Clinical Update on Nursing Home Medicine: 2008

Questionário nutricional simplificado de apetite (QNSA) para uso em programas de reabilitação cardiopulmonar e metabólica

O presente estudo teve por objetivo traduzir e validar para a língua portuguesa o Questionário Nutricional Simplificado de Apetite (QNSA), verificando sua clareza e validade para participantes de programa de Reabilitação Cardiopulmonar e Metabólica (RCPM). Cento e quarenta e seis indivíduos foram entrevistados, sendo 79 homens, com média de idade de 63 anos (± 10) e 67 mulheres, com média de 66 anos (± 11). A análise descritiva foi apresentada em média, desvio padrão e frequência. A consistência interna da escala foi avaliada por meio do coeficiente alfa de Cronbach e a análise fatorial pelo método de extração de análise dos componentes principais utilizando os critérios de Kaiser (autovalores > 1). Todas as questões do instrumento apresentaram resultados positivos em relação à clareza. Os itens do questionário apresentaram carga fatorial superior a 0,40, com variação de 0,40 a 0,81. Com exceção da questão relacionada com a quantidade de refeições diárias, todas as demais apresentaram alta correlação com o escore total da versão brasileira do instrumento. No que se refere à análise de consistência interna, obteve-se resultado de 0,61. A versão brasileira do QNSA demonstrou ser válida para aplicação em participantes de programa de RCPM, constituindo-se em uma importante ferramenta na avaliação do apetite nessa população.

Prevalence of diabetes and the burden of comorbid conditions among elderly nursing home residents

BACKGROUND

Although the reported prevalence of diabetes in nursing home residents varies greatly among studies, there remains a common trend: increasing prevalence. Diabetes in the elderly is often associated with the presence of multiple comorbid conditions. However, limited data exist regarding the characteristics, symptom severity, disease management, and outcomes of care for residents of nursing homes with diabetes.

OBJECTIVE

Our aim was to estimate the prevalence of diabetes in a national sample of skilled nursing facility (SNF) residents over a 12-month period and to examine differences in the burden of comorbidities between elderly residents with and without diabetes, including prevalence and severity of comorbidities, pharmacotherapy associated with these conditions, and cost.

METHODS

This was a multicenter, observational, medical utilization evaluation study in 23 geographically representative SNFs in the United States. Comorbidities, cognition, physical activity, utilization of health services, and medications were obtained from medical chart audits, minimum data set records, and prescription claims files. Chart abstraction was performed between June 2006 and March 2007. Residents eligible for inclusion in the prevalence analysis were aged ≥65 years, did not receive hospice care, and were not in a persistent vegetative condition.

RESULTS

A total of 2317 residents met the inclusion criteria and were included in the prevalence analysis; 761 (32.8%) had diabetes. Residents with a full minimum data set assessment within 12 months before chart abstraction (n = 2095) were included in the comorbid burden analysis. Compared with those without diabetes, a greater proportion of residents with diabetes were younger, male, Hispanic or African American, and were overweight or obese. Residents with diabetes had a greater comorbidity burden (Hierarchical Condition Category, 1.90 vs 1.58), including more prescribed medications for certain common comorbid conditions (including angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers [46% vs 24%], diuretics [44% vs 34%], statins [40% vs 18%], or antiplatelets/antithrombotics [43% vs 37%]), and experienced more hospitalizations (37% vs 18% at 6 months) than residents without diabetes.

CONCLUSION

Nearly one third of elderly SNF residents had diabetes. These patients, compared with SNF residents without diabetes, had a greater comorbid burden, were prescribed more medications to treat these conditions, and had more hospitalizations.