Abstract
BackgroundInterventions to improve the nutritional status of older adults and the integration of formal and family care systems are critical research areas to improve the independence and health of aging communities and are particularly relevant in the rehabilitation setting.ObjectiveThe primary outcome aimed to determine if the FREER (Family in Rehabilitation: EmpowERing Carers for improved malnutrition outcomes) intervention in malnourished older adults during and postrehabilitation improve nutritional status, physical function, quality of life, service satisfaction, and hospital and aged care admission rates up to 3 months postdischarge, compared with usual care. Secondary outcomes evaluated include family carer burden, carer services satisfaction, and patient and carer experiences. This pilot study will also assess feasibility and intervention fidelity to inform a larger randomized controlled trial.MethodsThis protocol is for a mixed-methods two-arm historically-controlled prospective pilot study intervention. The historical control group has 30 participants, and the pilot intervention group aims to recruit 30 patient-carer pairs. The FREER intervention delivers nutrition counseling during rehabilitation, 3 months of postdischarge telehealth follow-up, and provides supportive resources using a novel model of patient-centered and carer-centered nutrition care. The primary outcome is nutritional status measured by the Scored Patient-Generated Subjective Global Assessment Score. Qualitative outcomes such as experiences and perceptions of value will be measured using semistructured interviews followed by thematic analysis. The process evaluation addresses intervention fidelity and feasibility.ResultsRecruitment commenced on July 4, 2018, and is ongoing with eight patient-carer pairs recruited at the time of manuscript submission.ConclusionsThis research will inform a larger randomized controlled trial, with potential for translation to health service policies and new models of dietetic care to support the optimization of nutritional status across a continuum of nutrition care from rehabilitation to home.Trial RegistrationAustralian New Zealand Clinical Trials Registry Number (ACTRN) 12618000338268; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374608&isReview=true (Archived by WebCite at http://www.webcitation.org/74gtZplU2).International Registered Report Identifier (IRRID)DERR1-10.2196/12647
Highlights
BackgroundIn older Australians, protein-energy malnutrition (PEM) is highly prevalent and a strong independent contributor to poor health, but is preventable and treatable [1-4]
The primary outcome aimed to determine if the FREER (Family in Rehabilitation: EmpowERing Carers for improved malnutrition outcomes) intervention in malnourished older adults during and postrehabilitation improve nutritional status, physical function, quality of life, service satisfaction, and hospital and aged care admission rates up to 3 months postdischarge, compared with usual care
Recruitment commenced on July 4, 2018, and is ongoing with eight patient-carer pairs recruited at the time of manuscript submission
Summary
In older Australians, protein-energy malnutrition (PEM) is highly prevalent and a strong independent contributor to poor health, but is preventable and treatable [1-4]. PEM is defined as the unintentional and preventable loss of lean tissues such as muscle, blood and immune cells, and viscera, with or without fat loss, due to prolonged inadequate dietary intake or uptake of protein and energy [1]. A sufficient increase in protein and energy intake and uptake to meet individualized requirements will cease the loss of lean tissues and reverse PEM, except in severe cachectic states [1]. Encouraging malnourished older adults to consume appropriate types and quantities of foods encounters many diverse barriers due to its deeply complex physiological, socio-economic, and environmental risk factors, as well as unique presentation in each individual [5,6]. Individualized and long-term nutrition support is required to overcome these barriers and enable the older adult to improve their nutritional status [3,7]. Interventions to improve the nutritional status of older adults and the integration of formal and family care systems are critical research areas to improve the independence and health of aging communities and are relevant in the rehabilitation setting
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