[Bed confinement in old people-A literature review]. / Bettlägerigkeit bei alten Menschen ­ eine Literaturübersicht.

BACKGROUND: Particularly older people are affected by mobility restrictions and can go through the process of gradually becoming bedridden. This can potentially lead to extensive consequences for the individuals involved, which must be considered in their care. AIMS: To bundle nursing implications related to the phenomenon of being bedridden in the field of long-term care and to provide impulses for research in nursing science. METHODS: Research in relevant specialist databases (2003-2023) based on the criteria of a scoping review. RESULTS: In Germany there is a standard for maintaining and promoting mobility that addresses bed and local confinements but German language studies on these phenomena are rare. In the international context, these issues are researched more intensively, focussing on risk factors for the development of immobility and the negative consequences for those affected. The publications focus on the reduction of these factors, while less attention is paid to the organization of life in bed and the participation and involvement of those affected. DISCUSSION: The complexity of the phenomenon is not fully illustrated in current research. In order to develop a nursing perspective research projects that also include aspects of life in bed are a central aspect in order to take greater account of the reality of bedridden people's lives and their potential for participation and involvement.

[Medication supply and polypharmacy in long-term care : An overview of possible interventions and the question of a functioning concept]. / Medikamentenversorgung und Polypharmazie in der Langzeitpflege : Eine Übersicht zu möglichen Interventionen und die Frage nach einem funktionierenden Konzept.

BACKGROUND: Polypharmacy and the resulting problems lead to considerable consequences for those affected. There are also considerable problems with the medication management. OBJECTIVE: Which interventions and programs for optimizing the supply of medication are available for nursing homes and which implementation problems can be expected? MATERIAL AND METHOD: A literature search was carried out for interventional studies in nursing homes in Germany, with a focus on improving medication safety. RESULTS: A total of six programs were identified for which evaluation results are available. Despite a mostly multimodal approach with several pillars of intervention (e.g., medication reviews, further education and training, development of aids), the results are largely disappointing. The effects on the number of prescriptions in general, specific medication groups or outcome parameters such as hospital admissions could only be shown in one study, whereby, selection bias could also be at least partly responsible for this. Interdisciplinary collaboration and the implementation of medication recommendations formulated in reviews by the responsible physicians are the main problem areas. At the same time, too little attention is paid to the central role of nurses in the entire process and they are not actively promoted enough. This could be one of the reasons for the difficulties in implementation in practice. CONCLUSION: There are nearly no significant changes as a result of the interventions implemented in the studies reviewed. In particular, interprofessional cooperation, especially the skills of nurses and the reluctance on the part of physicians, should probably be given more attention.

[Estimation of the risk of drug-related problems in nursing home residents : A retrospective analysis of routine data]. / Einschätzung des Risikos für arzneimittelbezogene Probleme bei Pflegeheimbewohner*innen : Eine retrospektive Analyse von Routinedaten.

BACKGROUND: Polypharmacy and drug-related problems are major challenges in the care and treatment of nursing home residents. Many interventional studies showed disappointing results, which lead to the question if this could also be due to the selection of the target parameters of these studies. MATERIAL AND METHODS: A routine data set from six long-term care facilities was retrospectively analyzed. The question is if the recently validated medication risk score (MERIS) is suitable for carrying out a risk assessment in a population of nursing home residents. Associations between MERIS and the dependent variables hospital admissions and falls over 12 months and a weight loss of ≥ 5% over 3 months were examined. RESULTS: Out of 495 residents 38.6% (n = 191) have a high risk of drug-related problems according to MERIS. A univariate regression analysis showed a significantly increased risk of hospital admissions (OR 2.2; p < 0.001) and weight loss of ≥ 5% (OR 1.95; p = 0.041) with high MERIS, but no significant association with falls. In the multivariate regression the risk of hospitalization was increased by diabetes mellitus (OR 1.88; p = 0.004), falls in the same period (OR 1.91; p = 0.001), positive MERIS (OR 1.75; p = 0.006) and decreased with stable weight (OR 0.88; p = 0.004). CONCLUSION: The results indicate the potential of the score for future research projects and individual risk assessment; however, due to the limitations of retrospective secondary analyses further studies are required.

Malnutrition and Inadequate Eating Behaviour during Hospital Stay in Geriatrics-An Explorative Analyses of NutritionDay Data in Two Hospitals.

(1) Background: Malnutrition in hospitalized patients is prevalent worldwide, but the severity of the issue is often underestimated by practitioners. The purpose of this study is to investigate the prevalence of malnutrition and inadequate eating behaviour in a geriatric sample. (2) Methods: Two hospitals participated with six wards on nutritionDay in 2017, 2018 and 2019. Nutritional status, food intake, and nutritional interventions were analyzed for all patients ≥ 65 years (n = 156), using the official nutritionDay questionnaires. Malnutrition risk is identified by Malnutrition Universal Screening Tool (MUST), malnutrition by the ESPEN criteria (European Society of Clinical Nutrition and Metabolism). (3) Results: According to MUST (n = 136) 16.9% (n = 23) were at medium risk of malnutrition, 33.8% (n = 46) at high risk of malnutrition, 28.1% (n = 38) were malnourished. Overall, 62.8% (n = 98) showed an inadequate eating behaviour during hospital stay. Moreover, patients with inadequate nutrition had significantly worse self-reported health statuses (p = 0.001; r = -0.276), were less able to walk on nutritionDay (p = 0.002; r = -0.255), had eaten little in the week before admission to hospital (p < 0.001; r = -0.313), and had an increased length of stay (p = 0.036; r = -0.174). (4) Conclusion: To identify malnourished patients is a significant barrier for practitioners seeking to administer specific, tailored interventions. Malnutrition screening protocols must be improved, just as nutrition monitoring in general.

[Malnutrition in geriatric patients: risk factor residential nursing home?] / Mangelernährung bei geriatrischen Patient*innen: Risikofaktor stationäre Langzeitpflege?

Background: Malnutrition remains a challenging problem in hospitals, especially among geriatric patients. The background and causes are actually well known but still underestimated in clinical practice. Aim and methods: This study evaluated possible differences in rates of malnutrition risk and malnutrition in geriatric patients living at home and geriatric patients living in residential nursing homes. For this purpose, data from a total of 4 surveys (3 times nutritionDay plus 1 additional survey) were combined and evaluated. In this secondary analysis, 258 patients 65 years and older are included. Malnutrition risk is determined by the malnutrition universal screening tool (MUST) and malnutrition by the ESPEN criteria. Results: Of the patients 86.0% (n = 222) live at home and 14.0% (n = 36) in residential nursing homes. The patients living in nursing homes have a higher morbidity and need of care. Indicators for the increased morbidity are a larger number of nights spent in the clinic in the last 12 months (mdn 10.0 vs. 5; p 0.007), higher number of daily drug intake (mdn 9.0 vs. 7.0; p 0.002) and greater limitations in walking abilities (mdn 3.0 vs. 1.0; p < 0.001). They are significant older (median 86.0 vs. 78.0; p < 0.001) and show a higher percentage of manifest malnutrition (35.7%; n = 10 vs. 20.1%; n = 40; p 0.062). Conclusion: Geriatric patients living at home and in residential nursing homes show high rates of malnutrition. A malnutrition screening at the beginning and during hospital stay is urgently required in every case as this is the only way to identify those affected. In addition, regular screening in outpatient departments as well as in nursing homes is also necessary.

[Weight loss and malnutrition risk in geriatric patients]. / Gewichtsverluste und Mangelernährungsrisiko bei geriatrischen PatientInnen.

BACKGROUND: Malnutrition is a major challenge in routine clinical practice and is associated with increased mortality. OBJECTIVES: In the research project Prevention and treatment of malnutrition in geriatric patients in hospital funded by the Federal Ministry of Education and Research (BMBF), routine data were analyzed. The aim was to uncover the causes of malnutrition risks acquired in hospital. MATERIAL AND METHODS: Anonymized data from nursing home residents with at least a 3-day hospital stay were analyzed. The study included a total of 2058 residents from 19 nursing homes. The malnutrition risk was assessed by the combined MUST/PEMU (Malnutrition Universal Screening Tool/Nursing Measurement of Malnutrition and its Causes) screening and malnutrition by ESPEN (European Society for Clinical Nutrition and Metabolism) criteria. RESULTS: Of the residents 36.2% (n = 744) had an initial risk of malnutrition and 12.7% (n = 262) were already malnourished. The proportions increased to 48.6% (n = 881) and 14.3% (n = 259) at discharge, respectively. The logistic regression analysis showed a significantly increasing probability of developing a malnutrition risk during the hospital stay with the diagnoses diseases of the respiratory system (OR 2.686; CI 95 1.111-4.575), chondropathy and osteopathy (OR 1.892; CI 95 1.149-3.115) and a higher BMI (OR 0.108; CI 95 1.038-1.181), more positive weight changes 6 months before hospital (OR 1.055; CI 95 1.017-1.094) and an increasing hospital stay (OR 1.048; CI 95 1.029-1.067). CONCLUSION: The identification of an initial malnutrition and the prevention of developing a malnutrition risk represent major challenges in clinical practise. Both are equally necessary.