Current Nutritional Management for Home Care Patients

The purpose of this study was to clarify the current nutritional management of patients receiving home-care services after discharge from Nagano Matsusiro General Hospital and to mull over the future nutritional management in their home. A questionnaire survey about nutrition was conducted on 53 home nursing care receivers and rehabilitation program participants. Patients with a body mass index of less than 18.5 (low BMI patients) accounted for 39.6%, and the total energy intake was predicted to be lower than necessary for these patients. Therefore, we deemed that it was necessary to calculate their nutritional requirements and evaluate their nutritional status. Nutritional evaluation was made in 84.9% of the patients. Weight was seldom measured, especialy among the enteral feeding groups. Not measuring weight is known to be related to an unfavorable outcome and hospitalization. Therefore, we thought it necessary to perform somatometry using a nutrition assessment kit, calculate nutritional requirements, and evaluate the nutritional status for risk reduction. Of the 44 patients who were taking food orally, 34.1% had dysphagia, and for 40% of them, there was no specific coping strategy. This indicated that dysphagia was not considered to be a major problem. A significantly large number of dysphagia cases were found among low BMI patients. For these patients, intervention by a speech therapist, as well as instruction about the risk of aspiration and choking, should be considered. There were significantly many a number of users of nutritional supplements among the low BMI patients, but 84.6% of them used products categorized as health foods. This suggested a lack of appropriate information about nutritional supplements. Accurate information should be provided to these patients. For nutritional management of home care patients, we concluded that intervention by multiple specialists (including dietitians, speech therapists, and dental hygienists) was necessary. The nutritional support team (NST) should intervene in cooperation with these specialists.