Många människor har sömnproblem och sover mindre än rekommenderat hemma. På sjukhus, i en helt främmande miljö, är sannolikt sömnen ännu sämre. Det är därför angeläget att det finns kunskap om hur det är att sova på sjukhus samt vilka faktorer som påverkar sömnen. Då kan eventuella sömnproblem uppmärksammas och omvårdnadsinterventioner kan tillämpas för att underlätta för dessa patienter. Kunskapen kan också användas preventivt för att minska eventuella störningsmoment som kan påverka sömnen och hälsan. 

Objectives: Parkinson's disease (PD) has traditionally been associated with weight loss. However, recent studies have not found any evidence of underweight in PD. Nevertheless, few studies have addressed nutritional status changes over time in relation to other clinical PD features. Here, we explore changes in nutritional status and motor and non-motor PD features (including dopaminergic drug therapy) in PD patients after 1 year. Methods: Motor and non-motor PD features, dopaminergic drug therapy, under-nutrition and malnutrition risk, and anthropometric measures (BMI, handgrip strength, triceps skin-fold, mid-arm circumference, and mid-upper arm muscle circumference) were assessed at baseline and 1 year later among 65 people with PD. Results: Disability, PD motor symptoms, dysautonomia, and dopaminergic drug therapy increased. Underweight was uncommon both at baseline (n= 3) and follow-up (n = 2); malnutrition risk was common but stable (88 and 92%), whereas triceps skin-fold increased (P = 0.030); mid-upper arm muscle circumference decreased (P = 0.002); and the proportion of people with low handgrip strength (P = 0.012) increased. Correlations between nutritional variables and motor and non-motor PD features were absent to modest. Multiple linear regression analysis showed that baseline pupillomotor functioning was associated with decreased weight and BMI, and sleep with increased weight and BMI. In addition, increases in anxiety were associated with decreased weight, BMI, and triceps skin-fold. Discussion: During the PD course, there seems to be redistribution in body composition from muscle to fat. Studies are needed to identify possible explanations for the findings. This implies that malnutrition should be regularly screened to identify those at risk of developing reduced muscle mass and increased morbidity.

Background: Unintentional weight loss and undernutrition have been found common in  Parkinson’s disease but its relation to other disease aspects is unclear.

Objectives: To explore nutritional status in relation to disease duration in Parkinson’s disease, as well as associations between nutritional status and motor and autonomic features.

Design: Cross-sectional.

Setting: South-Swedish outpatient Parkinson-clinic.

Participants: Home-dwelling people with Parkinson’s disease (n=71), without significant cognitive impairment (mean age, 67.3 years; 56% men; mean disease duration, 6.3 years).

Measurements: Parkinsonian motor symptoms, mobility, activity level, disability, dyskinesias, dysautonomia, under- and malnutrition risk screening (using MEONF II and MUST for undernutrition and SCREEN II for malnutrition) and anthropometric measures (BMI, handgrip strength, triceps skin-fold, mid-arm circumference and mid-upper arm muscle circumference) were recorded. The sample was divided into those with longer (n=34) and shorter disease duration (n=37) according to the median (5 years).

Results: Longer disease duration was associated with more, disability, dyskinesias and dysautonomia than shorter duration (P ≤0.04). Mean (SD) body weight and BMI were 80.3 (16.3) kg and 28.1 (4.8) kg/m 2, respectively, and did not differ between duration groups (body weight, 80.9 vs. 79.6 kg; BMI, 28.0 vs. 28.3 kg/m 2; P≥0.738). There were no differences in other anthropometric measures between duration groups (P ≥0.300). BMI identified 4% and 62% as under- and overweight, respectively, and 4% exhibited  undernutrition risk, whereas 87% were at risk for malnutrition. Nutritional and motor/dysautonomic variables showed relatively weak correlations (r s, ≤ 0.33), but people with orthostatic hypotension had lower BMI (26.7 vs 29.2 kg/m 2; P=0.026) and lower handgrip strength (33.2 vs 41.6 kg; P=0.025) than those without orthostatic hypotension.

Conclusion: Motor and autonomic features showed expected relationships with disease duration. In contrast to these observations, and to most previous reports on nutrition in PD, frequencies of underweight and undernutrition were low. However, malnutrition risk was high, emphasizing the need for regular clinical monitoring of nutritional status. The reasons for the preserved nutritional status have to be explored prospectively.

AIMS AND OBJECTIVE: To evaluate patient-reported health outcomes of a multidisciplinary group educational programme for people with Parkinson's disease (PD), delivered as part of routine clinical practice. BACKGROUND: Studies suggest that educational programmes for people with PD have potential to improve patients' perceived health and well-being. However, controlled trials of multidisciplinary group educational programmes are lacking. DESIGN: Naturalistic non-randomized controlled trial. METHODS: Following ethical approval and informed consent, 48 people with PD (58% men; mean age, 69.3) received the intervention and 48 (52% men; mean age, 72) were allocated to a delayed intervention control group. The intervention was a six-week (two hours per week) multidisciplinary group educational programme. Patient-reported health outcomes were assessed by the 12-item short-form health survey (SF-12) at baseline and one month postintervention. RESULTS: Changes in SF-12 scores at follow-up did not differ between the groups and there were no within-group differences over time. Daily dopaminergic medication increased in the control group but not in the intervention group. CONCLUSIONS: Slightly, but significantly, increased drug requirement in the control group may in part have masked deterioration in perceived health. However, failure to demonstrate improved patient-reported health may relate to the intervention design, response shift (i.e. change in how people perceive their health), and/or quality and choice of outcome measures. Further studies that take these aspects into consideration are needed to determine the potential for patient education interventions in PD. RELEVANCE TO CLINICAL PRACTICE: Nurses and other healthcare professionals need to document the effects of patient educational programmes and to be aware of the importance of intervention design and challenges associated with evaluating programme outcomes. Otherwise, there is a risk that benefits cannot be demonstrated and that decision makers will not invest resources in interventions that actually are beneficial for chronically ill people.