Functional and Nutritional Assessments in Geriatric Rehabilitation. A Feasibility Study

Detta är en avhandling från Lund University, Department of Nursing, P.O.Box 157, SE-221 00 LUND, SWEDEN

Sammanfattning: The aim was to evaluate the effectiveness and feasibility of functional and nutritional assessments in geriatric rehabilitation in Copenhagen, Denmark, and in addition to study clinically identifiable risk factors for undernutrition, association between nutritional and ADL status, feasibility and effectiveness of nutritional intervention conducted by the nursing staff, and the nursing staffs attitudes towards nutrition-related assessments. Two data collections were conducted in the geriatric clinics in Copenhagen. The first sample consisted of 2812 geriatric patients, mean age 82.5 years in four different hospitals. In this study approximately 50 key persons were selected from the interdisciplinary staff to ensure the implementation of five functional assessment scales measuring basic activities of daily living: (BADL), (Barthel Index), balance (Berg's Balance Scale), mood (Montgomery and Åsberg's Depression Rating Scale), cognitive function (Mini Mental State Examination), and social network. All interdisciplinary staff, 500 persons (nurses, physiotherapists, occupational therapists, physicians and social workers) were trained in doing assessments before implementing them. A second sample consisted of 345 patients, mean age 84 years. The nurses assessed nutritional status, BADL and nutrition-related factors on admission and nutritional and BADL status on discharge. Nurses in the intervention unit received training and daily supervision to apply the intervention: identifying patients at risk for undernutrition and those who were undernourished, and consequently providing treatment. The nurses in a control unit assessed the nutritional and BADL status only. The inpatients needed some help for BADL, had poor balance and were at risk of falling, 19% had depressive thoughts or depression, and 53% had cognitive problems. Day-hospital patients had better functions. The patients? ADL and balance improved considerable during the rehabilitation. The interdisciplinary staff administered the scales to an acceptable level, despite not meeting the goals set. About 40% of the patients were undernourished and more than 50% were at risk for undernutrition on admission. No help with cooking, poor appetite, oral cavity problems and high age were associated with undernutrition on admission. The patients used a high numbers of drugs, many had nausea or vomiting and constipation. Positive association between nutritional status and ADL function was found. The nurses conducted the intervention significant higher than the nurses in the control unit did in 14 of 18 potential risk factors for undernutrition, but no difference was observed. Nurses from both the intervention and control unit had positive attitudes towards assessments of nutrition-related factors. This thesis show that functional and nutritional assessments gave important information about the patients? functional and nutritional status, identified nutrition-related risk factors on admission and were feasible in everyday practice.

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