Oranges and bananas at the hospital bedside are associated with visiting someone close to you. If we were to look at this picture from a broader perspective, we would also see the carer himself, who makes sure the meal is eaten, corrects the bedding, helps to wash up or simply keeps company. He or she performs a range of activities that allow him or her to show support and closeness to the sick person. The COVID-19 pandemic highlighted the importance of the role of the carer. At the moment, due to the restrictions in place in hospitals, their presence is impossible or minimised, which significantly affects the patient care system - emphasises Iwona Sarzyńska-Długosz, MD, PhD, a neurologist at the Department of Neurological Rehabilitation, 2nd Clinic of Neurology at the Institute of Psychiatry and Neurology in Warsaw.
We don't always realise how many situations a carer accompanies us in during our illness. We don't even know how many things he or she does outside the hospital room, how many conversations he or she has with doctors and nurses. The carer is simply there. The perspective has changed, however, as a result of the threat of COVID-19 infection. The absence of the caregiver in the daily life of a patient in hospital is another, less frequently noticed face of the pandemic.
For almost three years, we have been highlighting the role of the carer in the healing process as part of the educational campaign 'Medical Nutrition - Your Meals in the Fight Against Illness', but this is the first time we have had a situation where an external, independent factor shows what an important part of healthcare it is. I am referring not only to the people who spend hours at the patient's hospital bedside, but also to those who appear from time to time - the granddaughter making them smile, the daughter serving the soup spoon or the colleague helping them get up - says Adrianna Sobol, a psychologist from the Medical University of Warsaw.
The carer sees more
Carers, perhaps quite unknowingly, also provide support to medical staff who, due to their workload, are not always able to notice and take care of all the patients' needs.
Based on my experience of working in a neurological rehabilitation unit in recent weeks, I can say that the absence of carers in hospitals takes its toll on seemingly simple matters which, however, can have a significant impact on the treatment process at a later stage. One of these is nutrition. Before the pandemic, caregivers not only brought fruit or other favourite snacks for their loved ones, but also observed whether their loved ones were eating, helped feed patients who were unable to eat on their own, and motivated them to eat. Despite great efforts, medical staff are not always able to devote as much time to each patient as their loved ones had for them, which can also affect the amount of food consumed - highlights Iwona Sarzyńska-Długosz, MD, PhD.
Eating a meal is also social. Most of us are used to eating at least one meal in company. The feeling of loneliness and the additional psychological burden resulting from the illness and the prevailing atmosphere may cause the patient not to think about food, even to have no appetite. Therefore, if possible, it is advisable to enjoy the benefits of technology, a virtual meeting, perhaps even eating a meal in 'online company', looking at each other through the easily accessible webcams on the phone. It may feel strange the first time, but I assure you that most of us have chewed something more than once while talking to a loved one without even thinking about it. So it's worth a try - Adrianna Sobol adds.
Concern for safety
Many neurological diseases are associated with swallowing disorders, or dysphagia, which is one of the common problems of post-stroke patients. Dysphagia usually manifests as whooping, coughing during and after meals, a change in voice timbre during and after eating to a nasal or 'hoarse' voice, and is often related to nutritional disorders. If left untreated, dysphagia can lead to pharyngitis, which is life-threatening for the patient. It also often influences a change in eating habits, such as avoiding meals or eating smaller amounts of food[1], which in turn leads to a risk of malnutrition - up to half of dysphagia patients are malnourished and as many as 75% suffer from dehydration[2],[3].
Here again, the carer has a huge role to play, being able to observe the patient during and after the meal and being able to notice the symptoms mentioned and then report them to the doctor. Depending on its severity, dysphagia requires special management - sometimes it is sufficient to grind and thicken the meal with a specialised preparation, and in more advanced cases, enteral feeding may need to be included - and the patient will be able to have a more effective way of managing his or her dysphagia. explains Iwona Sarzyńska-Dlugosz, MD, PhD.
Proper nutrition integral to treatment
Following a stroke, the metabolic process may also be altered, resulting in an increase in metabolic rate and thus an increased need for energy and nutrients. A sequence of events is then observed - a reduction in food intake directly translates into a reduction in the amount of nutrients provided to the body, which compromises nutritional status and can lead to, among other things, a decrease in immunity, an increased risk of complications and a prolonged recovery process.[4].
This is an additional challenge for patients in hospital during this difficult period. Therefore, every patient should undergo a thorough nutritional assessment, and if meeting energy and nutrient requirements is not possible through traditional diet, consideration must be given to the inclusion of medical nutrition - oral nutritional preparations for patients who are able to consume food orally, or enteral nutrition through artificial access when oral feeding is impossible or insufficient - adds Iwona Sarzyńska-Dlugosz, MD, PhD.
Nutritional preparations contain a set of essential macro- and micro-nutrients.
For more on nutrition in illness and the role of the carer in the healing process, see www.zywieniemedyczne.pl
[1] Dysphagia in Head and Neck Cancer Patients: Pretreatment Evaluation, Predictive Factors, and Assessment during Radio-Chemotherapy, Recommendations Nerina Denaro, Marco C. Merlano, Elvio G. Russi, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3781223/table/T3/
[2] Fel P: Nutritional Management of Dysphagia in the Healthcare Setting Healthcare Caterer.2006: Spring 2006. Leibovitz A., Baumoehl Y., Lubart E., Yania, A., Platinovitz N &Segal R.: Dehydration among longterm care elderly patients with oropharyngeal dysphagia. Gerontology 2007: 53: 179183
[3] Leibovitz A, Baumoehl Y, Lubart E, Yaina A, Platinovitz N & Segal R: Dehrydation among longterm care elderly patients with oropharyngeal dysphagia. Gerontology. 2007; 53: 179183
[4] Członkowska A, Sarzyńska-Długosz I, Blażejewska-Hyżorek B, Nyka WM, Opuchlik A, Słowik A, Kuczyńska-Zardzewiały A, Kłęk S. Enteral and parenteral nutrition in stroke - position of the Expert Group of the Section of Vascular Diseases of the Polish Neurological Society. Pol. Przegl. Neurol 2013;9(4):141-145.