1. Association between being at‐risk of malnutrition and discontinued home medical care among older patients: a 1‐year follow‐up study.
- Author
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Tsuji, Taeko, Yamasaki, Kazuyo, Kondo, Kyoko, Hongu, Nobuko, Matsumoto, Yoshinari, Fukuo, Keisuke, and Habu, Daiki
- Subjects
EVALUATION of medical care ,HOME care services ,RISK assessment ,MALNUTRITION ,RESEARCH funding ,TERMINATION of treatment ,MEDICAL care ,QUESTIONNAIRES ,NURSING ,DESCRIPTIVE statistics ,LONGITUDINAL method ,SURVEYS ,NUTRITIONAL status ,CONFIDENCE intervals ,SOCIODEMOGRAPHIC factors ,COMPARATIVE studies ,PATIENT aftercare ,PROPORTIONAL hazards models ,ACTIVITIES of daily living ,COMORBIDITY ,DEGLUTITION disorders ,DISEASE risk factors ,OLD age - Abstract
Background: Both malnutrition and at‐risk of malnutrition are prevalent among older patients receiving home medical care. Discontinuation of home medical care usually occurs when an older patient is admitted to a hospital or nursing home or dies. This study aimed to assess prospective associations between nutritional status and discontinuation of home medical care in older patients. Methods: Three hundred and thirty‐three Japanese older patients receiving home‐visit nursing care services were included in this study. Their nutritional status was assessed using the Mini Nutritional Assessment®‐Short Form, and patients were classified into three groups (well‐nourished, at‐risk of malnutrition and malnourished). Outcomes were confirmed at the 1‐year follow‐up survey. Hazard ratios (HRs) and 95% confidence intervals (CIs) for discontinuation of home medical care based on nutritional status were calculated using a Cox proportional hazard model. Covariates included age, sex, living status, economic status, activities of daily living, comorbidities and dysphagia status. Results: In total, 297 patients (median age: 84 years) were analysed. At baseline, 48.5% of the patients were at‐risk of malnutrition and 18.9% were malnourished. During the observation period of 1 year, 27.6% patients discontinued their home medical care. In the adjusted model, the HR for discontinuation of home medical care among those at‐risk of malnutrition was 2.44 (95% CI: 1.34–4.45) times than that of the well‐nourished group, although the malnourished group was not significantly associated with discontinuation of home medical care (HR: 1.69, 95% CI: 0.77–3.72; referent: well‐nourished). Conclusions: At‐risk of malnutrition was associated with discontinuation of home medical care among older patients. Key points: Older patients receiving home medical care are already at risk for discontinuation of home medical care when they are at‐risk of malnutrition.The at‐risk of malnutrition is a stage of great opportunity for preventing malnutrition, as its early recognition and appropriate nutritional management may lead to the prevention of malnutrition, eventually contributing to an increase in the length of home medical care.Future studies are warranted to investigate whether nutritional interventions for those at‐risk of malnutrition contribute to prolonging the length of home medical care by improving nutritional status. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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