Department of Nursing Science, Charité Universitätsmedizin Berlin, Germany.
Int J Nurs Stud. 2012 Apr;49(4):378-85. doi: 10.1016/j.ijnurstu.2011.09.018. Epub 2011 Oct 19.
Reduced nutritional intake in care-dependent patients is a risk factor for malnutrition. The prevalence of malnutrition has been extensively reported, but there is little empirical data on the prevalence of the underlying causes of reduced oral intake and the extent of nursing interventions that address malnutrition.
To report the prevalence of problems that potentially led to decreased nutritional intake. To investigate the association between these problems and body mass index (BMI). To investigate the association between increased care dependency and BMI. To document nutrition-related interventions.
Cross-sectional multicentre study.
A total of 15 hospitals (H) and 76 nursing homes (NH) in Germany were included.
A total of 2930 hospital patients and 5521 nursing home residents were included in the study. The mean age was 66.6 ± 16.7 years (in H) and 84.9 ± 9.8 years (in NH); 14.7% (in H) and 50.4% (in NH) were almost or completely care dependent. A BMI ≤ 20kg/m² was found in 8.5% (in H) and 16.7% (in NH).
Most hospital patients were eating and drinking independently (72.2%), whereas 58.4% of the nursing home residents needed assistance. Major problems in hospitals were polypharmacy (18.6%), loss of appetite (14.6%) and pain (7.8%); in nursing home common problems were functional problems of the upper extremities (17%), loss of appetite (15.5%) and polypharmacy (15.5%). Patients with a high level of care dependency had higher rates of BMI ≤ 20kg/m². In both settings (H and NH), BMI ≤ 20kg/m² was significantly associated with loss of appetite (odds ratio (OR) 2.6, 95%CI 1.9-3.5 and OR 7.0, 95%CI 5.9-8.3), nausea (OR 2.1, 95%CI 1.3-3.3 and OR 2.8, 95%CI 1.9-4.1), chewing problems (OR 2.1, 95%CI 1.2-3.4 and OR 2.5, 95%CI 2.1-3.1) and swallowing problems (OR 2.3, 95%CI 1.4-3.6 and OR 2.3, 95%CI 1.9-2.8). Nutrition-related nursing interventions were employed more frequently in nursing homes than in hospitals.
A high care dependency in general and in terms of eating and drinking should be addressed in daily care to ensure sufficient nutritional intake. Additional problems, such as loss of appetite, should also be addressed with suitable interventions to prevent malnutrition. Nutrition-related interventions need to be increased in German health care facilities.
依赖护理的患者营养摄入减少是营养不良的一个风险因素。营养不良的患病率已经得到了广泛的报道，但关于导致口腔摄入减少的潜在原因的流行程度以及解决营养不良的护理干预措施的范围，实证数据却很少。
报告可能导致营养摄入减少的问题的流行程度。调查这些问题与身体质量指数（BMI）之间的关系。调查护理依赖性增加与 BMI 之间的关系。记录与营养相关的干预措施。
横断面多中心研究。
德国共有 15 家医院（H）和 76 家养老院（NH）参与了研究。
共有 2930 名住院患者和 5521 名养老院居民纳入了研究。平均年龄为 66.6 ± 16.7 岁（在 H）和 84.9 ± 9.8 岁（在 NH）；14.7%（在 H）和 50.4%（在 NH）几乎或完全依赖护理。在 H 中 BMI≤20kg/m²的比例为 8.5%，在 NH 中为 16.7%。
大多数住院患者能够独立进食和饮水（72.2%），而 58.4%的养老院居民需要帮助。在医院中主要的问题是多药治疗（18.6%）、食欲不振（14.6%）和疼痛（7.8%）；在养老院常见的问题是上肢功能障碍（17%）、食欲不振（15.5%）和多药治疗（15.5%）。护理依赖程度高的患者 BMI≤20kg/m²的比例更高。在这两个环境（H 和 NH）中，BMI≤20kg/m²与食欲不振（优势比（OR）2.6，95%置信区间（CI）1.9-3.5 和 OR 7.0，95%CI 5.9-8.3）、恶心（OR 2.1，95%CI 1.3-3.3 和 OR 2.8，95%CI 1.9-4.1）、咀嚼问题（OR 2.1，95%CI 1.2-3.4 和 OR 2.5，95%CI 2.1-3.1）和吞咽问题（OR 2.3，95%CI 1.4-3.6 和 OR 2.3，95%CI 1.9-2.8）显著相关。与医院相比，养老院更频繁地进行与营养相关的护理干预。
一般来说，以及在进食和饮水方面，较高的护理依赖程度应在日常护理中加以解决，以确保充足的营养摄入。还应通过适当的干预措施解决食欲减退等其他问题，以预防营养不良。德国的医疗保健机构需要增加与营养相关的干预措施。
