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Honda Y, Homma Y, Nakamura M, Ojima T, Saito K. Extremely Poor Post-discharge Prognosis in Aspiration Pneumonia and Its Prognostic Factors: A Retrospective Cohort Study. Dysphagia 2024; 39:837-845. [PMID: 38388805 DOI: 10.1007/s00455-023-10665-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 12/26/2023] [Indexed: 02/24/2024]
Abstract
There is little evidence regarding the long-term prognosis of patients with aspiration pneumonia. This study aimed to investigate post-discharge survival time and prognostic factors in older patients hospitalized for aspiration pneumonia. This retrospective cohort study included patients aged ≥ 65 years hospitalized for aspiration pneumonia and discharged alive from a tertiary care hospital in Japan between April 2009 and September 2014. Candidate prognostic factors were patient's age, sex, body mass index (BMI), performance status, chronic conditions, CURB-65 score, serum albumin level, hematocrit concentration, nutritional pathway at discharge, and discharge location. Kaplan-Meier curves were determined and multivariable survival analysis using Cox regression model was performed to analyze the effect of each factor on mortality. In total, 209 patients were included in this study. The median age was 85 years, 58% of the patients were males, 33% had a performance status of 4 and 34% were discharged home. Among the patients, 65% received oral intake, 23% received tube feeding, and 21% received parenteral nutrition at discharge. During the follow-up period, 77% of the patients died, and the median post-discharge survival time was 369 days. Besides male sex and low BMI, tube feeding (adjusted hazard ratio (aHR) = 1.70, 95% confidence interval (CI) 1.11-2.59) and parenteral nutrition (aHR = 4.42, 95% CI 2.57-7.60) were strongly associated with mortality. Long-term prognosis of patients hospitalized for aspiration pneumonia was extremely poor. The nutritional pathway at discharge was a major prognostic factor. These results may be useful for future care and research.
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Affiliation(s)
- Yuki Honda
- Department of General Internal Medicine, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Chuo-ku, Hamamatsu, Shizuoka, 430-8558, Japan.
- Department of Community Health and Preventive Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Chuo-ku, Hamamatsu, Shizuoka, 431-3192, Japan.
| | - Yoichiro Homma
- Department of General Internal Medicine, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Chuo-ku, Hamamatsu, Shizuoka, 430-8558, Japan
| | - Mieko Nakamura
- Department of Community Health and Preventive Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Chuo-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Toshiyuki Ojima
- Department of Community Health and Preventive Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Chuo-ku, Hamamatsu, Shizuoka, 431-3192, Japan
| | - Kazuhito Saito
- Department of General Internal Medicine, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Chuo-ku, Hamamatsu, Shizuoka, 430-8558, Japan
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Zuccari G, Macis S, Alfei S, Marchitto L, Russo E. The Role of the Pharmacist in Selecting the Best Choice of Medication Formulation in Dysphagic Patients. J Pers Med 2022; 12:jpm12081307. [PMID: 36013259 PMCID: PMC9410388 DOI: 10.3390/jpm12081307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/03/2022] [Accepted: 08/08/2022] [Indexed: 11/16/2022] Open
Abstract
Usually, the administration of drugs by feeding tube in dysphagic patients involves handling of marketing licenses outside their term, due to the lack of suitable formulations. This circumstance has put health professionals in the dilemma of choosing the formulation whose manipulation possibly does not alter the effectiveness of the drug. In this regard, a practical guide providing indications on the prescription, handling, and administration of drugs through enteral feeding tube could be of paramount utility. For this purpose, we have considered the 1047 solid oral pharmaceutical forms included in the formulary of San Paolo Hospital (Savona, Italy). From our analysis, it emerges that 95% of medicinal products are worryingly used off-label and 40% have to be managed by the hospital pharmacists without having suitable indications by either the manufacturers or by literature studies. To fill this gap, we have compiled a detailed table containing missing indications derived from pharmacist expertise and evidence-based practices, with the aim that the sharing of our procedures will contribute to make uniform pharmacological therapies from one hospital to another. This study will allow doctors to have easy access to information on drugs that can be prescribed and nurses to become familiar only with the pharmaceutical forms that can be administered.
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Affiliation(s)
- Guendalina Zuccari
- Department of Pharmacy, University of Genoa, Viale Cembrano, 16148 Genoa, Italy
- Correspondence: (G.Z.); (E.R.)
| | - Sara Macis
- Hospital Pharmacy, Department Technical Health, San Paolo Hospital, Via Genova, 17100 Savona, Italy
| | - Silvana Alfei
- Department of Pharmacy, University of Genoa, Viale Cembrano, 16148 Genoa, Italy
| | - Leonardo Marchitto
- Department of Sciences for the Quality of Life, University of Bologna, Corso D’Augusto 237, 47921 Rimini, Italy
| | - Eleonora Russo
- Department of Pharmacy, University of Genoa, Viale Cembrano, 16148 Genoa, Italy
- Correspondence: (G.Z.); (E.R.)
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Zazzara MB, Vetrano DL, Carfì A, Liperoti R, Damiano C, Onder G. Comorbidity patterns in institutionalized older adults affected by dementia. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2022; 14:e12320. [PMID: 35734097 PMCID: PMC9197250 DOI: 10.1002/dad2.12320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 03/28/2022] [Accepted: 04/14/2022] [Indexed: 11/23/2022]
Abstract
Introduction Dementia is common in nursing homes (NH) residents. Defining dementia comorbidities is instrumental to identify groups of persons with dementia that differ in terms of health trajectories and resources consumption. We performed a cross-sectional study to identify comorbidity patterns and their associated clinical, behavioral, and functional phenotypes in institutionalized older adults with dementia. Methods We analyzed data on 2563 Italian NH residents with dementia, collected between January 2014 and December 2018 using the multidimensional assessment instrument interRAI Long-Term Care Facility (LTCF). A standard principal component procedure was used to identify comorbidity patterns. Linear regression analyses were used to ascertain correlates of expression of the different patterns. Results Among NH residents with dementia, we identified three different comorbidity patterns: (1) heart diseases, (2) cardiovascular and respiratory diseases and sensory impairments, and (3) psychiatric diseases. Older age significantly related to increased expression of the first two patterns, while younger patients displayed increased expression of the third one. Recent hospital admissions were associated with increased expression of the heart diseases pattern (β = 0.028; 95% confidence interval [CI] 0.003 to 0.05). Depressive symptoms and delirium episodes increased the expression of the psychiatric diseases pattern (β = 0.130, 95% CI 0.10 to 0.17, and β 0.130, CI 0.10 to 0.17, respectively), while showed a lower expression of the heart diseases pattern. Discussion We identified different comorbidity patterns within NH residents with dementia that differ in term of clinical and functional profiles. The prompt recognition of health needs associated to a comorbidity pattern may help improve long-term prognosis and quality of life of these individuals. Highlights Defining dementia comorbidities patterns in institutionalized older adults is key.Institutionalized older adults with dementia express different care needs.Comorbidity patterns are instrumental to identify different patients' phenotypes.Phenotypes vary in terms of health trajectories and demand different care plans.Prompt recognition of phenotypes in nursing homes can positively impact on outcomes.
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Affiliation(s)
| | - Davide Liborio Vetrano
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm UniversityStockholmSweden
- Stockholm Gerontology Research CenterStockholmSweden
| | - Angelo Carfì
- Fondazione Policlinico Universitario A. Gemelli IRCCSRomeItaly
| | - Rosa Liperoti
- Fondazione Policlinico Universitario A. Gemelli IRCCSRomeItaly
| | - Cecilia Damiano
- Department of CardiovascularEndocrine‑Metabolic Diseases and Aging, Istituto Superiore di SanitàRomeItaly
| | - Graziano Onder
- Department of CardiovascularEndocrine‑Metabolic Diseases and Aging, Istituto Superiore di SanitàRomeItaly
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Hopkins B, Madill J. Understanding the Need for Tools and Resources to Manage Enteral Nutrition Intolerance: An On-line Survey. CAN J DIET PRACT RES 2021; 82:121-124. [PMID: 33876996 DOI: 10.3148/cjdpr-2021-007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Purpose: Enteral nutrition intolerance (ENI) is a common complication among tube-fed patients, associated with reduced volumes of nutrition delivered, and may contribute to malnutrition risk. This research aimed to obtain insights about dietitians' needs and preferences related to tools and resources to help identify and manage ENI.Methods: An online survey was administered to registered dietitians (RD) engaged in enteral nutrition (EN) management, recruited from a list of attendees at a national webinar. The 16-question survey asked about participant's experience with ENI and interest in resources to manage ENI.Results: Of the 219 surveys completed (25% response rate), 86% identified ENI as an issue/concern that interferes with adequate nutrition or hydration for their patients. Ninety-seven percent reported being interested in having tools/resources to manage ENI. The symptoms identified as most pressing to manage were diarrhea (73%), bloating/abdominal discomfort (42%), and nausea (32%). Preferred types of tools were hard-copy resources (70%), algorithms (67%), and web-based instruments (62%).Conclusions: ENI remains an issue for clinicians working with tube-fed patients and RDs are interested in management tools. These results have implications for the development of evidence-based resources to help improve EN delivery and ultimately may contribute to clinician's efforts at reducing malnutrition.
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Affiliation(s)
- Bethany Hopkins
- Medical Affairs Manager, Nestlé Health Science, North York, ON
| | - Janet Madill
- Associate Professor, School of Food and Nutritional Sciences, Brescia University College, 1285 Western Road, London, ON
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Diabetes-specific formulas high in monounsaturated fatty acids and metabolic outcomes in patients with diabetes or hyperglycaemia. A systematic review and meta-analysis. Clin Nutr 2020; 39:3273-3282. [DOI: 10.1016/j.clnu.2020.02.036] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 01/24/2020] [Accepted: 02/27/2020] [Indexed: 02/06/2023]
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Tube Feeding in Individuals with Advanced Dementia: A Review of Its Burdens and Perceived Benefits. J Aging Res 2019; 2019:7272067. [PMID: 31929906 PMCID: PMC6942829 DOI: 10.1155/2019/7272067] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 09/06/2019] [Indexed: 01/02/2023] Open
Abstract
Background Dementia remains a growing concern for societies globally, particularly as people now live longer. About 90% of individuals with advanced dementia suffer from eating problems that lead to general health decline and ultimately impacts upon the physical, psychological, and economic wellbeing of the individuals, caregivers, and the wider society. Objective To evaluate the burdens and perceived benefits of tube feeding in individuals with advanced dementia. Design Narrative review. Methods Computerized databases, including PubMed, Embase, Medline, CINAHL, PsycInfo, and Google Scholar were searched from 2000 to 2019 to identify research papers, originally written in or translated into English language, which investigated oral versus tube feeding outcome in individuals with advanced dementia. Results Over 400 articles were retrieved. After quality assessment and careful review of the identified articles, only those that met the inclusion criteria were included for review. Conclusion Tube feeding neither stops dementia disease progression nor prevents imminent death. Each decision for feeding tube placement in individuals with advanced dementia should be made on a case-by-case basis and involve a multidisciplinary team comprising experienced physicians, nurses, family surrogates, and the relevant allied health professionals. Careful considerations of the benefit-harm ratio should be discussed and checked with surrogate families if they would be consistent with the wishes of the demented person. Further research is required to establish whether tube feeding of individuals with advanced dementia provides more burdens than benefits or vice-versa and evaluate the impacts on quality of life and survival.
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McArthur C, Saari M, Northwood M, Taucar LS, Boscart VM. Profiling the Characteristics of People Who Are Comatose in Long-term and Complex Continuing Care Settings. J Am Med Dir Assoc 2019; 20:1331-1334. [PMID: 31230905 DOI: 10.1016/j.jamda.2019.04.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 04/22/2019] [Accepted: 04/25/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To describe the sociodemographic, clinical, and treatment characteristics of people who are comatose in Canadian complex continuing care (CCC) and long-term care (LTC) settings, and to make recommendations to promote comprehensive care planning for this population. DESIGN Retrospective, cross-sectional analysis of population data. SETTING AND PARTICIPANTS All residents in the Canadian provinces of Alberta, Ontario, British Columbia, Manitoba, Nova Scotia, Newfoundland, Saskatchewan, and the territory of Yukon with data available from the fiscal year 2015 (April 1, 2015, to March 31, 2016). MEASURES Demographic, clinical, and treatment variables were extracted from the Resident Assessment Instrument-Minimum Data Set (MDS 2.0) and were reported using descriptive statistics. RESULTS Of the LTC and CCC populations, 0.07% and 3.5% were identified as comatose, respectively. Overall, people who are comatose in both CCC or LTC settings are younger and have a longer length of stay than those who are not comatose. A higher proportion of people who are comatose experience active infections and irregular bowel elimination patterns, and those who are comatose were more likely to have a feeding tube and require oxygen therapy or suctioning than those who were not comatose. However, a lower proportion of people who were comatose had documented pain. In LTC, one-quarter of people who are comatose are expected to die within 6 months. CONCLUSION/IMPLICATIONS Although the prevalence of people who are comatose in LTC and CCC settings is low, this population is complex and has significant care needs that require comprehensive assessment and care planning.
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Affiliation(s)
- Caitlin McArthur
- GERAS Centre for Aging Research, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
| | - Margaret Saari
- Saint Elizabeth Health Care, Toronto, Ontario, Canada; School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | | | - Linda Sheiban Taucar
- Conestoga College, Schlegel Centre for Advancing Senior Care, Waterloo, Ontario, Canada; Schlegel-UW Research Institute for Aging, Waterloo, Ontario, Canada
| | - Veronique M Boscart
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada; Conestoga College, Schlegel Centre for Advancing Senior Care, Waterloo, Ontario, Canada; Schlegel-UW Research Institute for Aging, Waterloo, Ontario, Canada
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Fleurke M, Voskuil DW, Beneken Genaamd Kolmer DM. The role of the dietitian in the management of malnutrition in the elderly: A systematic review of current practices. Nutr Diet 2019; 77:60-75. [PMID: 31157519 DOI: 10.1111/1747-0080.12546] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 04/03/2019] [Accepted: 04/07/2019] [Indexed: 01/19/2023]
Abstract
AIM The prevalence of age-related malnutrition is increasing in almost all Western countries. Because of their expertise, dietitians should have a central role in the management of malnutrition. This review aimed to synthesise the literature on the role of the dietitian in the management of malnutrition in the elderly in comparison with other health professionals. METHODS In November 2018, a search of Embase, Medline Ovid, Cinahl Ebscohost, Cochrane Central, Web of Science and Google Scholar was undertaken using 'dietitian', 'elderly' and 'malnutrition' as the main search terms. Qualitative and quantitative empirical research studies that focussed on the role of dietitians as the (main) subject of the study were included. Data extraction and data synthesis were performed by the three authors using a thematic synthesis approach. RESULTS Three themes emerged from the coding and synthesis of the 21 included studies. The first theme demonstrates that other health professionals' time for, and knowledge of, screening policies negatively affects the role of the dietitian. The second theme demonstrates that the importance of nutritional care is acknowledged. However, this does not always imply familiarity with dietetics nor does it always mean that other health professionals think involving dietitians is worth the effort. The third theme demonstrates that issues of workload appeared to be especially important in crossing or guarding role boundaries. CONCLUSIONS The role of dietitians in managing age-related malnutrition is not always clear and coherent. Therefore, how dietitians shape their role to provide optimal management of malnutrition in the elderly is open to debate.
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Affiliation(s)
- Matthijs Fleurke
- Research Group Informal Care and Department of Nutrition and Dietetics, The Hague University of Applied Sciences, The Hague, Netherlands
| | - Dorien W Voskuil
- Research Group Informal Care and Department of Nutrition and Dietetics, The Hague University of Applied Sciences, The Hague, Netherlands
| | - Deirdre M Beneken Genaamd Kolmer
- Research Group Informal Care and Department of Nutrition and Dietetics, The Hague University of Applied Sciences, The Hague, Netherlands
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Lan SH, Lu LC, Yen YY, Hsieh YP, Chen JC, Wu WJ, Lan SJ, Lin LY. Tube Feeding among Elder in Long-Term Care Facilities: A Systematic Review and Meta-Analysis. J Nutr Health Aging 2017; 21:31-37. [PMID: 27999847 DOI: 10.1007/s12603-016-0717-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The use of tube feeding for elderly patients with poor nutritional intake is a ubiquitous method of feeding. This systematic review and meta-analysis were carried out to compare nutritional benefits of enteral feeding versus oral feeding in long-term care facilities. SETTING Databases including the Cochrane Library, ProQuest, PubMed, EMBASE, EBSCO, Web of Science and Google Scholar through April 2014 using keywords including enteral feeding, tube feeding or oral feeding combined with long term care facilities or nursing home. PARTICIPANTS Eight articles, with 841 participants were included in meta-analysis and 13 articles were included in systematic review. The elderly had to live in long-term care institutions and could not be on any mechanically assisted ventilation systems or be in any type of post-operative status. MEASUREMENTS The three investigators extracted and appraised data using the same study design, baseline characteristics, and outcomes, independently. RESULTS Following a systematic review, 13 articles out of 8218 original research articles were selected for this analysis. Meta-analysis of tube-fed patients found lower levels of hemoglobin (Weighted Mean Difference (WMD -0.21g/dl; 95% CI -0.42 to -0.01; p=0.04) and creatinine (WMD -0.08g/dl; 95% CI -0.17 to 0.00, p=0.05). Moreover, the results showed that there were no benefits regarding body mass index (BMI), albumin, dietary intake of proteins, total calories and fat. CONCLUSIONS The results show that tube feeding does not increase patients' nutrients absorption to improve nutritional status. Instead, these results indicate that oral feeding is better regarding some nutritional biochemical parameters.
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Affiliation(s)
- S-H Lan
- Shou-Jen Lan, Department of Healthcare Administration, Asia University, No. 500, Lioufeng Rd., Wufeng District, Taichung City 41354, Taiwan. , Tel: +886-4-2332-3456 ext. 1945.6414, Fax number: +886-4-2332-1206
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Burgermaster M, Slattery E, Islam N, Ippolito PR, Seres DS. Regional Comparison of Enteral Nutrition-Related Admission Policies in Skilled Nursing Facilities. Nutr Clin Pract 2016; 31:342-8. [PMID: 26993318 DOI: 10.1177/0884533616629636] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Nursing home admission policies are one driver of increased and earlier gastrostomy placement, a procedure that is not always medically or ethically indicated among patients needing short-term nutrition support. This important clinical decision should be based upon patient prognosis, goals, and needs. We compared nursing home enteral nutrition-related admission policies in New York City and other regions of the United States. We also explored motivations for these policies. METHODS We conducted a telephone survey with skilled nursing facility administrators in New York City and a random sample of facilities throughout the United States about enteral nutrition-related admission policies. Survey data were matched with publically available data about facility characteristics from the Centers for Medicare and Medicaid Services. The relationship between facility location and admission policies was described with regression models. Reasons for these policies were thematically analyzed. RESULTS New York City nursing homes were significantly less likely to admit patients with nasogastric feeding tubes than were nursing homes nationwide, after we controlled for facility characteristics (odds ratio = 0.111; 95% CI, 0.032-0.344). Reasons for refusing nasogastric tubes fell into 5 categories: safety, capacity, policy, perception of appropriate level of care, and patient quality of life. CONCLUSION Our findings indicate that enteral nutrition-related admission policies vary greatly between nursing homes in New York City and nationwide. Many administrators cited safety and policy as factors guiding their institutional policies and practices, despite a lack of evidence. This gap in research, practice, and policy has implications for quality and cost of care, length of hospital stay, and patient morbidity and mortality.
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Affiliation(s)
- Marissa Burgermaster
- Department of Medicine, Division of Preventive Medicine and Nutrition, Columbia University Medical Center, New York, New York
| | - Eoin Slattery
- Department of Gastroenterology, Galway University Hospitals, Gallimh, Ireland
| | - Nafeesa Islam
- Center for World Health, University of California, Los Angeles, California
| | | | - David S Seres
- Department of Medicine, Division of Preventive Medicine and Nutrition, Columbia University Medical Center, New York, New York Institute of Human Nutrition, Columbia University Medical Center, New York, New York
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Affiliation(s)
- Anne Rowat
- Lecturer, School of Nursing, Midwifery and Social Care, Edinburgh Napier University
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Affiliation(s)
- Peggi Guenter
- Peggi Guenter is the Senior Director for Clinical Practice, Advocacy, and Research Affairs for the American Society for Parenteral and Enteral Nutrition, Silver Spring, Md. Joseph Boullata is Professor of Pharmacology & Therapeutics at the University of Pennsylvania School of Nursing, and Clinical Pharmacy Specialist in Nutrition, Hospital of the University of Pennsylvania's Clinical Nutrition Support Services, Philadelphia, Pa
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Takezako Y, Ishikawa S, Kajii E. Advance directives in Japanese nursing homes. J Pain Symptom Manage 2013; 45:63-70.e7. [PMID: 22926089 DOI: 10.1016/j.jpainsymman.2011.12.287] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2011] [Revised: 12/19/2011] [Accepted: 12/31/2011] [Indexed: 11/26/2022]
Abstract
CONTEXT Advance directives are poorly understood in Japanese nursing homes. In April 2006, additional funding for end-of-life care became available as the first support for terminal care at Japanese nursing homes. OBJECTIVES The objectives of this study were to investigate the adoption of advance directives by Japanese nursing homes, the effect of additional funding for end-of-life care in nursing homes from long-term care insurance on the use of advance directives, and the types of directives used. METHODS A nationwide questionnaire survey of nursing homes was performed in Japan. The participants were 913 nursing homes. We investigated the prevalence of advance directives, details of the directives, and demographic data of the responders. RESULTS Advance directives were used in 58.4% of nursing homes. The timing of introduction of the directives and the results of multivariate analysis at the facility level suggested a relation between the availability of additional funding for end-of-life care and the adoption of advance directives. Most nursing homes used instructional directives, especially directives providing an explanation and informed consent for end-of-life care in the nursing home. CONCLUSION More than half of Japanese nursing homes have introduced advance directives, and additional funding for end-of-life care is related to their introduction. Most nursing homes have adopted instructional directives, especially those providing an explanation and informed consent regarding end-of-life care at the nursing home.
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Affiliation(s)
- Yayoi Takezako
- Division of Community and Family Medicine, Center for Community Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan.
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Abstract
The frailty syndrome is defined as unintentional weight and muscle loss, exhaustion, and declines in grip strength, gait speed, and activity. Evidence with respect to the clinical definition, epidemiology, mechanisms, interactions, assessment, prevention, and treatment of frailty in the older adult is reviewed.
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Affiliation(s)
- Roschelle A Heuberger
- Department of Human Environmental Studies, Central Michigan University, Mt. Pleasant, Michigan 48859, USA.
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Current World Literature. Curr Opin Support Palliat Care 2012; 6:109-25. [DOI: 10.1097/spc.0b013e328350f70c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Malnutrition in patients with acute stroke. J Nutr Metab 2011; 2011:167898. [PMID: 22254136 PMCID: PMC3255318 DOI: 10.1155/2011/167898] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Accepted: 11/03/2011] [Indexed: 02/06/2023] Open
Abstract
Stroke is a devastating event that carries a potential for long-term disability. Malnutrition is frequently observed in patients with stroke, and dysphagia contributes to malnutrition risk. During both the acute phase of stroke and rehabilitation, specific nutritional interventions in the context of a multidisciplinary team effort can enhance the recovery of neurocognitive function. Early identification and management of malnutrition with dietary modifications or specific therapeutic strategies to ensure adequate nutritional intake should receive more attention, since poor nutritional status appears to exacerbate brain damage and to contribute to adverse outcome. The main purpose of nutritional intervention should be the prevention or treatment of complications resulting from energy-protein deficit. This paper reviews the evaluation and management of malnutrition and the use of specialized nutrition support in patients with stroke. Emphasis is given to enteral tube and oral feeding and to strategies to wean from tube feeding.
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