Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland; Department of Nursing Development, Cantonal Hospital Aarau, Aarau, Switzerland.
Institute of Nursing Science, Department Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland; Department of Breast, Abdomen, Pelvis, University Hospital Basel, Basel, Switzerland.
J Am Med Dir Assoc. 2023 Jul;24(7):1074-1081. doi: 10.1016/j.jamda.2023.02.010. Epub 2023 Mar 17.
Malnutrition is frequent in older adults, associated with increased morbidity, mortality, and higher costs. Nursing home residents are especially affected, and evidence on institutional factors associated with malnutrition is limited. We calculated the prevalence of malnutrition in Swiss nursing home residents and investigated which structure and process indicators of nursing homes are associated with residents' malnutrition.
Subanalysis of the Swiss Nursing Homes Human Resources Project 2018, a multicenter, cross-sectional study conducted from 2018 to 2019 in Switzerland.
This study included 76 nursing homes with a total of 5047 residents.
Malnutrition was defined as a loss of bodyweight of ≥5% in the last 30 days or ≥10% in the last 180 days. Binomial generalized estimating equations (GEE) were applied to examine the association between malnutrition and structural (staffing ratio, grade mix, presence of a dietician, malnutrition guideline, support during mealtimes) and process indicators (awareness of malnutrition, food administration process). GEE models were adjusted for institutional (profit status, facility size) and specific resident characteristics.
The prevalence of residents with malnutrition was 5%. A higher percentage of units per nursing home having a guideline on prevention and treatment of malnutrition was significantly associated with more residents with weight loss (OR 2.47, 95% CI 1.31-4.66, P = .005). Not having a dietician in a nursing home was significantly associated with a higher rate of residents with weight loss (OR 1.60, 95% CI 1.09-2.35, P = .016).
Having a dietician as part of a multidisciplinary team in a nursing home is an important step to address the problem of residents' malnutrition. Further research is needed to clarify the role of a guideline on prevention and treatment of malnutrition to improve the quality of care in nursing homes.
老年人营养不良较为常见，与发病率和死亡率增加以及更高的成本相关。疗养院的居民尤其受到影响，与营养不良相关的机构因素的证据有限。我们计算了瑞士疗养院居民的营养不良患病率，并调查了哪些疗养院的结构和流程指标与居民的营养不良相关。
2018 年瑞士多中心、横断面研究——瑞士疗养院人力资源项目的亚组分析，于 2018 年至 2019 年在瑞士进行。
本研究包括 76 家疗养院，共有 5047 名居民。
营养不良定义为在过去 30 天内体重下降≥5%或在过去 180 天内体重下降≥10%。采用二项广义估计方程（GEE）检验营养不良与结构（人员配备比例、等级混合、营养师的存在、营养不良指南、用餐时的支持）和过程指标（对营养不良的认识、食物管理流程）之间的关联。GEE 模型调整了机构（盈利状况、设施规模）和特定居民特征。
营养不良居民的患病率为 5%。疗养院每单位拥有预防和治疗营养不良指南的比例越高，体重下降的居民比例越高（比值比 2.47，95%置信区间 1.31-4.66，P=0.005）。疗养院没有营养师与体重下降的居民比例较高显著相关（比值比 1.60，95%置信区间 1.09-2.35，P=0.016）。
在疗养院中，营养师作为多学科团队的一部分是解决居民营养不良问题的重要一步。需要进一步研究以明确预防和治疗营养不良指南的作用，以提高疗养院的护理质量。
