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Barriers and facilitators to screening and treating malnutrition in older adults living in the community: a mixed-methods synthesis

Barriers and facilitators to screening and treating malnutrition in older adults living in the community: a mixed-methods synthesis
Barriers and facilitators to screening and treating malnutrition in older adults living in the community: a mixed-methods synthesis
Background. Malnutrition (specifically undernutrition) in older, community-dwelling adults reduces well-being and predisposes to disease. Implementation of screen-and-treat policies could help to systematically detect and treat at-risk and malnourished patients. We aimed to identify barriers and facilitators to implementing malnutrition screen and treat policies in primary/community care, which barriers have been addressed and which facilitators have been successfully incorporated in existing interventions.

Method. A data-base search was conducted using MEDLINE, Embase, PsycINFO, DARE, CINAHL, Cochrane Central and Cochrane Database of Systematic Reviews from 2012 to June 2016 to identify relevant qualitative and quantitative literature from primary/community care. Studies were included if participants were older, community-dwelling adults (65+) or healthcare professionals who would screen and treat such patients. Barriers and facilitators were extracted and mapped onto intervention features to determine whether these had addressed barriers.

Results. Of a total of 2182 studies identified, 21 were included (6 qualitative, 12
quantitative and 3 mixed; 14 studies targeting patients and 7 targeting healthcare professionals). Facilitators addressing a wide range of barriers were identified, yet few interventions addressed psychosocial barriers to screen-and-treat policies for patients, such as loneliness and reluctance to be screened, or healthcare professionals’ reservations about prescribing oral nutritional supplements.

Conclusion. The studies reviewed identified several barriers and facilitators and
addressed some of these in intervention design, although a prominent gap appeared to be psychosocial barriers. No single included study addressed all barriers or made use of all facilitators, although this appears to be possible. Interventions aiming to implement screen-and-treat approaches to malnutrition in primary care should consider barriers that both patients and healthcare professionals may face.

Review registration. PROSPERO: CRD42017071398. The review protocol was
registered retrospectively

Keywords. Primary health care, general practice, malnutrition, independent living, health services for the aged, dietary supplements.
Primary health care, General practice, Malnutrition, Independent living, Health services for the aged, Dietary supplements
1471-2296
1-10
Harris, Philine S.
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Payne, Liz
862f8fcf-711d-4146-a723-a9109339c70a
Morrison, Leanne
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Green, Sue M.
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Ghio, Daniela
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Hallett, Claire
46463b9a-12f8-421b-87ab-bfc157634785
Parsons, Emma
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Aveyard, Paul
cb22de2b-29bc-4886-8a00-6e68aea59509
Roberts, Helen
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Sutcliffe, Michelle
223dd288-72e7-4da0-baf7-f9937260bbae
Robinson, Sian
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Slodkowska-Barabasz, Joanna
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Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Stroud, Michael A.
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Yardley, Lucy
64be42c4-511d-484d-abaa-f8813452a22e
Harris, Philine S.
f58996a4-7dfc-4960-aa27-0bc5d40674e8
Payne, Liz
862f8fcf-711d-4146-a723-a9109339c70a
Morrison, Leanne
920a4eda-0f9d-4bd9-842d-6873b1afafef
Green, Sue M.
79c7832a-f753-409b-88e4-7d2a6e469433
Ghio, Daniela
68e87380-d790-4f20-b24d-d3ac0ca5765d
Hallett, Claire
46463b9a-12f8-421b-87ab-bfc157634785
Parsons, Emma
4c139c27-03d0-4fba-9261-5e04eb06ab9c
Aveyard, Paul
cb22de2b-29bc-4886-8a00-6e68aea59509
Roberts, Helen
5ea688b1-ef7a-4173-9da0-26290e18f253
Sutcliffe, Michelle
223dd288-72e7-4da0-baf7-f9937260bbae
Robinson, Sian
6ada395c-a5e4-484b-b3a8-6760db7a48e4
Slodkowska-Barabasz, Joanna
18182048-55ee-474c-9790-1f5b81fa585c
Little, Paul
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Stroud, Michael A.
4543ff51-a8fe-4271-b11d-636a2f30c12f
Yardley, Lucy
64be42c4-511d-484d-abaa-f8813452a22e

Harris, Philine S., Payne, Liz, Morrison, Leanne, Green, Sue M., Ghio, Daniela, Hallett, Claire, Parsons, Emma, Aveyard, Paul, Roberts, Helen, Sutcliffe, Michelle, Robinson, Sian, Slodkowska-Barabasz, Joanna, Little, Paul, Stroud, Michael A. and Yardley, Lucy (2019) Barriers and facilitators to screening and treating malnutrition in older adults living in the community: a mixed-methods synthesis. BMC Family Practice, 20 (100), 1-10. (doi:10.1186/s12875-019-0983-y).

Record type: Article

Abstract

Background. Malnutrition (specifically undernutrition) in older, community-dwelling adults reduces well-being and predisposes to disease. Implementation of screen-and-treat policies could help to systematically detect and treat at-risk and malnourished patients. We aimed to identify barriers and facilitators to implementing malnutrition screen and treat policies in primary/community care, which barriers have been addressed and which facilitators have been successfully incorporated in existing interventions.

Method. A data-base search was conducted using MEDLINE, Embase, PsycINFO, DARE, CINAHL, Cochrane Central and Cochrane Database of Systematic Reviews from 2012 to June 2016 to identify relevant qualitative and quantitative literature from primary/community care. Studies were included if participants were older, community-dwelling adults (65+) or healthcare professionals who would screen and treat such patients. Barriers and facilitators were extracted and mapped onto intervention features to determine whether these had addressed barriers.

Results. Of a total of 2182 studies identified, 21 were included (6 qualitative, 12
quantitative and 3 mixed; 14 studies targeting patients and 7 targeting healthcare professionals). Facilitators addressing a wide range of barriers were identified, yet few interventions addressed psychosocial barriers to screen-and-treat policies for patients, such as loneliness and reluctance to be screened, or healthcare professionals’ reservations about prescribing oral nutritional supplements.

Conclusion. The studies reviewed identified several barriers and facilitators and
addressed some of these in intervention design, although a prominent gap appeared to be psychosocial barriers. No single included study addressed all barriers or made use of all facilitators, although this appears to be possible. Interventions aiming to implement screen-and-treat approaches to malnutrition in primary care should consider barriers that both patients and healthcare professionals may face.

Review registration. PROSPERO: CRD42017071398. The review protocol was
registered retrospectively

Keywords. Primary health care, general practice, malnutrition, independent living, health services for the aged, dietary supplements.

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More information

Accepted/In Press date: 18 June 2019
Published date: 15 July 2019
Keywords: Primary health care, General practice, Malnutrition, Independent living, Health services for the aged, Dietary supplements

Identifiers

Local EPrints ID: 432541
URI: https://eprints.soton.ac.uk/id/eprint/432541
ISSN: 1471-2296
PURE UUID: 7ffcefc7-13d9-40a3-871d-572f951a410c
ORCID for Philine S. Harris: ORCID iD orcid.org/0000-0001-6289-129X
ORCID for Liz Payne: ORCID iD orcid.org/0000-0002-6594-5668
ORCID for Leanne Morrison: ORCID iD orcid.org/0000-0002-9961-551X
ORCID for Helen Roberts: ORCID iD orcid.org/0000-0002-5291-1880
ORCID for Lucy Yardley: ORCID iD orcid.org/0000-0002-3853-883X

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Date deposited: 17 Jul 2019 16:31
Last modified: 29 Aug 2019 00:49

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