Nedim ONGUN

Nöroloji Kliniği’nde yatan hastalarda nutrisyonel durumun polifarmasi ve hastane yatış süresi ile ilişkisi

Amaç: Malnutrisyon hastane yatışı sırasında mevcut olabileceği gibi yatış sonrasında da ortaya çıkabilmektedir. Hastanede yatan hastalarda malnutrisyon birçok klinik sonuç ile ilişkilidir. Bu çalışmanın amacı nöroloji kliniğine yatan hastalarda nutrisyonel durumun ve polifarmasi ve hastane yatış süresi ile ilişkisinin değerlendirilmesidir. Gereç ve yöntem: Eylül 2017-Eylül 2018 tarihleri arasında Burdur Devlet Hastanesi nöroloji kliniğinde takip edilen 1422 hasta geriye dönük dosya incelemesi şeklinde taranarak değerlendirildi. Hastaların nutrisyonel durumları NRS-2002 skorları ile dosya üzerinden kayıt edildi. Toplam skoru ≥3 olan hastalar malnutrisyon riski altında olarak kabul edildi. Polifarmasi, altı ve daha fazla ilaç kullanımı olarak tanımlandı. Hastane yatış süresi on günden uzun olan hastalar uzamış yatış süresi olarak değerlendirildi. Normal nutrisyonel durum ve malnutrisyon riski altındaki hasta gruplarının özellikleri t-testi ile karşılaştırıldı. Nutrisyonel risk, polifarmasi ve hastane yatış süresi arasındaki ilişki korelasyon analizleri ile değerlendirildi. Bulgular: 760 kadın (%53,5), 662 erkek (%46,5) hasta çalışmaya alındı. Hastane başvurusu sırasında 656 hastada (%46,2) malnutrisyon riski saptanmaz iken 766 hasta (%53,8) malnutrisyon riski altında olarak değerlendirildi. Malnutrisyon riski cinsiyetler arasında farklılık göstermemekle birlikte yaş artışı ile ilişkili olarak saptandı. Malnutrisyon riski altındaki hastalarda malnutrisyon riski olmayan hastalara göre anlamlı olarak daha uzun hastane yatış süreleri saptandı (p

Nutritional status of the patients in neurology clinic and its relation with polypharmacy and length of hospital stay

Purpose: Malnutrition may be present during hospitalization or may occur after hospitalization. Malnutrition in hospitalized patients is associated with many clinical outcomes. The aim of this study is to determine the nutritional status and evaluate the relationship between nutritional status and polypharmacy and length of stay in hospital in neurology clinic. Materials and method: This study was conducted on 1422 patients retrospectively who were hospitalized in Burdur State Hospital neurology clinic between September 2017 and September 2018. The nutritional status of the patients was recorded with the NRS-2002 scores. Patients with a total score of ≥3 were considered to be at risk of malnutrition. Polypharmacy was defined as the use of six and more drugs. Patients with a hospital stay longer than ten days were evaluated as prolonged hospital stay. The characteristics of patients with normal nutritional status and malnutrition risk were compared with the t-test. The relationship between nutritional risk, polypharmacy and length of hospital stay were evaluated by correlation analysis. Results: 760 women (53.5%) and 662 men (46.5%) were included in the study. 656 patients (46.2%) were not at risk of malnutrition during hospital admission and 766 patients (53.8%) were at risk of malnutrition. The risk of malnutrition was not associated with genders, but was associated with an increase in age. The length of hospital stay was longer in patients with malnutrition risk than patients without malnutrition risk (p

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1. Barker LA, Gout BS, Crowe TC. Hospital malnutrition: Prevalence, identification and impact on patients and the healthcare system. Int J Environ Res Public Health 2011;8:514-527. https://doi.org/10.3390/ijerph8020514
2. Allard JP, Keller H, Jeejeebhoy KN, et al. Decline in nutritional status is associated with prolonged length of stay in hospitalized patients admitted for 7 days or more: A prospective cohort study. Clin Nutr 2016;35:144-152. https://doi.org/10.1016/j.clnu.2015.01.009
3. Jebb SA. Incidence and recognition of malnutrition in hospital J. P. McWhirter and C. R. Pennington BMJ 1994;308:945-948. Clin Nutr 1994;13:267-268.
4. Kondrup J, Allison SP, Elia M, Vellas B, Plauth M. ESPEN guidelines for nutrition screening 2002. Clin Nutr 2003;22:415-421.
5. Anthony PS. Nutrition screening tools for hospitalized patients. Nutr Clin Pract 2008;23:373-382. https://doi. org/10.1177/0884533608321130
6. Fillit HM, Futterman R, Orland BI, et al. Polypharmacy management in Medicare managed care: Changes in prescribing by primary care physicians resulting from a program promoting medication reviews. Am J Manag Care 1999;5:587-594.
7. Jyrkka J, Enlund H, Lavikainen P, Sulkava R, Hartikainen S. Association of polypharmacy with nutritional status, functional ability and cognitive capacity over a three- year period in an elderly population. Pharmacoepidemiol Drug Saf 2011;20:514-522. https://doi.org/10.1002/ pds.2116
8. Edington J, Boorman J, Durrant ER, et al. Prevalence of malnutrition on admission to four hospitals in England. The Malnutrition Prevalence Group. Clin Nutr 2000;19:191-195. https://doi.org/10.1054/ clnu.1999.0121
9. Waitzberg DL, Caiaffa WT, Correia MI. Hospital malnutrition: The Brazilian national survey (IBRANUTRI): A study of 4000 patients. Nutrition 2001;17:573-580.
10. Velasco C, Garcia E, Rodriguez V, et al. Comparison of four nutritional screening tools to detect nutritional risk in hospitalized patients: A multicentre study. Eur J Clin Nutr 2011;65:269-274. https://doi.org/10.1038/ejcn.2010.243
11. Pirlich M, Schütz T, Norman K, et al. The German hospital malnutrition study. Clin Nutr 2006;25:563-572. https:// doi.org/10.1016/j.clnu.2006.03.005
12. Naber THJ, Schermer T, de Bree A, et al. Prevalence of malnutrition in nonsurgical hospitalized patients and its association with disease complications. Am J Clin Nutr 1997;66:1232-1239. https://doi.org/10.1093/ ajcn/66.5.1232
13. Sacks GS, Dearman K, Replogle WH, Cora VL, Meeks M, Canada T. Use of subjective global assessment to identify nutrition-associated complications and death in geriatric long-term care facility residents. J Am Coll Nutr 2000;19:570-577.
14. Kang MC, Kim JH, Ryu SW, et al. Prevalence of malnutrition in hospitalized patients: A multicenter cross- sectional study. J Korean Med Sci 2018;33:e10. https:// doi.org/10.3346/jkms.2018.33.e10
15. Vanderwee K, Clays E, Bocquaert I, Gobert M, Folens B, Defloor T. Malnutrition and associated factors in elderly hospital patients: A Belgian cross-sectional, multi- centre study. Clin Nutr 2010;29:469-476. https://doi.org/ 10.1016/j.clnu.2009.12.013
16. Corsonello A, Pedone C, Corica F, Antonelli Incalzi R. Polypharmacy in the elderly patients at discharge from the acute care hospital. Therapeutics and Clinical Risk Management 2007;3:197-203.
17. Wawruch M, Zikavska M, Wsolova L, et al. Polypharmacy in elderly hospitalised patients in Slovakia. Pharm World Sci 2008;30:235-242. https://doi.org/10.1007/s11096- 007-9166-3
18. Schuler J, Duckelmann C, Beindl W, Prinz E, Michalski T, Pichelr M. Polypharmacy and inappropriate prescribing in elderly internal-medicine patients in Austria. Wien Klin Wochenschr 2008;120:733-741. https://doi.org/10.1007/ s00508-008-1089-z
19. Runciman WB, Roughead EE, Semple SJ, Adams RJ. Adverse drug events and medication errors in Australia. Int J Qual Health Care 2003;15:i49-i59.
20. Lisby M, Nielsen LP, Mainz J. Errors in the medication process: Frequency, type, and potential clinical consequences. Int J Qual Health Care 2005;17:15-22. https://doi.org/10.1093/intqhc/mzi015
21. Agostini JV, Han L, Tinetti ME. The relationship between number of medications and weight loss or impaired balance in older adults. J Am Geriatr Soc 2004;52:1719- 1723. https://doi.org/10.1111/j.1532-5415.2004.52467.x
22. Chen CCH, Tang ST, Wang C, Huang GH. Trajectory and determinants of nutritional health in older patients during and six-month post-hospitalisation. J Clin Nurs 2009;18:3299-3307. https://doi.org/10.1111/j.1365- 2702.2009.02932.x
23. Schilp J, Winjhoven HA, Deeg DJ, Visser M. Early determinants for the development of undernutrition in an older general population: Longitudinal aging study Amsterdam. Br J Nutr 2011;106:708-717. https://doi. org/10.1017/S0007114511000717
24. Norman K, Pichard C, Lochs H, Pirlich M. Prognostic impact of disease-related malnutrition. Clin Nutr 2008;27:5-15. https://doi.org/10.1016/j. clnu.2007.10.007
25. Rasmussen HH, Kondrup J, Staun M, Ladefoged K, Kristensen H, Wengler A. Prevalence of patients at nutritional risk in Danish hospitals. Clin Nutr 2004;23:1009-1015. https://doi.org/10.1016/j. clnu.2004.01.001
26. Sorensen J, Kondrup J, Prokopowicz J, et al. EuroOOPS study group. EuroOOPS: An international, multicentre study to implement nutritional risk screening and evaluate clinical outcome. Clin Nutr 2008;27:340-349. https://doi.org/10.1016/j.clnu.2008.03.012
27. Khalatbari-Soltani S, Marques-Vidal P. The economic cost of hospital malnutrition in Europe: A narrative review. Clin Nutr ESPEN 2015;10:e89-e94. https://doi. org/10.1016/j.clnesp.2015.04.003
28. Kondrup J, Johansen N, Plum LM, et al. Incidence of nutritional risk and causes of inadequate nutritional care in hospitals. Clin Nutr 2002;21:461-468.
29. O’Flynn J, Peake H, Hickson M, Foster D, Frost G. The prevalence of malnutrition in hospitals can be reduced: Results from three consecutive cross-sectional studies. Clin Nutr 2005;24:1078-1088. https://doi.org/10.1016/j. clnu.2005.08.012
30. Johansen N, Kondrup J, Plum LM, et al. Effect of nutritional support on clinical outcome in patients at nutritional risk. Clin Nutr 2004;23:539-550. https://doi. org/10.1016/j.clnu.2003.10.008
31. Tappenden KA, Quatrara B, Parkhurst ML, Malone AM, Fanjiang G, Ziegler TR. Critical role of nutrition in improving quality of care: An interdisciplinary call to action to address adult hospital malnutrition. JPEN J Parenter Enteral Nutr 2013;37:482-497. https://doi. org/10.1177/0148607113484066
32. White H, Pieper C, Schmader K. The association of weight change in Alzheimer’s Disease with severity of disease and mortality: A longitudinal analysis. J Am Geriatr Soc 1998;46:1223-1227.
33. Ongun N. Does nutritional status affect Parkinson’s Disease features and quality of life? PLoS one 2018;13:e0205100. https://doi.org/10.1371/journal. pone.0205100
34. Dávalos A, Ricart W, Gonzalez-Huix F, et al. Effect of malnutrition after acute stroke on clinical outcome. Stroke. 1996;27:1028-1032.
35. Hafsteinsdóttir TB, Mosselman M, Schoneveld C, Riedstra YD, Kruitwagen CL. Malnutrition in hospitalised neurological patients approximately doubles in 10 days of hospitalisation. J Clin Nurs 2010;19:639-648. https://doi.org/10.1111/j.1365- 2702.2009.03142.x
36. Clavé P, Terré R, de Kraa M, Serra M. Approaching oropharyngeal dysphagia. Rev Esp Enferm Dig 2004;96:119-131.
37. McWhirter JP, Pennington CR. Incidence and recognition of malnutrition in hospital. BMJ 1994;308:945-948.
38. Khalatbari-Soltani S, Marques-Vidal P. Impact of nutritional risk screening in hospitalized patients on management, outcome and costs: A retrospective study. Clin Nutr 2016;35:1340-1346. https://doi. org/10.1016/j.clnu.2016.02.012
39. Omidvari AH, Vali Y, Murray SM, Wonderling D, Rashidian A. Nutritional screening for improving professional practice for patient outcomes in hospital and primary care settings. Cochrane Database Syst Rev 2013;6:CD005539. https://doi.org/10.1002/14651858. CD005539.pub2