TY - JOUR
T1 - Effectiveness of multidisciplinary nutritional support in older hospitalised patients
T2 - A systematic review and meta-analyses
AU - Rasmussen, Nanna M L
AU - Belqaid, Kerstin
AU - Lugnet, Kerstin
AU - Nielsen, Anni Linnet
AU - Rasmussen, Henrik Højgaard
AU - Beck, Anne Marie
N1 - Copyright © 2018 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.
PY - 2018
Y1 - 2018
N2 - Malnutrition is common in older hospitalised patients. As the aetiology is multifactorial, nutritional care should involve a multidisciplinary team. However, the knowledge of the effectiveness of this strategy is limited. This systematic review aims at investigating the effectiveness of multidisciplinary nutritional support on mortality, readmissions and quality of life (QoL) in patients aged 65 years and above during hospitalisation and after discharge compared to usual practise. We conducted a series of systematic literature search from 2013 to 2017, with additional studies hand-searched from reference lists of retrieved publications. Eligible studies were controlled trials with a multidisciplinary nutritional intervention during hospitalisation and after discharge in older (65+) patients. A intervention by more than one profession incorporating a nutritional component was defined as "Multidisciplinary". The nutritional intervention included use of oral nutritional supplements (ONS), improved nutritional care, and/or dietary counselling. For quality assessment of studies, "Cochrane Collaboration's tool for assessing risk of bias" was used. Conduction of meta-analyses were by combining data from homogenous trials. The search resulted in five studies fulfilling the inclusion criteria, but varied in quality and type of interventions used. 598 patients were included. Meta-analyses found improved QoL (MD 0.13 (0.02, 0.23), P = 0.01) and indicated tendencies towards lower mortality (OR 0.50 (0.22, 1.14), P = 0.10), in the intervention group vs. control group. Meta-analysis showed no difference between intervention and control group regarding readmissions during intervention (OR 1.04 (0.40, 2.70)) or at a 26 weeks follow-up (OR 0.84 (0.18, 3.82)) Although a small number of studies and a relatively small sample size, a suggestion is that provision of multidisciplinary nutritional support may have a positive effect on mortality and improves quality of life in older patients. There is a need for more high-quality studies including multidisciplinary nutritional support to verify these findings. Study registration in PROSPERO is no. CRD42016047997.
AB - Malnutrition is common in older hospitalised patients. As the aetiology is multifactorial, nutritional care should involve a multidisciplinary team. However, the knowledge of the effectiveness of this strategy is limited. This systematic review aims at investigating the effectiveness of multidisciplinary nutritional support on mortality, readmissions and quality of life (QoL) in patients aged 65 years and above during hospitalisation and after discharge compared to usual practise. We conducted a series of systematic literature search from 2013 to 2017, with additional studies hand-searched from reference lists of retrieved publications. Eligible studies were controlled trials with a multidisciplinary nutritional intervention during hospitalisation and after discharge in older (65+) patients. A intervention by more than one profession incorporating a nutritional component was defined as "Multidisciplinary". The nutritional intervention included use of oral nutritional supplements (ONS), improved nutritional care, and/or dietary counselling. For quality assessment of studies, "Cochrane Collaboration's tool for assessing risk of bias" was used. Conduction of meta-analyses were by combining data from homogenous trials. The search resulted in five studies fulfilling the inclusion criteria, but varied in quality and type of interventions used. 598 patients were included. Meta-analyses found improved QoL (MD 0.13 (0.02, 0.23), P = 0.01) and indicated tendencies towards lower mortality (OR 0.50 (0.22, 1.14), P = 0.10), in the intervention group vs. control group. Meta-analysis showed no difference between intervention and control group regarding readmissions during intervention (OR 1.04 (0.40, 2.70)) or at a 26 weeks follow-up (OR 0.84 (0.18, 3.82)) Although a small number of studies and a relatively small sample size, a suggestion is that provision of multidisciplinary nutritional support may have a positive effect on mortality and improves quality of life in older patients. There is a need for more high-quality studies including multidisciplinary nutritional support to verify these findings. Study registration in PROSPERO is no. CRD42016047997.
KW - Elderly
KW - Mortality
KW - Nutrition
KW - Quality of life
KW - Readmissions
UR - http://www.scopus.com/inward/record.url?scp=85050113493&partnerID=8YFLogxK
U2 - 10.1016/j.clnesp.2018.07.002
DO - 10.1016/j.clnesp.2018.07.002
M3 - Journal article
C2 - 30144892
SN - 2405-4577
VL - 27
SP - 44
EP - 52
JO - Clinical Nutrition ESPEN
JF - Clinical Nutrition ESPEN
ER -