Evaluation of malnutrition frequency and related factors of geriatric patients in need of home healthcare

SUMMARY OBJECTIVE: The nutritional status of frail elderly people receiving home health services should be evaluated. This study aimed to determine the nutritional status of patients aged ≥65 years registered in the Home Healthcare Services unit and investigate the factors that may be associated with malnutrition. METHODS: This cross-sectional descriptive study was conducted during routine visits to patients and their caregivers. A total of 161 patients were asked to fill in surveys asking about sociodemographic characteristics, patient history, and clinical status. Anthropometric measurements were taken from all patients. The Mini Nutritional Assessment Short Form was applied to the patients for screening purposes. Patients who scored ≤11 on the Mini Nutritional Assessment Short Form were then asked to complete the full Mini Nutritional Assessment form. RESULTS: According to the Mini Nutritional Assessment Short Form and Mini Nutritional Assessment tests, almost half of the elderly patients included in the study (49.7%, n=161) were malnourished or at risk of malnutrition. Analyses showed that those who had COVID-19 [odds ratio (OR): 9.423, 95%CI 2.448-36.273) and those diagnosed with dementia/depression (OR: 8.688, 95%CI 3.246-23.255) were more likely to be malnourished, whereas those with diabetes (OR: 0.235, 95%CI 0.084-0.657) were less likely to have malnutrition. Strikingly, those who were fed by caregivers (OR: 15.061, 95%CI 3.617-62.710) were also more likely to be malnourished than those with self-feeding ability. CONCLUSION: Malnutrition or the risk of malnutrition is common in elderly patients receiving home care services. Many factors can have an impact on malnutrition.

Fatores associados à terapia nutricional domiciliar em pacientes sob cuidados paliativos / Factors associated with home nutritional therapy in patients under palliative care

ntrodução: A desnutrição é uma das condições frequentemente observadas em pacientes sob cuidados paliativos, afetando a via de alimentação e impactando na diminuição da ingestão alimentar. O atendimento nutricional permite a identificação das alterações nutricionais, direcionando para terapia nutricional adequada. Objetivo: Analisar a terapia nutricional domiciliar e identificar o estado nutricional em pacientes sob cuidados paliativos no domicílio. Método: Estudo prospectivo, observacional com pacientes do Programa Melhor em Casa, em Guarapuava-PR. Foram avaliados por meio de anamnese, que compreendia diagnóstico clínico, exame físico, caracterização e intercorrências da dieta, SARC-F e avaliação antropométrica. Resultados: Participaram do estudo 24 pacientes, com média de idade 70,2+15,0 anos. Os principais diagnóstico clínicos foram: 45,83% câncer e 45,83% doença neurológica. O baixo peso e a classificação sugestiva de sarcopenia predominaram nos avaliados, sendo 54,17% e 87,5%, respectivamente. A via de acesso para alimentação prevalente foi a oral (45,8%), seguida de 41,7% para sonda nasoenteral; a fórmula mais utiliza foi a hiperproteica. A maioria apresentou sinal da asa quebrada (70,8%), perda da bola de Bichat (66,7%) e perda de massa nos membros superiores e inferiores. O diagnóstico nutricional padronizado mais frequente foi NC-3.2 (perda de peso não intencional), seguido de 41,7% com NI-1.2 (ingestão de energia subótima). Conclusão: Observou-se que a maioria dos pacientes eram idosos, acamados, com doença neurológica e câncer. Em relação ao estado nutricional, a maioria apresentou baixo peso e sinais de desnutrição. O atendimento nutricional com pacientes em cuidados paliativos se faz necessário, pois são pacientes com risco nutricional.

Introduction: Malnutrition is one of the most common conditions seen in palliative care patients, which can affect the feeding route and decrease food intake. Nutritional counseling allows the detection of dietary changes, and referral to appropriate nutritional therapy. Aim: The purpose of this study was to analyze home nutritional therapy, and identify nutrient-related diagnoses in home palliative care patients. Materials and methods: It's a prospective, observational study involving patients assisted by the "Better at Home Program", in Guarapuava - PR. Anamnesis was carried out to assess the patients, which included clinical diagnosis, physical examination, diet characterization and complications, SARC-F, and anthropometric assessment. Results: The study included 24 patients, with an average age of 70,2+15,0. The most frequent clinical diagnoses were cancer (45.83 percent) and neurological disease (45.83 percent). Low weight and a classification indicative of sarcopenia predominated among the patients, accounting for 54.17% and 87.55%, respectively. The most common feeding route was oral (45.8%), followed by nasoenteral feeding l (41.7%). The most commonly used formula was the hyperproteic. The majority of patients had sunken temples (70.8%), loss of Bichat's fat pad (66.7%), and loss of muscle mass in the upper and lower limbs. The most frequent standardized nutrition diagnosis was NC-3.2 (unintentional weight loss), followed by 41.7% NI-1.2 (suboptimal energy intake). Conclusion: Most patients were elderly, bedridden, and had neurologic disease or cancer. Regarding the nutritional status, the majority were underweight and exhibited signs of malnutrition. Palliative care patients require nutritional therapy since they are at risk of malnutrition

Custo e efetividade de modalidades de serviços de atenção domiciliar para a população idosa: revisão integrativa da literatura / Cost and effectiveness of home care services modalities for the older population: integrative literature review / Costo y efectividad de las modalidades de servicios de atención domiciliaria para la población mayor: revisión integradora de la literatura

RESUMO Objetivo: analisar as modalidades de serviços de AD direcionadas ao público idoso, identificando a oferta de serviços no domicílio e seus resultados referentes aos custos e a efetividade. Método: revisão da literatura realizada nas bases de dados Literatura Latino-americana e do Caribe em Ciências da Saúde (LILACS) e Indice Bibliográico Español en Ciencias de la Salud (IBECS) via Biblioteca Virtual da Saúde (BVS), Medline via Pubmed, Scopus, Web of science, Cumulative Nursing and Allied Health Literature (CINAHL) e Cochrane. Foram incluídos 16 estudos publicados no período de 2008 a 2017, submetidos à análise de conteúdo. Resultados: a análise evidenciou que há diferentes modalidades de serviços que podem ser ofertados para a população idosa, incluindo o cuidado no domicílio. As modalidades identificadas foram serviços de visitas domiciliares, internação domiciliar; serviços institucionais de longa permanência; serviços de suporte de longo prazo que associam cuidado no domicílio e cuidado comunitário e serviços institucionais de transição de cuidado. Essas modalidades variaram segundo as formas de organização, público-alvo, resultados alcançados e custos associados. Os serviços mais custo-efetivos para os idosos foram os que incluem intervenção no domicílio tanto para condições agudas quanto crônicas; internação domiciliar; serviços combinados de intervenção domiciliar e comunitária, instituições de transição de cuidado e instituições de longa permanência. Conclusão: a atenção domiciliar, especialmente aquelas que ofertam intervenções no domicílio, mostrou-se com melhores resultados capazes de reduzir os custos gerais para os sistemas de saúde e pode ser efetiva na medida em que responde às demandas por cuidados requeridas pelos idosos.

RESUMEN Objetivo: analizar las modalidades de los servicios de AD dirigidos al público anciano, identificando la oferta de servicios a domicilio y sus resultados en cuanto a costos y efectividad. Método: revisión de la literatura realizada en las bases de datos de Literatura Latinoamericana y Caribeña en Ciencias de la Salud (LILACS) e Índice Bibliográfico Español en Ciencias de la Salud (IBECS) vía Biblioteca Virtual en Salud (BVS), Medline vía Pubmed, Scopus, Web of science, Cumulative Nursing and Allied Health Literature (CINAHL (CINAHL) y Cochrane. Se incluyeron 16 estudios publicados de 2008 a 2017, sometidos a análisis de contenido. Resultados: el análisis mostró que existen diferentes tipos de servicios que se pueden ofrecer a la población anciana, incluida la atención domiciliaria. Las modalidades identificadas fueron servicios de visitas domiciliarias, atención domiciliaria; servicios institucionales a largo plazo; servicios de apoyo a largo plazo que combinan atención domiciliaria y atención comunitaria, y servicios de transición de atención institucional. Estas modalidades variaron según las formas de organización, público objetivo, resultados obtenidos y costos asociados. Los servicios más rentables para los ancianos fueron los que incluían intervención domiciliaria tanto para enfermedades agudas como crónicas; cuidados en el hogar; servicios combinados de intervención en el hogar y la comunidad, instituciones de atención de transición e instalaciones de atención a largo plazo. Conclusión: la atención domiciliaria, especialmente aquellos que ofrecen intervenciones en el hogar, ha demostrado tener mejores resultados capaces de reducir los costos globales para los sistemas de salud y puede ser eficaz en la medida en que responda a las demandas de atención que requieren las personas mayores.

ABSTRACT Objective: to analyze the modalities of AD services aimed at the older people, identifying the offer of services at home and its results regarding costs and effectiveness. Method: literature review carried out in the databases of Literatura Latino-americana e do Caribe em Ciências da Saúde (LILACS) and Indice Bibliográico Español en Ciencias de la Salud (IBECS) via Biblioteca Virtual da Saúde (BVS), Medline via Pubmed, Scopus, Web of science, Cumulative Nursing and Allied Health Literature (CINAHL) and Cochrane. Sixteen studies published from 2008 to 2017 were included and submitted to content analysis. Results: the analysis showed that there are different types of services that can be offered to the older population, including home care. The modalities identified were home visiting services, home hospitalization; long-term institutional services; long-term support services that combine home and community care, and institutional care transition services. These modalities varied according to the forms of organization, target audience, results achieved, and associated costs. The most cost-effective services for the older adults were those that included home intervention for both acute and chronic conditions; home care; combined home and community intervention services, transitional care institutions, and long-term care facilities. Conclusion: home care, especially those that offer interventions at home, showed better results capable of reducing overall costs for health systems and can be effective as it responds to the demands for care required by older people.

Desempeño del rol de cuidador primario y eficiencia del programa Atención Hospitalaria a Domicilio / Caregiver role performance and efficiency of the Home Health Care program

Resumen:

Introducción: el programa de Atención Hospitalaria a Domicilio (ATHODO), del Instituto Mexicano del Seguro Social (IMSS), se implemento con el fin de llevar atención médica hasta el domicilio de los pacientes con enfermedades crónicas o terminales. Como requisito indispensable para formar parte del programa, el paciente debe contar con un cuidador primario, persona en la que recae la responsabilidad del cuidado del paciente.

Objetivo: evaluar el desempeño del cuidador principal y su relación con la eficiencia del programa ATHODO.

Metodología: estudio descriptivo y transversal correlacional en 72 cuidadores principales inscritos en el programa ATHODO. El desempeño del cuidador principal se evaluó con el instrumento elaborado por Landeros y Huitzache "Valoración para el Agente de Cuidado Dependiente", validado con alfa de Cronbach de 0.862; y la eficiencia del programa, con una lista de cotejo realizada conforme a lo establecido en los siete indicadores de calidad que marca el IMSS. Se consideró eficiente si se cumplieron positivamente los siete indicadores.

Resultados: el desempeño del rol de cuidador principal fue bueno en 58 % y regular en 42 %. El programa ATHODO fue evaluado como insuficiente por los cuidadores debido a que no se cumplió favorablemente con los siete indicadores. Se identificó asociación entre desempeño y eficiencia del programa.

Conclusiones: la asociación entre desempeño y eficiencia del programa ATHODO permite proponer acciones que lo perfeccionen y que mejoren el desempeño del cuidador principal.

Abstract:

Introduction: Instituto Mexicano del Seguro Social's (IMSS) Home Health Care program (ATHODO, according to its initials in Spanish) was implemented to bring medical care to the home of patients with chronic or terminal diseases. As a prerequisite for joining the program, the patient must have a primary caregiver: a person with the responsibility of giving care to him.

Objective: To evaluate the performance of the primary caregiver role and its relationship with the efficiency of ATHODO program.

Methodology: A descriptive, correlational cross-sectional study in 72 primary caregivers enrolled in ATHODO. Primary caregiver performance was assessed with the instrument developed by Lan-deros and Huitzache "Valoración para el Agente de CuidadoDependiente" ("Calculation for Dependent Care Agent"), validated with Cronbach's alpha of 0.862. The efficiency of the program was validated with a checklist made as provided in the seven indicators of quality that marks the IMSS. The program was considered efficient if it met with the seven points positively. Results: the performance of the role of primary caregiver was good in 58 %, fair in 42 %. The ATHODO program was evaluated as inefficient by all caregivers, because it didn't met favorably with the seven indicators. An association between performance and efficiency of the program was identified. Conclusions: the association between performance and efficiency of the program allows to propose actions to improve the program and consequently the performance of the primary caregiver.

A formação para o cuidado domiciliar: aspectos encontrados na produção científica da enfermagem brasileira / Home health care training: issues found in the Brazilian nursing scientific production / La formación para el cuidado domiciliario: aspectos encontrados en la producción científica de la enfermería Brasilera

O objetivo deste estudo é identificar os aspectos abordados sobre a formação para o cuidado domiciliar-CDnas produções científicas brasileiras. Realizou-se uma revisão integrativa que analisou 39 produções, compreendidasentre o período de Janeiro de 1999 e Maio de 2009. Como resultado, emergiram três aspectos relevantes: competênciasnecessárias ao CD, a formação para o CD e limitações na formação dos profissionais que atuam no CD. Constatou-se quesão escassas as produções que tratam exclusivamente da formação para o CD na Enfermagem. É necessário portanto,enfatizar junto às instituições formadoras e empregadoras a necessidade de qualificar quem atuará nessa área.

The aim of this study was to identify issues about home health care (HHC) training in Brazilian nursingscientific production. An integrative revision was developed, which analyzed 39 papers, that were published from January1999 to May 1999; as result, three main aspects emerged: necessary competences to HHC, HHC training, and the limitationson the HHC professionals? training. We stated that there are few scientific production exclusively about HHC training inNursing. It?s necessary to emphasize the importance of training in this area among training entities and HHC agencies.

El objetivo de este estudio es identificar los aspectos abordados sobre la formación para el cuidado domiciliario-CD en las producciones científicas brasileras. Se realizó una revisión integradora que analizó 39 producciones, comprendidasentre el período de Enero de 1999 a Mayo de 2009. Como resultado, surgieron tres aspectos relevantes: competenciasnecesarias al CD, la formación para el CD y limitaciones en la formación de los profesionales que actúan en el CD. Fueconstatado que son escasas las producciones que tratan exclusivamente de la formación para el CD en Enfermería. Esnecesario, por lo tanto, enfatizar junto a las instituciones formadoras y empleadoras la necesidad de cualificar quienactuará en esta área.

Working Conditions in Home Health Care Nursing: A Survey of Home Care Nurses in Hospitals in Korea / 간호학회지

PURPOSE: The purpose of this research was to address the working conditions of home health nurses through a nationwide home health agency survey conducted at hospitals. METHOD: The mail surveys were sent to 303 home health nurses nation wide and returned with a response rate of 71.8%. RESULT: (a) Seventy-five percent of home health agencies were established within the past5 years and half of home health nurses are over 40 years old. (b) Working conditions were considered as follows: Seventy-one percent of respondents were full-time employees, sixty-sixpercent of home health nurses had unscheduled visits on a regular day of duty and forty-eight percent were on vacation. Fifty-one percent of home health nurses have experienced traffic accidents and paid penalties (65.9%). Self-reported monthly income level per year was an average of 28,364,000 won. (c) Rates were significantly higher for shoulder pain (61.5%), lower back pain (54.1%), knee pain (39.4%), and gastrointestinal problems (33.0%). CONCLUSION: These baseline results show the importance of improving home health nursing working conditions, a comprehensive prevention system and safeguards from physical discomfort.