Palliative Care Center, Aichi Medical University, Aichi, Japan.
Department of Nutrition and Dysphagia Rehabilitation, Tamana Regional Health Medical Center, Kumamoto, Japan.
Clin Interv Aging. 2018 Jan 26;13:151-157. doi: 10.2147/CIA.S154129. eCollection 2018.
Little is known about the association between malnutrition and the chances of returning home from post-acute facilities in older adult patients. This study aimed to understand whether malnutrition and malnutrition-related factors would be determinants for returning home and activities of daily living (ADL) at discharge after post-acute care.
Patients aged ≥65 years living at home before the onset of an acute disease and admitted to a post-acute ward were enrolled (n=207) in this prospective observational study. Malnutrition was defined based on the criteria of the European Society for Clinical Nutrition and Metabolism. Nutritional parameters included the nutritional intake at the time of admission and oral conditions evaluated by the Oral Health Assessment Tool (OHAT). The Barthel Index was used to assess daily activities. A Cox regression analysis of the length of stay was performed. Multivariable linear regression analyses to determine associations between malnutrition, returning home, and ADL at discharge were performed, after adjusting the variables of acute care setting.
The mean patient age was 84.7±6.7 years; 38% were men. European Society for Clinical Nutrition and Metabolism-defined malnutrition was observed in 129 (62.3%) patients, and 118 (57.0%) of all patients returned home. Multivariable regression analyses showed that malnutrition was a negative predictor of returning home (hazard ratio: 0.517 [0.351-0.761], =0.001), and an increase in the nutritional intake (kcal/kg/d) was a positive predictor of the Barthel Index at discharge (coefficient: 0.34±0.15, =0.021). The OHAT was not associated with returning home and ADL.
Malnutrition and nutritional intake are associated with returning home and ADL at discharge, respectively, after post-acute care. Further studies investigating the effects of a nutritional intervention for post-acute patients would be necessary.
关于营养状况与老年患者在急性疾病后从康复机构返回家中的机会之间的关联，人们知之甚少。本研究旨在了解营养状况和与营养相关的因素是否是康复后返回家中和日常生活活动（ADL）能力的决定因素。
本前瞻性观察性研究纳入了在家中居住且在急性疾病发作前生活自理的年龄≥65 岁的患者（n=207），入住康复病房。根据欧洲临床营养和代谢学会的标准定义营养状况。营养参数包括入院时的营养摄入量和口腔健康评估工具（OHAT）评估的口腔状况。使用巴氏量表评估日常活动。对住院时间进行 Cox 回归分析。进行多变量线性回归分析，以确定营养状况、返回家中和出院时 ADL 之间的关联，调整急性护理环境的变量。
患者的平均年龄为 84.7±6.7 岁，38%为男性。根据欧洲临床营养和代谢学会的标准，129 例（62.3%）患者存在营养状况不良，所有患者中有 118 例（57.0%）返回家中。多变量回归分析显示，营养状况不良是返回家中的负面预测因素（风险比：0.517 [0.351-0.761]，=0.001），营养摄入量（千卡/公斤/天）的增加是出院时巴氏量表的正向预测因素（系数：0.34±0.15，=0.021）。OHAT 与返回家中和 ADL 均无关。
营养状况不良和营养摄入量分别与康复后返回家中和 ADL 能力有关。需要进一步研究营养干预对康复患者的影响。
