Chia-Hui Chen Cheryl, Yang Yi-Ting, Lai I-Rue, Lin Been-Ren, Yang Ching-Yao, Huang John, Tien Yu-Wen, Chen Chiung-Nien, Lin Ming-Tsan, Liang Jin-Tung, Li Hsiu-Ching, Huang Guan-Hua, Inouye Sharon K
Department of Nursing, College of Medicine, National Taiwan University and National Taiwan University Hospital, Taipei, Taiwan.
Taiwan Center for Disease Control, Taipei, Taiwan.
J Am Med Dir Assoc. 2019 May;20(5):524-529.e3. doi: 10.1016/j.jamda.2018.09.016. Epub 2018 Nov 10.
To evaluate the effects of the modified Hospital Elder Life Program (mHELP) comprising 3 nurse-administered protocols in older patients undergoing gastrointestinal (GI) surgery.
Cluster randomized trial.
Two 36-bed GI wards at a university-affiliated medical center in Taiwan.
Older patients (≥65 years, N = 377) were recruited if they were scheduled for elective GI surgery with an expected length of hospital stay >6 days. After transferring to the GI ward after surgery, participants were randomly assigned to the mHELP or control group (1:1) by room rather than individually because most patient units are double- or triple-occupancy rooms.
The mHELP protocols (early mobilization, oral and nutritional assistance, and orienting communication) were administered daily with usual care by a trained nurse until hospital discharge. The control group received usual care only.
Outcomes were in-hospital nutritional decline, measured by body weight and Mini-Nutritional Assessment (MNA) scores, and Fried's frailty phenotype. Return of GI motility was examined as a potential mechanism contributing to observed outcomes.
Participants (mean age = 74.5 years; 56.8% male) primarily underwent colorectal (56.5%), gastric (21.2%), and pancreatobiliary (13.8%) surgery. Participants who received the mHELP [for a median of 7 days (interquartile range = 6-10 days)] had significantly lower in-hospital weight loss and decline in MNA scores (weight -2.1 vs -4.0 lb, P = .002; score -3.2 vs -4.0, P = .03) than the control group. The mHELP group also had significantly lower rates of incident frailty during hospitalization (12.0% vs 21.7%, P = .022), and persistent frailty (50.0% vs 92.9%, P = .03). Participants in the mHELP group had trends toward an accelerated return of GI motility.
The mHELP effectively reduced nutritional decline, prevented new frailty, and promoted recovery of frailty present before admission. These nurse-administered protocols might be useful in other settings, including conditions managed at home or in nursing facilities.
评估由3项护士执行的方案组成的改良版医院老年生活计划（mHELP）对接受胃肠道（GI）手术的老年患者的影响。
整群随机试验。
台湾一所大学附属医院的两个拥有36张床位的胃肠病房。
年龄≥65岁的老年患者（N = 377），若计划接受预期住院时间>6天的择期胃肠道手术则被纳入研究。术后转至胃肠病房后，由于大多数病房为双人间或三人间，参与者按病房而非个体被随机分配至mHELP组或对照组（1:1）。
由经过培训的护士在日常护理的同时每天执行mHELP方案（早期活动、口腔和营养支持以及定向沟通），直至出院。对照组仅接受常规护理。
通过体重和简易营养评估（MNA）评分以及Fried衰弱表型来衡量住院期间的营养状况下降情况。检查胃肠道动力恢复情况，作为观察到的结果的潜在促成机制。
参与者（平均年龄 = 74.5岁；56.8%为男性）主要接受结直肠手术（56.5%）、胃手术（21.2%）和胰胆手术（13.8%）。接受mHELP的参与者[中位时间为7天（四分位间距 = 6 - 10天）]在住院期间的体重减轻和MNA评分下降幅度显著低于对照组（体重 -2.1磅对 -4.0磅，P = 0.002；评分 -3.2对 -4.0，P = 0.03）。mHELP组在住院期间发生衰弱的比率也显著较低（12.0%对21.7%，P = 0.022），以及持续性衰弱（50.0%对92.9%，P = 0.03）。mHELP组的参与者胃肠道动力恢复有加快的趋势。
mHELP有效减少了营养状况下降，预防了新的衰弱，并促进了入院前已存在的衰弱的恢复。这些由护士执行的方案可能在其他环境中有用，包括在家中或护理机构管理的情况。
