People experience eating problems and risk of malnutrition three months after stroke

People who suffered a stroke continued to experience eating problems and more than half still risked malnutrition after three months, even though there had been a marked improvement in most of their physical functions. That is one of the key findings of a study in the March issue of the Journal of Advanced Nursing.

Researchers from the Karolinska Institutet in Sweden studied 36 patients who had had a stroke, assessing them in hospital at a median of five days. They then assessed them again approximately three months after their stroke, when they were back in the community, with the majority living in their own homes.

All had experienced eating difficulties, reduced alertness or swallowing problems after their stroke. Just over half of the patients were female (58%) and they ranged from 40 to 80-years-of-age with a median age of 74.5 years.

"The aim of our study was to compare eating difficulties among patients three months after they suffered a stroke with the problems they experienced in the acute phase of the disease" explains nurse researcher Dr Jorgen Medin from the Department of Clinical Sciences.

"Approximately five days after they had had their stroke 78% of the patients were at nutritional risk and by three months this figure was still 56%.

"Although some of the patients' eating abilities improved at the three-month follow-up, the majority remained unchanged and some even deteriorated."

Other key findings of the study included:

• There were significant improvements in the number of patients who had difficulties with their sitting position (down from 44% during the acute phase to 17% at three months), managing food on the plate (down from 92% to 72%) and manipulating food in the mouth (down from 50% to 22%).
• However, the percentage of patients with unsatisfactory food consumption rose from 61% at the acute hospital phase to 89% at three months, when they had returned back to the community.
• Although the risk of malnutrition fell from 78% to 56%, the number of patients who were classified as malnourished stayed constant at 5.6%.
• Swallowing problems also remained constant at 33%, as did slow/forced eating speeds at 6%. Transporting food to the mouth improved slightly from 56% to 44% and opening and closing the mouth from 33% to 25%.
• Functional status and stroke severity had improved at the three-month follow-up, but general well-being remained unchanged, as did oral health problems.
• A quarter of the patients had had a previous stroke, 47% lived alone, 92% lived in their own home, 78% had retired and 17% received home care.

"Our findings show that although the patients' overall nutritional status improved in the three months after their stroke, more than a half of them were still at nutritional risk and the number that remained malnourished was the same as during the acute phase.

"We found it particularly interesting that the majority of eating problems persisted three months after stroke, despite a marked improvement in most of the patients' physical functions.

"These findings suggest a clear need for healthcare professionals to assess the eating problems faced by stroke patients when they have returned to the community to avoid them becoming malnourished."