Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
Department of Internal Medicine and Aged Care, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
Nutr Diet. 2018 Jul;75(3):283-290. doi: 10.1111/1747-0080.12408. Epub 2018 Feb 2.
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.
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.
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 12 weeks post-discharge.
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.
在急性住院期间和之后，老年人的营养状况下降很常见。这项质量改进计划旨在在两家医院引入营养师主导的出院计划和随访方案（医院至家庭营养不良老年人外展，HHOME），以改善营养和功能恢复。
采用前瞻性前后评估设计。有营养不良风险且出院后独立生活的 65 岁以上的住院患者符合条件。接受营养出院计划和饮食电话随访四周的患者（HHOME）与常规护理（HHOME 前）进行比较。出院时和六周后测量营养状况（体重和微型营养评估（MNA））、功能（步态速度、手握力和改良巴氏指数）和生活质量-6D 评估（AQoL-6D）结果。
在六周时，HHOME 组（n=39）和 HHOME 前组的营养状况没有显著差异，尽管 HHOME 组平均保持体重，而 HHOME 前组体重下降（0.4±2.9kg 与-1.0±3.7kg，P=0.060）。HHOME 组的步态速度改善更明显（+0.24±0.27 与+0.11±0.22，P=0.046），其他结果无显著改善。在两个队列中，有一半的患者再次住院，出院后 12 周内有 10%的患者死亡。
为社区居住的营养不良老年患者提供的营养出院计划和饮食随访对营养和功能参数的影响较小，但临床结果仍然较差。
