging more comprehensively and positively to better prepare dietitians for the job market. Recommendations for authors, course instructors, and publishers are given.

Aged↗
PubMed2004

Family caregivers of older adults on home enteral nutrition have multiple unmet task-related training needs and low overall preparedness for caregiving.

OBJECTIVES: We used stress process theory to identify family caregiving variables that are salient to the experience of managing older adults' home enteral nutrition. In this article, we describe the specific tasks family caregivers performed and their unique training needs in the context of caregiver preparedness, competence, effectiveness, and health care use. DESIGN: Hospital billing lists from two university-affiliated institutions in Miami, FL, were used to identify older adults who had enteral tubes placed over a 6-month period. Consent was obtained from those older adults discharged for the first time on home enteral nutrition and their family caregivers at the first scheduled outpatient visit. SUBJECTS/SETTING: In-home interviews were conducted with a diverse sample of 30 family caregivers (14 white, 8 Hispanic, 7 African-American, 1 Asian) during their first 3 months (mean=1.83+/-0.69 months) of home enteral nutrition caregiving. STATISTICAL ANALYSES PERFORMED: Descriptive statistics were used to summarize data for all variables; chi(2) analysis was conducted to analyze differences in categorical variables. One-way analysis of variance was used to analyze mean differences among caregivers grouped by ethnicity for total number of hours and tasks performed. Post hoc comparisons were conducted using the Tukey HSD test. The Spearman rho correlations were calculated to assess bivariate associations between quantitative variables. RESULTS: Caregivers reported providing from 6 to 168 hours of care weekly (mean=61.87+/-49.67 hours), in which they performed an average of 19.73+/-8.09 caregiving tasks daily. Training needs identified were greatest for technical and nutrition-related tasks. Preparedness for caregiving scores were low (mean=1.72, maximum=4.0) and positively correlated with caregiver competence (P<.001) and self-rated caregiver effectiveness (P=.004). Preparedness negatively correlated with health care use (P=.03). CONCLUSIONS: Caregivers of older adults on home enteral nutrition need training for multiple nutrition-related and caregiving tasks. Multidisciplinary interventions, involving dietitian expertise, are needed to better prepare caregivers to improve both caregiver effectiveness and enteral nutrition outcomes.

Adult↗
PubMed2004

Continued need for increased emphasis on aging in dietetics education.

This study examined the content on aging in dietetics curricula via the Internet and a follow-up questionnaire. Only 14% to 15% of programs were not online. The 203 undergraduate and 88 graduate program Web sites listed 44 (22%) undergraduate and 39 (44%) graduate courses in aging. However, more maternal and child courses were listed. The number of undergraduate aging courses was similar to the 20% reported in 1989, although methodologies differed among the studies. Life cycle and community nutrition courses had the most aging content. More than half of program directors were not satisfied with the aging curriculum content. Integrating aging material into existing courses was the most acceptable way of increasing aging content. The common barriers were "curriculum already full" and "lack of faculty expertise." As the nation's changing demographics are reshaping the dietetics marketplace, a greater emphasis on aging would enable students to be more effective in serving this booming population.

Aged↗
PubMed2004

Aging in introductory and life cycle nutrition textbooks.

The aging content in 11 undergraduate nutrition textbooks (8 introductory, 3 life cycle) was evaluated using content analysis. Repeated measures ANOVAs with Bonferroni post hoc procedures and t- tests were used. The 259 relevant pages largely focused on geriatrics (physiological decline, chronic diseases). Gerontological aspects were underemphasized. Mean number of pages on aging was significantly higher in life cycle (M = 37) than in introductory textbooks (M = 18), t (9) = 3.42, p < .008. In introductory textbooks, mean percentage of pages on aging (M = 3.2%) was significantly less than for maternal (M = 4.6%) and childhood topics (M = 6.2%), p < .05. Overall, topic omissions included discussion of ageism, death, dying, and dignity; and end-of-life decisions related to nutrition and hydration. Women and minorities were proportionately represented in generally positive photographs. Aging terminology was 81% neutral (older, aging), 14% negative (impaired, senile), and 5% positive (active, independent). These textbooks may not help students acquire the broad knowledge needed to work with older adults or develop positive attitudes about aging. Recommendations for authors, publishers, and instructors are provided.

Aged↗
PubMed2002

Dietetics students' low knowledge, attitudes, and work preferences toward older adults indicate need for improved education about aging.

OBJECTIVE: This study examined students' knowledge and attitudes about aging and their interest in working with the older adult population in the United States. DESIGN: A 97-item questionnaire included demographic items, a ranking section on work preferences by age groups, and two validated scales: the Palmore Facts on Aging Quiz, and the Oberleder Attitude Scale. SUBJECTS: Those surveyed were enrolled in the 10 largest universities in the 5 states with the largest population of older adults: California, Florida, New York, Texas, and Pennsylvania. Of 555 questionnaires that program directors requested for their class(es), 299 completed questionnaires were returned. This 54% return rate was affected by program directors requesting more questionnaires than needed. Of the 299 dietetics/nutrition students who completed the survey, 65% were in the 18 to 22 year age range, 91% were women, 81% were non-Hispanic white, and 81% were seniors in college. STATISTICAL ANALYSES: Pearson's correlation was applied to test for relationships between knowledge and attitudes; t tests for differences in knowledge, attitudes, and work preferences by age, gender, and experience with older adults; and Tukey's multiple comparison test for differences in knowledge, attitudes, and work preferences by state. RESULTS: Students had low knowledge about aging (Palmore, mean percent correct +/- standard deviation = 40.1%+/-13.0%) and neutral attitudes toward older adults (Oberleder, mean score = 69.1+/-8.2). When asked which of 10 age groups they preferred to work with, respondents ranked the 3 oldest age groups (65 to 74, 75 to 84, 85 and older) lowest on average (6.0, 7.3, 8.6, respectively). APPLICATIONS/CONCLUSIONS: More didactic instruction about aging and more positive experiences with older adults through fieldwork may be needed to prepare future practitioners to provide nutrition services to this increasing population segment.

Adolescent↗
PubMed2002

Family caregiver training is needed to improve outcomes for older adults using home care technologies.

Family caregivers, although uncompensated, provide daily care for more than 75% of the older adults who are dependent on home care technologies such as home enteral nutrition. The high complication rates and poor outcomes seen in older adults suggest that being an effective caregiver requires specialized training in home care technologies, and dietitians need to be more actively involved in discharge planning and follow-up home care. The level of knowledge and skill mastery required for technology-dependent care, along with the chronic, intensive nature of family caregiving and the disruptions in caregivers' daily lives, lead to negative emotional and physical consequences that may interfere with caregivers' ability to do caregiving well. Recognizing that care recipients and caregivers are underserved populations, dietitians should develop their professional competencies and expand their roles in technology-dependent home care. Dietitians can thereby contribute to better outcomes for both family caregivers and older home care recipients.

Aged↗
PubMedDate not supplied

Content analysis: review of methods and their applications in nutrition education.

Content analysis is a set of qualitative and quantitative methods for collecting and analyzing data from verbal, print, or electronic communication with numerous applications in nutrition education research. Textual information from interviews, focus groups, and open-ended survey questions can be evaluated using content analysis. Selection of method(s) depends on the type(s) and length of material to be analyzed, results desired, and researchers' preferences and technological capabilities. This article reviews options available to content analysts--from manual to fully computerized. Overcoming the challenges inherent in using these methodologies is recommended because of their usefulness in the information-based messaging discipline of nutrition education.

Data Collection↗
PubMedDate not supplied

Holocaust survivors report long-term effects on attitudes toward food.

OBJECTIVE: To gather information from survivors on the effects that the Holocaust had on their current attitudes toward food. DESIGN: Qualitative study: one-on-one semistructured interviews with a script shaped by a pilot study. SETTING: South Florida homes and community sites, including the Miami Beach Holocaust Memorial. PARTICIPANTS: Convenience sample of 25 Holocaust survivors: 14 men, 11 women; ages 71 to 85 years. PHENOMENON OF INTEREST: Current attitudes toward food in relation to Holocaust experiences. ANALYSIS: Themes and illustrative quotations from transcriptions of audiotaped interviews. RESULTS: Food attitudes were influenced by Holocaust experiences. Five themes emerged: (1) difficulty throwing food away, even when spoiled; (2) storing excess food; (3) craving certain food(s); (4) difficulty standing in line for food; and (5) experiencing anxiety when food is not readily available. Empathy for those currently suffering from hunger was also reported. CONCLUSIONS AND IMPLICATIONS: Food-related issues from the Holocaust remain for survivors. Now in their 70s and 80s, many use health care and related services. Nutritionists, educators, and health professionals should be aware of such issues. Food and nutrition programs should minimize uncomfortable food-related situations for Holocaust survivors and others who experienced food deprivation.

Aged↗
PubMedDate not supplied

Nutrition education may reduce burden in family caregivers of older adults.

The chronic, demanding nature of family caregiving for frail older adults creates a high degree of stress for caregivers, called caregiver burden. Caregiver burden compromises caregivers' emotional and physical health and health-promoting behaviors. Deterioration in caregivers' health and nutritional status may put caregivers at risk for chronic disease, diminish the ability of caregivers to provide care, and impair the quality of life experienced by caregivers and care recipients. Nutrition education may help reduce caregiver stress and maintain caregivers' health and well-being. Mediating caregiver stress may allow family caregivers to meet their societal role, which has intensified because of health care cost containment.

Aged↗
PubMedDate not supplied

Older adults receiving home enteral nutrition: enteral regimen, provider involvement, and health care outcomes.

BACKGROUND: Home enteral nutrition (HEN) is most frequently prescribed for older adults. Medicare reimbursement policy limits in-home nursing visits, and in-home professional nutrition services are restricted to those patients with diabetes or predialysis kidney disease. Most older adults receiving HEN rely on informal (family) caregivers to provide HEN care. The purpose of this study was to apply care process theory to identify and investigate variables related to health care outcomes of HEN in a sample of older adults dependent on informal caregivers. We assessed relationships among patient characteristics, the HEN regimen prescription and adherence, formal provider involvement, and health care outcomes. METHODS: In-home interviews were conducted with a multiethnic (14 white, 8 Hispanic, 7 African American, 1 Asian) sample of 30 older adults (mean = 68.4 years) during their first 3 months of HEN (mean = 1.83 months). RESULTS: Daily enteral intake averaged 1596 +/- 553 kcal. Gastrointestinal complications, occurring in up to 63.3% of patients, interrupted daily infusions. Further, one-third reported tube clogging or leaking, and one-third had tube displacement. Water intake was half of calculated need and associated with decreased urination (p = .001). Average weight change was -4.35 pounds (p = .001), and 17 patients had body mass indexes (BMIs) <18.5. Women had more complications (p = .004), lower enteral intake (p = .009), and lower BMIs (p = .02). Only 6 patients saw dietitians in follow-up care. Complications and type of feeding tube were associated with unscheduled health care visits and readmissions (p < .05). CONCLUSION: The efficacy of HEN in older adults (ie, reversal of malnutrition and improvements in health, functionality and quality of life) requires more frequent monitoring, reassessment, and intervention from a highly skilled multidisciplinary team that includes dietitians.

Activities of Daily Living↗