The Effect of Nutrition Follow up After Hospital Discharge in Undernourished Elderly

Study Overview
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Brief Summary
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The purpose of this study is to test two different interventions of nutrition follow up after discharge from geriatric ward in undernourished geriatric patients. The patients are randomized to a home visit arm, a telephone consultation arm, or a control arm. Patients in the home visit arm and their home care helper will get visits from a clinical dietician at one week, two weeks and four weeks after discharge, in order to follow up on the nutrition intervention. Patients in the telephone consultation arm and their home care helper will be contacted by a clinical dietician at one week, two weeks and four weeks after discharge, in order to follow up on the nutrition intervention. The control arm will not be contacted. The primarily outcome is functional ability. Secondary outcomes are quality of life, readmission and mortality.

Detailed Description
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Under nutrition among geriatric patients is a recurrent and well documented problem. Up to 55 % of the elderly are undernourished at the time of admission. Hospitalisation and acute illness are associated to loss of muscles and physical ability, complications, dependency, morbidity and mortality. Elderly who live alone are more vulnerable to nutritional problems, than elderly who live together with another person or in a nursing home. Geriatric patients, who are admitted to geriatric ward Aarhus University Hospital due to various acute somatic disorders, aged 75 and older and who are living alone with help from the home care facilities can participate in the study. According to the power calculation 150 patients must be included, 50 patients in each arm of the study. Informed consent will be obtained before inclusion and discharge from hospital. Randomization will be computerised and determine if the patient will be allocated to the home visit group, the telephone consultation group or the control group. Patients who suffer from mental disorder (MMSE<22) or active cancer are excluded as well as patients who live together with another person or live in a nursing home. During hospitalisation the three groups will receive the same nutritional care as all patients in nutritional risk. This includes nutritional intervention during hospitalization and an individual diet plan at discharge. Patients in the home visit arm will get visits from a clinical dietician at one week, two weeks and four weeks after discharge. Patients in the telephone consultation arm will be contacted by a clinical dietician at one week, two weeks and four weeks after discharge. In both intervention groups the patients and their home care helpers will get dietary advice and follow up on their individual diet plan. The main outcome is functional ability from discharge and to 8 weeks after discharge. Secondary outcomes are quality of life, readmission at 30 and 90 days and mortality at 30 and 90 days.

Official Title
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The Effect of Follow up on Nutrition Intervention After Discharge in Undernourished Geriatric Patients

Conditions
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Under Nutrition

Intervention / Treatment
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* Other: Home visit
* Other: Telephone consultation


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: aged 75 and over undernourished according to Mini Nutritional Assessment (MNA) living alone in own home admitted and discharged from geriatric ward Aarhus, Denmark, due to various acute somatic disorders Exclusion Criteria: active cancer mental disorder (MMSE<22) live together with another person live in a nursing home

Ages Eligible for Study
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Minimum Age: 75 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Factorial Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Home visits<br>Nutritional follow-up after discharge, conducted as nutritional counselling performed as in-person counselling in the participants homes | Other: Home visit<br>* Patients and their homecare helper will receive visits from a clinical dietician 1 week, 2 weeks and 4 weeks after discharge. The purpose of the visits is follow up on the individual diet plan distributed at discharge and supply dietary advice.<br>* Other names: Dietary advice after discharge by home visits;|
| Experimental: Telephone consultation<br>Nutritional follow-up after discharge, conducted as nutritional counselling performed as telephone consultation | Other: Telephone consultation<br>* Patients and their homecare helper will be contacted on telephone from a clinical dietician 1 week, 2 weeks and 4 weeks after discharge. The purpose of the telephone contact is follow up on the individual diet plan distributed at discharge and supply dietary advice.<br>* Other names: Dietary advice after discharge by telephone consultation;|
| No Intervention: Control<br>No follow-up after discharge | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Functional ability. | Measurements: Barthel-100 Index, Cumulated Ambulation Score (CAS), handgrip strength, part of senior fitness test,fatigue test (Avlund) | Between discharge and 8 weeks after discharge | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Quality of Life | Measurements: SF-36, geriatric depression score (GDS), depression list (DL) | Between discharge and 8 weeks after discharge | 
| Mortality |  | Between discharge and 30 after discharge | 
| Readmission to hospital |  | Between discharge and 30 days after discharge | 
| Readmission |  | Between discharge and 90 days after discharge | 
| Mortality |  | Between discharge and 90 days after discharge |