Post-Discharge Nutritional Support in Malnourished Elderly Individuals Improves Functional Limitations

Neelemaat, F.; Bosmans, Judith E.; Thijs, Abel; Seidell, Jacob C.; Schueren, Marian A.E. de van der

doi:10.1016/j.jamda.2010.12.005

Cited by 97 publications

(148 citation statements)

References 18 publications

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“…Lack of time as well as economical aspects were also in focus, when establishing parenteral nutrition in patients after care. It was striking that doctors and nurses would spent so much time and economic resources on the treatment of patients while at hospital, but did not take responsibility for the patient to gain nutritional status and general health in the period of convalescence, thus beneficial [11, pages 3299–3307], [3, pages 321–325], [14, pages 2239–2245], [13, pages 61–67], [15, pages 295–301], [4, pages 386–395], and [16]. However, it does not seem rational that every doctor and nurse should have these conflicts in their daily effort to treat the patients.…”

Section: Discussionmentioning

confidence: 99%

“…Studies have demonstrated that efforts on optimizing energy and protein intake at discharge and in the rehabilitation period after discharge are beneficial [11, pages 3299–3307], [3, pages 321–325], [14, pages 2239–2245], [13, pages 61–67], [15, pages 295–301], [4, pages 386–395], and [16]. A recent review found a positive effect on nutritional intake and/or nutritional status by nutritional intervention after discharge from hospital [17, pages 19–27].…”

Section: Introductionmentioning

confidence: 99%

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Nutrition Therapy in the Transition between Hospital and Home: An Investigation of Barriers

Holst

Rasmussen

2013

Journal of Nutrition and Metabolism

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Aims and Objectives. This study aimed to investigate barriers for nutrition therapy in the transition between hospital and home and hereby to identify areas for potential improvements. Background. Though the focus on nutritional risk is improving in hospital, there seems to be less effort to maintain or even improve nutritional status after discharge and during the rehabilitation period. Design. Qualitative focus group interviews. Methods. Semistructured focus group interviews with experienced multiprofessional staff from hospital, home care, nursing homes, and general practise. The study was done in the county of Aalborg with about 280.000 inhabitants regarding homecare and general practise as well as Aalborg University Hospital, Denmark. Results. Interviews were generated with 41 professionals from hospital, general practise, and home care. Barriers identified between settings included the following aspects: economic, organisation, and education. The impression of professionals was that few patients are discharged with nutrition therapy, compared to who could benefit from nutrition therapy after discharge. Most often, reasons were a short in-hospital stay and lack of knowledge and interest. Moreover, lack of clinical guidelines throughout all settings, time consumption, lack of transparency regarding economy and workflows, and lack of assistance from experts regarding complicated nutritional problems were identified. Conclusions. Many barriers were found in hospital as well as in the community and general practise. These were most often practical as well as organizational. Improvements of clinical guidelines and instructions and improvement of knowledge and communication at all levels are needed. Relevance to Clinical Practise. This study emphasizes that responsibility needs to be taken for patients whom are still at nutritional risk at discharge, and even before hospitalization. Nurses and doctors in and outside hospital are in need of improved knowledge, standard care plans, and instructions.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Nutrition Therapy in the Transition between Hospital and Home: An Investigation of Barriers

Holst

Rasmussen

2013

Journal of Nutrition and Metabolism

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“…57 Nutritional supplementation is effective in the treatment of weight loss. 58,59 Protein supplementation increases muscle mass, 60–65 reduces complications, 66 improves grip strength, 66 produces weight gain, 66 and may act synergistically with resistance exercise in older persons. 62,63 Frailty can also be seen in persons who are morbidly obese.…”

Section: Recommendationsmentioning

confidence: 99%

Frailty Consensus: A Call to Action

Morley¹,

Vellas²,

Kan³

et al. 2013

Journal of the American Medical Directors Association

3,110

2,393

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Frailty is a clinical state in which there is an increase in an individual’s vulnerability for developing increased dependency and/or mortality when exposed to a stressor. Frailty can occur as the result of a range of diseases and medical conditions. A consensus group consisting of delegates from 6 major international, European, and US societies created 4 major consensus points on a specific form of frailty: physical frailty. Physical frailty is an important medical syndrome. The group defined physical frailty as “a medical syndrome with multiple causes and contributors that is characterized by diminished strength, endurance, and reduced physiologic function that increases an individual’s vulnerability for developing increased dependency and/or death.”Physical frailty can potentially be prevented or treated with specific modalities, such as exercise, protein-calorie supplementation, vitamin D, and reduction of polypharmacy.Simple, rapid screening tests have been developed and validated, such as the simple FRAIL scale, to allow physicians to objectively recognize frail persons.For the purposes of optimally managing individuals with physical frailty, all persons older than 70 years and all individuals with significant weight loss (≥5%) due to chronic disease should be screened for frailty.

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“…For example, Feldblum et al [10] demonstrated that in-hospital and home dietitian visits, prescriptive diets and use of oral nutritional supplements (ONS), improved nutritional status as measured with the Mini Nutritional Assessment. Care that starts in the hospital and follows through with transitions to the community has also been shown to improve functional outcomes [11]. Thus, quality nutrition care that promotes individualized approaches for malnourished patients is a best practice [12, 13] that has benefits to the patient and potentially the health system.…”

Section: Introductionmentioning

confidence: 99%

The Integrated Nutrition Pathway for Acute Care (INPAC): Building consensus with a modified Delphi

Keller

McCullough

Davidson

et al. 2015

Nutr J

110

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BackgroundMalnutrition is commonly underdiagnosed and undertreated in acute care patients. Implementation of current pathways of care is limited, potentially as a result of the perception that they are not feasible with current resources. There is a need for a pathway based on expert consensus, best practice and evidence that addresses this crisis in acute care, while still being feasible for implementation.MethodsA modified Delphi was used to develop consensus on a new pathway. Extant literature and other resources were reviewed to develop an evidence-informed background document and draft pathway, which were considered at a stakeholder meeting of 24 experts. Two rounds of an on-line Delphi survey were completed (n = 28 and 26 participants respectively). Diverse clinicians from four hospitals participated in focus groups to face validate the draft pathway and a final stakeholder meeting confirmed format changes to make the pathway conceptually clear and easy to follow for end-users. Experts involved in this process were researchers and clinicians from dietetics, medicine and nursing, including management and frontline personnel.Results80 % of stakeholders who were invited, participated in the first Delphi survey. The two rounds of the Delphi resulted in consensus for all but two minor components of the Integrated Nutrition Pathway for Acute Care (INPAC). The format of the INPAC was revised based on the input of focus group participants, stakeholders and investigators.ConclusionsThis evidence-informed, consensus based pathway for nutrition care has greater depth and breadth than prior guidelines that were commonly based on systematic reviews. As extant evidence for many best practices is absent, the modified Delphi process has allowed for consensus to be developed based on better practices. Attention to feasibility during development has created a pathway that has greater implementation potential. External validation specifically with practitioner groups promoted a conceptually easy to use format. Test site implementation and evaluation is needed to identify resource requirements and demonstrate process and patient reported outcomes resulting from embedding INPAC into clinical practice.

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Post-Discharge Nutritional Support in Malnourished Elderly Individuals Improves Functional Limitations

Cited by 97 publications

References 18 publications

Nutrition Therapy in the Transition between Hospital and Home: An Investigation of Barriers

Nutrition Therapy in the Transition between Hospital and Home: An Investigation of Barriers

Frailty Consensus: A Call to Action

The Integrated Nutrition Pathway for Acute Care (INPAC): Building consensus with a modified Delphi

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