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HOMEFOOD six-month randomised trial. Nutrition therapy including home delivered food for older adults at discharge from hospital

Year: 2024
Type: dissertation
Study design: Clinical Trial
Abstract: Background: Malnutrition, or the risk of being malnourished, is a common problem \nthat affects many older adults. This condition is highly prevalent among hospitalised \nolder adults. Because hospital stays are short and screening for nutritional risk at the \nhospital is rarely done, the nutritional status of this population often continues to \ndeteriorate during hospitalisation and after discharge. Many nutritional intervention \nstudies have been conducted throughout the years to find ways to improve outcomes \nfor older adults at nutritional risk. These outcomes include anthropometric measures, \ndietary intake, physical function, cognitive function, health-related quality of life, \ndepressive symptoms, number of emergency room visits, readmissions, length of \nhospital stays, risk of going into long-term care and mortality. Previous findings have \nbeen inconsistent; thus, we aimed to investigate whether a nutritional intervention for \nolder adults at nutritional risk, discharging to independent living, could result in \npositive changes to the abovementioned outcomes. The intervention included nutrition \ntherapy administered by a dietitian using the Nutrition Care Process and its \nterminology, as well as the provision of free energy- and protein-rich foods, snacks and \noral nutrition supplements for six months. \nMethods: In total, 106 participants (≥ 65 years) were recruited while hospitalised and \nsigned formal consent. Baseline measures were conducted on the day of discharge and \nthen the participants were randomised into two groups: the intervention group (n = 53) \nand the control group (n = 53). The control group received standard care (based on \nthe nutritional guidelines for sick or frail older adults and were encouraged to order \nhome-delivered meals). The intervention group received nutrition therapy from a \ndietitian, according to the Nutrition Care Process, for five sessions at home (caregivers \nwere invited to join) and three sessions by phone. The intervention group also received \nfree protein- and energy-rich meals, snacks and oral nutritional supplements for six \nmonths after discharge. Dietary intake, anthropometrics, physical function, depressive \nsymptoms, self-rated health, cognitive function and health-related quality of life were \nmeasured at the baseline and at the endpoint (six months). For the secondary analysis \nof our randomised controlled trial, we collected information from the Icelandic \nelectronic hospital registry on emergency room visits, hospital readmissions, length of \nhospital stays, whether the participant had received a positive assessment on needing \nlong-term care residency and mortality. \nResults: One participant from each of the two groups dropped out. Energy intake did \nnot differ significantly between the two groups (≈ 1500 kcal/day, P = 0.410) at the \nbaseline. A significant increase in both energy intake and body weight was observed in \nvi \nthe intervention group, whereas a decrease was observed in the control group (+919 \nkcal/day, P < 0.001 and +1.7 kg, P < 0.001 vs – 815 kcal/day, P < 0.001 and -3.5 \nkg, P < 0.001) during the study period. Physical function improved significantly in the \nintervention group but remained unchanged in the control group during the study \nperiod (P = 0.007). The intervention group improved their cognitive function \n(measured with the Mini-Mental State Examination, MMSE), self-rated health (SRH) and \nhealth-related quality of life (measured with the EQ-5D) during the study period. \nHowever, the control group’s depressive symptoms (measured with the CES-D) \nincreased whilst their SRH declined. This resulted in significant differences between the \ngroups at the endpoint, all favouring the intervention group: MMSE: 1.701, P < 0.001; \nSRH: 15.876, P < 0.001; EQ-5D 0.102, P = 0.001; CES-D - 3.072, P < 0.001. \nImprovements in cognitive function, self-rated health and depressive symptoms were \nlinearly and significantly correlated with the increase in body weight. Through our \nsecondary analysis, we found that the control group had a significantly higher \nproportion of at least one readmission in comparison to the intervention group at one \nand six months (15.8% vs 1.9%, P = 0.033; 46.2% vs 25.0%, P = 0.021) but \ninsignificant at 12 and 18 months (55.8% vs 38.5%, P = 0.051; 65.4% vs 51.9%, P = \n0.107). Readmissions were significantly more frequent in the control group than in the \nintervention group at one, six and 12 months (0.19 vs 0.02, P = 0.015; 0.77 vs 0.33, P \n= 0.014; 1.12 vs 0.62, P = 0.044), and the control group also had a significantly \nlonger length of hospital stay at one, six, 12 and 18 months (0.92 vs 0.02, P = 0.013; \n13.21 vs 2.44, P = 0.006; 19.40 vs 5.83, P = 0.034; 26.00 vs 10.42, P = 0.033). \nNevertheless, there were no significant differences between the groups regarding the \nnumber of emergency room visits, the need for long-term care or mortality. \nConclusion: The nutritional status of many older adults worsens after hospital \ndischarge, leading to a decline in body weight, nutritional status, physical function, \ncognitive function and mental well-being, which further leads to an increase in hospital \nreadmissions and longer hospital stays. A six-month multimodal nutritional intervention, \nproviding nutritional therapy by a dietitian applying the Nutrition Care Process and its \nterminology, along with free protein- and energy-rich foods, snacks and oral nutritional \nsupplements delivered to the participant’s home, had significant positive effects on \nthese outcomes. These positive effects were related to the improvement of \nanthropometrics and nutritional status. First and foremost, we recommend revising the \ncare given to older adults and adding the proposed approach to the standard care of \nolder adults at nutritional risk. Furthermore, we suggest providing nutritional support \nfrom a clinical dietitian and raising awareness of nutritional risk among older adults at \nall levels of the healthcare system. Such an intervention can positively affect the quality \nof life and independence of older adults and benefit society as a whole.
Author: Ásbjörnsdóttir Blöndal, Berglind Soffía
Language: English
Field: Medicine
Open Access status: green
OpenAlex ID: W6991496210
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