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Am Fam Physician. 2012;85(2):200

Background: Undernutrition in older persons has been linked with longer hospital stays and greater mortality, and up to 71 percent of older persons requiring hospitalization are believed to be at nutritional risk. A recent review found that nutritional supplementation significantly reduced mortality rates among undernourished patients; however, it is unknown if individualized nutrition therapy during and after hospitalization can also reduce mortality. Feldblum and colleagues investigated the effect of individualized nutrition interventions on mortality and nutritional outcomes in hospitalized older adults.

The Study: A total of 259 newly hospitalized patients 65 years or older were enrolled in the study. Those who were determined to be at nutritional risk according to their Mini Nutritional Assessment score and those who lost more than 10 percent of their body weight in the past six months were eligible to participate. Exclusion criteria included cognitive impairment (Mini-Mental State Examination score of less than 23) or a current diagnosis of cancer.

Patients were randomized to receive one of three nutrition interventions: standard hospital care, a single in-hospital dietitian visit, or an in-hospital dietitian visit plus three home dietitian visits postdischarge that included an individualized nutrition plan and patient and caregiver reinforcement. Nutrition interventions were based on recommendations of the Nutrition Screening Initiative, a project of the American Academy of Family Physicians, the American Dietetic Association, and the National Council on Aging. Patients were followed for six months after hospital discharge and were monitored for functional and cognitive status. The data from both hospital-only intervention groups were combined and compared with the data from the home-visit group.

Results: No differences were noted among the groups regarding functional or cognitive status; however, significantly fewer patients in the home-visit group had died after six months than in the other two groups combined (3.8 versus 11.6 percent mortality, respectively; P = .046). There was also moderately greater improvement in nutritional status in the home-visit group (the score of the Mini Nutritional Assessment increased from baseline by 3.0 ± 2.6 versus 1.8 ± 3.0 for the other two groups combined; P = .004). The home-visit group also had a significantly lower incidence of hypoalbuminemia (i.e., serum albumin level of less than 3.5 g per dL [35 g per L]) after six months than did the other two groups combined (9.7 versus 22.9 percent, respectively; P = .03).

Conclusion: Individualized nutrition treatment during and after acute hospitalization reduces six-month mortality and moderately improves nutritional status among older adults at nutritional risk, compared with inhospital management.

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