標題: Three Nurse-administered Protocols Reduce Nutritional Decline and Frailty in Older Gastrointestinal Surgery Patients: A Cluster Randomized Trial
作者: Chen, Cheryl Chia-Hui
Yang, Yi-Ting
Lai, I-Rue
Lin, Been-Ren
Yang, Ching-Yao
Huang, John
Tien, Yu-Wen
Chen, Chiung-Nien
Lin, Ming-Tsan
Liang, Jin-Tung
Li, Hsiu-Ching
Huang, Guan-Hua
Inouye, Sharon K.
統計學研究所
Institute of Statistics
關鍵字: Frailty;Hospital Elder Life Program;Ileus;nutritional status;surgery
公開日期: 1-May-2019
摘要: Objective: To evaluate the effects of the modified Hospital Elder Life Program (mHELP) comprising 3 nurse-administered protocols in older patients undergoing gastrointestinal (GI) surgery. Design: Cluster randomized trial. Setting: Two 36-bed GI wards at a university-affiliated medical center in Taiwan. Participants: Older patients (>= 65 years, N = 377) were recruited if they were scheduled for elective GI surgery with an expected length of hospital stay > 6 days. After transferring to the GI ward after surgery, participants were randomly assigned to the mHELP or control group (1: 1) by room rather than individually because most patient units are double-or triple-occupancy rooms. Intervention: The mHELP protocols (early mobilization, oral and nutritional assistance, and orienting communication) were administered daily with usual care by a trained nurse until hospital discharge. The control group received usual care only. Measures: Outcomes were in-hospital nutritional decline, measured by body weight and Mini-Nutritional Assessment (MNA) scores, and Fried's frailty phenotype. Return of GI motility was examined as a potential mechanism contributing to observed outcomes. Results: Participants (mean age = 74.5 years; 56.8% male) primarily underwent colorectal (56.5%), gastric (21.2%), and pancreatobiliary (13.8%) surgery. Participants who received the mHELP [for a median of 7 days (interquartile range = 6-10 days)] had significantly lower in-hospital weight loss and decline in MNA scores (weight -2.1 vs -4.0 lb, P = .002; score -3.2 vs -4.0, P =.03) than the control group. The mHELP group also had significantly lower rates of incident frailty during hospitalization (12.0% vs 21.7%, P = .022), and persistent frailty (50.0% vs 92.9%, P = .03). Participants in the mHELP group had trends toward an accelerated return of GI motility. Conclusion and Implications: The mHELP effectively reduced nutritional decline, prevented new frailty, and promoted recovery of frailty present before admission. These nurse-administered protocols might be useful in other settings, including conditions managed at home or in nursing facilities. (C) 2018 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
URI: http://dx.doi.org/10.1016/j.jamda.2018.09.016
http://hdl.handle.net/11536/151929
ISSN: 1525-8610
DOI: 10.1016/j.jamda.2018.09.016
期刊: JOURNAL OF THE AMERICAN MEDICAL DIRECTORS ASSOCIATION
Volume: 20
Issue: 5
起始頁: 524
結束頁: 0
Appears in Collections:Articles