Effectiveness of multidisciplinary nutritional support in older hospitalised patients: A systematic review and meta-analyses

Rasmussen, Nanna Møller Lykkegaard; Belqaid, Kerstin; Lugnet, Kerstin; Nielsen, Ann; Rasmussen, Henrik Højgaard; Beck, Anne Marie

doi:10.1016/j.clnesp.2018.07.002

Cited by 41 publications

(43 citation statements)

References 22 publications

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“…Another systematic review that explored the role of exercise added to oral nutritional support reported improvements in muscle strength but not in any other outcome, however mostly based on low or very low quality evidence [42]. An interesting analysis showed that nutritional support performed by a multidisciplinary team—as recommended in the ESPEN guideline—might fare better than simple interventions in reducing mortality risk and improving quality of life [43]. A systematic review looking at studies performed in nursing homes found an effect on handgrip strength only and not in other functional parameters [44].…”

Section: Management Of Malnutritionmentioning

confidence: 99%

Management of Malnutrition in Older Patients—Current Approaches, Evidence and Open Questions

Volkert

Beck

Cederholm

et al. 2019

JCM

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143

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Malnutrition is widespread in older people and represents a major geriatric syndrome with multifactorial etiology and severe consequences for health outcomes and quality of life. The aim of the present paper is to describe current approaches and evidence regarding malnutrition treatment and to highlight relevant knowledge gaps that need to be addressed. Recently published guidelines of the European Society for Clinical Nutrition and Metabolism (ESPEN) provide a summary of the available evidence and highlight the wide range of different measures that can be taken—from the identification and elimination of potential causes to enteral and parenteral nutrition—depending on the patient’s abilities and needs. However, more than half of the recommendations therein are based on expert consensus because of a lack of evidence, and only three are concern patient-centred outcomes. Future research should further clarify the etiology of malnutrition and identify the most relevant causes in order to prevent malnutrition. Based on limited and partly conflicting evidence and the limitations of existing studies, it remains unclear which interventions are most effective in which patient groups, and if specific situations, diseases or etiologies of malnutrition require specific approaches. Patient-relevant outcomes such as functionality and quality of life need more attention, and research methodology should be harmonised to allow for the comparability of studies.

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Section: Management Of Malnutritionmentioning

confidence: 99%

Management of Malnutrition in Older Patients—Current Approaches, Evidence and Open Questions

Volkert

Beck

Cederholm

et al. 2019

JCM

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143

120

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“…We identified four types of interventions, which had also been evaluated in previous systematic reviews and meta‐analyses (Allen et al, ; Avenell et al, ; Bandayrell & Wong, ; Milne et al, ; Morilla‐Herrera et al, ; Munk et al, ). Additionally, in one review trained volunteer mealtime assistants (Howson et al, ) and in one meta‐analysis multidisciplinary support (Rasmussen et al, ) had been investigated. Given the inclusion criteria, these interventions were not assessed in our review, but could possibly add to nursing care to prevent and treat malnutrition in older adults.…”

Section: Discussionmentioning

confidence: 99%

“…In this process, nurses themselves appropriately provide different kinds of nursing care activities, but also refer to specialist care by other disciplines where indicated. Hence, the coordination and activities of nurses in collaboration with other disciplines within nutritional care should be part of evidence‐based multimodal and multidisciplinary interventions (Rasmussen et al, ; Volkert et al, ). Moreover, nurses ensure there is a clinical handover across the continuum within and between different care settings.…”

Section: Relevance To Clinical Practicementioning

confidence: 99%

“…In a number of systematic reviews and meta‐analyses, one or more evidence‐based interventions for the prevention and treatment of malnutrition to support oral nutritional care are described (Allen, Methven, & Gosney, ; Avenell, Smith, Curtain, Mak, & Myint, ; Bandayrell & Wong, ; Howson, Sayer, & Roberts, ; Milne, Potter, Vivanti, & Avenell, ; Morilla‐Herrera et al, ; Munk et al, ; Rasmussen et al, ). These systematic reviews and meta‐analyses have illustrated contrasting results with both significant and nonsignificant effects on outcomes related to malnutrition.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Interventions to prevent and treat malnutrition in older adults to be carried out by nurses: A systematic review

Cate

Ettema

Waal³

et al. 2020

Journal of Clinical Nursing

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Aims and objectives:To identify interventions to prevent and treat malnutrition in older adults, which can be integrated in nursing care, and to evaluate the effects of these interventions on outcomes related to malnutrition.Background: Older adults are at great risk for malnutrition, which can lead to a number of serious health problems. Nurses have an essential role in nutritional care for older adults. Due to a lack of evidence for nursing interventions, adequate nursing nutritional care still lags behind.Design: Systematic review. Method:We searched for and included randomised controlled trials on interventions, which can be integrated in nursing care for older adults, to prevent and treat malnutrition. We assessed the risk of bias with the Cochrane tool and evidence for outcomes with the GRADE. The PRISMA statement was followed for reporting. Results:We included 21 studies of which 14 studies had a high risk of bias. Identified interventions were oral nutritional supplements, food/fluid fortification or enrichment, dietary counselling and educational interventions. In evaluating the effects of these interventions on 11 outcomes related to malnutrition, significant and nonsignificant effects were found. We graded the certainty of evidence as very low to moderate. Conclusion:Although slight effects were found in protein intake and body mass index, there is no convincing evidence about the effectiveness of the four identified interventions. There seems no harm in using these interventions, although it should be kept in mind that the evidence is sparse. Therefore, there is a need for high-quality research in building evidence for interventions in nursing nutritional care.Relevance to clinical practice: Nurses can safely provide oral nutritional supplements and food/fluid fortification or enrichment, and give dietary counselling and

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“…23 In a systematic review, Feinberg et al 24 reported a lack of quality evidence that examined different forms of nutrition support including general support, fortified foods, and artificial nutrition support. Rasmussen et al 25 suggested from a systematic review and meta-analysis that providing multidisciplinary nutrition support for older patients may have a positive effect on patients' clinical outcomes, mortality and quality of life. This review sought to assess the effectiveness of multidisciplinary nutrition support studies including randomised controlled trials and excluding heterogeneous studies on multidisciplinary interventions of interest to this review.…”

mentioning

confidence: 99%

Multidisciplinary provision of food and nutritional care to hospitalised adult in-patients: A scoping review protocol v1

Yinusa¹,

Scammell²,

Murphy³

et al. 2020

Preprint

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O bj e cti ve : O bj e cti ve : The review will examine the evidence and characteristics of multidisciplinary care interventions in food and nutritional care provision for adult in-patients. Introducti on: Introducti on: Providing appropriate nutritional care is fundamental in patient-centred care. Nutritional care requires a coordinated approach to the delivery of food and fluids by different healthcare professionals and the wider hospital staff. Evidence demonstrates improved patients' clinical outcomes by enhancing hospital food and providing nutritional care throughout a patient's pathway. While there are good examples of nutritional care initiatives, implementing appropriate nutritional care remain a challenge. Managing malnutrition particularly with adult in-patients on admission or at risk of becoming malnourished requires multidisciplinary care; the hospital team plays a crucial role in ensuring these patients' nutritional needs are met. The review aims to identify the evidence with specific focus on reported multidisciplinary coordination and collaboration excluding artificial nutritional support (enteral and parenteral nutrition)a domain where wellestablished evidence already exists. Incl usi on cri te ri a : Incl usi on cri te ri a : The context is limited to the hospital setting with an adult in-patient population. Studies involving healthcare professionals or the wider hospital staff will be included. Me thods: Me thods: Primary evidence will be included from both published and unpublished sources. The search strategy will follow the three-step process recommended by Joanna Briggs Institute' (JBI). Data will be extracted after screening from relevant papers by two or more independent reviewers and one or more verifier using a developed data extraction tool. A narrative description of findings will be reported following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. Introducti on Introducti on Key nutrition interventions and strategies to reduce malnutrition have been recommended and some integrated into standard guidelines and policies. For instance, the recommendations for nutrition screening in routine practice to identify people with (or at risk of) malnutrition using validated malnutrition screening tools by the European Society for Clinical Nutrition and Metabolism, British Association of Parenteral and Enteral Nutrition and the National Institute for Clinical Excellence in the UK. 13,14 Nutrition screening as the first step enables appropriate interventions with subsequent monitoring and assessment to be implemented. Global consensus on core diagnostic criteria for malnutrition has also been proposed to enable comparison of malnutrition prevalence, interventions, and outcomes across the world. 15 Other strategies include the Protected Mealtime policy (2004) implemented in the UK aimed at avoiding all non-urgent activity on the wards during mealtimes and allowing patients to have uninterrupted meals. 16 Mealtime volun...

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Effectiveness of multidisciplinary nutritional support in older hospitalised patients: A systematic review and meta-analyses

Cited by 41 publications

References 22 publications

Management of Malnutrition in Older Patients—Current Approaches, Evidence and Open Questions

Management of Malnutrition in Older Patients—Current Approaches, Evidence and Open Questions

Interventions to prevent and treat malnutrition in older adults to be carried out by nurses: A systematic review

Multidisciplinary provision of food and nutritional care to hospitalised adult in-patients: A scoping review protocol v1

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