Home-based dietetic intervention improves nutritional status post hospital discharge in older people (original) (raw)
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European Journal of Clinical Nutrition
Background/objectives Malnutrition is common among older adults. Dietary intervention studies in older adults aiming to improve anthropometrics measures and physical function have been inconsistent. We aimed to investigate the effects of nutrition therapy in combination with home delivered meals and oral nutritional supplements (ONS) in community-dwelling older adults discharged from hospital. Methods A total of 106 participants (>65 years) were randomized into the intervention group (n = 53) and into the control group (n = 53). The intervention group received individual nutrition therapy (five in person visits and three phone calls) and freely delivered energy- and protein- rich foods, while the control group received standard care. Dietary intake, anthropometrics, and short physical performance battery (SPPB) were assessed at baseline and at endpoint. Results Energy intake at baseline was similar in both groups (~1500 kcal at the hospital) but there was a significant increase i...
Meals Enhancing Nutrition After Discharge: Findings from a Pilot Randomized Controlled Trial
Journal of the Academy of Nutrition and Dietetics, 2017
After older adults experience episodes of poor health or are hospitalized, they may not return to premorbid or prehospitalization eating behaviors. Furthermore, poor nutrition increases hospital readmission risk, but evidence-based interventions addressing these risks are limited. This pilot study's objective was to evaluate the feasibility of conducting a randomized controlled trial assessing a post-discharge home-delivered meal program's impact on older adults' nutritional intake and hospital readmissions and to assess patient acceptability and satisfaction with the program. The aims of the study were to evaluate successful recruitment, randomization, and retention of at least 80% of the 24 participants sought; to compare the outcomes of hospital readmission and total daily caloric intake between participants in the intervention and control groups; and to assess patient acceptability and satisfaction with the program. This study used a two-arm randomized controlled tri...
Nutrition & dietetics: the journal of the Dietitians Association of Australia, 2018
Nutritional decline during and after acute hospitalisation is common amongst older people. This quality improvement initiative aimed to introduce a dietitian-led discharge planning and follow-up program (Hospital to Home Outreach for Malnourished Elders, HHOME) at two hospitals within usual resources to improve nutritional and functional recovery. Prospective pre-post evaluation design was used. Medical patients aged 65+ years at-risk of malnutrition and discharged to independent living were eligible. Participants receiving nutrition discharge planning and dietetic telephone follow up for four weeks post-discharge ('HHOME') were compared to usual care ('pre-HHOME'). Nutritional (weight and mini nutritional assessment (MNA)), functional (gait speed, handgrip strength and modified Barthel index) and assessment of quality of life-6D (AQoL-6D) outcomes were measured on discharge and six weeks later. At six weeks, no significant difference in nutritional status was observ...
Nutrients
At hospital discharge, many older patients are at health and nutritional risk, indicating a requirement for ongoing care. We aim to evaluate the effects of comprehensive individualized care by geriatric-experienced care professionals, the so-called “pathfinders”, on nutritional status (NS) of older patients after discharge. A total of 244 patients (median age 81.0 years) without major cognitive impairment were randomized to Intervention Group (IG: 123) or Control Group (CG: 121) for a 12-month intervention, with up to 7 home visits and 11 phone calls. The comprehensive individualized care contained nutritional advice, when required. The intervention effect after three (T3m) and 12 (T12m) months on change in MNA-SF (Mini Nutritional Assessment-Short Form) and BMI was evaluated by Univariate General Linear Model (ANOVA), adjusted for age, sex, living situation, and activities of daily living. At baseline, mean MNA-SF did not differ between IG and CG (10.7 ± 2.6 vs. 11.2 ± 2.5, p = 0.1...
The journal of nutrition, health & aging, 2002
Up to 65% of elderly patients are protein-energy undernourished at admission or acquire nutritional deficits while hospitalised. The aims of this project were: 1) to assess the quality of care concerning nutrition among geriatric units; 2) to assess the impact of implementive nutritional interventions on nutritional status and on the length of hospitalisation. Two hundred and six patients consecutively admitted in a geriatric unit of a general hospital were studied prospectively for 6 months (from January to June 2001). All patients underwent a comprehensive geriatric assessment. For the first 3 months the nutritional status of the patients on admission and at discharge were assessed without particular recommendations for nutritional intervention. A standardised nutritional intervention was proposed for the last 3 months. Median value of Mini-Nutritional Assessment was 19 points (ranged from 9 to 29), mean admission s prealbumin concentration (PAB) was 0.179 g/l, and C-reactive prot...
Journal of the American Geriatrics Society, 2000
OBJECTIVES: To determine whether the oral nutritional supplementation of undernourished older people upon discharge from hospital improves muscle function and reduces disability. DESIGN: Randomized controlled trial. SETTING: Community-based study in two centers in Scotland. PARTICIPANTS: Two hundred fifty-three people. INTERVENTION: Randomization to oral nutritional supplementation (600 kcal/d) or control supplement of 200 kcal/d. MEASUREMENTS: Primary outcome (20-point activity of daily living Barthel Index) and secondary outcomes (handgrip strength, Sit-to-Stand test, and Euroquol) were measured at baseline (after discharge from the hospital and before supplement was commenced) and 8 and 16 weeks and accelerometry-measured physical activity levels at baseline and 16 weeks. Falls were recorded prospectively. RESULTS: Mean age was 82. There was no significant difference in change in Barthel score between supplement and control groups (adjusted mean difference 5 0.28, 95% confidence interval (CI) 5 À 0.28-0.84). Handgrip strength improved more in the supplemented group (adjusted mean difference 5 1.52 kg, 95% CI 5 0.50-2.55; P 5.004). The supplemented group exhibited modestly greater vector movement (overall activity) than controls (P 5.02). There were no significant between-group differences in Sitto-Stand test, health-related quality of life, or falls. Adherence was 38.2% in the nutritional supplement group and 50.0% in the control supplement group. Weight did not increase in the nutritional supplement group as a whole, but on-treatment analysis adjusting for adherence showed a mean weight gain of 1.17 kg (95% CI 5 0.07-2.27; P 5.04) more than in controls. CONCLUSION: Oral nutritional supplementation of undernourished older people upon hospital discharge did not reduce disability, despite improving handgrip strength and modestly increasing objectively measured physical activity levels. Lack of an effect of the nutritional supplement used in this study may have been due to low adherence, suggesting that different approaches to nutritional supplementation need to be tested in this population.
Nutrition Care after Discharge from Hospital: An Exploratory Analysis from the More-2-Eat Study
Healthcare (Basel, Switzerland), 2018
Many patients leave hospital in poor nutritional states, yet little is known about the post-discharge nutrition care in which patients are engaged. This study describes the nutrition-care activities 30-days post-discharge reported by patients and what covariates are associated with these activities. Quasi-randomly selected patients recruited from 5 medical units across Canada ( = 513) consented to 30-days post-discharge data collection with 48.5% ( = 249) completing the telephone interview. Use of nutrition care post-discharge was reported and bivariate analysis completed with relevant covariates for the two most frequently reported activities, following recommendations post-discharge or use of oral nutritional supplements (ONS). A total of 42% ( = 110) received nutrition recommendations at hospital discharge, with 65% ( = 71/110) of these participants following those recommendations; 26.5% ( = 66) were taking ONS after hospitalization. Participants who followed recommendations were...
The Journal of Nutrition Health and Aging
Up to 65% of elderly patients are protein-energy undernourished at admission or acquire nutritional deficits while hospitalised. The aims of this project were: 1) to assess the quality of care concerning nutrition among geriatric units; 2) to assess the impact of implementive nutritional interventions on nutritional status and on the length of hospitalisation. Two hundred and six patients consecutively admitted in a geriatric unit of a general hospital were studied prospectively for 6 months (from January to June 2001). All patients underwent a comprehensive geriatric assessment. For the first 3 months the nutritional status of the patients on admission and at discharge were assessed without particular recommendations for nutritional intervention. A standardised nutritional intervention was proposed for the last 3 months. Median value of Mini-Nutritional Assessment was 19 points (ranged from 9 to 29), mean admission s prealbumin concentration (PAB) was 0.179 g/l, and C-reactive prot...
Journal of Clinical Nursing, 2009
Aim. The aim of this study was to characterise the trajectory and to identify determinants of nutritional health over time in a sample of older hospitalised patients, using the Generalized Estimating Equation.Background. Nutritional health deteriorates and may fluctuate over time during and post-hospitalisation. To develop a target intervention it is essential that we first have a clear picture of how the nutrition changes and examine the determinants of nutritional health during and post-hospitalisation.Design. A prospective cohort study was conducted on 306 older hospitalised patients aged 65 years and older.Methods. Subjects were recruited from five surgical and medical wards at a tertiary medical center in northern Taiwan and assessed at four points in time: within 48 hours after admission, before discharge and 3–6 months post-discharge.Results. Nutritional health fluctuated significantly over time. The curve dropped during hospitalisation, returned at three months and rose slightly at six months post hospitalisation. After controlling for length of stay and surgical treatment, patients showed decreased cognitive capacity, worsening oral health, increased use of medications, increased functional limitations and raised depressive symptoms, all of which affects their nutritional health over time. The extent of functional status impacting on nutrition varies at different points in time while the predictability of other determinants remained stable.Conclusion. The trajectory of nutritional health is a reflection of the patients’ cognitive status, oral health, medication taken, functional status and depressive symptoms. The findings of our study should provide guidance in the development of intervention for the nutritional health of older patients during inpatient as well as transitional care.Relevance to clinical practice. Multi-faceted packages of interventions targeting a range of determinants for managing undernutrition and subsequent decline during and post-hospitalisation need to be tested.