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

Adrienne M. Young, Alison M. Mudge, Merrilyn D. Banks, Lauren Rogers, Kristen Demedio, Elisabeth Isenring

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Abstract

Aim: Nutritional decline during and after acute hospitalisation is common amongst older people. This quality improvement initiative aimed to introduce a dietitian-led discharge planning and follow-up program (Hospital to Home Outreach for Malnourished Elders, HHOME) at two hospitals within usual resources to improve nutritional and functional recovery. Methods: Prospective pre-post evaluation design was used. Medical patients aged 65+ years at-risk of malnutrition and discharged to independent living were eligible. Participants receiving nutrition discharge planning and dietetic telephone follow up for four weeks post-discharge ('HHOME') were compared to usual care ('pre-HHOME'). Nutritional (weight and mini nutritional assessment (MNA)), functional (gait speed, handgrip strength and modified Barthel index) and assessment of quality of life-6D (AQoL-6D) outcomes were measured on discharge and six weeks later. Results: At six weeks, no significant difference in nutritional status was observed between pre-HHOME (n=39) and HHOME cohorts, although the HHOME cohort on average maintained weight while pre-HHOME cohort lost weight (0.4±2.9 kg vs -1.0±3.7 kg, P=0.060). Greater improvement in gait speed was seen in HHOME group (+0.24±0.27 vs +0.11±0.22, P=0.046) with no other significant outcome improvements. Across both cohorts, half were readmitted to hospital and 10% died within 12weeks post-discharge. Conclusions: The nutritional discharge planning and dietetic follow up provided to older community-living malnourished patients made a small impact on nutritional and functional parameters but clinical outcomes remained poor.

Original languageEnglish
Pages (from-to)283-290
Number of pages8
JournalNutrition and Dietetics
Volume75
Issue number3
DOIs
Publication statusPublished - Jul 2018

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Patient Discharge
Inpatients
Dietetics
Weights and Measures
Independent Living
Nutrition Assessment
Nutritionists
Quality Improvement
Nutritional Status
Telephone
Malnutrition
Hospitalization
Quality of Life

Cite this

Young, Adrienne M. ; Mudge, Alison M. ; Banks, Merrilyn D. ; Rogers, Lauren ; Demedio, Kristen ; Isenring, Elisabeth. / Improving nutritional discharge planning and follow up in older medical inpatients : Hospital to Home Outreach for Malnourished Elders. In: Nutrition and Dietetics. 2018 ; Vol. 75, No. 3. pp. 283-290.
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title = "Improving nutritional discharge planning and follow up in older medical inpatients: Hospital to Home Outreach for Malnourished Elders",
abstract = "Aim: Nutritional decline during and after acute hospitalisation is common amongst older people. This quality improvement initiative aimed to introduce a dietitian-led discharge planning and follow-up program (Hospital to Home Outreach for Malnourished Elders, HHOME) at two hospitals within usual resources to improve nutritional and functional recovery. Methods: Prospective pre-post evaluation design was used. Medical patients aged 65+ years at-risk of malnutrition and discharged to independent living were eligible. Participants receiving nutrition discharge planning and dietetic telephone follow up for four weeks post-discharge ('HHOME') were compared to usual care ('pre-HHOME'). Nutritional (weight and mini nutritional assessment (MNA)), functional (gait speed, handgrip strength and modified Barthel index) and assessment of quality of life-6D (AQoL-6D) outcomes were measured on discharge and six weeks later. Results: At six weeks, no significant difference in nutritional status was observed between pre-HHOME (n=39) and HHOME cohorts, although the HHOME cohort on average maintained weight while pre-HHOME cohort lost weight (0.4±2.9 kg vs -1.0±3.7 kg, P=0.060). Greater improvement in gait speed was seen in HHOME group (+0.24±0.27 vs +0.11±0.22, P=0.046) with no other significant outcome improvements. Across both cohorts, half were readmitted to hospital and 10{\%} died within 12weeks post-discharge. Conclusions: The nutritional discharge planning and dietetic follow up provided to older community-living malnourished patients made a small impact on nutritional and functional parameters but clinical outcomes remained poor.",
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Improving nutritional discharge planning and follow up in older medical inpatients : Hospital to Home Outreach for Malnourished Elders. / Young, Adrienne M.; Mudge, Alison M.; Banks, Merrilyn D.; Rogers, Lauren; Demedio, Kristen; Isenring, Elisabeth.

In: Nutrition and Dietetics, Vol. 75, No. 3, 07.2018, p. 283-290.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Improving nutritional discharge planning and follow up in older medical inpatients

T2 - Hospital to Home Outreach for Malnourished Elders

AU - Young, Adrienne M.

AU - Mudge, Alison M.

AU - Banks, Merrilyn D.

AU - Rogers, Lauren

AU - Demedio, Kristen

AU - Isenring, Elisabeth

PY - 2018/7

Y1 - 2018/7

N2 - Aim: Nutritional decline during and after acute hospitalisation is common amongst older people. This quality improvement initiative aimed to introduce a dietitian-led discharge planning and follow-up program (Hospital to Home Outreach for Malnourished Elders, HHOME) at two hospitals within usual resources to improve nutritional and functional recovery. Methods: Prospective pre-post evaluation design was used. Medical patients aged 65+ years at-risk of malnutrition and discharged to independent living were eligible. Participants receiving nutrition discharge planning and dietetic telephone follow up for four weeks post-discharge ('HHOME') were compared to usual care ('pre-HHOME'). Nutritional (weight and mini nutritional assessment (MNA)), functional (gait speed, handgrip strength and modified Barthel index) and assessment of quality of life-6D (AQoL-6D) outcomes were measured on discharge and six weeks later. Results: At six weeks, no significant difference in nutritional status was observed between pre-HHOME (n=39) and HHOME cohorts, although the HHOME cohort on average maintained weight while pre-HHOME cohort lost weight (0.4±2.9 kg vs -1.0±3.7 kg, P=0.060). Greater improvement in gait speed was seen in HHOME group (+0.24±0.27 vs +0.11±0.22, P=0.046) with no other significant outcome improvements. Across both cohorts, half were readmitted to hospital and 10% died within 12weeks post-discharge. Conclusions: The nutritional discharge planning and dietetic follow up provided to older community-living malnourished patients made a small impact on nutritional and functional parameters but clinical outcomes remained poor.

AB - Aim: Nutritional decline during and after acute hospitalisation is common amongst older people. This quality improvement initiative aimed to introduce a dietitian-led discharge planning and follow-up program (Hospital to Home Outreach for Malnourished Elders, HHOME) at two hospitals within usual resources to improve nutritional and functional recovery. Methods: Prospective pre-post evaluation design was used. Medical patients aged 65+ years at-risk of malnutrition and discharged to independent living were eligible. Participants receiving nutrition discharge planning and dietetic telephone follow up for four weeks post-discharge ('HHOME') were compared to usual care ('pre-HHOME'). Nutritional (weight and mini nutritional assessment (MNA)), functional (gait speed, handgrip strength and modified Barthel index) and assessment of quality of life-6D (AQoL-6D) outcomes were measured on discharge and six weeks later. Results: At six weeks, no significant difference in nutritional status was observed between pre-HHOME (n=39) and HHOME cohorts, although the HHOME cohort on average maintained weight while pre-HHOME cohort lost weight (0.4±2.9 kg vs -1.0±3.7 kg, P=0.060). Greater improvement in gait speed was seen in HHOME group (+0.24±0.27 vs +0.11±0.22, P=0.046) with no other significant outcome improvements. Across both cohorts, half were readmitted to hospital and 10% died within 12weeks post-discharge. Conclusions: The nutritional discharge planning and dietetic follow up provided to older community-living malnourished patients made a small impact on nutritional and functional parameters but clinical outcomes remained poor.

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U2 - 10.1111/1747-0080.12408

DO - 10.1111/1747-0080.12408

M3 - Article

VL - 75

SP - 283

EP - 290

JO - Nutrition and Dietetics

JF - Nutrition and Dietetics

SN - 1032-1322

IS - 3

ER -