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Published in: Trials 1/2020

Open Access 01-12-2020 | Nutrition | Study protocol

Effect of nutritional interventions on discharged older patients: study protocol for a randomized controlled trial

Authors: Tina Munk, Jonas Anias Svendsen, Anne Wilkens Knudsen, Tanja Bak Østergaard, Anne Marie Beck

Published in: Trials | Issue 1/2020

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Abstract

Background

During hospitalization, many older patients are at nutritional risk or malnourished, and their nutritional condition is often further impaired during hospitalization. After discharge, a “nutrition gap” often occurs in which the patient does not receive enough nutrition to ensure an optimal recovery.

Methods

The study is a randomized controlled study ongoing over 112 days. At discharge, the intervention group receives guidance from a clinical dietitian, and an individualized nutrition plan is made. The dietitian will perform telephone follow-up after 4 and 30 days. It will also be possible for the participant, the participant’s relatives, or the participant’s municipality to contact the dietitian if nutritional questions arise. At the time of discharge, the intervention group will receive a package containing foods and drinks that will cover their nutritional needs on the first day after discharge. They will also receive a goodie bag containing samples of protein-rich, milk-based drinks. Data are collected on quality of life, appetite, physical function, dietary intake, weight, height, energy and protein needs, and experience of discharge and cooperation with the municipality. Information about nutrition status will be sent to the municipality so that the municipality can take over nutritional treatment. The control group receives a standard treatment.

Discussion

This study is the first to combine previously successful single nutritional interventions into a multimodal intervention whose aim is to obtain an effect on patient-related outcomes. We hope that the results will prove beneficial and help to ensure the cross-sector quality of nutritional support to older patients.

Trial registration

ClinicalTrials.gov, NCT03488329. April 5, 2018.
Appendix
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Literature
1.
go back to reference Beck AM, Kjær S, Hansen BS, Storm RL, Thal-Jantzen K, Bitz C. Follow-up home visits with registered dietitians have a positive effect on the functional and nutritional status of geriatric medical patients after discharge: a randomized controlled trial. Clin Rehabil. 2013;27:483–93.CrossRef Beck AM, Kjær S, Hansen BS, Storm RL, Thal-Jantzen K, Bitz C. Follow-up home visits with registered dietitians have a positive effect on the functional and nutritional status of geriatric medical patients after discharge: a randomized controlled trial. Clin Rehabil. 2013;27:483–93.CrossRef
2.
go back to reference Beck A, Andersen UT, Leedo E, Jensen LL, Martins K, Quvang M, Rask KØ, Vedelspang A, Rønholt F. Does adding a dietician to the liaison team after discharge of geriatric patients improve nutritional outcome: a randomised controlled trial. Clin Rehabil. 2015;29:1117–28.CrossRef Beck A, Andersen UT, Leedo E, Jensen LL, Martins K, Quvang M, Rask KØ, Vedelspang A, Rønholt F. Does adding a dietician to the liaison team after discharge of geriatric patients improve nutritional outcome: a randomised controlled trial. Clin Rehabil. 2015;29:1117–28.CrossRef
3.
go back to reference Charlton KE, Nichols C, Bowden S, Lambert K, Barone L, Mason M, Milosavljevic M. Older rehabilitation patients are at high risk of malnutrition: evidence from a large Australian database. J Nutr Health Aging. 2010;14:622–8.CrossRef Charlton KE, Nichols C, Bowden S, Lambert K, Barone L, Mason M, Milosavljevic M. Older rehabilitation patients are at high risk of malnutrition: evidence from a large Australian database. J Nutr Health Aging. 2010;14:622–8.CrossRef
5.
go back to reference Collins J. Porter J. The effect of interventions to prevent and treat malnutrition in patients admitted for rehabilitation: a systematic review with meta-analysis. J Hum Nutr Diet. 2015;28:1–15.CrossRef Collins J. Porter J. The effect of interventions to prevent and treat malnutrition in patients admitted for rehabilitation: a systematic review with meta-analysis. J Hum Nutr Diet. 2015;28:1–15.CrossRef
6.
go back to reference Cramon MO, Raben I, Beck AM, Andersen JR. Individual nutritional intervention during 4 weeks for the prevention of re-admissions among geriatric patients – RCT [abstract OR28]. Clin Nutr ESPEN. 2019;38(Suppl 1):S14–5.CrossRef Cramon MO, Raben I, Beck AM, Andersen JR. Individual nutritional intervention during 4 weeks for the prevention of re-admissions among geriatric patients – RCT [abstract OR28]. Clin Nutr ESPEN. 2019;38(Suppl 1):S14–5.CrossRef
7.
go back to reference Danish National Board of Health. National clinical guideline for nutrition and training initiatives aimed at elderly people with geriatric issues. 2016. Danish National Board of Health. National clinical guideline for nutrition and training initiatives aimed at elderly people with geriatric issues. 2016.
8.
go back to reference Goldberg GR, Black AE, Jebb SA, Cole TJ, Murgatroyd PR, Coward WA, et al. Critical evaluation of energy intake data using fundamental principles of energy physiology: 1. Derivation of cut-off limits to identify under-recording. Eur J Clin Nutr. 1991;45(12):569–81.PubMed Goldberg GR, Black AE, Jebb SA, Cole TJ, Murgatroyd PR, Coward WA, et al. Critical evaluation of energy intake data using fundamental principles of energy physiology: 1. Derivation of cut-off limits to identify under-recording. Eur J Clin Nutr. 1991;45(12):569–81.PubMed
9.
go back to reference Husted MM. The effect of nutritional therapy til older patients including follow-up using electronic communication to the municipality [in Danish]: Master’s thesis, University of Southern Denmark; 2015. Husted MM. The effect of nutritional therapy til older patients including follow-up using electronic communication to the municipality [in Danish]: Master’s thesis, University of Southern Denmark; 2015.
10.
go back to reference Jones CJ, Rikli RE, Beam WC. A 30-s chair-stand test as a measure of lower body strength in community-residing older adults. Res Q Exerc Sport. 1999;70:113–9.CrossRef Jones CJ, Rikli RE, Beam WC. A 30-s chair-stand test as a measure of lower body strength in community-residing older adults. Res Q Exerc Sport. 1999;70:113–9.CrossRef
11.
go back to reference Kaiser MJ, Bauer JM, Rämsch C, Uter W, Guigoz Y, Cederholm T, Thomas DR, Anthony PS, Charlton KE, Maggio M, Tsai AC, Vellas B, Sieber CC, Mini Nutritional Assessment International Group. Frequency of malnutrition in older adults: a multinational perspective using the Mini Nutritional Assessment. J Am Geriatr Soc. 2010;58:1734–8.CrossRef Kaiser MJ, Bauer JM, Rämsch C, Uter W, Guigoz Y, Cederholm T, Thomas DR, Anthony PS, Charlton KE, Maggio M, Tsai AC, Vellas B, Sieber CC, Mini Nutritional Assessment International Group. Frequency of malnutrition in older adults: a multinational perspective using the Mini Nutritional Assessment. J Am Geriatr Soc. 2010;58:1734–8.CrossRef
12.
go back to reference Kim IY, Deutz NEP, Wolfe RR. Update on maximal anabolic response to dietary protein. Clin Nutr. 2018;37:411–8.CrossRef Kim IY, Deutz NEP, Wolfe RR. Update on maximal anabolic response to dietary protein. Clin Nutr. 2018;37:411–8.CrossRef
13.
go back to reference Kondrup J, Allison SP, Elia M, Vellas B, Plauth M, Educational and Clinical Practice Committee, European Society of Parenteral and Enteral Nutrition (ESPEN). ESPEN guidelines for nutrition screening 2002. Clin Nutr. 2003;22:415–21.CrossRef Kondrup J, Allison SP, Elia M, Vellas B, Plauth M, Educational and Clinical Practice Committee, European Society of Parenteral and Enteral Nutrition (ESPEN). ESPEN guidelines for nutrition screening 2002. Clin Nutr. 2003;22:415–21.CrossRef
14.
go back to reference Lindegaard Pedersen J, Pedersen PU, Damsgaard EM. Nutritional follow-up after discharge prevents readmission to hospital - a randomized clinical trial. J Nutr Health Aging. 2017;21:75–82.CrossRef Lindegaard Pedersen J, Pedersen PU, Damsgaard EM. Nutritional follow-up after discharge prevents readmission to hospital - a randomized clinical trial. J Nutr Health Aging. 2017;21:75–82.CrossRef
15.
go back to reference Milne AC, Potter J, Vivanti A, Avenell A. Protein and energy supplementation in elderly people at risk from malnutrition. Cochrane Database Syst Rev. 2009;2:CD003288. Milne AC, Potter J, Vivanti A, Avenell A. Protein and energy supplementation in elderly people at risk from malnutrition. Cochrane Database Syst Rev. 2009;2:CD003288.
16.
go back to reference Morilla-Herrera JC, Garcia-Mayor S, Martín-Santos FJ, Kaknani Uttumchandani S, Leon Campos Á, Caro Bautista J, Morales-Asencio JM. A systematic review of the effectiveness and roles of advanced practice nursing in older people. Int J Nurs Stud. 2016;53:290–307.CrossRef Morilla-Herrera JC, Garcia-Mayor S, Martín-Santos FJ, Kaknani Uttumchandani S, Leon Campos Á, Caro Bautista J, Morales-Asencio JM. A systematic review of the effectiveness and roles of advanced practice nursing in older people. Int J Nurs Stud. 2016;53:290–307.CrossRef
17.
go back to reference Munk T, Beck AM, Holst M, Rosenbom E, Rasmussen HH, Nielsen MA, Thomsen T. Positive effect of protein-supplemented hospital food on protein intake in patients at nutritional risk: a randomised controlled trial. J Hum Nutr Diet. 2014;27:122–32.CrossRef Munk T, Beck AM, Holst M, Rosenbom E, Rasmussen HH, Nielsen MA, Thomsen T. Positive effect of protein-supplemented hospital food on protein intake in patients at nutritional risk: a randomised controlled trial. J Hum Nutr Diet. 2014;27:122–32.CrossRef
18.
go back to reference Munk T, Bruun N, Nielsen MA, Thomsen T. From evidence to clinical practice: positive effect of implementing a protein-enriched hospital menu in conjunction with individualized dietary counseling. Nutr Clin Pract. 2017;32:420–6.CrossRef Munk T, Bruun N, Nielsen MA, Thomsen T. From evidence to clinical practice: positive effect of implementing a protein-enriched hospital menu in conjunction with individualized dietary counseling. Nutr Clin Pract. 2017;32:420–6.CrossRef
19.
go back to reference Munk T, Tolstrup U, Beck AM, Holst M, Rasmussen HH, Hovhannisyan K, Thomsen T. Individualised dietary counselling for nutritionally at-risk older patients following discharge from acute hospital to home: a systematic review and meta-analysis. J Hum Nutr Diet. 2016;29:196–208.CrossRef Munk T, Tolstrup U, Beck AM, Holst M, Rasmussen HH, Hovhannisyan K, Thomsen T. Individualised dietary counselling for nutritionally at-risk older patients following discharge from acute hospital to home: a systematic review and meta-analysis. J Hum Nutr Diet. 2016;29:196–208.CrossRef
20.
go back to reference Nordic Council of Ministers. Nordic nutrient recommendation. Nord. 2014:002.. Nordic Council of Ministers. Nordic nutrient recommendation. Nord. 2014:002..
21.
go back to reference Norman K, Pichard C, Lochs H, Pirlich M. Prognostic impact of disease-related malnutrition. Clin Nutr. 2008;27:5–15.CrossRef Norman K, Pichard C, Lochs H, Pirlich M. Prognostic impact of disease-related malnutrition. Clin Nutr. 2008;27:5–15.CrossRef
22.
go back to reference Okkels SL, Saxosen M, Bügel S, Olsen A, Klausen TW, Beck A. Acceptance of texture-modified in-between-meals among old adults with dysphagia. Clin Nutr ESPEN. 2018;25:126–32.CrossRef Okkels SL, Saxosen M, Bügel S, Olsen A, Klausen TW, Beck A. Acceptance of texture-modified in-between-meals among old adults with dysphagia. Clin Nutr ESPEN. 2018;25:126–32.CrossRef
23.
go back to reference Okkels SL, Dybdal DR, Beck A, Bügel S, Klausen TW, Olsen A. An investigation of main meal preferences in nursing homes. J Sens Stud. 2019;34:e12504.CrossRef Okkels SL, Dybdal DR, Beck A, Bügel S, Klausen TW, Olsen A. An investigation of main meal preferences in nursing homes. J Sens Stud. 2019;34:e12504.CrossRef
24.
go back to reference Pedersen JL, Pedersen PU, Damsgaard EM. Early nutritional follow-up after discharge prevents deterioration of ADL functions in malnourished, independent, geriatric patients who live alone - a randomized clinical trial. J Nutr Health Aging. 2016;20:845–53.CrossRef Pedersen JL, Pedersen PU, Damsgaard EM. Early nutritional follow-up after discharge prevents deterioration of ADL functions in malnourished, independent, geriatric patients who live alone - a randomized clinical trial. J Nutr Health Aging. 2016;20:845–53.CrossRef
25.
go back to reference Pohju A, Belqaid K, Brandt CF, Lugnet K, Nielsen AL, Rasmussen NML, Rasmussen HH, Beck AM. Adding a dietitian to a Danish liaison-team after discharge of geriatric patients at nutritional risk may save health care costs. Aging Sci. 2016;4:2.CrossRef Pohju A, Belqaid K, Brandt CF, Lugnet K, Nielsen AL, Rasmussen NML, Rasmussen HH, Beck AM. Adding a dietitian to a Danish liaison-team after discharge of geriatric patients at nutritional risk may save health care costs. Aging Sci. 2016;4:2.CrossRef
26.
go back to reference Sørensen J, Davidsen M, Gudex C, Pedersen KM, Brønnum-Hansen H. Danish EQ-5D population norms. Scand J Public Health. 2009;37:467–74.CrossRef Sørensen J, Davidsen M, Gudex C, Pedersen KM, Brønnum-Hansen H. Danish EQ-5D population norms. Scand J Public Health. 2009;37:467–74.CrossRef
27.
go back to reference Terp R, Jacobsen KO, Kannegaard P, Larsen AM, Madsen OR, Noiesen E. A nutritional intervention program improves the nutritional status of geriatric patients at nutritional risk-a randomized controlled trial. Clin Rehabil. 2018;32:930–41.CrossRef Terp R, Jacobsen KO, Kannegaard P, Larsen AM, Madsen OR, Noiesen E. A nutritional intervention program improves the nutritional status of geriatric patients at nutritional risk-a randomized controlled trial. Clin Rehabil. 2018;32:930–41.CrossRef
28.
go back to reference Trabal J, Farran-Codina A. Effects of dietary enrichment with conventional foods on energy and protein intake in older adults: a systematic review. Nutr Rev. 2015;73:624–33.CrossRef Trabal J, Farran-Codina A. Effects of dietary enrichment with conventional foods on energy and protein intake in older adults: a systematic review. Nutr Rev. 2015;73:624–33.CrossRef
29.
go back to reference Volkert D, Beck AM, Cederholm T, Cruz-Jentoft A, Goisser S, Hooper L, Kiesswetter E, Maggio M, Raynaud-Simon A, Sieber CC, Sobotka L, van Asselt D, Wirth R, Bischoff SC. ESPEN guideline on clinical nutrition and hydration in geriatrics. Clin Nutr. 2019;38:10–47.CrossRef Volkert D, Beck AM, Cederholm T, Cruz-Jentoft A, Goisser S, Hooper L, Kiesswetter E, Maggio M, Raynaud-Simon A, Sieber CC, Sobotka L, van Asselt D, Wirth R, Bischoff SC. ESPEN guideline on clinical nutrition and hydration in geriatrics. Clin Nutr. 2019;38:10–47.CrossRef
30.
go back to reference Wilson MM, Thomas DR, Rubenstein LZ, Chibnall JT, Anderson S, Baxi A, Diebold MR, Morley JE. Appetite assessment: simple appetite questionnaire predicts weight loss in community-dwelling adults and nursing home residents. Am J Clin Nutr. 2005;82:1074–81.CrossRef Wilson MM, Thomas DR, Rubenstein LZ, Chibnall JT, Anderson S, Baxi A, Diebold MR, Morley JE. Appetite assessment: simple appetite questionnaire predicts weight loss in community-dwelling adults and nursing home residents. Am J Clin Nutr. 2005;82:1074–81.CrossRef
31.
go back to reference Ygil KH. Dimensions, weight and portion sizes of foods [in Danish]. Kongens Lyngby: National Food Institute (DTU); 2003. Ygil KH. Dimensions, weight and portion sizes of foods [in Danish]. Kongens Lyngby: National Food Institute (DTU); 2003.
Metadata
Title
Effect of nutritional interventions on discharged older patients: study protocol for a randomized controlled trial
Authors
Tina Munk
Jonas Anias Svendsen
Anne Wilkens Knudsen
Tanja Bak Østergaard
Anne Marie Beck
Publication date
01-12-2020
Publisher
BioMed Central
Published in
Trials / Issue 1/2020
Electronic ISSN: 1745-6215
DOI
https://doi.org/10.1186/s13063-020-04301-6

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