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Oral nutritional supplements during acute illness and recovery reduced non-elective hospital readmissions in older patients
  1. Nancy Bergstrom, RN, PhD, FAAN
  1. University of Texas Health Science Center Houston,
 Houston, Texas, USA

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 Q Does nutritional support during acute illness and recovery improve clinical outcome in older patients?

    METHODS

    Embedded ImageDesign:

    randomised placebo controlled trial.

    Embedded ImageAllocation:

    concealed.

    Embedded ImageBlinding:

    blinded (patients, healthcare providers, {data collectors, outcome assessors,}* and data analysts).

    Embedded ImageFollow up period:

    6 months.

    Embedded ImageSetting:

    {a hospital in South Yorkshire, UK}.*

    Embedded ImagePatients:

    445 patients ⩾65 years of age (mean age 77 y, 53% men) who were admitted to hospital and able to swallow. Exclusion criteria were gastric surgery, malabsorption or morbid obesity (body mass index >40), coma, severe dementia (Abbreviated Mental Test Score <6), malignancy, current receipt of supplements, or residence in an institution.

    Embedded ImageIntervention:

    usual hospital diet plus daily oral nutritional supplements, 200 ml twice daily, which provided 995 kcal of energy and 100% of vitamins recommended by Reference Nutrient Intakes for healthy older people (n = 223) or usual hospital diet plus matching placebo supplement, which contained no protein or micronutrients and a minimum of 60 kcal of energy (n = 222) for 6 weeks.

    Embedded ImageOutcomes:

    mortality, morbidity (infectious complications), disability (Barthel score; 0  =  fully dependent, 20  =  independent), non-elective hospital readmission, length of hospital stay, discharge destination (own home or institution), and nutritional status.

    Embedded ImagePatient follow up:

    100% (intention to treat analysis). Follow up for nutritional status was 51%.

    MAIN RESULTS

    The oral nutritional supplement group had fewer non-elective hospital readmissions than the placebo group (table); groups did not differ for mortality, morbidity (table), disability (mean Barthel score 18.3 v 18.6, p = 0.9), length of hospital stay (mean 9.4 v 10 d, p = 0.2), or discharge destination. Nutritional status is not reported here because <80% of patients were included in the analysis.

    Oral nutritional supplements v placebo during acute illness and recovery in older patients*

    CONCLUSION

    Oral nutritional supplements during acute illness and recovery reduced non-elective hospital readmissions in older patients but did not reduce mortality, morbidity, disability, length of hospital stay, or discharge destination.

    Commentary

    Does nutritional supplementation provide a clinical benefit for older people? In the impeccably designed study by Gariballa et al, 6 weeks of nutritional supplementation beginning in hospital led to reduced hospital readmissions at the 6 month follow up.

    A previous systematic review of 55 randomised controlled trials (RCTs) by Milne et al showed that mortality was reduced in malnourished patients, and complications were reduced in hospital patients.1 The combined evidence continues to lend support to the use of nutritional supplementation for older hospital patients, although better evidence is needed to determine who should be supported, at what level, and for what length of time. The supplement levels were low in some RCTs in the review by Milne et al, and the supplement goals of Gariballa et al were very high (∼160% of dietary intake). 60% of patients ingested ⩽25% of the supplement (250 kcal), and only 10% ingested 75–100% (750–995 kcal) of the supplement or placebo. Did a small amount of supplement lead to better outcomes? If so, finding the appropriate supplement level and length of supplementation would have both clinical and financial effects. Cost may be an issue with broad based, non-specific supplementation.

    Further studies should consider the level of dietary and supplemental intake needed to determine the specific role of nutritional supplementation. In the meantime, the evidence seems to cautiously imply that nutritional supplementation leads to improved outcomes in older patients.

    References

    View Abstract

    Footnotes

    • * Information provided by author.

    • For correspondence: Dr S Gariballa, United Arab Emirates University, United Arab Emirates. s.gariballa{at}uaeu.ac.ae

    • Source of funding: Health Foundation, UK.

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