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Barriers for nutritional care in the transition from hospital to the community among older patients.
Ginzburg, Yulia; Shmilovitz, Inbar; Monastyrsky, Nechama; Endevelt, Ronit; Shahar, Danit R.
Afiliação
  • Ginzburg Y; Bait Balev Rehabilitation Hospital, Maccabi Health Services, Israel.
  • Shmilovitz I; Bait Balev Rehabilitation Hospital, Maccabi Health Services, Israel.
  • Monastyrsky N; Bait Balev Rehabilitation Hospital, Maccabi Health Services, Israel.
  • Endevelt R; The Nutrition Division, Israel Ministry of Health, Israel; School of Public Health, University of Haifa, Israel.
  • Shahar DR; The S. Daniel Abraham International Center for Health and Nutrition, Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Israel. Electronic address: dshahar@bgu.ac.il.
Clin Nutr ESPEN ; 25: 56-62, 2018 06.
Article em En | MEDLINE | ID: mdl-29779819
BACKGROUND & AIMS: Data on the continuity of nutritional care in the transition from the hospital to the community is scarce although its impact on medical complications is highly significant. The aim of the current study is to determine level of adherence to dietary recommendations after hospitalization and identify barriers for adherence. METHODS: A prospective study among patients age ≥65 who were treated with oral nutritional supplements (ONS) during their hospitalization and discharged with dietary recommendations. Data was obtained in the hospital and at a 3-month home-visit. Adherence was assessed monthly and barriers for non-adherence were determined. Adherence levels were summed for 3 months and then divided into: 1. Full adherence: complete consumption as prescribed; 2. Partial adherence: partial consumption of the prescription [at least half]; or 3. No adherence: not consumed or less than half. Health-status was obtained from medical records; nutritional-status using anthropometric measurements, depressive symptoms using GDS [Geriatric Depression Scale], and functional abilities using FIM [Functional Independence Measure] were determined. Dietary intake was assessed by 24-h recall. RESULTS: Eighty-six patients were recruited (56 women) and followed for 3-months after discharge; 47.7% were advised in their discharge letter to consume at least one liquid ONS daily, 29% daily powder ONS, and 23.3% were advised to consume both. Adherence with liquid ONS was significantly higher among both groups, p < 0.001. In the no-adherence group 26.7% were edentulous, BMI was lower (23.6 ± 4.2 vs. 26 ± 4.9), depression symptoms were less prevalent (45.3% vs. 61.3%), and protein intake was higher compared with the adherence group. Barriers for no-adherence were gastrointestinal symptoms, lack of knowledge of ONS purpose, and other including no prescription by the primary care physician; only 21% received a prescription for nutritional supplements. In a regression model patients who were edentulous (OR = 9.13), with more depression symptoms (OR = 5.12), or lower BMI (OR = 1.13) were significantly more likely to adhere to ONS than patients with full dentition, fewer depression symptoms, and higher BMI. Providing a prescription for ONS by a primary care physician was a significant predictor [OR = 4.7] for adherence. CONCLUSIONS: Our results show low adherence to nutritional treatment in the community. Improving hospital-community communication is required.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Alta do Paciente / Cooperação do Paciente / Serviços de Saúde Comunitária / Apoio Nutricional / Prestação Integrada de Cuidados de Saúde / Continuidade da Assistência ao Paciente / Suplementos Nutricionais / Serviços de Saúde para Idosos Tipo de estudo: Diagnostic_studies / Guideline / Observational_studies / Prognostic_studies / Risk_factors_studies Aspecto: Patient_preference Limite: Aged / Aged80 / Female / Humans / Male País/Região como assunto: Asia Idioma: En Revista: Clin Nutr ESPEN Ano de publicação: 2018 Tipo de documento: Article País de afiliação: Israel País de publicação: Reino Unido

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Alta do Paciente / Cooperação do Paciente / Serviços de Saúde Comunitária / Apoio Nutricional / Prestação Integrada de Cuidados de Saúde / Continuidade da Assistência ao Paciente / Suplementos Nutricionais / Serviços de Saúde para Idosos Tipo de estudo: Diagnostic_studies / Guideline / Observational_studies / Prognostic_studies / Risk_factors_studies Aspecto: Patient_preference Limite: Aged / Aged80 / Female / Humans / Male País/Região como assunto: Asia Idioma: En Revista: Clin Nutr ESPEN Ano de publicação: 2018 Tipo de documento: Article País de afiliação: Israel País de publicação: Reino Unido