Per Bjurulf

The development and healing of pressure sores related to the nutritional state

The aims of the study were to investigate the relationship between nutritional state and the development of pressure sores and to test the hypothesis that supplementary nutritional support might prevent pressure sore development and improve healing. Newly admitted long-term care patients hospitalised for more than 3 weeks were included and randomised into an experimental and a control group. The nutritional state was evaluated using serum protein analyses, anthropometry and the delayed hypersensitivity skin test. Further, the patients condition was assessed weekly using a modified Norton scale. The experimental group received extra nutritional support. Significantly more patients with protein-energy malnutrition had, or developed, pressure sores. Regression analyses indicated albumin, mobility, activity and food intake as predictors for pressure sores. Patients who received extra nutritional support tended to develop fewer pressure sores and to heal existing pressure sores to a greater extent than the control group, although this did not reach statistical significance.

Feeding dependence and nutritional status after acute stroke.

BACKGROUND AND PURPOSEnWe assessed the nutritional status of patients with acute stroke and evaluated it in relation to the patients dependence on assistance with feeding.nnnMETHODSnFifty patients aged 70 years or older, admitted from their homes, were included. Weight index, triceps skinfold thickness, arm muscle circumference, serum proteins, delayed hypersensitivity, body composition measured by bioelectric impedance, and functional condition were determined on admission and 2 and 9 weeks after admission. Food and fluid consumption were also recorded.nnnRESULTSnOn admission, four patients were regarded as protein-energy malnourished. Those who required assistance with feeding after admission (n = 18, 36%) had lower serum albumin (P < .05), lower body cell mass (P < .01), and were more anergic than the independent patients (P < .01) on admission. The mean food consumption was 72% of the food served without significant difference between dependent and independent patients. Nine weeks after the onset of stroke symptoms, the patients who were dependent on assisted feeding showed a decrease in body cell mass. The loss of body cell mass was related to their activity and feeding dependence.nnnCONCLUSIONSnLow serum albumin and anergy commonly occur in elderly patients with acute stroke, and they occur more prevalently among those with a severely impaired functional condition. During the recovery period, the patients use body fat to compensate for energy needs, and immobility leads to loss of body cell mass.

Effects of dietary supplement on functional condition and clinical outcome measured with a modified Norton scale

Elderly long-term care patients (n = 501) were randomly allocated to receive dietary supplementation (400 kcal/day) in addition to a normal hospital diet, or normal hospital diet only, for 26 weeks. The patients functional condition was assessed by a modified Norton scale comprising mental condition, activity, mobility, food intake, fluid intake, incontinence and general physical state. Nutritional status was assessed by anthropometry, serum protein analysis and delayed hypersensitivity skin tests. Improvements during the first 8 weeks were seen in activity and general physical condition in the supplemented group, and in mobility and general physical condition in the control group. After 8 weeks the supplemented group showed a significantly higher level of activity (p < 0.05) compared to the control group. We conclude that in long-term geriatric care nutritional supplements help to maintain and improve the patients function.

The correlation between anergy, malnutrition and clinical outcome in an elderly hospital population

The nutritional state of 482 out of 501 newly admitted elderly patients was assessed by anthropometry, serum protein analyses and the delayed hypersensitivity skin test (DH) on admission and after 8 and 26 weeks. The mean age of the women was 81.3 +/- 7.7 and of the men 77.9 +/- 9.3. Protein-energy malnutrition (PEM) was initially defined as three or more subnormal criteria, one in each of the three categories of measurement. The data was then reanalysed excluding anergy and using the two other criteria only. The prevalence of PEM on the first assessment was 28.5% and was 10% higher when anergy was excluded as a criterion. PEM was more common in women and increased with age. The anergic patients had lower mean values in serum protein and anthropometry than those with normal reactivity. Anergic patients had a higher mortality rate and more pressure sores than the reactive group. Nutritional supplementation was associated with an increase in skin reactivity.

Influence of Macro-nutrient Status on Recovery after Hip Fracture

The objective of this study was to evaluate the influence of macro-nutrient status on recovery in patients with hip fracture and to observe nutrition during 2 post-operative months. Fifty patients aged 70 years or older, admitted from their homes, were included. Weight index, triceps skinfolds thickness, arm-muscle circumference, serum albumin and transthyretin, body composition, food intake and functional state were determined on admission and 2 and 9 weeks later. On admission, 38% of the patients were regarded as protein-energy malnourished. Subsequent discharge to own homes or need of continued institutional care was not significantly influenced by admission values of nutritional status and body composition, but was related to mental state and social conditions before the fracture and post-operative functional state, including activities of daily living. Deterioration of nutritional status 9 weeks after fracture was significantly greater in the continuing care group than in the discharged patients. Mac...