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Abstract(s)
A desnutrição na população idosa é um grave problema de saúde pública, com a sua prevalência a rondar os 60% em instituições hospitalares. Além do estado nutricional, o aparecimento de doenças crónicas é frequente. As úlceras de pressão são feridas crónicas, bastante comuns entre a população mais idosa e têm um impacto negativo na qualidade de vida. O objetivo do estudo foi avaliar o estado nutricional de idosos hospitalizados com presença de úlcera de pressão e comparar com idosos sem úlcera de pressão. Foram avaliados 80 doentes idosos (40 com UP e 40 sem UP) entre janeiro e março de 2016. Foram registados dados sociodemográficos, dados clínicos, parâmetros antropométricos (IMC, PB, PG, PCT, PCSE, APB, AMB, MAP), composição corporal (MIG, MG, AF), risco nutricional (MUST®), avaliação nutricional subjetiva (MNA®) e parâmetros bioquímicos (hemoglobina, proteínas totais, albumina e colesterol total). As úlceras de pressão foram avaliadas tendo em conta o seu risco de desenvolvimento pela Escala de Braden, origem, número, localização e categoria. A análise estatística foi realizada pelo SPSS versão 22.0. 40 doentes do grupo “Caso”, 72,5% feminino com média de idades 83,5±6,3 e 40 doentes do grupo “Controlo”, 50% feminino com média de idades 81,6±8,4. Verificaram-se diferenças significativas na avaliação do risco nutricional pelo MUST® (risco nutricional elevado em 52,5% do grupo “Caso” e 12,5% do grupo “Controlo”). Após aplicação do MNA®, o grupo “Caso” apresentou 97,5% em desnutrição e o grupo “Controlo” apenas 7,5%. O grupo “Caso” apresentou todos os parâmetros antropométricos inferiores ao grupo “Controlo” à exceção do MAP. Entre os dois grupos, verificaram-se diferenças estatisticamente significativas ao nível do PG (“Caso”=27,7cm e “Controlo”=30,3cm; p=0,008), da MIG (“Caso”=35,3kg e “Controlo”=41kg; p=0,002), da albumina (“Caso”=2,7g/dl e “Controlo”=3,8g/dl; p=0,000) e do colesterol total (“Caso”=121mg/dl e “Controlo”=148,9mg/dl; p=0,000). A albumina (𝑂𝑅̂=0,010,𝐼.𝐶95%=(0,001;0,102)),o colesterol total (𝑂𝑅̂=0,974,𝐼.𝐶95%=(0,948;1,000)) e o score do MNA® (𝑂𝑅̂=0,525,𝐼.𝐶95%=(0,374;0,738)) mostraram-se fatores protetores para o aparecimento de úlceras de pressão. A combinação de diferentes métodos de avaliação nutricional é essencial para identificar e avaliar do risco e o estado nutricional dos doentes com UPs, para que se possa intervir antecipadamente em casos de desnutrição. É importante para reduzir as complicações, diminuir o tempo de internamento e, consequentemente reduzir os custos de cuidados de saúde e melhorar a qualidade de vida dos doentes.
ABSTRACT - Malnutrition in the elderly population is a significant problem of public health, with its penetration in hospital environments reaching near 60%. Beyond their general nutritional status, further diseases are frequent to happen, some of them chronic. Pressure ulcers are chronic wounds very common in the elderly population and that may have a significant impact on the quality of life of the people suffering from them. The objective of this study was the assessment of the overall nutritional status of a population of elderly individuals with pressure ulcer occurrences under hospital stay, and compare their nutrition status with one of the individuals in absence of pressure ulcers, under the same hospital environment. Eighty elderly individuals (from 40 with PUs and another 40 without PUs) have been assessed from January to March 2016 on parameters such as sociodemographic background, clinical history, anthropometric parameters (BMI, AC, CC, TSF, SSF, APM), body composition (FFM, FM, PA), nutritional risk (MUST®), subjective nutritional assessment (MNA®) and biochemical parameters (hemoglobin, total proteins, albumin, and total cholesterol). Pressure ulcers followed their risk of development as per the Braden Scale, origin, count, location, and level of ulcer. Finally, a statistical analysis has been performed using SPPS® software version 22.0. Forty patients from the “Case” group, 72.5% women and 27.5% men, averaging 83.5±6.3 years old, and 40 patients from the “Control” group, 50% women, averaging 81.6±8.4 years old. Following MUST®, significant differences have been identified, with 52.5% of the patients from the “Case” group showing high nutritional risk and only 12.5% within the “Control” group. Excepting APM, the “Case” group showed all anthropometric parameters lower than what has been seen on the “Control” group. After the application of MNA®, the “Case” group showed 97.5% of malnutrition, as opposed to only 7.5% on the “Control” group. Between both groups, statistical differences have been in CC (“Case”=27.7cm and “Control”=30.3; p=0.008), FFM (“Case”=35.3kg and “Control”=41kg; p=0.002), albumin (“Case”=2.7g/dl and “Control”=3.8g/dl; p=0.000) and total cholesterol (“Case”=121mg/dl and “Control”=148,9mg/dl; p=0.000). Albumin (𝑂𝑅̂=0,010,𝐼.𝐶95%=(0,001;0,102)), total cholesterol (𝑂𝑅̂=0,974,𝐼.𝐶95%=(0,948;1,000)) and MNA® score (𝑂𝑅̂=0,525,𝐼.𝐶95%=(0,374;0,738)) have been seen as a protective factors for the occurrence of PUs. The combination of different methods for nutritional assessment is the key to identify and evaluate the risk and nutritional status of patients with PUs, in order to allow timely intervention on malnutrition patients. It is important to reduce further deterioration of general health conditions, reduce hospital stay and, consequently, reduce overall care and treatment cost, ultimately contributing improve patients' quality of life.
ABSTRACT - Malnutrition in the elderly population is a significant problem of public health, with its penetration in hospital environments reaching near 60%. Beyond their general nutritional status, further diseases are frequent to happen, some of them chronic. Pressure ulcers are chronic wounds very common in the elderly population and that may have a significant impact on the quality of life of the people suffering from them. The objective of this study was the assessment of the overall nutritional status of a population of elderly individuals with pressure ulcer occurrences under hospital stay, and compare their nutrition status with one of the individuals in absence of pressure ulcers, under the same hospital environment. Eighty elderly individuals (from 40 with PUs and another 40 without PUs) have been assessed from January to March 2016 on parameters such as sociodemographic background, clinical history, anthropometric parameters (BMI, AC, CC, TSF, SSF, APM), body composition (FFM, FM, PA), nutritional risk (MUST®), subjective nutritional assessment (MNA®) and biochemical parameters (hemoglobin, total proteins, albumin, and total cholesterol). Pressure ulcers followed their risk of development as per the Braden Scale, origin, count, location, and level of ulcer. Finally, a statistical analysis has been performed using SPPS® software version 22.0. Forty patients from the “Case” group, 72.5% women and 27.5% men, averaging 83.5±6.3 years old, and 40 patients from the “Control” group, 50% women, averaging 81.6±8.4 years old. Following MUST®, significant differences have been identified, with 52.5% of the patients from the “Case” group showing high nutritional risk and only 12.5% within the “Control” group. Excepting APM, the “Case” group showed all anthropometric parameters lower than what has been seen on the “Control” group. After the application of MNA®, the “Case” group showed 97.5% of malnutrition, as opposed to only 7.5% on the “Control” group. Between both groups, statistical differences have been in CC (“Case”=27.7cm and “Control”=30.3; p=0.008), FFM (“Case”=35.3kg and “Control”=41kg; p=0.002), albumin (“Case”=2.7g/dl and “Control”=3.8g/dl; p=0.000) and total cholesterol (“Case”=121mg/dl and “Control”=148,9mg/dl; p=0.000). Albumin (𝑂𝑅̂=0,010,𝐼.𝐶95%=(0,001;0,102)), total cholesterol (𝑂𝑅̂=0,974,𝐼.𝐶95%=(0,948;1,000)) and MNA® score (𝑂𝑅̂=0,525,𝐼.𝐶95%=(0,374;0,738)) have been seen as a protective factors for the occurrence of PUs. The combination of different methods for nutritional assessment is the key to identify and evaluate the risk and nutritional status of patients with PUs, in order to allow timely intervention on malnutrition patients. It is important to reduce further deterioration of general health conditions, reduce hospital stay and, consequently, reduce overall care and treatment cost, ultimately contributing improve patients' quality of life.
Description
Mestrado em Nutrição Clínica
Keywords
Idoso Internamento hospitalar Avaliação nutricional Ulcera de pressão Elderly Hospitalized Nutritional assessment Pressure ulcer
Citation
Santos TL. Avaliação nutricional de idosos hospitalizados com úlcera de pressão [dissertation]. Lisboa: Escola Superior de Tecnologia da Saúde de Lisboa/Instituto Politécnico de Lisboa; Faculdade de Medicina da Universidade de Lisboa; 2016.
Publisher
Instituto Politécnico de Lisboa, Escola Superior de Tecnologia da Saúde de Lisboa