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

Research output: Contribution to journalArticlepeer-review

14 Scopus citations


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 languageEnglish
Pages (from-to)524-529.e3
JournalJournal of the American Medical Directors Association
Issue number5
StatePublished - 1 May 2019


  • Frailty
  • Hospital Elder Life Program
  • Ileus
  • nutritional status
  • surgery


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