Determination of malnutrition status in palliative care patients

Year 2020, , 64 - 70, 21.09.2020

Derya Bıçak Ayık , Zeliha Büyükbayram , Gülbeyaz Can

https://doi.org/10.47582/jompac.777125

Cited By: 2

Abstract

Aim: The study was carried out in the descriptive form in order to determine the malnutrition status in palliative care patients.
Material and Method: The research was conducted in the palliative care unit of a hospital in the east of Turkey between May 2019 and December 2019. Since the entire population was aimed to be included in the research, 123 palliative care patients were reached without calculating the sample size and using any sampling method. In order to evaluate the nutritional status of the patients, patient introductory information form and Mini Nutritional Assessment Test (MNA) were used. In the evaluation of the data, descriptive statistics, Kruskal-Wallis Test, Chi-Square and Mann-Whitney U test were used. All the findings were evaluated at p<0.05 significance level.
Results: The mean age of the patients was 71.88±14.16, and 51.2% of them were male, 95.9% were married, 39.8% had cancer and 45.5% were nourished orally. There was a risk of malnutrition in 89.4% of the patients and malnutrition development risk in 7.3%. The presence of malnutrition was found to be higher in cancer patients compared with Alzheimer’s patients, and in those nourished via percutaneous endoscopic gastronomy, nasogastric catheter and total parenteral nutrition compared to the ones nourished orally (p<0.05).
Conclusion: The results obtained from this study showed that it is very important, in palliative care patients with a high risk of malnutrition development, to follow the nutritional status closely and to arrange nutritional supportive treatment early so that the patients can go through a good process in the last days of their lives. 

Keywords

Nutrition, Patient, Malnutrition, Palliative care

Palyatif bakım hastalarında yetersiz beslenme durumunun belirlenmesi

Abstract

Amaç: Palyatif bakım hastalarında malnütrisyon durumunu saptamak amacıyla tanımlayıcı olarak gerçekleştirildi.
Gereç ve Yöntem: Araştırma Türkiye’nin doğusunda yer alan bir hastanenin palyatif bakım ünitesinde Mayıs 2019-Aralık 2019 tarihleri arasında gerçekleştirildi. Evrenin tümünün araştırmaya alınması hedeflendiği için örneklem büyüklüğü hesaplaması yapılmayıp herhangi bir örnekleme yöntemi kullanılmadan 123 palyatif bakım hastasına ulaşıldı. Hastaların beslenme durumunu değerlendirilmek için, hasta tanıtıcı bilgi formu, Mini Nütrisyonel Değerlendirme Testi (MNA) kullanıldı. Verilerin değerlendirilmesinde tanımlayıcı istatistikler, ANOVA, Kruskal Wallis Testi, Ki-Kare ve Mann Whitney U testi kullanıldı. Tüm bulgular p<0,05 anlamlılık düzeyinde değerlendirildi.
Bulgular: Yaş ortalaması 71,88± 14.16 olan hastaların %51,2’si erkek, %95,9’u evli, %39,8’si kanser, %45,5’i oral yolla beslenmekteydi. Hastaların %89,4’ünde malnütrisyon, %7,3’ünde malnütrisyon gelişme riski olduğu saptandı. Alzheimer hastaları ile kıyaslandığında kanser hastalarında ve beslenme şekli oral olanlar ile kıyaslandığında perkütan endoskopik gastronomi, nazogastrik sonda ve total parenteral beslenme ile beslenenlerde malnütrisyon varlığının daha yüksek olduğu saptandı (p<0.05).
Sonuç: Bu çalışmadan elde edilen sonuçlar, malnütrisyon gelişme riski yüksek olan palyatif bakım hastalarında, beslenme durumunun yakından takip edilmesinin ve nütrisyon destek tedavisinin erken dönemde düzenlenmesinin hastanın yaşamının son günlerinde iyi bir süreç geçirmesi açısından oldukça önemli olduğunu göstermiştir.

Keywords

Beslenme, hasta, malnütrisyon, palyatif bakım

References

• Day T. Managing the nutritional needs of palliative care patients. Br J Nurs Mark Allen Publ 2017; 26: 1151–9.
• Avcı D. Are the nutritional NRS-2002 scores of cancer patients at the palliative care center related to inflammation? Bozok Tıp Derg 2018; 8: 71–5.
• Prevost V, Grach M-C. Nutritional support and quality of life in cancer patients undergoing palliative care: Nutritional support in cancer palliative care. Eur J Cancer Care (Engl) 2012; 21: 581–90.
• Acreman S. Nutrition in palliative care. Br J Community Nurs 2009; 14: 427–31.
• Bazzan AJ, Newberg AB, Cho WC, Monti DA. Diet and nutrition in cancer survivorship and palliative care. Evid Based Complement Alternat Med 2013; 2013: 1–12.
• Çinar H, Kaya Y, Enginyurt Ö. Effects of nutritional status on quality of life in palliative care patients. Bozok Med J 2017; 7: 1–7.
• Hurlow A. Nutrition and hydration in palliative care. Br J Hosp Med 2019; 80: 78–85.
• Sancar Bekircan E, Ünlü A. The detection of the relationship between depression and malnutrition in cancer patients. J Tradit Med Complement Ther 2018; 1: 109–14.
• Lottes Stewart M. Nutrition support protocols and their influence on the delivery of enteral nutrition: a systematic review. Worldviews Evid Based Nurs 2014; 11: 194–9.
• Tuncer Ö, Bayindir A. Malnutrition approach in the palliative care patients. Klin Tıp Aile Hekim 2016 May 30; 8: 11–4.
• Muir CI, Linklater GT. A qualitative analysis of the nutritional requirements of palliative care patients. J Hum Nutr Diet 2011; 24: 470–8.
• Good P, Richard R, Syrmis W, Jenkins-Marsh S, Stephens J. Medically assisted hydration for adult palliative care patients. Cochrane Database Syst Rev 2014; 4: CD006273.
• Gillespie L, Raftery A-M. Nutrition in palliative and end-of-life care. Br J Community Nurs 2014; 19: S15–20.
• Río MI, Shand B, Bonati P, et al. Hydration and nutrition at the end of life: a systematic review of emotional impact, perceptions, and decision-making among patients, family, and health care staff: Perceptions toward hydration and nutrition at the end of life. Psychooncology 2012; 21: 913–21.
• Hopkinson J, Wright D, Corner J. Exploring the experience of weight loss in people with advanced cancer. J Adv Nurs 2006; 54: 304–12.
• Skates JJ, Anthony PS. Identifying geriatric malnutrition in nursing practice: The Mini Nutritional Assessment, an evidence, based screening tool. J Gerontol Nurs 2012; 38: 18–27.
• Muurinen SM, Soini HH, Suominen MH, Saarela RKT, Savikko NM, Pitkälä KH. Vision impairment and nutritional status among older assisted living residents. Arch Gerontol Geriatr 2014; 58: 384–7.
• Baz S, Ardahan M. Malnutrition in the elderly, nursing approaches. Balıkesir Sağlık Bilim Derg 2016; 5: 147–53.
• Rubenstein LZ, Harker JO, Salvà A, Guigoz Y, Vellas B. Screening for undernutrition in geriatric practice: developing the short-form mini-nutritional assessment (MNA-SF). J Gerontol A Biol Sci Med Sci 2001; 56: M366–M372.
• Şahin H, Çiçek B, Yılmaz M, Ongan D, Kaya N, İnanç N. Determining nutritional status and quality of life of 65 years and older individuals in Kayseri. Turk J Geriatr 2013; 16: 322–9.
• Balcı E, Şenol V, Eşel E, Günay O, Elmalı F. The relationship between malnutrition and depression in people aged over 65 years. Türkiye Halk Sağlığı Derg 2012; 10: 37–43.
• Cohendy R, Rubenstein LZ, Eledjam JJ. The Mini Nutritional Assessment-Short Form for preoperative nutritional evaluation of elderly patients. Aging Clin Exp Res 2001; 13: 293–7.
• Özgün Başıbüyük G, Ayremlou P, Nourı Saeıdlou S, et al. Evaluation of malnutrition among elderly people living in nursing homes by Mini Nutritional Assessment Short Form (MNA-SF) in Turkey. Mædica 2019; 14: 38–44.
• Bassim CW, Fassil H, Dobbin M, et al. Malnutrition in patients with chronic GVHD. Bone Marrow Transplant 2014; 49: 1300–6.
• Guyonnet S, Rolland Y. Screening for malnutrition in older people. Clin Geriatr Med 2015; 31: 429–37.
• Agarwal E, Miller M, Yaxley A, Isenring E. Malnutrition in the elderly: a narrative review. Maturitas 2013; 76: 296–302.
• Field LB, Hand RK. Differentiating malnutrition screening and assessment: a nutrition care process perspective. J Acad Nutr Diet 2015; 115: 824–8.
• Çınar H, Kaya Y, Enginyurt Ö. Quality of life in palliative care patients. Turk Klin J Fam Med-Spec Top 2017; 8: 282–6.
• Aaldriks AA, Maartense E, Le Cessie S, et al. Predictive value of geriatric assessment for patients older than 70 years, treated with chemotherapy. Crit Rev Oncol Hematol 2011; 79: 205–12.
• Bayır H, Yıldız İ, Erkuran MK, Koçoğlu H. Malnutrition in intensive care patients. Abant Med J 2015; 4: 420–7.
• Çınar H, Kaya Y, Özyurt N, Çakır L, Ongun A. Assessment of nutritional status in palliative care patients. Klin Tıp Aile Hekim 2016; 8: 15–8.
• Ravasco P. Nutrition in Cancer Patients. J Clin Med. 2019; 8: 1211.
• Holder H. Nursing management of nutrition in cancer and palliative care. Br J Nurs 2003; 12: 667–74.
• Bourdel-Marchasson I, Diallo A, Bellera C, et al. One-year mortality in older patients with cancer: development and external validation of an MNA-based prognostic score. PLoS One 2016; 11: e0148523.
• Cui HY, Zhu MW, Wei JM, Chen W, Yang X, Zhu SN. Changes in nutritional status of patients with different diseases during hospitalization. Zhonghua Wai Ke Za Zhi 2017; 55: 297–302.
• Fernández ML, Saenz CF, Alonso SU, et al. Malnutrition in patients with cancer; four years experience. Nutr Hosp 2013; 28: 372–81.
• Shaw C, Fleuret C, Pickard JM, Mohammed K, Black G, Wedlake L. Comparison of a novel, simple nutrition screening tool for adult oncology inpatients and the Malnutrition Screening Tool (MST) against the Patient-Generated Subjective Global Assessment (PG-SGA). Support Care Cancer 2015; 23: 47–54.
• Zhu MW, Wei JM, Chen W, et al. Dynamic investigation of nutritional risk in patients with malignant tumor during hospitalization. Zhonghua Yi Xue Za Zhi 2018; 98: 1093–8.
• Uster A, Ruefenacht U, Ruehlin M, et al. Influence of a nutritional intervention on dietary intake and quality of life in cancer patients: a randomized controlled trial. Nutrition 2013; 29: 1342–9.
• Hébuterne X, Lemarié E, Michallet M, de Montreuil CB, Schneider SM, Goldwasser F. Prevalence of malnutrition and current use of nutrition support in patients with cancer. J Parenter Enter Nutr 2014; 38: 196–204.
• Vonzun N, Rühlin M, Sterchi A. Malnutrition in the era of DRG. Ther Umsch Rev Ther 2014; 71: 185–9.