Aim. The aim of this study was to characterise the trajectory and to identify determinants of nu... more Aim. The aim of this study was to characterise the trajectory and to identify determinants of nutritional health over time in a sample of older hospitalised patients, using the Generalized Estimating Equation.Background. Nutritional health deteriorates and may fluctuate over time during and post-hospitalisation. To develop a target intervention it is essential that we first have a clear picture of how the nutrition changes and examine the determinants of nutritional health during and post-hospitalisation.Design. A prospective cohort study was conducted on 306 older hospitalised patients aged 65 years and older.Methods. Subjects were recruited from five surgical and medical wards at a tertiary medical center in northern Taiwan and assessed at four points in time: within 48 hours after admission, before discharge and 3–6 months post-discharge.Results. Nutritional health fluctuated significantly over time. The curve dropped during hospitalisation, returned at three months and rose slightly at six months post hospitalisation. After controlling for length of stay and surgical treatment, patients showed decreased cognitive capacity, worsening oral health, increased use of medications, increased functional limitations and raised depressive symptoms, all of which affects their nutritional health over time. The extent of functional status impacting on nutrition varies at different points in time while the predictability of other determinants remained stable.Conclusion. The trajectory of nutritional health is a reflection of the patients’ cognitive status, oral health, medication taken, functional status and depressive symptoms. The findings of our study should provide guidance in the development of intervention for the nutritional health of older patients during inpatient as well as transitional care.Relevance to clinical practice. Multi-faceted packages of interventions targeting a range of determinants for managing undernutrition and subsequent decline during and post-hospitalisation need to be tested.
Postsurgical functional decline is common in older patients and can lead to frailty and increased... more Postsurgical functional decline is common in older patients and can lead to frailty and increased mortality. Comprehensive interventions such as the Hospital Elder Life Program (HELP) have been shown to be effective, but modifying the HELP to include only 3 key interventions might prove cost-effective for surgical patients. Consecutive patients from August 2007 through April 2009 (n = 179) were enrolled if they had undergone common elective abdominal surgical procedures, such as gastrectomy, cholecystectomy, and Whipple surgery. A modified HELP intervention consisting of early mobilization, nutritional assistance, and therapeutic (cognitive) activities implemented by a trained nurse was introduced on a surgical ward in May 2008. Patients enrolled before May 2008 received usual care and served as controls (n = 77). Those enrolled after the modified HELP intervention constituted the experimental group (n = 102). Changes in performance of activities of daily living, nutritional status, and cognitive function between admission and discharge were the primary end points. Independent of baseline functions, education, periampullary diagnosis, comorbidity, surgical procedure, and duration of surgery, patients in the HELP group declined significantly less on activities of daily living performance and nutritional status (p < 0.001) than controls. The delirium rate was also significantly lower in the HELP group (0%) than in the control group (16.7%) (p < 0.001). The modified HELP intervention effectively reduced older surgical patients' functional decline and delirium rates by hospital discharge. This program, conducted by a trained nurse, was not costly but did require commitment and ongoing cooperation between physician and nursing leadership to achieve compliance with the protocols.
A concept analysis of malnutrition in the elderlyPurpose. Malnutrition is a frequent and serious ... more A concept analysis of malnutrition in the elderlyPurpose. Malnutrition is a frequent and serious problem in the elderly. Today there is no doubt that malnutrition contributes significantly to morbidity and mortality in the elderly. Unfortunately, the concept of malnutrition in the elderly is poorly defined. The purpose of this paper is to clarify the meaning of malnutrition in the elderly and to develop the theoretical underpinnings, thereby facilitating communication regarding the phenomenon and enhancing research efforts.Scope, sources used. Critical review of literature is the approach used to systematically build and develop the theoretical propositions. Conventional search engines such as Medline, PsyINFO, and CINAHL were used. The bibliography of obtained articles was also reviewed and additional articles identified. Key wards used for searching included malnutrition, geriatric nutrition, nutritional status, nutrition assessment, elderly, ageing, and weight loss.Conclusions. The definition of malnutrition in the elderly is defined as following: faulty or inadequate nutritional status; undernourishment characterized by insufficient dietary intake, poor appetite, muscle wasting and weight loss. In the elderly, malnutrition is an ominous sign. Without intervention, it presents as a downward trajectory leading to poor health and decreased quality of life. Malnutrition in the elderly is a multidimensional concept encompassing physical and psychological elements. It is precipitated by loss, dependency, loneliness and chronic illness and potentially impacts morbidity, mortality and quality of life.
Aim. The aim of this study is to revisit the concept of malnutrition in older people, trace the ... more Aim. The aim of this study is to revisit the concept of malnutrition in older people, trace the new development and test the use of refined framework with empirical data.Background. Malnutrition in older people is a common and significant problem worldwide. Continuing Chen's earlier work in 2001, a refinement was conducted and a prospective study was designed to test the use of this refined framework.Design. A cohort study of 114 hospitalized older patients in Northern Taiwan.Methods. The sample consists of 114 older patients aged 65 years and older, who were admitted for the cardiac and orthopaedic services at a tertiary 2300-bed hospital. From March to August 2004, assessed by one trained nurse, participants completed a structured face-to-face interview evaluating their age, visual/hearing impairments, oral health, cognitive status, comorbidities, medication use, social economic status, functional status, social support, depressive symptoms and nutritional status within 48 hours of admission. Participants who stayed >5 days were reassessed before discharge (n = 70). The data from admission were the main focus of this report.Results. Regression analysis revealed that that more medication taken, female gender, lower functional status (beta = 0·34, P < 0·001) and higher depressive symptoms were independent predictors of poor nutritional status, with the full model accounting for 48·2% of the variance. The result is in-line with the original theoretical underpinnings and it suggests that this refined framework detailing sub-concepts and measurable indices appears to fit the empirical data and suitable for clinical use.Conclusion. The findings lend support to the use of this framework in managing malnutrition in older people.Relevance to clinical practice. Nurses have an essential role in providing care for older people a framework like this would provide a road map guiding the intervention efforts.
Background Family caregiving is common and important in Taiwanese culture. However, the combinati... more Background Family caregiving is common and important in Taiwanese culture. However, the combination of anticipated loss, prolonged psychological distress, and the physical demands of caregiving can seriously compromise the quality of life (QOL) of a family caregiver (FC). The effect of caring for a dying cancer patient on a FC’s QOL has been explored in western countries—primarily with small sample sizes or short-term follow-ups—but has not yet been investigated in Taiwan. Therefore, the purposes of this study were to: (1) identify the trajectory of the QOL of FCs of terminally ill cancer patients in Taiwan; and (2) investigate the determinants of the QOL of FCs, in a large sample and with longer follow-ups, until the patient dies. Methods A prospective, longitudinal study was conducted among 167 FCs. Trajectory and determinants of FCs’ QOL were identified by a generalized estimation equation (GEE). Results Caregiving for a terminally ill cancer patient extracts a toll from a FC’s QOL and causes it to deteriorate significantly over time. The results from the multivariate GEE analysis indicated that this deterioration of a FC’s QOL reflects the patient’s increasing distress from symptoms, the gradual loss of confidence in caregiving and an increased subjective caregiving burden on the FC as the patient’s death approaches, and a weaker psychological resource (i.e., sense of coherence) of the FC. Conclusion Taiwanese FCs’ QOL deteriorated significantly as the patient’s death approached. This study contributes to the family caregiving literature by using longitudinal data to confirm that the available psychological resource of a FC and the ‘appraisals of caregiving’ are more salient in determining a FC’s QOL than the patient’s/FC’s characteristics and the caregiving demands.
Aim. The aim of this study was to characterise the trajectory and to identify determinants of nu... more Aim. The aim of this study was to characterise the trajectory and to identify determinants of nutritional health over time in a sample of older hospitalised patients, using the Generalized Estimating Equation.Background. Nutritional health deteriorates and may fluctuate over time during and post-hospitalisation. To develop a target intervention it is essential that we first have a clear picture of how the nutrition changes and examine the determinants of nutritional health during and post-hospitalisation.Design. A prospective cohort study was conducted on 306 older hospitalised patients aged 65 years and older.Methods. Subjects were recruited from five surgical and medical wards at a tertiary medical center in northern Taiwan and assessed at four points in time: within 48 hours after admission, before discharge and 3–6 months post-discharge.Results. Nutritional health fluctuated significantly over time. The curve dropped during hospitalisation, returned at three months and rose slightly at six months post hospitalisation. After controlling for length of stay and surgical treatment, patients showed decreased cognitive capacity, worsening oral health, increased use of medications, increased functional limitations and raised depressive symptoms, all of which affects their nutritional health over time. The extent of functional status impacting on nutrition varies at different points in time while the predictability of other determinants remained stable.Conclusion. The trajectory of nutritional health is a reflection of the patients’ cognitive status, oral health, medication taken, functional status and depressive symptoms. The findings of our study should provide guidance in the development of intervention for the nutritional health of older patients during inpatient as well as transitional care.Relevance to clinical practice. Multi-faceted packages of interventions targeting a range of determinants for managing undernutrition and subsequent decline during and post-hospitalisation need to be tested.
Postsurgical functional decline is common in older patients and can lead to frailty and increased... more Postsurgical functional decline is common in older patients and can lead to frailty and increased mortality. Comprehensive interventions such as the Hospital Elder Life Program (HELP) have been shown to be effective, but modifying the HELP to include only 3 key interventions might prove cost-effective for surgical patients. Consecutive patients from August 2007 through April 2009 (n = 179) were enrolled if they had undergone common elective abdominal surgical procedures, such as gastrectomy, cholecystectomy, and Whipple surgery. A modified HELP intervention consisting of early mobilization, nutritional assistance, and therapeutic (cognitive) activities implemented by a trained nurse was introduced on a surgical ward in May 2008. Patients enrolled before May 2008 received usual care and served as controls (n = 77). Those enrolled after the modified HELP intervention constituted the experimental group (n = 102). Changes in performance of activities of daily living, nutritional status, and cognitive function between admission and discharge were the primary end points. Independent of baseline functions, education, periampullary diagnosis, comorbidity, surgical procedure, and duration of surgery, patients in the HELP group declined significantly less on activities of daily living performance and nutritional status (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) than controls. The delirium rate was also significantly lower in the HELP group (0%) than in the control group (16.7%) (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). The modified HELP intervention effectively reduced older surgical patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; functional decline and delirium rates by hospital discharge. This program, conducted by a trained nurse, was not costly but did require commitment and ongoing cooperation between physician and nursing leadership to achieve compliance with the protocols.
A concept analysis of malnutrition in the elderlyPurpose. Malnutrition is a frequent and serious ... more A concept analysis of malnutrition in the elderlyPurpose. Malnutrition is a frequent and serious problem in the elderly. Today there is no doubt that malnutrition contributes significantly to morbidity and mortality in the elderly. Unfortunately, the concept of malnutrition in the elderly is poorly defined. The purpose of this paper is to clarify the meaning of malnutrition in the elderly and to develop the theoretical underpinnings, thereby facilitating communication regarding the phenomenon and enhancing research efforts.Scope, sources used. Critical review of literature is the approach used to systematically build and develop the theoretical propositions. Conventional search engines such as Medline, PsyINFO, and CINAHL were used. The bibliography of obtained articles was also reviewed and additional articles identified. Key wards used for searching included malnutrition, geriatric nutrition, nutritional status, nutrition assessment, elderly, ageing, and weight loss.Conclusions. The definition of malnutrition in the elderly is defined as following: faulty or inadequate nutritional status; undernourishment characterized by insufficient dietary intake, poor appetite, muscle wasting and weight loss. In the elderly, malnutrition is an ominous sign. Without intervention, it presents as a downward trajectory leading to poor health and decreased quality of life. Malnutrition in the elderly is a multidimensional concept encompassing physical and psychological elements. It is precipitated by loss, dependency, loneliness and chronic illness and potentially impacts morbidity, mortality and quality of life.
Aim. The aim of this study is to revisit the concept of malnutrition in older people, trace the ... more Aim. The aim of this study is to revisit the concept of malnutrition in older people, trace the new development and test the use of refined framework with empirical data.Background. Malnutrition in older people is a common and significant problem worldwide. Continuing Chen's earlier work in 2001, a refinement was conducted and a prospective study was designed to test the use of this refined framework.Design. A cohort study of 114 hospitalized older patients in Northern Taiwan.Methods. The sample consists of 114 older patients aged 65 years and older, who were admitted for the cardiac and orthopaedic services at a tertiary 2300-bed hospital. From March to August 2004, assessed by one trained nurse, participants completed a structured face-to-face interview evaluating their age, visual/hearing impairments, oral health, cognitive status, comorbidities, medication use, social economic status, functional status, social support, depressive symptoms and nutritional status within 48 hours of admission. Participants who stayed >5 days were reassessed before discharge (n = 70). The data from admission were the main focus of this report.Results. Regression analysis revealed that that more medication taken, female gender, lower functional status (beta = 0·34, P < 0·001) and higher depressive symptoms were independent predictors of poor nutritional status, with the full model accounting for 48·2% of the variance. The result is in-line with the original theoretical underpinnings and it suggests that this refined framework detailing sub-concepts and measurable indices appears to fit the empirical data and suitable for clinical use.Conclusion. The findings lend support to the use of this framework in managing malnutrition in older people.Relevance to clinical practice. Nurses have an essential role in providing care for older people a framework like this would provide a road map guiding the intervention efforts.
Background Family caregiving is common and important in Taiwanese culture. However, the combinati... more Background Family caregiving is common and important in Taiwanese culture. However, the combination of anticipated loss, prolonged psychological distress, and the physical demands of caregiving can seriously compromise the quality of life (QOL) of a family caregiver (FC). The effect of caring for a dying cancer patient on a FC’s QOL has been explored in western countries—primarily with small sample sizes or short-term follow-ups—but has not yet been investigated in Taiwan. Therefore, the purposes of this study were to: (1) identify the trajectory of the QOL of FCs of terminally ill cancer patients in Taiwan; and (2) investigate the determinants of the QOL of FCs, in a large sample and with longer follow-ups, until the patient dies. Methods A prospective, longitudinal study was conducted among 167 FCs. Trajectory and determinants of FCs’ QOL were identified by a generalized estimation equation (GEE). Results Caregiving for a terminally ill cancer patient extracts a toll from a FC’s QOL and causes it to deteriorate significantly over time. The results from the multivariate GEE analysis indicated that this deterioration of a FC’s QOL reflects the patient’s increasing distress from symptoms, the gradual loss of confidence in caregiving and an increased subjective caregiving burden on the FC as the patient’s death approaches, and a weaker psychological resource (i.e., sense of coherence) of the FC. Conclusion Taiwanese FCs’ QOL deteriorated significantly as the patient’s death approached. This study contributes to the family caregiving literature by using longitudinal data to confirm that the available psychological resource of a FC and the ‘appraisals of caregiving’ are more salient in determining a FC’s QOL than the patient’s/FC’s characteristics and the caregiving demands.
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Papers by Cheryl Chen