Nutrition Therapy For Quality Of Life In Older adults After Hospital Discharge

This randomized controlled trial found that hospitalized Icelandic older adults who were at nutritional risk after discharge had better outcomes when provided with counseling and free food.

Background

Malnourishment is common among vulnerable older adults and unsurprisingly leads to poor health outcomes. Malnourishment in this population is also strongly associated with lower cognitive function and lower mental well-being.

Malnourished older adults are more likely to be diagnosed with depression, and older adults with dementia are frequently underweight. This study investigated whether providing free food and personal dietary counseling to older adults leaving the hospital could have an effect on their post-discharge physical and mental health outcomes.

The study

This 6-month randomized controlled trial included 106 Icelandic community-dwelling seniors who were hospitalized on geriatric units and were evaluated to be at nutritional risk after discharge. The participants were randomized into two groups. After discharge to the community, the control group received the current standard of care; they were given a nutrition pamphlet and encouraged to order from Meals on Wheels (a paid meal delivery service for people with age-related or medical conditions). The treatment group received five home visits and three phone calls from a clinical nutritionist and had free energy-rich and protein-rich food delivered once per week (a daily meal to reheat and two daily snacks, consisting of yogurt and a nutrition-supplement drink).

Before leaving the hospital and again after the 24-week intervention, the participants were assessed for health-related quality of life (HRQL), self-rated health, cognitive function, depressive symptoms, body weight, and dietary intake.

The results

At the end of the trial, the participants in the control group were consuming half of the calories that they did at the beginning, on average, including less than half the protein. In contrast, the participants in the treatment group were consuming greater than 50% more calories, on average, including 50% more protein. At the end of the trial, the treatment group was eating significantly more calories, including more of every macronutrient, than the control group. The control group experienced significant weight loss during the trial, and the treatment group experienced significant weight gain.

The treatment group's average scores on the HRQL, self-rated health, and cognitive function increased from pretrial to post-trial, whereas the control group's average scores decreased. The control group's average depression score increased, whereas the treatment group's average depression score decreased. At the end of the trial, the treatment group had significantly higher HRQL, self-rated health, and cognitive function scores and significantly lower depression scores than the control group.

Note

According to this trial’s preregistration, it aimed to recruit twice as many patients and listed 38 primary outcomes, including weight, energy intake, HRQL, cognitive function, and depression. The fact that so many outcomes were planned but not reported suggests that the researchers may in fact have performed more comparisons than reported, without correcting statistically for multiple comparisons, and therefore, the results may not be as significant.

The authors also stated that the main outcomes of the study were weight and body composition, but body composition is not reported in this paper. This paper's stated intent was to report on the secondary outcomes. However, we were unable to locate a separate published paper reporting on the primary outcomes. The results for the primary outcomes may not have been published separately or that paper may simply not be available in English.

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