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Nutrition, Health and Life-Situation in Elderly Patients with Leg Ulcers
Linköping University, Department of Medicine and Care, Nursing Science. Linköping University, Faculty of Health Sciences.
2000 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The aim of the present work was to describe nutrition, health and life-situation over time in elderly patients with leg ulcers and to evaluate if dietary intervention could improve healing in otherwise therapy resistant venous leg ulcers. All patients, mean age 80 years (range 66-97 years), were living at home and receiving treatment for their leg u1cers within the primary health care system.

A summary of the main measurements follows. Food diaries and diet histories were performed to collect data conceming dietary intakes. Dietary intakes were assessed by making calculations of energy and nutrients. To evaluate dietary quality, a qualitative meal classification method was used. Mini Nutritional Assessment was used to assess nutritional status. In the intervention study, the patients were offered dietary supplements containing energy, vitamins and minerals to be taken daily between ordinary meals in a specially designed diet plan based on individual needs and the patient's own preferences; The Philadelphia Geriatric Center Multilevel Assessment Instrument was used to investigate the life-situation.

The intakes of energy and nutrients were not optimal in relation to the Swedish Nutrition Recommendations. Nearly half of 70 patients were assessed as being in the risk zone of malnutrition and two were assessed as being malnourished. Patients in the risk zone of malnutrition were usually living alone, more dependent on aids for mobility and on home help services. They usually did not buy their food themselves and seldom ate in company. Incomplete Meals and Low Quality Snacks were the most common eating types. Compared to people of the same age without leg ulcers the patients with leg ulcers had a worse lifesituation with respect to behavioural competence, personal adjustment and environmenta1 quality. Pain was a common problem. Thirty-eight of 70 patients could be folIowed from 1996 to 2000. In 2000, nineteen patients had healed ulcers. Two patients had required amputation and had no ulceration after surgery and seventeen patients had open ulcers. The patients with healed ulcers had better nutritional status and a better life-situation with respect to social interaction than patients with open ulcers. The patients with healed ulcers had improved perceived environmental quality over time. Before the intervention, six patients presented with 10 ulcerated legs. After nine months two patients, one with two ulcerated legs and another with one u1cerated leg had healed u1cers. In one patient with two ulcerated legs, one leg was healed and one was almost healed. In another patient with one ulcerated leg, the ulcer area was reduced by approximately 90%.

Risk for malnutrition was common, probably due to poor intake. The life-situation was worse when compared to elderly of the same age. Patients whose ulcers had healed in the mean time had a better nutritional status and social interaction than patients with open ulcers. Nutritional assessment and preventive actions to meet the nutritional needs of elderly patients with leg ulcers are important. Health promotive and preventive strategies ought to be developed and initiated since reduced everyday activity may be threatening to ulcer healing, nutrition and health.

Place, publisher, year, edition, pages
Linköping: Linköpings universitet , 2000. , 57 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 654
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-27557Local ID: 12219ISBN: 91-7219-755-2 (print)OAI: oai:DiVA.org:liu-27557DiVA: diva2:248109
Public defence
2000-12-08, Berzeliussalen, Hälsouniversitetet, Campus US, Linköpings universitet, Linköping, 00:00 (Swedish)
Opponent
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2012-08-16Bibliographically approved
List of papers
1. Nutritional intake and physical activity in leg ulcer patients
Open this publication in new window or tab >>Nutritional intake and physical activity in leg ulcer patients
1997 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 25, no 3, 571-578 p.Article in journal (Refereed) Published
Abstract [en]

The aim of the study was to describe the nutritional intake, meal patterns, physical activity and need for help in nine women living in their own homes and being treated for venous leg ulcers. Food habits were identified by use of interviews and food diaries completed by the women during a period of seven days. The intake of energy and nutrients from 304 eating events during seven days was calculated and meal patterns were evaluated using a qualitative system for meal classification. Physical activity and the degree of need were identified with the help of interviews. The intakes of energy and key nutrients for wound healing, such as protein, vitamin C and zinc, were not optimal according to the Swedish nutrition recommendations, although food habits were well organized. Most of the women had hardly any physical activities and the need of help and support varied, from daily visits to visits every second week.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-79946 (URN)10.1046/j.1365-2648.1997.1997025571.x (DOI)9080285 (PubMedID)
Available from: 2012-08-16 Created: 2012-08-16 Last updated: 2017-12-07Bibliographically approved
2. Monitoring of dietary quality in outpatients by qualitative meal classification method
Open this publication in new window or tab >>Monitoring of dietary quality in outpatients by qualitative meal classification method
1998 (English)In: Journal of human nutrition and dietetics (Print), ISSN 0952-3871, E-ISSN 1365-277X, Vol. 11, no 2, 125-133 p.Article in journal (Refereed) Published
Abstract [en]

Background: The aim of this study was to evaluate whether qualitative meal-classification used as a dietary evaluation tool reflects eating frequency and key nutrients in the diet, and whether it could be used to monitor the dietary quality in elderly outpatients. The qualitative meal-classification tool used was based on eight food categories combined into four types of meals: Complete, Incomplete, Less Balanced and Vegetarian Meals, and three types of snacks: High-, Mixed- and Low-Quality Snacks.

Methods: Dietary intake was assessed during 7 consecutive days by use of an estimated food record in nine elderly women with leg ulcers. Mean 7-day dietary intakes of energy, macronutrients, beta-carotene, retinol, vitamin E, ascorbic acid, calcium, iron, zinc and dietary fibre were calculated. Each eating event was classified in accordance with the food-based classification method. The frequency of the four types of meals and three types of snacks, their energy content and nutrients, and their contribution to total intake were subsequently analysed.

Results: Meals were associated with a higher energy, vitamin and mineral content than were snacks. Complete Meals were the major source for beta-carotene and ascorbic acid. Intakes from Low-Quality Snacks were relatively high in energy, fat and sucrose.

Conclusion: The qualitative meal-classification tool was found to be simple to use and useful for reflecting meal order and the nutritional roles of different types of meals and snacks in the diet. This method is recommended for dietary monitoring.

Keyword
elderly outpatients, meal patterns, nutrition, qualitative meal classification
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-79947 (URN)10.1046/j.1365-277X.1998.00089.x (DOI)
Available from: 2012-08-16 Created: 2012-08-16 Last updated: 2017-12-07Bibliographically approved
3. The relationship between nutritional status and physical activity, ulcer history and ulcer-related problems in patients with leg and foot ulcers
Open this publication in new window or tab >>The relationship between nutritional status and physical activity, ulcer history and ulcer-related problems in patients with leg and foot ulcers
1999 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 13, no 2, 123-128 p.Article in journal (Refereed) Published
Abstract [en]

The nutritional status in patients with leg and foot ulcers is assessed in relation to sociodemographic data, mobility, physical activity, ulcer history, and ulcer-related problems from the patients' point of view. The patients (20 men and 50 women, mean age 79 years) were living in their own homes and treatment was given in primary health care. The Mini Nutritional Assessment (MNA) was used to assess nutritional status. Interviews were conducted to collect data on patients' mobility, physical activity, ulcer history and ulcer-related problems. According to the MNA, 32 patients were classified as being at risk of malnutrition and two were malnourished. Patients classified as at risk of malnutrition or malnourishment were usually living alone and were more dependent on aids for mobility and on home-help services than the well-nourished patients (p < 0.05). There were no significant differences between the well-nourished patients and those classified as at risk of malnutrition or malnourished in the number and the duration of open ulcers. This study shows that risk of malnutrition was common in this elderly population of 70 patients with leg and foot ulcers. Comprehensive patient care should include nutritional assessment and preventive actions to restore the nutritional status before malnutrition is manifest.

Keyword
Elderly, Leg ulcer, nutritional status, Primary health care
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-79948 (URN)
Available from: 2012-08-16 Created: 2012-08-16 Last updated: 2017-12-07Bibliographically approved
4. Meal patterns and meal quality in patients with leg ulcers
Open this publication in new window or tab >>Meal patterns and meal quality in patients with leg ulcers
2000 (English)In: Journal of human nutrition and dietetics (Print), ISSN 0952-3871, E-ISSN 1365-277X, Vol. 13, no 1, 3-12 p.Article in journal (Refereed) Published
Abstract [en]

Background Wound healing is a complex process, which requires adequate energy sources, proteins, and specific minerals and vitamins. If an individual is unable to get or to eat the nutrients required, the wound healing process might be disrupted. The aim of this study was to investigate food-related factors, meal patterns and meal quality in relation to nutritional status in elderly out-patients with leg ulcers.

Methods Nutritional status was assessed by use of the Mini Nutritional Assessment in 70 patients living in their own homes. Fifty-six of the patients recorded actual meals and snacks over four consecutive days. Meal patterns and meal quality were evaluated with the help of a qualitative classification system, the Food Based Concept for Classification of Eating Episodes.

Results Thirty-six patients were classified as well-nourished, 32 were at risk of malnutrition and two were malnourished. More patients in the risk group for malnutrition did not buy their own food, and usually ate alone. Incomplete Meals and Low Quality Snacks were the most common eating types. The patients at risk of malnutrition had significantly fewer prepared Complete Meals than the well-nourished patients.

Conclusion The results show a diet and meal quality which hardly meets the requirements for nutrients that are important in wound healing, especially for those patients assessed at risk of malnutrition.

Keyword
elderly, out-patients, leg ulcer, meal patterns, meal quality, nutrition
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-26869 (URN)10.1046/j.1365-277X.2000.00207.x (DOI)11490 (Local ID)11490 (Archive number)11490 (OAI)
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2012-08-16Bibliographically approved
5. Life situation and function in elderly people with and without leg ulcers
Open this publication in new window or tab >>Life situation and function in elderly people with and without leg ulcers
2002 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 16, no 1, 59-65 p.Article in journal (Refereed) Published
Abstract [en]

The majority of elderly patients with leg ulcers live at home and receive treatment for their ulcers within the primary health care system. Little is known about the patients' ability or behaviour in the life situation and how well they manage their daily life at home. The Philadelphia Geriatric Center Multilevel Assessment Instrument (PGC MAI) was used to assess and compare the life situation in 70 patients (mean age 79 +/- 6.5 years) with leg ulcers and in 74 elderly persons (mean age 80 +/- 5.7 years) without leg ulcers. The patients with leg ulcers had significantly lower mean values in the domains of physical health, activity of daily living (ADL), cognition, time use and social behaviour, personal adjustment and environmental quality than those without ulcers. Sixty-three percent of the patients reported ulcer-related pain, and all of them were dependent on health care personnel for dressing changes. This may indicate that the life situation among elderly persons with leg ulcers is not so good as compared with that of elderly persons without ulcers and that patients with leg ulcers are more vulnerable than elderly people of the same age.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-26875 (URN)10.1046/j.1471-6712.2002.00051.x (DOI)11985750 (PubMedID)11496 (Local ID)11496 (Archive number)11496 (OAI)
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2012-08-16Bibliographically approved
6. A follow-up study of ulcer healing, nutrition, and life-situation in elderly patients with leg ulcer
Open this publication in new window or tab >>A follow-up study of ulcer healing, nutrition, and life-situation in elderly patients with leg ulcer
2001 (English)In: The Journal of Nutrition, Health & Aging, ISSN 1279-7707, E-ISSN 1760-4788, Vol. 5, no 1, 37-42 p.Article in journal (Refereed) Published
Abstract [en]

This study was undertaken in order to follow up ulcer healing, ulcer recurrence, nutritional status and life-situation in elderly patients with leg ulcers. Of 70 patients assessed previously in 1996, 43 (61%) were still alive in 2000 and, of these, 38 (88%) participated in the follow-up. Rate of healing, recurrence and amputation were obtained from medical records and interviews with the patients. The Mini Nutritional Assessment (MNA) was used to assess their nutritional status and the Philadelphia Geriatric Center Multilevel Assessment Instrument was used for assessment of their life-situation. Nineteen patients (50%), mean age 82+/-4.6 years, had healed ulcers. Two (5%) patients, mean age 86+/-2.8, had required amputation and had no ulceration after surgery. Seventeen patients (45%), mean age 80.3+/-6 years, had open ulcers, six had their original ulcers still unhealed, and 11 had open recurrent ulcers. Decreased mean MNA scores, as well as decreased mean scores in ADL and mobility, were seen over time in patients with open ulcers but not in those who were healed. Patients with healed ulcers had significantly higher mean scores in social interaction than those with open ulcers and significantly increased mean scores in environmental quality over time. The results indicate that nutrition and the life-situation might be related to leg ulcer healing. The nutritional situation and the whole life-situation should be observed and taken into consideration when care is planned. Additional research is needed to increase the understanding of the relationship between nutrition, life-situation and ulcer healing.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-26871 (URN)11250668 (PubMedID)11492 (Local ID)11492 (Archive number)11492 (OAI)
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2012-08-16Bibliographically approved
7. Nutritional support for elderly patients with non-healing venous ulcers: a single case study
Open this publication in new window or tab >>Nutritional support for elderly patients with non-healing venous ulcers: a single case study
Show others...
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Tills single-case study was undertaken in order to evaluate if an individually designed programme of nutritional support could improve healing in otherwise therapy resistant venous leg ulcers. Six patients, between 79 and 93 years of age, with venous ulcers open for one year or more were recruited from primary health care. The patients were offered liquid dietary supplements to be taken between meals in a specially designed diet plan based on individual needs and the patient's own preferences. Ulcer area, anthropometric and biochemical variables, and intake of energy and nutrients were assessed before intervention and then regularly for nine months.

After nine months, two patients, one with two ulcerated legs and another with one ulcerated leg had healed ulcers. In one patient with two ulcerated legs, one leg was healed and one leg almost healed. In another patient with one ulcerated leg, the ulcer area was reduced by about 90%. The duration of open ulcers before the study in the healed legs was 2, 1.5, 4, and 8 years and in those almost healed 4, and 1.5 years. It seems reasonable to suggest that nutritional support might have played a role in improving healing in those patients with a less satisfactory situation nutritionally. Although the relationship between nutritional supplementation and wound healing is far from well defined, an appropriately used nutritional plan is recommended when problems with the nutritional situation are anticipated and the ulcers do not heal.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-79951 (URN)
Available from: 2012-08-16 Created: 2012-08-16 Last updated: 2012-08-16Bibliographically approved

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