Abstract
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 = 0.148); however, mean BMI was significantly lower in IG compared to CG (27.2 ± 4.7 vs. 28.8 ± 4.8 kg/m2, p = 0.012). At T3m, mean change did not differ significantly between the groups, neither in MNA-SF (0.6; 95%CI: −0.1–1.3 vs. 0.4; −0.3–1.1, p = 0.708) nor in BMI (−0.2; −0.6–0.1 vs. 0.0; −0.4–0.4 kg/m2, p = 0.290). At T12m, mean change of MNA-SF was significantly higher in IG than in CG (1.4; 0.5–2.3 vs. 0.0; −0.9–0.8; p = 0.012). BMI remained unchanged in IG, whereas it slightly declined in CG (0.0; −0.7–0.6 vs. −0.9; −1.6–−0.2 kg/m2, p = 0.034). We observed rather small effects of comprehensive individualized care by pathfinders on NS in older patients 12 months after discharge. For more pronounced effects nutrition expertise might be needed.
Highlights
Malnutrition is a common issue among older adults and prevalence rates of 21% to 45% have been reported according to MNA (Mini Nutritional Assessment) in hospitalized older patients [1,2,3,4,5]
Another randomized controlled trial with protein-enriched foods and drinks for patients with a mean age of 77 years for three-month after discharge indicated an enhancement in body weight and nutritional status according to MNA after six months; no differences were observed between intervention and control group [10]
This review suggested that an improvement in the nutritional status of older adults might be achieved through individualized nutritional care plans by dietitians [11]
Summary
Malnutrition is a common issue among older adults and prevalence rates of 21% to 45% have been reported according to MNA (Mini Nutritional Assessment) in hospitalized older patients [1,2,3,4,5]. A 12-week randomized controlled trial with three follow-up home visits after discharge by registered dietitians showed an improvement in body weight, energy, and protein intake of geriatric patients with a median age of 80 years and at risk of malnutrition after three months [9]. Another randomized controlled trial with protein-enriched foods and drinks for patients with a mean age of 77 years for three-month after discharge indicated an enhancement in body weight and nutritional status according to MNA after six months; no differences were observed between intervention and control group [10]. This review suggested that an improvement in the nutritional status of older adults might be achieved through individualized nutritional care plans by dietitians [11]
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