Radka Kozáková

Comparison of three screening tools for nutritional status assessment of the elderly in their homes.

BACKGROUND The prevailing recommendation for the elderly is to live in their own homes as long as conditions allow. With this emphasis on the natural living environment, it is imperative to closely monitor both the general health and nutritional needs of the elderly in community settings. AIM The aim of the study was to compare three nutritional status screening and evaluation tools of the elderly in their homes. METHODS Testing of measuring instruments, MNA, SGA, and MUST took place in the homes of 120 seniors in selected areas of the Czech and Slovak Republics. The study included 120 seniors. For testing of the relationships and dependencies, Pearsons correlation coefficient, t and Fisher tests were used. The level of statistical significance was α = 0.05. RESULTS All tests were to a large degree correlated (p(MNA) = 0.0049; p(MUST) = -0.537; p(SGA) = -0.578) with the body mass index of the seniors. Simultaneously, it was confirmed that the tools for assessing nutritional status in the study showed significant differences regarding the classification of patients at risk of malnutrition and/or malnourished patients. CONCLUSIONS Based on the findings, we conclude that MNA appeared to be a more appropriate tool for nutritional assessment of the elderly living in their homes. SGA and MUST provided rather subjective evaluation of the nutritional status and did not furnish an in-depth categorization of malnutrition.

Clinical Validation of the Nursing Diagnosis Caregiver Role Strain in the Czech Republic

PURPOSE The aim of the study was to clinically validate the defining characteristics of the nursing diagnosis caregiver role strain in the Czech Republic. METHODS This is a cross-sectional study. The patient-focused clinical diagnostic validity model was used for clinical validation. FINDINGS Only two major defining characteristics were identified for caregiver role strain in a sample of 225 caregivers. CONCLUSION The study has identified the most frequently present defining characteristics related to the nursing diagnosis caregiver role strain in a caregiver population in the Czech Republic caring for their loved ones in home settings. IMPLICATIONS FOR NURSING PRACTICE It is important that defining characteristics aid diagnosis and direct nursing interventions.

Psychometric evaluation of a Czech version of the Family Inventory of Needs

OBJECTIVE Identification of areas that family members consider important and in which they need help and support is one of the main goals of palliative care. Our research aimed to assess the psychometric properties of a Czech version of the Family Inventory of Needs (FIN). METHOD The group comprised 272 family members of terminally ill cancer patients at the University Hospital in Ostrava. Reliability was assessed by internal consistency (Cronbachs alpha), test-retest reliability, and correlation of both scales and items within the scales (item-total correlation). To verify construct validity, exploratory factor analysis and principal component analysis with a varimax rotation were utilized. RESULTS Using exploratory factor analysis, the following four factors (domains) were extracted: basic information, information on treatment and care, support, and comfort of the patient. Cronbachs α for the entire questionnaire was 0.924 on the importance scale and 0.912 for the satisfaction scale; for all domains, a value of α greater than 0.7 was ascertained. Test-retest reliability was also higher than 0.7 for all domains. On the satisfaction scale, a moderate correlation was confirmed between unmet needs in the domains basic information, support, and comfort of the patient, and the total score, and in selected quality-of-life domains. SIGNIFICANCE OF RESULTS The results of tests on the psychometric properties of the FIN questionnaire demonstrated at least satisfactory validity and reliability, and confirmed that it can be employed to assess the needs of palliative care patients in the Czech Republic.

The Unmet Needs of Patients With Progressive Neurological Diseases in the Czech Republic: A Qualitative Study

Aim: The aim of our research was to explore the unfulfilled needs of patients with a progressive neurological disease in advanced stage of the illness within the current system of health and social care in the Czech Republic. Design and Setting: Qualitative research (grounded theory) was used to conceptualize the patterns of unmet palliative care needs in Czech Republic. Methods: The data collection method comprised individual, in-depth interviews (n = 19) and focus groups (n = 4) where a total of 52 respondents participated (patients with progressive neurological diseases [PNDs], family members, and professionals). Results: Two main categories of unfulfilled needs were determined (life with the disease, professional help), and they were described in the context of the 3 crucial themes identified in the study—the symptoms of the advanced stage of the disease resulted in substantial reduction of physical self-sufficiency, loss of autonomy, and social isolation; the level of dependence on the support and help of others increased; the patients also highlighted several problems related to health-care services. Conclusion: The unmet needs should be taken into consideration when creating the concept of the neuropalliative and rehabilitation care, including the mental health support plan, because of the emotional, behavioral, and cognitive disorders that frequently occur in the lives of a substantial amount of patients with PND.

Predictors of Change in Quality of Life in Patients With End-Stage Disease During Hospitalization

Background: Currently, there are no studies aimed at evaluating the quality of life (QoL) of patients with end-stage disease during hospitalization and the factors that influence it. Aim: The aim of the research was to identify predictors of change in the QoL of patients hospitalized due to advanced stage of disease. Methods: The sample consisted of 140 patients with end-stage disease who were hospitalized on this account. For evaluation of QoL, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) was used. The Hospital Anxiety and Depression Scale and Karnofsky Performance Status questionnaires were used for the assessment of mental and functional status. For the evaluation of predictors of negative change in QoL, a logistic regression analysis was used. Results: During hospitalization, there was a significant deterioration in the scores given for all domains of the functional QLQ-C30 scale, but not the symptomatic scale. Predictors of change in overall QoL detected were marital status, improved functional status, and depression detected on admission to hospital. Gender and age were found to be protective factors against deterioration in overall QoL. Conclusion: Sociodemographic characteristics and mental and functional status may be associated with change in QoL of patients with end-stage disease during hospitalization.

NUTRITIONAL STATUS ASSESSMENT OF PATIENTS IN A GENERAL PRACTITIONER’S OFFICE

Aim: The study aimed at determining the nutritional status of senior citizens in a general practitioners office. Design: A cross-sectional study. Methods: Nutritional status was assessed with the Mini Nutritional Assessment (MNA), Malnutrition Universal Screening Tool (MUST), Mini Nutritional Assessment - Short Form (MNA-SF) and laboratory parameters (prealbumin, transferrin and CRP). The study comprised 241 participants. The significance of differences in selected nutritional markers for various groups was determined using a chi-squared test, Spearmans correlation coefficient and Fishers test at a critical statistical significance level of 0.05. Results: Malnutrition was detected in a relatively high proportion of the elderly, ranging from 13% to 90% depending on the tools used. There were significant differences between the tools when identifying patients as malnourished or being at risk of malnutrition. The MNA revealed more patients at risk of or with malnutrition (90%) than the MNA-SF (58%) or MUST (13%). No statistically significant correlations were found either between nutritional status and biochemical markers of nutrition or between nutritional status and age of the elderly. Conclusion: In the general practice setting, nutrition of the elderly must not be neglected as adequate nutrition is a prerequisite for faster convalescence and return to a normal life.

Measuring quality of life of cognitively impaired elderly inpatients in palliative care: psychometric properties of the QUALID and CILQ scales

ABSTRACT Objectives: The study aimed to assess the psychometric properties of the Czech versions of the Quality of Life in Late-Stage Dementia (QUALID) and the Cognitively Impaired Life Quality (CILQ) scales for use in the palliative care setting in terminally ill patients with cognitive impairment. Methods: The sample comprised 306 cognitively impaired inpatients with advanced cancer and non-cancer conditions. In this cross-sectional study, two Quality of Life (QoL) measurements were performed at baseline and after five days. The dimensionality of the QUALID and CILQ scales was evaluated using a principal component analysis with Varimax rotation. Reliability was assessed using Cronbachs alpha; inter-rater reliability was evaluated with Kappa index. Test–retest stability was calculated using the intraclass correlation coefficients (ICCs) comparing scores from baseline and 3–5 days post-baseline. The construct validity of the QUALID and CILQ scale was established by Spearmans correlation coefficients with the Symptom Management at the End-of-Life in Dementia (SM-EOLD). Results: Both scales were shown to have adequate validity and reliability (Cronbachs α = 0.812 for QUALID, and α = 0.73 for CILQ), good inter-rater agreement (QUALID: κ = 0.760; CILQ: κ = 0.801) as well as test–retest reliability (QUALID: ICC = 0.847; CILQ: ICC = 0.925). Conclusion: The Czech versions of the QUALID and CILQ scales may be recommended for use in the Czech Republic in the area of palliative care.