Evaluation of the impact of a post‐hospital discharge Transitional Aged Care Service on frailty, malnutrition and functional ability

Abstract

Aim To investigate the relationship between nutritional status, functional ability and frailty in older adults participating in a 12‐week Transitional Aged Care Service program. Methods A retrospective analysis of a clinical cohort of older adults aged 65+ years after hospital discharge. At entry into the program and at completion, nutritional status was measured using the Mini Nutritional Assessment (MNA), frailty status was measured using the Groningen Frailty Indicator and functional ability was measured using the Modified Barthel Index (MBI). Demographic data were obtained from electronic medical records. Results Baseline data were available for 115 participants (mean age = 81.7 (SD =7.9) years; 20.9% classified as malnourished and 89.6% as frail). A positive association was found between nutritional status and frailty (r = 0.298; P = 0.001), and frailty and functional ability (r = 0.204; P = 0.029). Multiple regression analysis, accounting for the cofounders of baseline MNA, MBI, age, gender, length of hospital stay and living situation, found that nutritional status and functional ability were able to indicate the presence of frailty on admission to the program (P = 0.002, P = 0.007, respectively). In those program completers (n = 79), significant improvements were found in nutritional status, frailty and functional ability (P < 0.0005). Conclusions Nutrition status, frailty and functional ability are closely and positively related, and should therefore be considered simultaneously in rehabilitation for older adults. A post‐hospital transitional program with a multidisciplinary approach significantly improved all three outcomes, suggesting its value in enabling frail older people to remain independent for as long as possible.

Trends and Novel Research in Hospital Nutrition Care: A Narrative Review of Leading Clinical Nutrition Journals

“…We reported on several studies assessing diverse strategies to support food intake and nutrition status post discharge. [70][71][72][86][87][88][89][90][91][92] Interventions longer than 12 weeks showed improvements in nutrition status, function, quality of life, and clinical outcome. Although ineligible for this review, as it was published in 2020, a more recent study found that 30 days of intensive individualized (including ONS use and patient education) home health nutrition support post discharge for malnourished patients was sufficient to reduce readmission rate.…”

“…Fifteen articles, [70][71][72][86][87][88][89][90][91][92][93][94][95][96][97] including 2 systematic reviews, 86,87 5 RCTs, [70][71][72]88,89 and 3 non-RCT interventions, [90][91][92] focused on postdischarge nutrition care. It was found that dietitian consults after discharge were rare, 95 despite a quarter of medical and surgical patients showing continued weight loss after return to the community.…”

“…71 Other studies showed that individualized diet counseling by a dietitian during and after hospital discharge improved protein and energy intake and weight 86,90 as well as gait speed, 91 whereas multicomponent nutrition care (eg, counseling with ONS) promoted quality of life, 87 and multidisciplinary rehabilitation improved nutrition status. 92 Other interventions also showed benefits: 10 days of home-delivered meals with nutrition education for older adults after hospital discharge improved energy intake, 88 and protein intake improved when proteinenriched foods started in hospital were continued after discharge. 89…”

Coding for Malnutrition in the Hospital: Does It Change Reimbursement?

“…In recent years, healthcare facilities and providers have focused more efforts and resources to improve transition of care from one healthcare setting to another. Some of these efforts include programs, products, and services to improve post‐discharge access to nutrition interventions and resources for food insecure and/or malnourished patients and communities . These resources are generally not reimbursable or covered by insurance providers and thus can incur a significant cost attributable to PCM.…”

Generational change in nutrition and dietetics: The millennial dietitian

“…This issue of Nutrition & Dietetics explores the challenges and opportunities that our modern world presents for the profession and how we can appreciate and respond to generational differences. It includes papers that report on research about technology in health-care, 5-7 communicating health information, [8][9][10][11] health and nutrition interventions [12][13][14][15][16] and education. 17,18 In addition, other reports in this issue from the international context add to the discussion.…”