Strategies to implement community guidelines on nutrition and their long-term clinical effects in nursing home residents
Strategies to implement community guidelines on nutrition and their long-term clinical effects in nursing home residents
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实施社区营养指南的策略及其对疗养院居民的长期临床影响
DOI：
10.1007/s12603-014-0522-4
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发表时间：
2015
期刊：
影响因子：
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通讯作者：
T. Cederholm
中科院分区：
文献类型：
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作者：
J. Törmä;U. Winblad;A. Saletti;T. Cederholm
目的在老年护理环境中注重营养的实施技术研究较少。本研究的目的是比较两种实施策略，即外部促进（EF）和教育外展访问（EOVs），以便在养老院（NH）环境中引入营养指南（如筛查，食品质量和用餐环境）并评估临床结果。设计一项具有基线和随访测量的对照研究。SettingFour NHs。参与者共101名香港居民。EF是一项为期一年，多方面的干预，包括支持、指导、实践审计和反馈，提供给两个NHs。在其他NHs进行的EOVs包括一个为期三小时的指导方针讲座。两种干预措施的目标都是由病房经理、护士长和5-10名护理人员组成的团队。测量结果包括营养状况（Mini nutrition Assessment-Short Form, MNA-SF）、体重指数（BMI）、功能能力（Barthel index， BI）、认知功能（Short Portable Mental status Questionnaire， SPMSQ）、健康相关生活质量（EQ-5D）以及某些生化指标的水平，如维生素D、白蛋白和胰岛素样生长因子1。结果平均18个月后，两组患者的营养参数（MNA-SF和BMI）保持不变。虽然两组之间的大多数结果没有差异，但EOV组的认知能力恶化程度高于EF组（p=0.008）。多元线性回归分析表明，干预组分配（EF）独立于与认知能力下降较少相关的其他潜在相关因素。结论营养指南实施的扩展模型，包括对NH工作人员的指导和反馈，不影响营养状况，但可能与沟通NH居民的延迟认知能力下降有关。
ObjectivesStudies on implementation techniques that focus on nutrition in the setting of elderly care are scarce. The aims of this study were to compare two implementation strategies i.e., external facilitation (EF) and educational outreach visits (EOVs), in order to introduce nutritional guidelines (e.g. screening, food quality and mealtime ambience), into a nursing home (NH) setting and to evaluate the clinical outcomes.DesignA controlled study with baseline and follow-up measurements.SettingFour NHs.ParticipantsA total of 101 NH residents.InterventionThe EF was a one-year, multifaceted intervention that included support, guidance, practice audits, and feedback that were provided to two NHs. The EOVs performed at the other NHs consisted of one session of three hours of lectures about the guidelines. Both interventions targeted a team of the unit manager, the head nurse, and 5–10 of the care staff.MeasurementsThe outcomes were nutritional status (Mini Nutritional Assessment-Short Form, MNA-SF), body mass index (BMI), functional ability (Barthel Index, BI), cognitive function (Short Portable Mental Status Questionnaire, SPMSQ, performed in a subgroup of communicative NH residents), health-related quality of life (EQ-5D), and the levels of certain biochemical markers like for example vitamin D, albumin and insulin-like growth factor 1.ResultsAfter a median of 18 months, nutritional parameters (MNA-SF and BMI) remained unchanged in both groups. While there were no differences in most outcomes between the two groups, the cognitive ability of those in the EOV group deteriorated more than in individuals in the EF group (p=0.008). Multiple linear regression analyses indicated that the intervention group assignment (EF) was independently from other potentially related factors associated with less cognitive decline.ConclusionAn extended model of implementation of nutritional guidelines, including guidance and feedback to NH staff, did not affect nutritional status but may be associated with a delayed cognitive decline in communicative NH residents.