Factors associated with dietitian referrals to support long-term care residents advancing towards the end of life

IF 2.9 3区医学 Q3 NUTRITION & DIETETICS

Journal of Human Nutrition and Dietetics Pub Date : 2024-03-06 DOI:10.1111/jhn.13294

Jill Morrison-Koechl, George Heckman, Albert Banerjee, Heather Keller

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引用次数: 0

Abstract

Background

Dietitians are central members of the multidisciplinary long-term care (LTC) healthcare team. The overall aim of this current investigation is to gain a better understanding of dietitian involvement in LTC resident's end-of-life care via referrals.

Methods

Retrospective chart reviews for 164 deceased residents (mean age = 88.3 ± 7.3; 61% female) in 18 LTC homes in Ontario, Canada, identified dietitian referrals and documented eating challenges recorded over 2-week periods at four time points (i.e., 6 months, 3 months, 1 month and 2 weeks) prior to death. Nutrition care plans at the beginning of these time points were also noted. Logistic mixed effects regression models identified time-varying predictors of dietitian referrals. Bivariate tests identified associations between nutrition orders and dietitian referrals that occurred in the last month of life.

Results

Nearly three-quarters (73%) of participants had at least one dietitian referral across the four observations. Referrals increased significantly with proximity to death; 45% of residents had a referral documented in the last 2 weeks of life. Dietitian referrals were associated with the number of eating challenges (odds ratio [OR] = 1.42, 95% confidence interval [CI] = 1.27, 1.58). Comfort-focused nutrition care orders were significantly more common when a dietitian was referred (25%) compared with when a dietitian was not referred (12%) in the final month of life (p = 0.04).

Conclusions

Our findings suggest that dietitians are involved in end-of-life and comfort-focused nutrition care initiatives, yet they are not engaged consistently for this purpose. This presents a significant opportunity for dietitians to upskill and champion palliative approaches to nutrition care within the multidisciplinary LTC team.

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营养师转介以支持迈向生命终点的长期护理居民的相关因素。

背景：营养师是多学科长期护理（LTC）医疗团队的核心成员。本次调查的总体目标是更好地了解营养师通过转介参与长期护理中心居民临终关怀的情况：方法：对加拿大安大略省 18 家 LTC 养老院的 164 位已故住院者（平均年龄 = 88.3 ± 7.3；61% 为女性）进行回顾性病历审查，确定营养师转诊情况，并记录死亡前四个时间点（即 6 个月、3 个月、1 个月和 2 周）的 2 周饮食挑战。同时还记录了这些时间点开始时的营养护理计划。逻辑混合效应回归模型确定了营养师转介的时变预测因素。双变量检验确定了生命最后一个月发生的营养订单与营养师转介之间的关联：近四分之三（73%）的参与者在四次观察中至少有一次营养师转介。随着死亡时间的临近，转诊率明显增加；45%的居民在生命的最后两周内有转诊记录。营养师转介与饮食挑战的数量有关（几率比 [OR] = 1.42，95% 置信区间 [CI] = 1.27，1.58）。在生命的最后一个月，有营养师转介（25%）与没有营养师转介（12%）相比，以舒适为重点的营养护理指令明显更常见（P = 0.04）：我们的研究结果表明，营养师参与了生命末期和以舒适为重点的营养护理活动，但他们并没有为此目的持续参与。这为营养师在多学科长寿护理团队中提高技能和倡导姑息营养护理方法提供了重要机会。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Human Nutrition and Dietetics 医学-营养学

CiteScore

5.30

自引率

15.20%

发文量

133

审稿时长

6-12 weeks

期刊介绍： Journal of Human Nutrition and Dietetics is an international peer-reviewed journal publishing papers in applied nutrition and dietetics. Papers are therefore welcomed on: - Clinical nutrition and the practice of therapeutic dietetics - Clinical and professional guidelines - Public health nutrition and nutritional epidemiology - Dietary surveys and dietary assessment methodology - Health promotion and intervention studies and their effectiveness - Obesity, weight control and body composition - Research on psychological determinants of healthy and unhealthy eating behaviour. Focus can for example be on attitudes, brain correlates of food reward processing, social influences, impulsivity, cognitive control, cognitive processes, dieting, psychological treatments. - Appetite, Food intake and nutritional status - Nutrigenomics and molecular nutrition - The journal does not publish animal research The journal is published in an online-only format. No printed issue of this title will be produced but authors will still be able to order offprints of their own articles.