Feasibility of home‐based dietetic intervention to improve the nutritional status of older adults post‐hospital discharge

Abstract

Aim To determine if a model of home-based dietetic care improves dietary intake and weight status in a specific group of older adults post-hospitalisation. MethodsThe Department of Veterans' Affairs clients aged 65 years and over were recruited from hospitals in a regional area of New South Wales, Australia (n = 32 men, n = 36 women). Nutritional status was assessed at home at baseline (within two weeks post-discharge) and three months post-discharge using a diet history, a food frequency checklist and Mini Nutritional Assessment (MNA). Personalised dietary advice was provided by a single dietitian according to participants' nutritional status.Results Mean body weight improved significantly (P = 0.048), as well as mean MNA score (21.9 ± 3.5 vs 25.2 ± 3.1) (P < 0.001). Mean energy, protein and micronutrient intakes were adequate at baseline and three months, except for vitamin D. At three months, the underweight group (body mass index (BMI) < 23 kg/m 2 ) had significantly higher mean protein intake per body weight (1.7 ± 0.4 g/kg) compared to those who were a desirable weight (BMI 23-27 kg/m 2 ) (1.4 ± 0.3 g/kg) or overweight (BMI>27 kg/m 2 ) (1.1 ± 0.3 g/kg) peers (P < 0.001). There was significant improvement in energy intake contributed from oral nutrition supplements (+95.5 ± 388.2 kJ/day) and milk (+259.6 ± 659.8 kJ/day).Conclusions Dietetic intervention improved nutritional status 3 months after hospital discharge in older adults living in the community. Methods: Department of Veterans' Affairs (DVA) patients aged 65 years and over were recruited from hospitals in a regional area of New South Wales, Australia (n=32 men, n=36 women). Nutritional status was assessed at home at baseline (within 2 weeks post discharge) and 3 months post discharge using a diet history, food frequency checklist There was a significant improvement in energy intake contributed from oral nutrition supplements (+95.5±388.2kJ/day) and milk (+259.6±659.8 kJ/day). Conclusions:Dietetic intervention improved nutritional status 3 months after hospital discharge in older adults living in the community.

Improving nutritional discharge planning and follow up in older medical inpatients: Hospital to Home Outreach for Malnourished Elders

“…Research assistants involved in outcome measurement were not involved in design or delivery of the intervention but were aware of the HHOME program and the pre–post design. It is possible that the six‐week follow‐up period was too short to observe significant improvement in nutritional and functional after acute hospitalisation, with other studies showing some benefits at 12 weeks post‐discharge . We did not assess individual adherence to post‐nutrition support strategies such as supplements.…”

“…Previous controlled trials suggest that nutritional discharge planning and post‐discharge follow up may improve nutritional, functional and/or clinical outcomes for older malnourished medical patients . Using a collaborative quality improvement approach, we implemented measureable changes in clinical practice within existing hospital and community resources.…”

“…Previous controlled trials suggest that nutritional discharge planning and post-discharge follow up may improve [13][14][15][16]26 Using a collaborative quality improvement approach, we implemented measureable changes in clinical practice within existing hospital and community resources. The trend to reduced weight loss in the HHOME group suggests that this complex intervention improved nutritional intake.…”

Disease‐related malnutrition in the twenty‐first century: From best evidence to best practice

“…The literature cites several barriers at the organisational, health‐care personnel and patient level that prevent the integration of nutrition screening into routine practice (Figure ). Although identifying and diagnosing malnutrition will not directly improve patient outcomes, resultant appropriate nutritional intervention is likely to commence, which is likely to have a positive influence on health‐related outcomes . Recent reports from multicentre studies reflect disparity in malnutrition diagnosis in medical charts and malnutrition prevalence.…”

“…Although identifying and diagnosing malnutrition will not directly improve patient outcomes, resultant appropriate nutritional intervention is likely to commence, which is likely to have a positive influence on health-related outcomes. 9,17,27,28 Recent reports from multicentre studies reflect disparity in malnutrition diagnosis in medical charts and malnutrition prevalence. Potential reasons to explain this deficit are that there is a lack of understanding regarding malnutrition amongst health-care staff members; malnutrition is not routinely identified, diagnosed and/or documented in medical charts; and malnutrition is perceived as an outcome rather than a medical condition by health-care staff members.…”