TY - JOUR
T1 - Comprehensive care improves physical recovery of hip-fractured elderly Taiwanese patients with poor nutritional status
AU - Liu, Hsin Yun
AU - Tseng, Ming Yueh
AU - Li, Hsiao Juan
AU - Wu, Chi Chuan
AU - Cheng, Huey Shinn
AU - Yang, Ching Tzu
AU - Chou, Shih Wei
AU - Chen, Ching Yen
AU - Shyu, Yea Ing L.
PY - 2014/6
Y1 - 2014/6
N2 - Objectives: The effects of nutritional management among other intervention components have not been examined for hip-fractured elderly persons with poor nutritional status. Accordingly, this study explored the intervention effects of an in-home program using a comprehensive care model that included a nutrition-management component on recovery of hip-fractured older persons with poor nutritional status at hospital discharge. Design: A secondary analysis of data from a randomized controlled trial with 24-month follow-up. Setting: A 3000-bed medical center in northern Taiwan. Participants: Subjects were included only if they had "poor nutritional status" at hospital discharge, including those at risk for malnutrition or malnourished. The subsample included 80 subjects with poor nutritional status in the comprehensive care group, 87 in the interdisciplinary care group, and 85 in the usual care group. Interventions: The 3 care models were usual care, interdisciplinary care, and comprehensive care. Usual care provided no in-home care, interdisciplinary care provided 4 months of in-home rehabilitation, and comprehensive care included management of depressive symptoms, falls, and nutrition as well as 1 year of in-home rehabilitation. Measurements: Data were collected on nutritional status and physical functions, including range of motion, muscle power, proprioception, balance and functional independence, and analyzed using a generalized estimating equation approach. We also compared patients' baseline characteristics: demographic characteristics, type of surgery, comorbidities, length of hospital stay, cognitive function, and depression. Results: Patients with poor nutritional status who received comprehensive care were 1.67 times (95% confidence interval 1.06-2.61) more likely to recover their nutritional status than those who received interdisciplinary and usual care. Furthermore, the comprehensive care model improved the functional independence and balance of patients who recovered their nutritional status over the first year following discharge, but not of those who had not yet recovered. Conclusions: An in-home program using the comprehensive care model with a nutritional component effectively improved the nutritional status of hip-fractured patients with poor nutrition. This comprehensive care intervention more effectively improved recovery of functional independence and balance for patients with recovered nutritional status.
AB - Objectives: The effects of nutritional management among other intervention components have not been examined for hip-fractured elderly persons with poor nutritional status. Accordingly, this study explored the intervention effects of an in-home program using a comprehensive care model that included a nutrition-management component on recovery of hip-fractured older persons with poor nutritional status at hospital discharge. Design: A secondary analysis of data from a randomized controlled trial with 24-month follow-up. Setting: A 3000-bed medical center in northern Taiwan. Participants: Subjects were included only if they had "poor nutritional status" at hospital discharge, including those at risk for malnutrition or malnourished. The subsample included 80 subjects with poor nutritional status in the comprehensive care group, 87 in the interdisciplinary care group, and 85 in the usual care group. Interventions: The 3 care models were usual care, interdisciplinary care, and comprehensive care. Usual care provided no in-home care, interdisciplinary care provided 4 months of in-home rehabilitation, and comprehensive care included management of depressive symptoms, falls, and nutrition as well as 1 year of in-home rehabilitation. Measurements: Data were collected on nutritional status and physical functions, including range of motion, muscle power, proprioception, balance and functional independence, and analyzed using a generalized estimating equation approach. We also compared patients' baseline characteristics: demographic characteristics, type of surgery, comorbidities, length of hospital stay, cognitive function, and depression. Results: Patients with poor nutritional status who received comprehensive care were 1.67 times (95% confidence interval 1.06-2.61) more likely to recover their nutritional status than those who received interdisciplinary and usual care. Furthermore, the comprehensive care model improved the functional independence and balance of patients who recovered their nutritional status over the first year following discharge, but not of those who had not yet recovered. Conclusions: An in-home program using the comprehensive care model with a nutritional component effectively improved the nutritional status of hip-fractured patients with poor nutrition. This comprehensive care intervention more effectively improved recovery of functional independence and balance for patients with recovered nutritional status.
KW - Hip-fractured elders
KW - Nutrition intervention
KW - Physical function
KW - Poor nutrition
UR - http://www.scopus.com/inward/record.url?scp=84901499755&partnerID=8YFLogxK
U2 - 10.1016/j.jamda.2014.01.009
DO - 10.1016/j.jamda.2014.01.009
M3 - 文章
C2 - 24613271
AN - SCOPUS:84901499755
SN - 1525-8610
VL - 15
SP - 416
EP - 422
JO - Journal of the American Medical Directors Association
JF - Journal of the American Medical Directors Association
IS - 6
ER -
