Comparison of three interventions in the treatment of malnutrition in hospitalised older adults: A clinical trial

摘要

Aim: The objective of the present study was to determine the most effective method for providing oral nutrition support to hospitalised older adult patients with malnutrition using clinical and patient-centred measures. Methods: The present study involved consecutive assignment of 98 inpatients assessed as malnourished (Subjective Global Assessment B or C) to conventional commercial supplements (traditional, n = 33), MedPass (n = 32, 2 cal/mL supplement delivered 60 mL four times a day at medication rounds) or mid-meal trolley (n = 33, selective snack trolley offered between meals) for two weeks. Weight change, supplement compliance, energy and protein intake (3-day food records), quality of life (EQ-5D), patient satisfaction and cost were evaluated. Results: Weight change was similar across the three interventions (mean ± SD): 0.4 ± 3.8% traditional; 1.5 ± 5.8% MedPass; 1.0 ± 3.1% mid-meal (P = 0.53). Energy and protein intakes (% of requirements) were more often achieved with traditional (107 ± 26, 128 ± 35%) and MedPass (110 ± 28, 126 ± 38%) compared with mid-meal (85 ± 25, 88 ± 25%) interventions (P= < 0.01). Overall quality-of-life ratings (scale 0-100) improved significantly with MedPass (mean change, 12.4 ± 20.9) and mid-meal (21.1 ± 19.7) interventions, however, did not change with traditional intervention (1.5 ± 18.1) (P = 0.05). Patient satisfaction including sensory qualities (taste, look, temperature, size) and perceived benefit (improved health and recovery) was rated highest for mid-meal trolley (all P < 0.05). Conclusions: Patients achieved recommended intake with supplements (MedPass or traditional), and despite lower cost, higher satisfaction and quality of life with selective mid-meal trolley did not achieve recommended energy and proteinintake. Future research is warranted for implementing a combination of strategies in providing oral nutrition support.