Zagotavljanje optimalne prehranske obravnave pri starostnikih z napredovalo stopnjo demence v institucionalnem varstvu : diplomsko delo

Florjančič, Petra (author), Milavec Kapun, Marija (mentor), Debeljak, Tadej (comentor)

Uvod: Napredovala stopnja demence je zadnja stopnja v kliničnem poteku demence, za katero je, ob poglobljenih kognitivnih, telesnih, vedenjskih in psiholoških okvarah, značilna izguba samostojnosti pri izvajanju osnovnih dnevnih opravil ter visoka stopnja ogroženosti za podhranjenost. Namen: Želeli smo ugotoviti obstoječe pristope k prehranski oskrbi, ki spodbujajo kakovost življenja in dobro počutje oseb z napredovalo stopnjo demence ter obstoječe strokovne intervencije, ki omogočajo izbiro optimalnega načina prehranjevanja pri osebah z napredovalo stopnjo demence v celodnevni institucionalni oskrbi. Metode dela: Uporabili smo deskriptivno metodo dela s sistematičnim pregledom literature. Za identifikacijo literature smo prek iskalnika DiKUL uporabili iskanje ključnih besed (dementia OR alzheimers OR cognitive impairment OR memory loss) IN (feeding OR eating OR nutrition) v izvlečku v podatkovnih bazah CINAHL in MEDLINE. Omejili smo se na recenzirane publikacije v angleškem jeziku, objavljene v znanstveni reviji, z letom objave 2014–2019 in polnim dostopom besedila. V analizo smo vključili 19 člankov, ki smo jih glede na moč dokaza ovrednotili z uporabo sistema štirih kategorij. Rezultati: Pristopi za zagotavljanje kakovosti življenja oseb z napredovalo stopnjo demence so bili usmerjeni k omogočanju in spodbujanju samostojnosti pri hranjenju, ki se je dosegala z obvladovanjem upada umskih in telesnih sposobnosti, zagotavljanjem prehranskega vnosa per os, uporabo prilagojene prehrane, obvladovanjem motenj požiranja, zagotavljanjem k posamezniku usmerjene oskrbe in s prilagojenim ter spodbudnim socialnim in fizičnim okoljem. Z izobraževanjem in usposabljanjem zdravstvenega osebja o priporočenih pristopih obravnave oseb z napredovalo stopnjo demence ter uporabo strokovnih merskih instrumentov, bi lahko zagotovili višjo kakovost zdravstvene oskrbe in zmanjšali konflikt pri obravnavi težav s hranjenjem v demenci. Z opolnomočenjem zakonitih zastopnikov oseb z napredovalo stopnjo demence o možnih oblikah obvladovanja prehranskih težav, lahko dosežemo višjo stopnjo skladnosti med želeno in dejansko izvedeno zdravstveno oskrbo. Razprava in zaključek: Ugotovili smo pomanjkanje visokokakovostnih randomiziranih kontrolnih raziskav na večjem vzorcu oseb z napredovalo stopnjo demence, ki preverjajo tudi dolgoročne učinke intervencij. Potrebno bi bilo preveriti učinkovitost intervencij za posamezni tip in stopnjo napredovanja demence ter raziskati časovne, kadrovske in politične ovire pri prenosu priporočenih pristopov k prehranski oskrbi v klinično okolje.

• Language: Slovenian
• Keywords: huda kognitivna motnja, podhranjenost, odvrnilno vedenje, kakovost življenja, dolgotrajna oskrba, zdravstvena nega
• Work type: Bachelor thesis/paper
• Organization: ZF - Faculty of Health Sciences
• Year: 2019
• PID: 20.500.12556/RUL-113458
• COBISS.SI-ID: 5762155
• Publication date in RUL: 08.01.2020

Secondary language

• Language: English
• Title: Providing optimal nutritional treatment in institutionalized elderly with advanced dementia : diploma work

Abstract

Introduction: Advanced dementia is the final stage in the clinical course of dementia, characterized by a loss of autonomy in carrying out activities of daily living and a high risk of malnutrition in addition to severe cognitive, physical, behavioral and psychological impairments. Purpose: We aim to identify both, available nutritional care approaches that promote the quality of life and well-being of persons with advanced dementia and existing professional interventions that facilitate the selection of optimal feeding option for people with advanced dementia in long-term care. Methods: A systematic review was conducted using DiKUL. Databases MEDLINE and CINAHL were searched for peer-reviewed publications in English, published 2014–2019 in scientific journals and with full text access. We used keyword search (dementia OR alzheimers OR cognitive impairment OR memory loss) AND (feeding OR eating OR nutrition) in abstract. 19 articles were included in the analysis. Strength of evidence was evaluated using a system of four categories. Results: Aproaches to improve or maintain the quality of life of people with advanced dementia focused on facilitation and promotion of self-feeding and eating independence, which was achieved through management of mental, functional and swallowing problems, promotion of oral food intake, use of modified diets, providing of person-centered care and supportive social and physical environment. Training programs for health care professionals and professional assessment tools could reduce decisional conflict for feeding options in advanced dementia and ensure higher health care quality. Informing surrogate decision-makers of people with dementia about possible feeding options could help promote goal-directed care in advanced dementia. Discussion and conclusion: We found a lack of high-quality randomized control trials, research studies on larger sample sizes and reports of long-term outcomes. Further research is required to determine the effectiveness of interventions, targeted to population with specific stages or types of dementia. In addition, time, staffing and institutional policy barriers to nutritional guideline implementations should be examined.

• Keywords: severe cognitive impairment, malnutrition, aversive feeding behaviour, quality of life, long-term care, nursing