Three Nurse-administered Protocols Reduce Nutritional Decline and Frailty in Older Gastrointestinal Surgery Patients: A Cluster Randomized Trial
| Autor: | John Huang, Been-Ren Lin, Cheryl Chia-Hui Chen, Jin-Tung Liang, Hsiu-Ching Li, Guan-Hua Huang, Yi-Ting Yang, Chiung-Nien Chen, Yu-Wen Tien, Ming-Tsan Lin, I-Rue Lai, Ching-Yao Yang, Sharon K. Inouye |
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| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty Frail Elderly Taiwan Body weight Article 03 medical and health sciences Postoperative Complications 0302 clinical medicine Nursing Older patients Interquartile range Weight loss medicine Hospital discharge Humans 030212 general & internal medicine Cluster randomised controlled trial Digestive System Surgical Procedures General Nursing Aged Postoperative Care Frailty Nutritional Support business.industry Health Policy Malnutrition General Medicine Length of Stay Surgery Trained nurse Usual care Female Geriatrics and Gerontology medicine.symptom business 030217 neurology & neurosurgery |
| Zdroj: | J Am Med Dir Assoc |
| ISSN: | 1525-8610 |
| DOI: | 10.1016/j.jamda.2018.09.016 |
| Popis: | OBJECTIVE: To evaluate the effects of the modified Hospital Elder Life Program (mHELP) comprising three 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 since 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. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01045330 |
| Databáze: | OpenAIRE |
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