HUBUNGAN STATUS GIZI (MINI NUTRITIONAL ASSESSMENT) DENGAN OUTCOME HASIL PERAWATAN PENDERITA DI DIVISI GERIATRI RUMAH SAKIT DOKTER KARIADI SEMARANG

Hardini, RA Sri (2005) HUBUNGAN STATUS GIZI (MINI NUTRITIONAL ASSESSMENT) DENGAN OUTCOME HASIL PERAWATAN PENDERITA DI DIVISI GERIATRI RUMAH SAKIT DOKTER KARIADI SEMARANG. Masters thesis, Program Pasca Sarjana Universitas Diponegoro.

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Abstract

BACKGROUND : Elderly people are at risk of malnutrition because of reduction in food intake due to changes in intestinal function, inefficient metabolism, failure in homeostasis, and defective nutrient utilization. In clinical practice as well as medical education, elderly nutritional status has received little attention. Malnutrition is common in hospitalized elderly and may influence hospitalization outcomes. The Mini Nutritional Assessment (MNA) was recently designed and validated to provide a single, rapid assessment of nutritional status of elderly patients either in outpatient clinics, hospitals, or nursing homes. OBJECTIVE : The aim of this study was to see the association assessment of nutritional status (using MNA) on hospital admission and length of stay (LOS), functional dependency, and mortality. Eating habit, and neuropsychological problem before on admission were also assessed. MATERIAL AND METHOD : The study was a cross sectional study. Geriatric patients admitted to Dokter Kariadi hospital between July 2004 until June 2005 were studied. Nutritional status was measured using MNA. The other data were Activity Daily Living on admission and on discharge, length of stay, change of Activity Daily Living, and in-hospital mortality. Statistical analysis was done with CM-square and Spearman's rank correlation with significance ofp < 0,05. RESULTS : The study covered 104 subjects, with 83 (79,81%) alive geriatric patients on discharge and 51 (61,45%) had improvement on their Activity Daily Living on discharge. The mean MNA score was 18,4 (± 5,63) and categorized to be malnourished 36,5%, at risk of malnutrition 44,3%, and satisfactory nutritional status 19,2%. MNA score was associated with both Activity Daily Living on admission (r=0,269 p=0,06), and on discharge (r=0,379 p=0,000), number of problem/acute disease (r=-0,298 p=0,002), and length of stay (r=-0,377 p=0,000). There was no association between MNA with the change of Activity Daily Living on discharge (x2:1,92 p=0,922), and in-hospital mortality (x =3,269 p=0,195). In this study, we found more than 50% geriatric patients had low number of meals, protein intake, and loss of appetite. They also had stress or acute disease before admission. CONCLUSION : There were associations between nutritional status measured by the MNA with Activity Daily Living on admission, and on discharge, number of problems/diseases, and length of stay. Low frequency of meal and low intake of protein were in line with the high prevalence of malnutrition scored by MNA. LATAR BELAICANG : Penderita geriatri selalu dalam risiko malnutrisi karena penurunan asupan makanan sebagai akibat perubahan fungsi usus, metabolisme tidak efektif, kegagalan homeostasis dan defek utilisasi nutrien. Status gizi penderita sebelumnya sering merupakan subyek yang ditinggalkan pada praktek klinik dan pada program pendidikan medis dasar maupun lanjutan. Malnutrisi sering terjadi pada penderita geriatri yang di rawat di rumah sakit dan bisa berpengaruh pada outcome hasil perawatan. MNA (Mini Nutritional Assessment) didesain dan telah dibuktikan bagus sebagai alat kajian tunggal dan cepat untuk menilai status gizi penderita geriatri pada penderita rawat jalan, penderita yang di rawat di rumah sakit dan di nursing home. TUJUAN : Penelitian ini bertujuan menganalisa hubungan antara MNA saat masuk di rumah sakit dengan lama waktu perawatan, fungsi kemandirian (dengan penilaian Aktifitas Kehidupan Sehari — hari = AKS) dan angka mortalitas.Selain itu dinilai pula kebiasaan makan dan problem neuropsikologis yang tercakup di dalam MNA yang dialami penderita sebelum di rawat di rumah sakit. SABAN DAN CARA : Desain penelitian adalah studi potong lintang. Subyek penelitian adalah penderita geriatri yang masuk perawatan di rumah sakit. Dokter Kariadi pada periode Juli 2004 sampai dengan Juni 2005. Status gizi dinilai dengan menggunakan MNA yang juga mengungkapkan kebiasaan makan dan problem neuropsikologis. Data lain meliputi AKS waktu masuk perawatan dan AKS waktu keluar, lama waktu perawatan, perubahan AKS waktu keluar bagi yang hidup dan angka mortalitas. Dilakukan analisa statistik dengan menggunakan uji x2 (Chi-square test) dan uji korelasi dari Spearman dengan tingkat kemaknaanp < 0,05. BASIL : Selama periode penelitian didapatkan penderita rawat inap sebanyak 104 lansia yang masuk perawatan di rumah sakit dan 83 penderita keluar hidup dengan 55 penderita mengalami perbaikan AKS Berdasar skor MNA didapatkan mean 18,4 (± 5,63) dan prevalensi 36,5% lansia kategori malnutrisi, 44,3% risiko malnutrisi dan 19,2% gizi baik. Skor MNA berhubungan dengan AKS waktu masuk perawatan (r=0,269 p=0,006), AKS waktu keluar (r=0,379 p=0,000), jumlah problem/penyakit akut saat masuk perawatan (r=-0,298 p=0,002) dan lamanya waktu perawatan (r=-0,377 p=0,000). Tidak ada hubungan antara skor MNA dengan perubahan AKS waktu keluar bagi penderita yang hidup (karena 51 dari 83 penderita geriatri terjadi perbaikan saat keluar) (x2=0,92 p=0,922), dan angka mortalitasnya (x2=3,269 p=0,I95). Lebih 50% penderita lansia yang jumlah asupan, konsumsi protein kurang maupun kehilangan nafsu makan serta mengalami stres/penyakit akut. SIMPULAN : Ada hubungan antara status gizi yang dinilai berdasar MNA dengan AKS waktu masuk perawatan maupun waktu keluar rumah sakit, jumlah problem/penyakit yang disandang dan lama waktu perawatan. Asupan makanan yang secara kuantitatif rendah mendukung temuan malnutrisi dan risiko malnutrisi yang diukur dengan skor MNA

Item Type:Thesis (Masters)
Subjects:K Law > K Law (General)
Divisions:School of Postgraduate (mixed) > Master Program in Notary
ID Code:15033
Deposited By:Mr UPT Perpus 1
Deposited On:22 Jun 2010 09:26
Last Modified:22 Jun 2010 09:26

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