Associação da Terapia Nutricional, Qualidade de Vida e desfecho hospitalar na pessoa idosa internada em unidade de cuidados paliativos – estudo de coorte

Abstract

Introduction: Palliative Care (PC) is understood as an approach that promotes quality of life and dignity through the prevention and relief of suffering. Among the aspects that can affect the quality of life of elderly people in PC are factors related to food and nutrition. When the oral route is not available, enteral nutritional (EN) may be an alternative method, but its impact on the well-being and quality of life of patients in PC has been investigated. Objective: To compare exclusive oral or enteral feeding routes with physical and non-physical symptoms and hospital outcomes in elderly people on PC. Methods: Observational prospective cohort study, carried out in the PC Unit of a public hospital. The sample was obtained by convenience. All patients admitted to the PC Unit between July 2023 and May 2024 were eligible. The inclusion criteria were individuals aged 60 years or older; on early, complementary, or predominant PC; on exclusive oral or enteral feeding on the first day of hospitalization; who agreed to participate in the study. The exclusion criteria were those on exclusive PC; in an active dying process; who had their feeding route changed or suspended before the fourth day of hospitalization in the CP Unit. On the first day of hospitalization, data on population characteristics and feeding route (oral or enteral) were collected. On the fourth day, physical and non-physical symptoms were assessed using the Integrated Palliative Care Outcomes Scale (IPOS). At the end of hospitalization, hospital outcomes were collected. In the statistical analysis, the group was dichotomized according to the oral or enteral feeding route to analyze the association with the explanatory variables. The Student's t-test or Mann-Whitney test was performed for quantitative variables with normal and non-normal distribution, respectively, and the Chi-square test for qualitative variables. Significance level was set at 5% (p<0.05) was adopted. Results: The sample consisted of 61 elderly individuals with a mean age of 79.7 (±8.0) years, 57.4% were female, and 95% had a diagnosis of malnutrition. Of the participants, 77% were fed orally and 23% were fed enterally. In the oral group, 34.0% had frailty as the main predictor of poor prognosis, and among those fed enterally, 35.7% had dementia syndrome (p=0.002). The most prevalent physical and non-physical symptoms were: anxious or worried family members or friends, limited mobility, drowsiness, constipation, weakness, and pain, with no difference regarding the feeding route (p>0,05). Patients receiving oral feeding were little affected by drowsiness, while those receiving enteral feeding were very affected (p=0.016). Regarding the outcomes, 67.2% of the sample were discharged from hospital, with no statistical difference between the groups (p>0.05). The length of hospital stays before (p=0.017) and during (p=0.026) the remain in the CP unit and the total length of hospital stay were longer in those patients who were receiving exclusive EN (p=0.004). Conclusion: There were significant differences between the feeding routes and the symptom "sleepiness", which mainly affected elderly people in PC with enteral route. In addition, these individuals had a longer hospital stay, which can compromise quality of life.