Maria Crotty | Flinders University of South Australia (original) (raw)

Papers by Maria Crotty

There will be a release of Wiley Online Library scheduled for Sunday 19th December 2010. Access t... more There will be a release of Wiley Online Library scheduled for Sunday 19th December 2010. Access to the website will be disrupted as follows: New York 0500 EDT to 0700 EDT; London 1000 GMT to 1200 GMT; Singapore 1800 SGT to 2000 SGT

Journal of Quality in Clinical Practice, 2000

International Journal of Stroke, 2011

Nutrition & …, 2007

Aim: To determine the inter-rater reliability of the Mini Nutritional Assessment (MNA) and relati... more Aim: To determine the inter-rater reliability of the Mini Nutritional Assessment (MNA) and relationship with body composition and nutritional biochemistry among older Australians undergoing rehabilitation. Methods: Thirty-eight adults aged≥ 65 years were ...

Journal of the American Dietetic …, 2008

Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research, 2014

This exploratory study sought to investigate the effect of cognitive functioning on the consisten... more This exploratory study sought to investigate the effect of cognitive functioning on the consistency of individual responses to a discrete choice experiment (DCE) study conducted exclusively with older people. A DCE to investigate preferences for multidisciplinary rehabilitation was administered to a consenting sample of older patients (aged 65 years and older) after surgery to repair a fractured hip (N = 84). Conditional logit, mixed logit, heteroscedastic conditional logit, and generalized multinomial logit regression models were used to analyze the DCE data and to explore the relationship between the level of cognitive functioning (specifically the absence or presence of mild cognitive impairment as assessed by the Mini-Mental State Examination) and preference and scale heterogeneity. Both the heteroscedastic conditional logit and generalized multinomial logit models indicated that the presence of mild cognitive impairment did not have a significant effect on the consistency of re...

Archives of physical medicine and rehabilitation, 2009

Crotty M, George S. Retraining visual processing skills to improve driving ability after stroke. ... more Crotty M, George S. Retraining visual processing skills to improve driving ability after stroke. To evaluate the effectiveness of retraining using the Dynavision on driving performance of people with stroke. Randomized controlled trial. Outpatient rehabilitation clinic in Australia. People with stroke (N=26) referred for driving assessment. Eligible participants were randomized to either receive retraining with the Dynavision apparatus for 18 sessions or to receive no intervention and go onto a waitlist. The primary outcome was an assessment of on-road ability. Secondary outcomes included measures of response speed, visual scanning, and self-efficacy. All assessments were conducted by assessors blinded to group assignment. No significant difference (P=.223) was found between the intervention and control groups in results of on-road assessment in terms of pass or fail; the primary outcome measure; or the results on the secondary outcome measures of response speed, visual scanning, an...

To provide an epidemiological perspective of the clinical profile, frequency, and determinants of... more To provide an epidemiological perspective of the clinical profile, frequency, and determinants of poststroke hemiplegic shoulder pain. A prospective population-based study of an inception cohort of participants with a 12-month follow-up period. General community and hospital within a geographically defined metropolitan region. Multiple ascertainment techniques were used to identify 318 confirmed stroke events in 301 individuals. Among adults with stroke, data on shoulder pain were available for 198 (83% of the survivors) at baseline and for 156 and 148 at 4 and 12 months, respectively. Not applicable. Subjective reports of onset, severity, and aggravating factors for pain and 3 passive range-of-motion measures were collected at baseline and at 4- and 12-month follow-up. A total of 10% of the participants reported shoulder pain at baseline, whereas 21% reported pain at each follow-up assessment. Overall, 29% of all assessed participants reported shoulder pain during 12-month follow-up, with the median pain score (visual analog scale score=40) highest at 4 months and more often associated with movement at later time points. Objective passive range-of-motion tests elicited higher frequencies of pain than did self-report and predicted later subjective shoulder pain (crude relative risk of 3.22 [95% confidence interval, 1.01-10.27]). The frequency of poststroke shoulder pain is almost 30%. Peak onset and severity of hemiplegic shoulder pain in this study was at 4 months, outside of rehabilitation admission time frames. Systematic use of objective assessment tools may aid in early identification and management of stroke survivors at risk of this common complication of stroke.

BMJ open, Jan 25, 2014

Consumer-directed care is currently being embraced within Australia and internationally as a mean... more Consumer-directed care is currently being embraced within Australia and internationally as a means of promoting autonomy and choice in the delivery of health and aged care services. Despite its wide proliferation little research has been conducted to date to assess the views and preferences of older people for consumer-directed care or to assess the costs and benefits of such an approach relative to existing models of service delivery. A comprehensive health economic model will be developed and applied to the evolution, implementation and evaluation of consumer-directed care in an Australian community aged care setting. A mixed methods approach comprising qualitative interviews and a discrete choice experiment will determine the attitudes and preferences of older people and their informal carers for consumer-directed care. The results of the qualitative interviews and the discrete choice experiment will inform the introduction of a new consumer-directed care innovation in service de...

Age and ageing, 2014

accurate and practical assessment methods for assessing appendicular skeletal muscle (ASM) is of ... more accurate and practical assessment methods for assessing appendicular skeletal muscle (ASM) is of clinical importance for the diagnosis of geriatric syndromes associated with skeletal muscle wasting. the purpose of this study was to develop and cross-validate novel anthropometric prediction equations for the estimate of ASM in older adults post-surgical fixation for hip fracture, using dual-energy X-ray absorptiometry (DEXA) as the criterion measure. community-dwelling older adults (aged ≥65 years) recently hospitalised for hip fracture. participants were recruited from hospital in the acute phase of recovery. validation measurement study. a total of 79 hip fracture patients were involved in the development of the regression models (MD group). A further 64 hip fracture patients also recruited in the early phase of recovery were used in the cross-validation of the regression models (CV group). Multiple linear regression analyses were undertaken in the MD group to identify the best per...

Archives of Physical Medicine and Rehabilitation, 2014

To determine whether normalizing spatial-temporal gait data for walking speed obtained from multi... more To determine whether normalizing spatial-temporal gait data for walking speed obtained from multiple walking trials leads to differences in gait variability parameters associated with a history of falling in people with transtibial amputations. Cross-sectional study. Rehabilitation center. People with unilateral transtibial amputations (N=45; mean age ± SD, 60.5±13.7y; 35 men [78%]) were recruited. Not applicable. Participants completed 10 consecutive walking trials using an instrumented walkway system. Primary gait parameters were walking speed and step-length, step-width, step-time, and swing-time variability. A retrospective 12-month fall history was obtained from participants. Sixteen amputees (36%) were classified as fallers. Variation in gait speed across the 10 walking trials was 2.9% (range, 1.1%-12.1%). Variability parameters of normalized gait data were significantly different from variability parameters of nonnormalized data (all P<.01). For nonnormalized data, fallers had greater amputated limb step-time (P=.02), step-length (P=.02), swing-time (P=.05), and step-width (P=.03) variability and nonamputated limb step-length (P=.04) and step-width (P=.01) variability. For normalized data, only 3 variability parameters were significantly greater for fallers. These were amputated limb step-time (P=.05), step-length (P=.02), and step-width (P=.01) variability. Normalizing spatial-temporal gait data for walking speed before calculating gait variability parameters may aid in discerning variability parameters related to falls histories in people with transtibial amputations. This may help focus on the initial rehabilitation efforts of amputees with a fall history.

Archives of physical medicine and rehabilitation, 2015

To evaluate the effect of wearing a dorsiflexion assist orthosis (DAO) on walking distance, physi... more To evaluate the effect of wearing a dorsiflexion assist orthosis (DAO) on walking distance, physiological cost, fatigue, and strength and balance measures after a modified 6-minute walk test (6MWT) in people with multiple sclerosis (MS). Randomized crossover trial. Hospital Movement Laboratory. People with moderate MS and Expanded Disability Status Scale score of 3.7±0.7 (N=34; 26 women). Modified 6MWT with and without a DAO worn on the weaker leg. Distance walked, perceived fatigue, and the physiological cost of walking were compared between walking conditions. Pre- and postwalk changes in knee extensor and ankle dorsiflexor isometric strength and standing postural sway with eyes open and closed were compared between walking conditions. There were no differences in distance walked or perceived fatigue between the 2 walking conditions. However, there was a reduced physiological cost of walking (P<.05), a smaller reduction in knee extensor strength (P<.05), and a smaller increa...

British Journal of Nutrition, 2005

International Workshop on Virtual Rehabilitation, 2011

ABSTRACT While there has been wide uptake of the Nintendo Wii Fit as a therapy tool in hospital a... more ABSTRACT While there has been wide uptake of the Nintendo Wii Fit as a therapy tool in hospital and aged care settings there is a lack of evidence regarding the effectiveness and safety of this approach when used with older people. This pilot study compared the effect of a physiotherapist providing activities from the Wii Fit with conventional therapy on mobility, activities of daily living and safety. The study used a randomized controlled design with masked outcome assessment. A total of 44 participants were recruited from a Geriatric Evaluation and Management (GEM) Unit and randomized to either therapy using the Wii Fit (n=22) or conventional physiotherapy (n=22). Therapy sessions were 25 minutes per workday for the duration of the participant&#39;s stay on the unit. Assessment measures were taken at baseline, post intervention (on discharge from the unit) and one month after discharge. The primary outcome used was the Timed Up and Go Test and additional measures included balance and activities of daily living function. Adverse events were recorded. Preliminary analyses of results showed that both groups improved however there was a small significant difference between groups on balance and the Timed Up and Go Test with the Wii Fit appearing to be a more effective approach to balance and mobility training in hospitalized older people.

International Journal of Stroke, 2011

International Journal of Geriatric Psychiatry, 2004

To determine whether individualized advice on non-pharmacological strategies for hospitalized old... more To determine whether individualized advice on non-pharmacological strategies for hospitalized older patients with confusion and behavioral problems can improve levels of agitation and reduce the use of psychotropic medication. Pragmatic randomized controlled trial in two metropolitan teaching hospitals in South Australia. Seventy-one older patients with confusion and a behavioral disturbance were randomly allocated to receive either an assessment and ongoing individualized advice from an extended practice nurse on non-pharmacological strategies or usual care. Usual care included an assessment by a geriatrician. Primary outcomes were levels of agitation (Pittsburgh Agitation Scale), appropriateness of psychotropic medication prescribing (Medication Appropriateness Index) and levels of psychotropics administered (chlorpromazine and diazepam dose equivalents). Secondary outcomes were length of stay, discharge destination, number of falls, restraint use and satisfaction from nursing staff and next of kin. Levels of agitation were modest at baseline with mean PAS intervention group 3.4 (SD = 0.5) and control group 4.0 (SD = 0.4) and both groups improved over time to 1.7 (SD = 0.4) for the intervention group and 1.8 (SD = 0.3) for the control group on the final day of data collection. Median length of follow-up was nine days. There was no effect of the intervention on levels of agitation, amount and appropriateness of psychotropic medication prescribed and administered, falls, length of stay, discharge destination, restraint use and nursing and next of kin satisfaction. A nursing consultation service providing individualized non-pharmacological advice does not improve patient agitation or use of psychotropic medication for older patients with confusion and behavioral problems in an acute hospital.

Health and Quality of Life Outcomes, 2009

European journal of …, 2006

To report the dietary energy and protein intake of undernourished older adults (with and without ... more To report the dietary energy and protein intake of undernourished older adults (with and without cognitive impairment) admitted to hospital following a lower limb fracture and to determine whether dietary intakes met estimated requirements. An observational study of a sequential sample. The orthopaedic ward of a South Australian metropolitan teaching hospital. Sixty-eight patients aged &gt; or =70 years screened as undernourished and admitted to hospital following lower limb fracture (50% cognitively impaired) provided 3 to 5 days of dietary data. MAJOR OUTCOME METHODS: Dietary energy and protein intake. Dietary assessment using plate waste methodology and snack record charts commenced within 6 days postinjury and continued for up to five consecutive days or until discharge. Estimated resting energy requirements were calculated and adjusted for activity equivalent to bed rest and physiological stress. Protein requirements were calculated as 1 g/kg/day. Cognition was assessed using the Short Portable Mental Status Questionnaire. Cognitively impaired participants and those without cognitive impairment consumed, mean (95% CI) respectively, 3661 kJ/day (3201, 4121) versus 4208 kJ/day (3798, 4619) and 38 g (33, 44) versus 47 g (41, 52) protein/day. Cognitively impaired participants consumed mean (95% CI) 48% (43, 53) of estimated total energy expenditure and 78% (69, 87) of estimated protein requirements. Orthopaedic fracture patients at greatest nutritional risk, including those with cognitive impairment, do not achieve estimated energy or protein requirements from diet alone. Effective methods of achieving requirements in this vulnerable group are needed before improvements in outcomes will be observed.

There will be a release of Wiley Online Library scheduled for Sunday 19th December 2010. Access t... more There will be a release of Wiley Online Library scheduled for Sunday 19th December 2010. Access to the website will be disrupted as follows: New York 0500 EDT to 0700 EDT; London 1000 GMT to 1200 GMT; Singapore 1800 SGT to 2000 SGT

Journal of Quality in Clinical Practice, 2000

International Journal of Stroke, 2011

Nutrition & …, 2007

Aim: To determine the inter-rater reliability of the Mini Nutritional Assessment (MNA) and relati... more Aim: To determine the inter-rater reliability of the Mini Nutritional Assessment (MNA) and relationship with body composition and nutritional biochemistry among older Australians undergoing rehabilitation. Methods: Thirty-eight adults aged≥ 65 years were ...

Journal of the American Dietetic …, 2008

Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research, 2014

This exploratory study sought to investigate the effect of cognitive functioning on the consisten... more This exploratory study sought to investigate the effect of cognitive functioning on the consistency of individual responses to a discrete choice experiment (DCE) study conducted exclusively with older people. A DCE to investigate preferences for multidisciplinary rehabilitation was administered to a consenting sample of older patients (aged 65 years and older) after surgery to repair a fractured hip (N = 84). Conditional logit, mixed logit, heteroscedastic conditional logit, and generalized multinomial logit regression models were used to analyze the DCE data and to explore the relationship between the level of cognitive functioning (specifically the absence or presence of mild cognitive impairment as assessed by the Mini-Mental State Examination) and preference and scale heterogeneity. Both the heteroscedastic conditional logit and generalized multinomial logit models indicated that the presence of mild cognitive impairment did not have a significant effect on the consistency of re...

Archives of physical medicine and rehabilitation, 2009

Crotty M, George S. Retraining visual processing skills to improve driving ability after stroke. ... more Crotty M, George S. Retraining visual processing skills to improve driving ability after stroke. To evaluate the effectiveness of retraining using the Dynavision on driving performance of people with stroke. Randomized controlled trial. Outpatient rehabilitation clinic in Australia. People with stroke (N=26) referred for driving assessment. Eligible participants were randomized to either receive retraining with the Dynavision apparatus for 18 sessions or to receive no intervention and go onto a waitlist. The primary outcome was an assessment of on-road ability. Secondary outcomes included measures of response speed, visual scanning, and self-efficacy. All assessments were conducted by assessors blinded to group assignment. No significant difference (P=.223) was found between the intervention and control groups in results of on-road assessment in terms of pass or fail; the primary outcome measure; or the results on the secondary outcome measures of response speed, visual scanning, an...

To provide an epidemiological perspective of the clinical profile, frequency, and determinants of... more To provide an epidemiological perspective of the clinical profile, frequency, and determinants of poststroke hemiplegic shoulder pain. A prospective population-based study of an inception cohort of participants with a 12-month follow-up period. General community and hospital within a geographically defined metropolitan region. Multiple ascertainment techniques were used to identify 318 confirmed stroke events in 301 individuals. Among adults with stroke, data on shoulder pain were available for 198 (83% of the survivors) at baseline and for 156 and 148 at 4 and 12 months, respectively. Not applicable. Subjective reports of onset, severity, and aggravating factors for pain and 3 passive range-of-motion measures were collected at baseline and at 4- and 12-month follow-up. A total of 10% of the participants reported shoulder pain at baseline, whereas 21% reported pain at each follow-up assessment. Overall, 29% of all assessed participants reported shoulder pain during 12-month follow-up, with the median pain score (visual analog scale score=40) highest at 4 months and more often associated with movement at later time points. Objective passive range-of-motion tests elicited higher frequencies of pain than did self-report and predicted later subjective shoulder pain (crude relative risk of 3.22 [95% confidence interval, 1.01-10.27]). The frequency of poststroke shoulder pain is almost 30%. Peak onset and severity of hemiplegic shoulder pain in this study was at 4 months, outside of rehabilitation admission time frames. Systematic use of objective assessment tools may aid in early identification and management of stroke survivors at risk of this common complication of stroke.

BMJ open, Jan 25, 2014

Consumer-directed care is currently being embraced within Australia and internationally as a mean... more Consumer-directed care is currently being embraced within Australia and internationally as a means of promoting autonomy and choice in the delivery of health and aged care services. Despite its wide proliferation little research has been conducted to date to assess the views and preferences of older people for consumer-directed care or to assess the costs and benefits of such an approach relative to existing models of service delivery. A comprehensive health economic model will be developed and applied to the evolution, implementation and evaluation of consumer-directed care in an Australian community aged care setting. A mixed methods approach comprising qualitative interviews and a discrete choice experiment will determine the attitudes and preferences of older people and their informal carers for consumer-directed care. The results of the qualitative interviews and the discrete choice experiment will inform the introduction of a new consumer-directed care innovation in service de...

Age and ageing, 2014

accurate and practical assessment methods for assessing appendicular skeletal muscle (ASM) is of ... more accurate and practical assessment methods for assessing appendicular skeletal muscle (ASM) is of clinical importance for the diagnosis of geriatric syndromes associated with skeletal muscle wasting. the purpose of this study was to develop and cross-validate novel anthropometric prediction equations for the estimate of ASM in older adults post-surgical fixation for hip fracture, using dual-energy X-ray absorptiometry (DEXA) as the criterion measure. community-dwelling older adults (aged ≥65 years) recently hospitalised for hip fracture. participants were recruited from hospital in the acute phase of recovery. validation measurement study. a total of 79 hip fracture patients were involved in the development of the regression models (MD group). A further 64 hip fracture patients also recruited in the early phase of recovery were used in the cross-validation of the regression models (CV group). Multiple linear regression analyses were undertaken in the MD group to identify the best per...

Archives of Physical Medicine and Rehabilitation, 2014

To determine whether normalizing spatial-temporal gait data for walking speed obtained from multi... more To determine whether normalizing spatial-temporal gait data for walking speed obtained from multiple walking trials leads to differences in gait variability parameters associated with a history of falling in people with transtibial amputations. Cross-sectional study. Rehabilitation center. People with unilateral transtibial amputations (N=45; mean age ± SD, 60.5±13.7y; 35 men [78%]) were recruited. Not applicable. Participants completed 10 consecutive walking trials using an instrumented walkway system. Primary gait parameters were walking speed and step-length, step-width, step-time, and swing-time variability. A retrospective 12-month fall history was obtained from participants. Sixteen amputees (36%) were classified as fallers. Variation in gait speed across the 10 walking trials was 2.9% (range, 1.1%-12.1%). Variability parameters of normalized gait data were significantly different from variability parameters of nonnormalized data (all P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;.01). For nonnormalized data, fallers had greater amputated limb step-time (P=.02), step-length (P=.02), swing-time (P=.05), and step-width (P=.03) variability and nonamputated limb step-length (P=.04) and step-width (P=.01) variability. For normalized data, only 3 variability parameters were significantly greater for fallers. These were amputated limb step-time (P=.05), step-length (P=.02), and step-width (P=.01) variability. Normalizing spatial-temporal gait data for walking speed before calculating gait variability parameters may aid in discerning variability parameters related to falls histories in people with transtibial amputations. This may help focus on the initial rehabilitation efforts of amputees with a fall history.

Archives of physical medicine and rehabilitation, 2015

To evaluate the effect of wearing a dorsiflexion assist orthosis (DAO) on walking distance, physi... more To evaluate the effect of wearing a dorsiflexion assist orthosis (DAO) on walking distance, physiological cost, fatigue, and strength and balance measures after a modified 6-minute walk test (6MWT) in people with multiple sclerosis (MS). Randomized crossover trial. Hospital Movement Laboratory. People with moderate MS and Expanded Disability Status Scale score of 3.7±0.7 (N=34; 26 women). Modified 6MWT with and without a DAO worn on the weaker leg. Distance walked, perceived fatigue, and the physiological cost of walking were compared between walking conditions. Pre- and postwalk changes in knee extensor and ankle dorsiflexor isometric strength and standing postural sway with eyes open and closed were compared between walking conditions. There were no differences in distance walked or perceived fatigue between the 2 walking conditions. However, there was a reduced physiological cost of walking (P<.05), a smaller reduction in knee extensor strength (P<.05), and a smaller increa...

British Journal of Nutrition, 2005

International Workshop on Virtual Rehabilitation, 2011

ABSTRACT While there has been wide uptake of the Nintendo Wii Fit as a therapy tool in hospital a... more ABSTRACT While there has been wide uptake of the Nintendo Wii Fit as a therapy tool in hospital and aged care settings there is a lack of evidence regarding the effectiveness and safety of this approach when used with older people. This pilot study compared the effect of a physiotherapist providing activities from the Wii Fit with conventional therapy on mobility, activities of daily living and safety. The study used a randomized controlled design with masked outcome assessment. A total of 44 participants were recruited from a Geriatric Evaluation and Management (GEM) Unit and randomized to either therapy using the Wii Fit (n=22) or conventional physiotherapy (n=22). Therapy sessions were 25 minutes per workday for the duration of the participant&#39;s stay on the unit. Assessment measures were taken at baseline, post intervention (on discharge from the unit) and one month after discharge. The primary outcome used was the Timed Up and Go Test and additional measures included balance and activities of daily living function. Adverse events were recorded. Preliminary analyses of results showed that both groups improved however there was a small significant difference between groups on balance and the Timed Up and Go Test with the Wii Fit appearing to be a more effective approach to balance and mobility training in hospitalized older people.

International Journal of Stroke, 2011

International Journal of Geriatric Psychiatry, 2004

To determine whether individualized advice on non-pharmacological strategies for hospitalized old... more To determine whether individualized advice on non-pharmacological strategies for hospitalized older patients with confusion and behavioral problems can improve levels of agitation and reduce the use of psychotropic medication. Pragmatic randomized controlled trial in two metropolitan teaching hospitals in South Australia. Seventy-one older patients with confusion and a behavioral disturbance were randomly allocated to receive either an assessment and ongoing individualized advice from an extended practice nurse on non-pharmacological strategies or usual care. Usual care included an assessment by a geriatrician. Primary outcomes were levels of agitation (Pittsburgh Agitation Scale), appropriateness of psychotropic medication prescribing (Medication Appropriateness Index) and levels of psychotropics administered (chlorpromazine and diazepam dose equivalents). Secondary outcomes were length of stay, discharge destination, number of falls, restraint use and satisfaction from nursing staff and next of kin. Levels of agitation were modest at baseline with mean PAS intervention group 3.4 (SD = 0.5) and control group 4.0 (SD = 0.4) and both groups improved over time to 1.7 (SD = 0.4) for the intervention group and 1.8 (SD = 0.3) for the control group on the final day of data collection. Median length of follow-up was nine days. There was no effect of the intervention on levels of agitation, amount and appropriateness of psychotropic medication prescribed and administered, falls, length of stay, discharge destination, restraint use and nursing and next of kin satisfaction. A nursing consultation service providing individualized non-pharmacological advice does not improve patient agitation or use of psychotropic medication for older patients with confusion and behavioral problems in an acute hospital.

Health and Quality of Life Outcomes, 2009

European journal of …, 2006

To report the dietary energy and protein intake of undernourished older adults (with and without ... more To report the dietary energy and protein intake of undernourished older adults (with and without cognitive impairment) admitted to hospital following a lower limb fracture and to determine whether dietary intakes met estimated requirements. An observational study of a sequential sample. The orthopaedic ward of a South Australian metropolitan teaching hospital. Sixty-eight patients aged &gt; or =70 years screened as undernourished and admitted to hospital following lower limb fracture (50% cognitively impaired) provided 3 to 5 days of dietary data. MAJOR OUTCOME METHODS: Dietary energy and protein intake. Dietary assessment using plate waste methodology and snack record charts commenced within 6 days postinjury and continued for up to five consecutive days or until discharge. Estimated resting energy requirements were calculated and adjusted for activity equivalent to bed rest and physiological stress. Protein requirements were calculated as 1 g/kg/day. Cognition was assessed using the Short Portable Mental Status Questionnaire. Cognitively impaired participants and those without cognitive impairment consumed, mean (95% CI) respectively, 3661 kJ/day (3201, 4121) versus 4208 kJ/day (3798, 4619) and 38 g (33, 44) versus 47 g (41, 52) protein/day. Cognitively impaired participants consumed mean (95% CI) 48% (43, 53) of estimated total energy expenditure and 78% (69, 87) of estimated protein requirements. Orthopaedic fracture patients at greatest nutritional risk, including those with cognitive impairment, do not achieve estimated energy or protein requirements from diet alone. Effective methods of achieving requirements in this vulnerable group are needed before improvements in outcomes will be observed.