PubMed · 14894639
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C STONE. 1952. Aftercare.. https://pubmed.ncbi.nlm.nih.gov/14894639/
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OBJECTIVE: To examine the agreement and association of elders' responses with family member proxy responses using the same, previously validated satisfaction instrument on both groups of respondents. METHODS: Satisfaction data came from transitional care unit residents and family members (N = 462 paired responses) from one facility and were collected between 1999 and 2000. The satisfaction questionnaire consisted of 17 items evaluating the art of care, technical quality, efficacy, amenities of the care environment, and global satisfaction. Bias indexes and intraclass correlation coefficients were used to examine the satisfaction scores. RESULTS: In general, proxy satisfaction ratings were higher than ratings of residents. The results also show that proxy ratings varied less from resident ratings for the amenity items, which were considered the most concrete items. Proxy ratings were much higher for the art of care and efficacy domain items, which were considered the least concrete items. CONCLUSION: The results of this investigation show that proxy ratings do not necessarily substitute for resident ratings.
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BACKGROUND: Fractures of the hip are an important cause of later ill health and mortality in older people. People with hip fractures are often malnourished at the time of fracture, and have poor food intake in hospital. OBJECTIVES: This review assesses the effects of nutritional interventions in older people recovering from hip fracture. SEARCH STRATEGY: We searched the Cochrane Musculoskeletal Injuries Group Specialised Register, the Cochrane Central Register of Controlled Trials (The Cochrane Library issue 3, 2004), MEDLINE (1966 to October week 1 2004), Nutrition Abstracts and Reviews, EMBASE, BIOSIS, CINAHL, HEALTHSTAR, the National Research Register and reference lists. We contacted investigators and handsearched four nutrition journals. SELECTION CRITERIA: Randomised and quasi-randomised trials of nutritional interventions for mainly older people (aged over 65 years) with hip fracture. DATA COLLECTION AND ANALYSIS: Both authors independently selected trials, extracted data and assessed trial quality. We sought additional information from all trialists, and pooled data for primary outcomes. MAIN RESULTS: Eighteen randomised trials involving 1306 participants were included. Overall trial quality was poor; specifically in terms of allocation concealment, assessor blinding and intention-to-treat analysis. This, and the limited availability of outcome data, mean that the following results must be interpreted with caution. Eight trials evaluated oral multinutrient feeds: these provided non-protein energy, protein, some vitamins and minerals. Oral feeds had no statistically significant effect on mortality (15/161 versus 17/176; relative risk (RR) 0.89, 95% confidence interval (CI) 0.47 to 1.68) but may reduce 'unfavourable outcome' (combined outcome of mortality and survivors with complications) (14/66 versus 26/73; RR 0.52, 95% CI 0.32 to 0.84). Four trials examining nasogastric multinutrient feeding showed no evidence of an effect on mortality (RR 0.99, 95% CI 0.50 to 1.97), but the studies were heterogeneous regarding case mix. There was insufficient information for other outcomes. The specific effect of protein given in an oral feed was tested in three trials. There was no evidence for an effect on mortality (RR 1.38, 95% CI 0.82 to 2.34). Protein supplementation may have reduced the number of long term complications and days spent in rehabilitation wards. Two trials, testing intravenous thiamin (vitamin B1) and other water soluble vitamins, or 1-alpha-hydroxycholecalciferol (an active form of vitamin D) respectively, produced no evidence of effect for either vitamin supplement. AUTHORS' CONCLUSIONS: While some evidence exists for the effectiveness of oral protein and energy feeds, overall the evidence for the effectiveness of nutritional supplementation remains weak. Future trials are required which overcome the defects of the reviewed studies, particularly inadequate size, methodology and outcome assessment.