Whitley A, Skliros E, Graven C, McIntosh R, Lasry C, Newsome C, Bowie A
A. Whitley, St Vincents Hospital Melbourne, Australia,
J Nutr Health Aging. 2017;21(6):686-691. doi: 10.1007/s12603-016-0838-3.
Malnutrition and functional decline are common in older inpatients admitted to subacute care settings. However the association between changes in nutritional status and relevant functional outcomes remains under-researched. This study examined changes in nutritional status, function and mobility in patients admitted to a Geriatric Evaluation and Management (GEM) unit who had a length of stay (LOS) longer than 21 days.
A prospective, observational study.
Two GEM units at St Vincent's Hospital Melbourne, Australia.
Patients admitted to the GEM units who stayed longer than 21 days were included in the study.
Patients were assessed on admission and prior to discharge using the Subjective Global Assessment (SGA), Functional Independence Measure (FIM) motor domain and the Modified Elderly Mobility Scale (MEMS).
Fifty-nine patients (Mean age 84.0 ± 7 years) met the required length of stay and were included in the study. Fifty-four per cent (n=32) were malnourished on admission (SGA B/C) and 44% (n=26) were malnourished on discharge. Twenty-two per cent (n=13) improved SGA category, 75% remained stable (n=44) and 3% deteriorated (n=2) from admission to discharge. Total Motor FIM scores significantly increased from admission to discharge in both the improved (p<0.001) and stable or deteriorated (p<0.001) nutritional status groups. Subjects who improved in nutritional status had a significantly higher MEMS score at discharge (p<0.001).
On admission to the GEM unit, just over half the included patients were rated as malnourished defined by SGA category. Nearly one quarter of the sample had improved their nutritional status at the time of discharge. Improvement in nutritional status was associated with greater improvement in mobility scores. Further studies are required to investigate the effectiveness of nutrition interventions, which will inform models of care aiming to optimise nutritional, functional, and associated clinical outcomes in patients admitted to GEM units.
营养不良和功能衰退在入住亚急性护理机构的老年住院患者中很常见。然而，营养状况变化与相关功能结局之间的关联仍未得到充分研究。本研究调查了入住老年评估与管理（GEM）病房且住院时间超过21天的患者的营养状况、功能和活动能力的变化。
一项前瞻性观察性研究。
澳大利亚墨尔本圣文森特医院的两个GEM病房。
入住GEM病房且住院时间超过21天的患者被纳入研究。
使用主观全面评定法（SGA）、功能独立性测量（FIM）运动领域评分和改良老年活动量表（MEMS）在入院时和出院前对患者进行评估。
59名患者（平均年龄84.0±7岁）达到所需住院时间并被纳入研究。入院时54%（n=32）的患者营养不良（SGA B/C级），出院时44%（n=26）的患者营养不良。从入院到出院，22%（n=13）的患者SGA类别改善，75%（n=44）保持稳定，3%（n=2）恶化。在营养状况改善组（p<0.001）和稳定或恶化组（p<0.001）中，运动FIM总分从入院到出院均显著增加。营养状况改善的受试者出院时MEMS评分显著更高（p<0.001）。
入住GEM病房时，超过一半的纳入患者根据SGA类别被评定为营养不良。近四分之一的样本在出院时营养状况有所改善。营养状况的改善与活动能力评分的更大改善相关。需要进一步研究营养干预的有效性，这将为旨在优化入住GEM病房患者的营养、功能及相关临床结局的护理模式提供依据。
