Stressors, mediators, and health care outcomes of home enteral nutrition in family caregivers and their older adult care recipients

Family caregivers manage home enteral nutrition (HEN) for over 77% of an estimated 1 of every 400 Medicare recipients. Increasing usage of HEN in older adults combined with reliance on family caregivers raises concerns for the quality, outcomes, and costs of care. These concerns are relevant in light of Medicare limitations on nursing assistance and non-reimbursement for nutrition services, despite annual costs of over $600 million. This study applied stress process theories to assess stressor, mediator, and outcome variables salient to HEN and caregiving. In-home structured interviews occurred with a multi-ethnic sample of 30 caregiving dyads at 1–3 months after discharge on HEN. Care recipients were aged ≥60 (M = 68.4 years) and did not have dementia. Caregivers were aged ≥21, unpaid, and lived within 45 minutes of care recipients. Caregivers performed an average of 19.7 tasks daily for 61.9 hours weekly. Training needs were identified for 33 functional, care management, technical, and nutritional tasks. Preparedness scores were low (M = 1.73/4.0), and positively correlated with competence, self-rated quality of care and positive feelings, and negatively with overload, role captivity, and negative feelings (Ps < .05). Caregivers had multiple changes in lifestyle and dietary behaviors. Lifestyle changes positively correlated with overload, and negatively with preparedness and positive feelings. Dietary changes positively correlated with number of tasks, overload, role captivity and negative feelings, and negatively with preparedness (Ps < .01). Fifty-seven percent of caregivers aged >50 were at nutrition risk. Care recipients fared worse. Average weight change was −4.35 pounds (P < .001). Physical complications interrupted daily enteral infusions. Water intake was half of fluid need and associated with signs of dehydration (P < .001). Physical and social function was poor, with older subjects more impaired ( P < .04). Those with better prepared or less overloaded caregivers had higher functionality and QOL (P < .002). Complications, type of feeding tube, and caregiver preparedness correlated with frequency of health care utilization (Ps < .05). Efficacy of HEN in older adults requires specialized caregiver training, attention to caregivers' needs, and frequent monitoring from a highly skilled multidisciplinary team including dietitians. ^

The palatability of monosodium glutamate-enhanced vegetables as rated by Cuban-American older adults at a congregate meal site

The purpose of this study was to investigate the efficacy of using monosodium glutamate (MSG) as a means to increase palatability and prospective consumption of vegetables at a congregate meal site with Cuban-American clients. Thirty to 32 subjects participated in hedonic testing each day. MSG-enhanced (2 g MSG/500 g vegetable) and non-enhanced beets, string beans, carrots and peas were evaluated for palatability, preference and prospective consumption. Results showed that MSG significantly increased both palatability and prospective consumption of string beans (ps < .05) but not of the other 3 vegetables tested. These findings provide some evidence that MSG can be used to increase the palatability of vegetables served at congregate meal sites. However, these results suggest that older adults may not find the palatability of some vegetables to be improved by MSG and that optimal flavor enhancement cannot be achieved by adding the same amount of MSG to every vegetable.

The Efficacy of San Lazaro and His Manifestations: Divine Mediators of Health Within Miami's Cuban-American Santeria Community.

This study explored the origins, evolution and influence of the tradition of San Lázaro as it currently pertains to the Cuban-American Santeria community in Miami. The main argument of the study is that in the context of the contemporary religious culture of Santeria in Miami, San Lázaro is a hybrid spirit. Many manifestations of healing entities have come to merge in the person of this spirit. Though practitioners identify with specific manifestations of this spirit, the processes of transmigration have blurred the lines of deep-rooted faiths and created a fusion of meanings from disparate traditions, making San Lázaro an ambivalent personality. San Lázaro’s ambivalence is the very quality that makes him such an important Orisha. As a deity whose personalities demonstrates the combination of a diversity of qualities, including those that contradict each other, San Lázaro is deployed in a very broad range of healing context, making him a versatile Orisha. This study clarified the contrasting qualities this deity embodies and traces the socio-historical context in which the deity acquires the layers of meanings it is currently associated with. Drawing on interviews with Lázaranian worshipers [Lázarenos] in Miami and engaging in Bourdieu’s concept of Habitus, the study provided a window into the nature of the tradition of San Lázaro and how its usage is linked with the African heritage of the worshipers.