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

Cheryl Chia-Hui Chen; Yi Ting Yang; I. Rue Lai; Been Ren Lin; Ching Yao Yang; John Huang; Yu Wen Tien; Chiung Nien Chen; Ming Tsan Lin; Jin Tung Liang; Hsiu Ching Li; Guan-Hua Huang; Sharon K. Inouye

doi:10.1016/j.jamda.2018.09.016

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

Cheryl Chia-Hui Chen^*, Yi Ting Yang, I. Rue Lai, Been Ren Lin, Ching Yao Yang, John Huang, Yu Wen Tien, Chiung Nien Chen, Ming Tsan Lin, Jin Tung Liang, Hsiu Ching Li, Guan-Hua Huang, Sharon K. Inouye

^*Corresponding author for this work

Institute of Statistics

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16 Scopus citations

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.

Original language	English
Pages (from-to)	524-529.e3
Journal	Journal of the American Medical Directors Association
Volume	20
Issue number	5
DOIs	https://doi.org/10.1016/j.jamda.2018.09.016
State	Published - May 2019

Keywords

Frailty
Hospital Elder Life Program
Ileus
nutritional status
surgery

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.jamda.2018.09.016

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Chia-Hui Chen, C., Yang, Y. T., Lai, I. R., Lin, B. R., Yang, C. Y., Huang, J., Tien, Y. W., Chen, C. N., Lin, M. T., Liang, J. T., Li, H. C., Huang, G.-H., & Inouye, S. K. (2019). Three Nurse-administered Protocols Reduce Nutritional Decline and Frailty in Older Gastrointestinal Surgery Patients: A Cluster Randomized Trial. Journal of the American Medical Directors Association, 20(5), 524-529.e3. https://doi.org/10.1016/j.jamda.2018.09.016

@article{7c50e62ab4e5465688a8ac982864f351,

title = "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.",

keywords = "Frailty, Hospital Elder Life Program, Ileus, nutritional status, surgery",

author = "{Chia-Hui Chen}, Cheryl and Yang, {Yi Ting} and Lai, {I. Rue} and Lin, {Been Ren} and Yang, {Ching Yao} and John Huang and Tien, {Yu Wen} and Chen, {Chiung Nien} and Lin, {Ming Tsan} and Liang, {Jin Tung} and Li, {Hsiu Ching} and Guan-Hua Huang and Inouye, {Sharon K.}",

note = "Publisher Copyright: {\textcopyright} 2018 AMDA – The Society for Post-Acute and Long-Term Care Medicine",

year = "2019",

month = may,

doi = "10.1016/j.jamda.2018.09.016",

language = "English",

volume = "20",

pages = "524--529.e3",

journal = "Journal of the American Medical Directors Association",

issn = "1525-8610",

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Chia-Hui Chen, C, Yang, YT, Lai, IR, Lin, BR, Yang, CY, Huang, J, Tien, YW, Chen, CN, Lin, MT, Liang, JT, Li, HC, Huang, G-H & Inouye, SK 2019, 'Three Nurse-administered Protocols Reduce Nutritional Decline and Frailty in Older Gastrointestinal Surgery Patients: A Cluster Randomized Trial', Journal of the American Medical Directors Association, vol. 20, no. 5, pp. 524-529.e3. https://doi.org/10.1016/j.jamda.2018.09.016

Three Nurse-administered Protocols Reduce Nutritional Decline and Frailty in Older Gastrointestinal Surgery Patients: A Cluster Randomized Trial. / Chia-Hui Chen, Cheryl; Yang, Yi Ting; Lai, I. Rue et al.
In: Journal of the American Medical Directors Association, Vol. 20, No. 5, 05.2019, p. 524-529.e3.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Three Nurse-administered Protocols Reduce Nutritional Decline and Frailty in Older Gastrointestinal Surgery Patients

T2 - A Cluster Randomized Trial

AU - Chia-Hui Chen, Cheryl

AU - Yang, Yi Ting

AU - Lai, I. Rue

AU - Lin, Been Ren

AU - Yang, Ching Yao

AU - Huang, John

AU - Tien, Yu Wen

AU - Chen, Chiung Nien

AU - Lin, Ming Tsan

AU - Liang, Jin Tung

AU - Li, Hsiu Ching

AU - Huang, Guan-Hua

AU - Inouye, Sharon K.

PY - 2019/5

Y1 - 2019/5

N2 - 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.

AB - 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.

KW - Frailty

KW - Hospital Elder Life Program

KW - Ileus

KW - nutritional status

KW - surgery

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U2 - 10.1016/j.jamda.2018.09.016

DO - 10.1016/j.jamda.2018.09.016

M3 - Article

C2 - 30424980

AN - SCOPUS:85056222927

SN - 1525-8610

VL - 20

SP - 524-529.e3

JO - Journal of the American Medical Directors Association

JF - Journal of the American Medical Directors Association

IS - 5

ER -

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

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Keywords

UN SDGs

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