Burden assessment in caregivers of patients with home artificial nutrition: a need and a challenge.

BACKGROUND/OBJECTIVES: Caregiving can be a stressful task with severe consequences on caregivers' health. Our aim was to evaluate the profile and the burden of caregivers of patients with home artificial nutrition (HAN) in our area. SUBJECTS/METHODS: We conducted a prospective observational study of patients who had started HAN over a period of a year (n=573) and their home caregivers (n=103). Epidemiological characteristics of the patients and the type of HAN were registered. Caregivers' profile data (gender, age and degree of kinship) and Zarit Burden Assessments were recorded. RESULTS: Care recipients had a median age of 79.0 (IQR 87) years, neurological and oncological diseases in 50% and a high rate of mobility limitations (80%). Oral supplements with high-calorie formulas were predominant (60%). The usual caregiver profile was a patient's daughter with a mean age of 53.1 (s.d. 13.4) years acting as the primary caregiver. Burden was absent in 49.5%, light in 18.4% and intense in 32% of caregivers. Intense burden was more frequent in oral over enteral nutrition (42% versus 22.6%; P=0.036). Supplementary nutrition was also associated with higher caregiver burden scores compared with complete diets. In patients with functional limitations, a tendency toward a slightly higher burden was observed. No differences in caregiver burden were detected according to other patient or caregiver characteristics. CONCLUSIONS: HAN type appears to be a factor influencing caregiver burden and therefore, evaluation of caregiver burden should be part of HAN programs.

Consecuencias y tratamiento de la disfagia / Consequences and treatment of dysphagia

La disfagia es un trastorno complejo, producido por diferentes patologías, pero sus complicaciones son comunes y graves aumentando la morbilidad y mortalidad delos pacientes que la padecen. Afecta especialmente apacientes ancianos, debido a que durante el envejecimiento se incrementa la frecuencia de enfermedades que la causan. Las complicaciones son consecuencia de la alteración de la eficacia y la seguridad de la deglución. La deglución dificultada impide que el ingreso de líquidos y alimentos por vía oral sea suficiente, lo que conduce a deshidración y desnutrición. Al mismo tiempo se acompaña de un aumento del riesgo de aspiración de estos alimentos y del material orofaríngeo hacia los pulmones, lo que es causa de complicaciones respiratorias graves, especialmente de neumonía por aspiración. Estas complicaciones y los síntomas que afectan al paciente durante las comidas,alteran negativamente su calidad de vida. Su tratamiento requiere el abordaje de diferentes aspectos como la enfermedad causal, las características de la propia disfagia,y la prevención y el tratamiento de las complicaciones.Por ello su manejo eficaz precisa de un equipo multidisciplinary coordinado para diagnosticar y tratar el trastorno y evaluar su evolución. La atención nutricionales uno de los aspectos más importantes porque previene la desnutrición y sus complicaciones y disminuye el riesgo de aspiración. En la disfagia, motora o mixta se debe acompañar de la rehabilitación de la deglución para permitir en lo posible el restablecimiento de la alimentación normal sin riesgo (AU)

Dysphagia is a complex disorder produced by different pathologies, although its complications are common and severe increasing the morbidity and mortality of the patients suffering from it. It specially affects elder patients because during the aging process the frequency of diseases causing it is increased. The complications are the result of the impairment in swallowing efficacy and safety. Impaired swallowing prevents that liquids and food intake be insufficient leading to dehydration and hyponutrition. At the same time, it is accompanied by an increased risk of food and oropharyngeal aspiration to the lungs, which causes severe respiratory complications,particularly aspiration pneumonia. These complications and the symptoms affecting the patients during the meals negatively alter their quality of life. Its treatment requires managing different issues such as the causing disease, the characteristics of dysphagia itself, and the prevention and treatment of the complications.Effective management requires a multidisciplinary and coordinated team to diagnose and treat the disorder and assess its course. Nutritional care is one of the most important issues because it prevents hyponutrition and its complications and it decreases the risk for aspiration.Treatment of motor or mixed dysphagia must be accompanied by swallowing rehabilitation to allow as far as possiblere-establishing normal risk-free feeding (AU)

[Patient with Crohn's disease and seizures due to hypomagnesemia]. / Paciente con enfermedad de Crohn y convulsiones por hipomagnesemia.

We report a patient with Crohn's disease who suffered several generalized convulsions. He was studied with cerebral image techniques and neurophysiologic tests without getting the aetiology of the convulsions. A severe depletion in magnesium levels was suspected at the time of the initial evaluation by the Nutritional Team Group. Low serum magnesium levels were confirmed in the first blood test. Convulsions disappeared when magnesium was normalised by intravenous infusion. It is necessary for specialist physicians to be on the alert of severe complications of nutrients deficiency and that this kind of patients should be checked by the Nutrition Team.

Paciente con enfermedad de Crohn y convulsiones por hipomagnesemia / Patient with Crohn’s disease and seizures due to hypomagnesemia

Se trata de un paciente con enfermedad de Crohn y afectación intestinal extensa por su enfermedad, que presenta episodios repetidos de convulsiones generalizadas. Fue valorado con pruebas de imagen cerebral y neurofisiología sin conseguir establecer su etiología. En la primera valoración nutricional se objetiva un déficit severo de magnesio, coincidiendo con un episodio convulsivo y consiguiendo el cese de los mismos tras la normalización del magnesio mediante reposición parenteral. Es preciso alertar a los especialistas respectivos de las graves repercusiones del déficit de nutrientes en estos pacientes y de la necesidad de que sean controlados por la Unidad de Nutrición

We report a patient with Crohn’s disease who suffered several generalized convulsions. He was studied with cerebral image techniques and neurophysiologic tests without getting the a etiology of the convulsions. A severe depletion in magnesium levels was suspected at the time of the initial evaluation by the Nutritional Team Group. Low serum magnesium levels were confirmed in the first blood test. Convulsions disappeared when magnesium was normalized by intravenous infusion. It is necessary for specialist physicians to be on the alert of severe complications of nutrients deficiency and that this kind of patients should be checked by the Nutrition Team

Consecuencias de la desnutrición en el cáncer / No disponible

No disponible

[Protein-energy malnutrition: its effects on 4 metabolic parameters]. / Malnutrición energético proteica: repercusión sobre cuatro parámetros metabólicos.

The usefulness of cholinesterase (CS) and cholesterol (CO) in evaluating the nutritional state has been studied, comparing them to two classic parameters: albumin (ALB) and transferrin (TF). The study was done on 73 patients between the ages of 17 and 93, suffering from different afflictions, all of whom were suffering from energy-protein malnutrition (EPM). The patients were divided according to whether the EPM was predominantly visceral (V) or non-visceral (NV), based on the following parameters: ALB, TF, total lymphocytes (TL), cellular immunity test (CIT), triceps skin fold (TSF) and muscular circumference (MC). Our results show significant differences between the V and NV groups for the 4 studied parameters, obtaining lower values for each in the V group. There were significant differences between the ages of both groups, while these did not have any influence on any of the parameters. We found a positive and significant correlation when comparing TF and ALB, TF and CO, TF and CS, CS and ALB, and lastly, CS and CO. There was no correlation between ALB and COO. From our data we concluded that serum cholinesterase is a useful parameter for evaluating the nutritional state of the hospitalized patients.

[An analysis of an enteral nutrition guideline in patients with cancer of the ORL area]. / Análisis de una pauta de nutrición enteral en pacientes con cáncer del área ORL.

AIMS: The result was assessed of the enteral nutrition guideline prescribed in 50 patients using internationally accepted parameters as indicators of the nutritional state. METHODS: Fifty patients were selected at random with an ORL zone neoplasm, they were prescribed enteral nutrition according to our Section's procedure, involving the administration of a commercialized enteral diet whose composition is a homogenization of natural foods administered in 6 sessions at three-hour intervals during the day, begun with 100 cc of diet per session up to a total of 400 (2400 kcal/day), and with the addition of 100 cm of water in each administration. The average age was 59.58 +/- 11.2 years (range 30-81), the average duration of nutrition was 34.02 +/- 32.1 days (range, 3-201 days). The following were taken in all cases: Weight (W), Size (S), Tricipital fold (TF), brachial circumference, urinary creatinin, seric albumin (A), seric transferrin (T), total lymphocytes (Lt) and retarded cutaneous sensitivity, using Multitest IMC (M), and these data were used to calculate muscular circumference (MC) and the creatinin size index (CSI). Two nutritional valuations (NV) were analyzed, the first one taken (NV1) and the one prior to discharge (V2). Analytical calculations were done by our Center's Analytical Laboratory. We used Wilcoxon's test included in the SX statistical package for statistical analysis. RESULTS: On the fifty patients selected, only thirty had a second NV. Comparison of the two calculations gave the following results: A statistically significant rise of A (A1: 3.6 +/- 0.8, vs A: 3.8 +/- 0.7; p < 0.0001) and of T (T1: 208.2 +/- 52.0, vs T2: 237.5 +/- 44.39; p < 0.0001). There was also a statistically significant reduction of P (P1: 63.93 +/- 12.32 vs P2: 62.88 +/- 11.28; p < 0.04). Comparison of the remaining variables did not provide statistically significant differences: PT (PT1: 11.46 +/- 4.9 vs PT2: 12.07 +/- 4.6; p > 0.05). MC (MC1: 23.93 +/- 2.5 vs MC2: 23.58 +/- 1.9; P > 0.05). CSI (CSI1: 8.5 +/- 8 vs CSI2: 6.9 +/- 2.9; p > 0.05). L (L1: 1855 +/- 760.5 vs L2: 1808 +/- 769.1; p > 0.05). M (M1: 12.58 +/- 7.8 vs M2: 14.01 +/- 8.5; p > 0.05). CONCLUSIONS: It is deduced from the results that the guideline used is useful in maintaining the nutritional state of patients prior to their treatment, despite weight-loss, since the ratio of weight-loss to the time between NV1 and NV2 is not significant.