KejŽar Anamarija, Rihter Liljana, Sajovic Jakob, Drevenšek Gorazd
Faculty of Social Work, University of Ljubljana, Ljubljana, Slovenia.
Department of Stomatology, University Medical Centre Ljubljana, Ljubljana, Slovenia.
Front Nutr. 2022 Mar 4;9:796031. doi: 10.3389/fnut.2022.796031. eCollection 2022.
Current nutritional strategies for people with dementia focus on nutritional diets and regimens, although in recent years congruent care for people with dementia has been increasingly recognized to improve their wellbeing. This includes consistency of care, respecting the variability of psycho-sociological factors, emphasizing the importance of participation in activities, and congruence with the individual's needs and capabilities. When applied to the nutritional aspects of care, it aims to empower people with dementia to have an active role in their care and during meals. Congruent care has previously shown promising results in improving the quality of life of residents, reducing the incidence of negative social interactions and daily intake of medicines.
A mixed methods qualitative-quantitative study was carried out. Out of 102 residential care homes for the elderly in Slovenia, a non-random sample of homes was selected. Seven homes that have implemented congruent care and five who have not implemented it agreed to participate. Content analysis of the transcripts of focus group interviews was carried out, to establish how the congruent care model was included into their everyday practice of care for people with dementia. Qualitative comparative analysis was used to describe the differences in the practice of care between the two groups of homes, in the fields of nutritional and general care. Frequencies and assigned importance of statements relating to different aspects of nutritional care were statistically compared.
The introduction of congruent care improved the wellbeing of the people with dementia, as observed by caregivers. The homes that had implemented congruent care gave more attention to the food choice aspects of nutritional care ( = 0.0474, 95%CI = 50.77-72.35%, 95%CI = 27.65-49.23%), while the homes that had not were more attentive to the dietary intake aspects ( = 0.0067, 95%CI = 22.79-44.74%, 95%CI = 55.26-77.21%). In the homes for the elderly that had implemented congruent care, both caregivers and management reported that the frequency of use of medication decreased, which is supported by the results of the linear regression ( =78.4, = 0.005), although the data available is limited.
First, the people with dementia in the care homes that had implemented congruent care were observed to have improved in mood, attitudes toward eating and wellbeing, as reported by caregivers. Second, the implementation of congruent care was well received by the management and caregivers of the care homes. A model of implementation of congruent nutritional care for people with dementia is presented.
目前针对痴呆症患者的营养策略主要集中在营养饮食和养生法上，不过近年来，人们越来越认识到为痴呆症患者提供契合性护理有助于改善他们的健康状况。这包括护理的连贯性、尊重心理社会因素的变异性、强调参与活动的重要性以及与个人需求和能力相契合。应用于护理的营养方面时，其目的是使痴呆症患者能够在自身护理及用餐过程中发挥积极作用。契合性护理此前已在改善居民生活质量、减少负面社交互动发生率和药物每日摄入量方面显示出了有前景的成果。
开展了一项定性 - 定量混合方法研究。在斯洛文尼亚的102家老年养老院中，选取了一个非随机样本。七家已实施契合性护理的养老院和五家未实施的养老院同意参与。对焦点小组访谈的文字记录进行了内容分析，以确定契合性护理模式是如何融入他们对痴呆症患者的日常护理实践中的。采用定性比较分析来描述两组养老院在营养护理和一般护理领域的护理实践差异。对与营养护理不同方面相关陈述的频率和重要性分配进行了统计比较。
护理人员观察到，实施契合性护理改善了痴呆症患者的健康状况。实施契合性护理的养老院更关注营养护理中的食物选择方面（=0.0474，95%置信区间=50.77 - 72.35%，95%置信区间=27.65 - 49.23%），而未实施的养老院更关注饮食摄入方面（=0.0067，95%置信区间=22.79 - 44.74%，95%置信区间=55.26 - 77.21%）。在实施契合性护理的老年养老院中，护理人员和管理人员均报告用药频率有所下降，线性回归结果支持了这一点（=78.4，=0.005），不过现有数据有限。
第一，据护理人员报告，在实施契合性护理的养老院中，痴呆症患者的情绪、对饮食的态度和健康状况有所改善。第二，契合性护理的实施受到了养老院管理人员和护理人员的好评。本文提出了一种针对痴呆症患者的契合性营养护理实施模式。
