Malnutrition is common among hospitalised older adults, and weight may continue to decline after discharge without nutritional support. Post-discharge home visit programmes by dieticians show positive outcomes, but not all participants experience improvement of their nutritional status. We compared participant’s characteristics according to weight change groups in a 3-month public community programme of dietician home visits. This observational retrospective study included older adults at risk of malnutrition or malnourished in geriatric acute care wards and discharged home. Hospital data included pre-hospital basic (ADL) and instrumental (IADL) activities of daily living, comorbidity (Cumulative Illness Rating Scale-Geriatric), plasma albumin and CRP, and oral nutritional supplement prescription at discharge. The programme consisted in four or five home visits over three months, depending on the first full home Mini Nutritional Assessment (MNA) score. Dieticians provided individualised counselling and recorded weight, appetite, energy and protein intake, ADL, IADL, handgrip strength (HS), self-perceived health status (SPHS), and quality of life (QoL). The number of family or professional caregivers was noted. Participants were classified according to weight change between the first and last visit: gain > 1 kg, loss > 1 kg, or stability. Among 351 participants (mean age 87.3 ± 6.1), 197 (56%) completed ≥ 2 visits, weight change was available for 189 (54%), and 149 (42%) completed all planned visits. A higher number of caregivers at home was associated with completing ≥ 2 visits (1.9 ± 1.3 vs. 1.6 ± 1.1; p = 0.01). Between the first and last visit, 46% gained weight, 33% remained stable, and 21% lost weight. No baseline characteristic was significantly different between weight change groups. Over time, weight (median + 0.9 kg; Q1–Q3 0.5–1.2), appetite, QoL, SPHS, MNA, and HS improved significantly (all p < 0.01). Almost half of participants gained weight during the dietician-led home visit programme. Baseline geriatric assessment did not allow discrimination between weight change groups. In older adults discharged from geriatric acute care, factors influencing dietary counselling efficacy remains to be identified in order to support individualised care plans. (ClinicalTrials.gov):NCT04016532
Sanchez et al. (Wed,) studied this question.