Survey of current enteral nutrition practices in treatment of amyotrophic lateral sclerosis.

BACKGROUND AND AIMS: Enteral nutrition (EN) is commonly prescribed for dysphagia and weight loss in amyotrophic lateral sclerosis (ALS), but there are currently no ALS-specific EN guidelines. We aimed to survey current practices prescribing EN to ALS patients. METHODS: An online survey was distributed using list servers administered by the Academy of Nutrition and Dietetics (AND), Muscular Dystrophy Association (MDA), and ALS Association (ALSA). RESULTS: A total of 148 dietitians, nurses, and physicians participated in the survey, of whom 50% were dietitians and 68% were associated with an ALS clinic. Only 47% of respondents reported their patients to be fully compliant with EN recommendations. Side effects (fullness, diarrhea, constipation, and bloating) were the most important reason for patient noncompliance, followed by dependence on caregivers. By contrast, only 3% of providers rated depression/hopelessness as the most important reason for noncompliance. Half of those surveyed reported that more than 25% of patients continued to lose weight after starting EN. CONCLUSIONS: Our survey results show a high frequency of gastrointestinal side effects and weight loss in ALS patients receiving EN. These findings may be limited by sampling error and non-response bias. Prospective studies are needed to help establish EN guidelines for ALS.

A service model of short-term case management for elderly people at risk of hospital admission.

This article presents the model of a short-term case management program focused on reducing emergency department presentations and unplanned hospital admissions for a targeted group of older people with complex care needs. As a semi-integrated health care program, Treatment Response and Assessment for Aged Care (TRAAC) is implemented by short-term case managers located in a variety of community agencies as well as acute and sub-acute hospital settings. The article discusses the features of the model including case finding, early intervention and risk screening, combined with the rapid mobilisation of specialised geriatric assessment services. The model has the potential to contribute to positive results in managing the complex health needs of this group. Evaluation outcomes including reductions in hospital use for the target group, and positive client and staff perceptions of the service model are discussed in relation to the unique features of the intervention program.