Dataset Information

Three Nurse-administered Protocols Reduce Nutritional Decline and Frailty in Older Gastrointestinal Surgery Patients: A Cluster Randomized Trial.

ABSTRACT:

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.

SUBMITTER: Chia-Hui Chen C

PROVIDER: S-EPMC6607892 | biostudies-literature | 2019 May

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Three Nurse-administered Protocols Reduce Nutritional Decline and Frailty in Older Gastrointestinal Surgery Patients: A Cluster Randomized Trial.

Chia-Hui Chen Cheryl C Yang Yi-Ting YT Lai I-Rue IR Lin Been-Ren BR Yang Ching-Yao CY Huang John J Tien Yu-Wen YW Chen Chiung-Nien CN Chen Chiung-Nien CN Lin Ming-Tsan MT Liang Jin-Tung JT Li Hsiu-Ching HC Huang Guan-Hua GH Inouye Sharon K SK

Journal of the American Medical Directors Association 20181110 5

<h4>Objective</h4>To evaluate the effects of the modified Hospital Elder Life Program (mHELP) comprising 3 nurse-administered protocols in older patients undergoing gastrointestinal (GI) surgery.<h4>Design</h4>Cluster randomized trial.<h4>Setting</h4>Two 36-bed GI wards at a university-affiliated medical center in Taiwan.<h4>Participants</h4>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 tr ...[more]

PMID: 30424980

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Dataset Information

Three Nurse-administered Protocols Reduce Nutritional Decline and Frailty in Older Gastrointestinal Surgery Patients: A Cluster Randomized Trial.

Objective

Design

Setting

Participants

Intervention

Measures

Results

Conclusion and implications

Publications

Three Nurse-administered Protocols Reduce Nutritional Decline and Frailty in Older Gastrointestinal Surgery Patients: A Cluster Randomized Trial.

Similar Datasets

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