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Three Nurse-administered Protocols Reduce Nutritional Decline and Frailty in Older Gastrointestinal Surgery Patients: A Cluster Randomized Trial.

Abstract：

OBJECTIVE:To evaluate the effects of the modified Hospital Elder Life Program (mHELP) comprising 3 nurse-administered protocols in older patients undergoing gastrointestinal (GI) surgery. DESIGN:Cluster randomized trial. SETTING:Two 36-bed GI wards at a university-affiliated medical center in Taiwan. PARTICIPANTS: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. INTERVENTION: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. MEASURES: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. RESULTS: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. CONCLUSION AND IMPLICATIONS: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.

journal_name

J Am Med Dir Assoc

journal_title

Journal of the American Medical Directors Association

authors

Chia-Hui Chen C,Yang YT,Lai IR,Lin BR,Yang CY,Huang J,Tien YW,Chen CN,Lin MT,Liang JT,Li HC,Huang GH,Inouye SK

doi

10.1016/j.jamda.2018.09.016

subject

Has Abstract

pub_date

2019-05-01 00:00:00

pages

524-529.e3

issue

5

eissn

1525-8610

issn

1538-9375

pii

S1525-8610(18)30507-3

journal_volume

20

pub_type

杂志文章,随机对照试验

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