Simmons Sandra F, Schnelle John F
University of California, Los Angeles, School of Medicine, Department of Geriatrics, Borun Center for Gerontological Research, 91335, USA.
J Gerontol A Biol Sci Med Sci. 2004 Sep;59(9):M966-73. doi: 10.1093/gerona/59.9.m966.
Recommendations have been made to increase the number of nursing home (NH) staff available to provide feeding assistance during meals and to individualize care for residents. However, there are few data reflecting the number of residents responsive to feeding assistance during meals and what alternative interventions might be appropriate for other residents. The purpose of this study was to evaluate the effects and staffing requirements of two individualized feeding assistance interventions to improve oral food and fluid intake in NH residents.
Skilled nursing participants (n = 134) in 3 NHs received a 2-day trial of one-on-one feeding assistance during 6 meals. 68 participants who did not increase their oral intake in response to feeding assistance during meals received a 2-day intervention trial during which snacks were offered between meals 3 times daily. As part of both interventions, research staff provided adequate feeding assistance that enhanced the resident's self-feeding ability, social stimulation throughout the meal or snack period, and availability of choices for foods and fluids.
46% significantly increased their oral intake in response to one-on-one mealtime feeding assistance, and the staff time required to implement this intervention was 35 (+/- 8) minutes/meal per resident compared with usual NH care, which averaged 6 (+/- 9) minutes. 44% of the participants significantly increased their oral intake in response to the between-meal snack intervention, which required 12 (+/- 6) minutes of staff time per snack/resident compared with usual NH care (1 +/- 4 minutes).
Most participants (90%) significantly increased their daily oral food and fluid intake in response to one of two individualized interventions. The staff time necessary to implement each intervention was significantly greater than the staff time currently being spent on feeding assistance care delivery. Suggestions are made to increase the efficiency of staff time when delivering feeding assistance.
已有建议提出要增加养老院工作人员数量，以便在进餐时提供喂食协助，并为居民提供个性化护理。然而，几乎没有数据反映出在进餐时对喂食协助有反应的居民数量，以及其他居民可能适合何种替代干预措施。本研究的目的是评估两种个性化喂食协助干预措施对改善养老院居民口服食物和液体摄入量的效果及人员配备要求。
3家养老院的134名熟练护理参与者在6餐期间接受了为期2天的一对一喂食协助试验。68名在进餐时对喂食协助无口服摄入量增加反应的参与者接受了为期2天的干预试验，在此期间，每天3次在两餐之间提供零食。作为两种干预措施的一部分，研究人员提供了充分的喂食协助，增强了居民的自我喂食能力、进餐或吃零食期间的社交互动，以及食物和液体的选择。
46%的参与者因一对一进餐时喂食协助而口服摄入量显著增加，与养老院常规护理（平均6（±9）分钟）相比，实施该干预措施每名居民每餐所需工作人员时间为35（±8）分钟。44%的参与者因两餐之间吃零食干预而口服摄入量显著增加，与养老院常规护理（1±4分钟）相比，每次零食/居民所需工作人员时间为12（±6）分钟。
大多数参与者（90%）因两种个性化干预措施之一而每日口服食物和液体摄入量显著增加。实施每种干预措施所需的工作人员时间明显多于目前用于提供喂食协助护理的工作人员时间。文中提出了一些建议，以提高提供喂食协助时工作人员时间的效率。
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