Nutrition, Health and Life-Situation in Elderly Patients with Leg Ulcers
Abstract: 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.
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