Posouzení výživového stavu v komplexní diagnostice a managementu geriatrické křehkosti

• Název práce v češtině: Posouzení výživového stavu v komplexní diagnostice a managementu geriatrické křehkosti
• Název v anglickém jazyce: The assessment of nutritional status in the comprehensive diagnosis and management of geriatric frailty
• Klíčová slova: geriatrická křehkost, podvýživa, geriatrický pacient, soběstačnost
• Klíčová slova anglicky: geriatric frailty, malnutrition, geriatric patient, self-sufficiency
• Akademický rok vypsání: 2016/2017
• Typ práce: diplomová práce
• Jazyk práce: čeština
• Ústav: III. interní klinika – klinika endokrinologie a metabolismu 1. LF UK a VFN (11-00530)
• Vedoucí / školitel: prof. MUDr. Eva Topinková, CSc.
• Řešitel: skrytý - zadáno a potvrzeno stud. odd.
• Datum přihlášení: 17.10.2016
• Datum zadání: 17.10.2016
• Datum potvrzení stud. oddělením: 17.10.2016
• Datum a čas obhajoby: 15.06.2017 00:00
• Datum odevzdání elektronické podoby: 11.04.2017
• Datum proběhlé obhajoby: 15.06.2017
• Předmět: Obhajoba diplomové práce (B02793)
• Oponenti: MUDr. Eva Meisnerová

Seznam odborné literatury

Seznam použité literatury:
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Předběžná náplň práce

Abstrakt
Cíle práce:Cílem této neintervenční observační studie bylo zjistit prevalenci křehkosti v souboru 200 geriatrických pacientů a její korelaci a závislost ve vztahu k nutričnímu stavu. Též zhodnotit vzájemné korelace mezi jednotlivými položkami testových baterií MNA – SF a SPPB a určit, zda má hmotnostní úbytek vztah ke zhoršeným výsledkům v hodnocení geriatrické křehkosti. Dále zhodnotit, zda kognitivní funkce ovlivňují nutriční stav a zároveň zda nutriční stav ovlivňuje soběstačnost probandů zkoumaného souboru.
Metody: Jako data k této diplomové práci byly využity výsledky standardně vy-užívaných testů v rámci komplexního geriatrického hodnocení (Comprehensive Geriatric, Assessment, CGA) Geriatrické kliniky VFN a 1. LF UK, které zahrnují posouzení soběstačnosti (ADL) a fyzické zdatnosti (SPPB), poznávacích a kognitivních funkcí (MMSE) a posouzení stavu výživy (MNA – SF). U pacientů byla též zjišťována tělesná hmotnost, výška a BMI.
Výsledky: Do studie bylo zařazeno celkem 200 pacientů, z nichž 46 (23 %) bylo mužů a 154 žen (77 %). Geriatrická křehkost byla diagnostikována u 59,5 % pacientů, 29,5 % pacientů bylo klasifikováno jako „pre-frailty“ (v riziku rozvoje křehkosti) a 19 % mělo dobrou fyzickou zdatnost. Podvyživených pacientů v tomto souboru bylo 15,5 %, v riziku podvýživy 37,5 % a v dobrém nutričním stavu 47 %. Statisticky významná závislost mezi nutričním stavem a geriatrickou křehkostí byla prokázána – χ² = 30,337, p = 0,000 (< 0,050). Závislost mez váhovým úbytkem a výsledky v testové baterii SPPB prokázaná nebyla – χ² = 8,012, p = 0,237, ani závislost nutričního stavu a kognitivních funkcí - χ² = 12,982, p = 0,112. Statisticky významná závislost byla prokázána mezi poruchami soběstačnosti a výživovým stavem – χ² = 79,233, p = 0,000 (< 0,050).
Závěr: Vzhledem k vysoké prevalenci podvýživy u pacientů ohrožených geriatrickou křehkostí či již křehkých, není pochyb, že malnutrice je významným indikátorem geriatrické křehkosti. Nutriční podpora založená na vyváženém příjmu energie, dostatku kvalitních bílkovin, minerálních látek, vitaminů (především vitamin D) a pravidelná fyzická aktivita jsou základními kameny multidisciplinární léčby, která je v geriatrii nezbytná.

Předběžná náplň práce v anglickém jazyce

Abstract
Objectives: The aim of this non-interventional observational study was to determine the prevalence of frailty in a cohort of 200 elderly patients and its correlation and dependence in relation to nutritional status and to evaluate the correlation of the items in the MNA - SF and SPPB test batteries and determine whether the weight loss is related to poor results in the evaluation of geriatric frailty, and to evaluate whether cognitive function affects nutritional status and if nutritional status in such circumstances affects subjects’ self-sufficiency.
Methods:Data was sourced from the results of standardized tests in Comprehensive Geriatric, Assessment, CGA at the 1. LF UK Geriatric Clinic, which include the assessment of selfsufficiency (ADL) and condition (SPPB), cognitive functions (MMSE) and the assessment of nutritional status (MNA - SF). Patients were also measured for bodyweight, height and BMI.
Results:The study included a total of 200 patients, of whom 46 (23%) were men and 154 women (77%). Geriatric frailty was diagnosed in 59.5% of patients, with 21.5% of patients being classified as "pre-frailty" and 19 % of good physical condition. In this group 15.5% of patients were malnourished, 37.5% were at risk of malnutrition and 47 % were in a good nutritional condition. A statistically significant relationship between nutritional status and geriatric fragility was demonstrated between self-sufficiency and nutritional status - χ2 = 79.233, p = 0.000 (< 0,05).
Conclusion: Considering the high prevalence of malnutrition in geriatric patients at risk of frailty or already frail, there is no doubt that malnutrition is an important indicator and initiator of geriatric frailty. Nutritional support based on a balanced energy intake, plenty of quality protein, minerals, vitamins (especially vitamin D) and regular physical activity are the cornerstones of the multidisciplinary treatment necessary in geriatrics.