A Clinical Trial to Determine Outcomes and Cost Effectiveness of Nutritional Intervention in Elderly Patients
Condition: Aging
Study type: Interventional

Summary: 
      With the introduction of the National Insurance Law in Israel in 1995, there have been
      increased efforts to reduce hospitalization in general and length of stay in the hospital in
      particular. Under nourished patients have been shown to have a longer mean length of stay and
      they are more likely to suffer from complications, which significantly increase cost of care.
      Intense nutritional intervention programs, aimed at decreasing rehospitalizations and post
      hospitalization complications, are not clearly currently included in the basket of services
      provided under the law. Nutritional intervention has been shown to be clinically efficacious
      and cost-effective. Demonstration of the benefits of such intervention, both in terms of
      reduced expenditures and quality of care, may open a path for specific nutritional
      intervention programs that are needed for older persons during and after discharge from Acute
      Care. Given the effort made to reduce the length of hospitalization time, even in frail
      elderly patients, it is clear that full scale nutritional intervention cannot be completed
      during their hospitalization. Therefore, there is a need to create continuity between
      in-patient and follow-up nutritional intervention. This combined policy has the potential to
      improve general health, reduce the rates of under nutrition and its associated complications,
      and thus reduce future hospitalization, along with the mortality and morbidity associated. It
      is plausible that improved general health and less frequent hospitalization will eventuate in
      cost reduction and allow the intervention to be cost effective. Furthermore, the descriptive
      information regarding the nutritional status of older patients admitted to an Acute Care
      department may be important for policy makers in their development of nutritional
      intervention programs to support the elderly before, during and after hospitalization.

      Study Hypothesis:

      We hypothesize that multidisciplinary nutritional intervention, during and following
      hospitalization, will improve dietary intake and nutritional status. Improvement in
      nutritional status will, in turn, cut health care costs by decreasing the use of health
      services. In-hospital nutritional care will be beneficial, but combined in-hospital and
      community care will be more clinically efficacious and more cost effective in the long run.
    

Detailed description: 
      Hospitalized elderly are susceptible to under nutrition, affecting their clinical course and
      outcome. We recently found 30% under nutrition in 200 inpatients aged 65 and older.
      Interestingly few, if any, of these patients recieved nutritional intervention while
      hospitalized.

      Objectives: 1. To develop models for nutritional intervention among under nourished elderly
      inpatients.

      2. To determine the impact of the intervention programs and compare them to standard care.
      Prospective outcomes include health care use, health and nutritional status and dietary
      intake in the year following hospitalization.

      3. To assess the cost-effectiveness and clinical feasibility of the nutritional interventions
      proposed.

      Methods: Patients over 70 years of age, admitted to the Internal Medicine Department at
      Soroka University Hospital will be screened for nutritional risk. Patients at risk will be
      randomly allocated to 3 groups: standard care, in-hospital intensive intervention and
      in-hospital and community intensive intervention. In the year following their
      hospitalization, health status, health care use, quality of life and nutritional status will
      be assessed using validated tools.

      Importance of the study: Under nourished patients are at increased risk for medical
      complications and increased duration of hospitalization, both of which raise the cost of
      care. Intensive nutritional intervention may reduce length of stay and thus costs. A
      formalized intervention plan is crucial for efficacious cost-effective care. We feel that
      acute hospitalization is a window of opportunity for initiating long-term nutritional advice
      and follow-up.
    

Intervention name(s): Multidisciplinary dietary intervention
Intervention type(s): Behavioral
Allocation: Randomized
Intervention model: Factorial Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Nutritional status, dietary intervention, health care use, costs