333: “They Didn’t Say What to Eat”: Patient Recall and Use of Icu-Initiated Nutrition Messaging

Introduction: Older adults recovering from critical illness often receive individualized nutrition support during their ICU and hospital stay. However, the continuity and clarity of nutrition guidance following discharge are highly variable. Patients may be discharged without specific instructions or the ability to retain and act on prior recommendations. We hypothesized that ICU- and hospital-based nutrition recommendations would be poorly recalled and inconsistently implemented after discharge. To evaluate this, we analyzed post-discharge interviews with older trauma patients admitted to the ICU who received goal-directed ICU nutrition and post-discharge oral nutrition supplementation. Methods: Twenty patients aged ≥ 60 years randomized to the intervention arm of a pilot randomized control trial were interviewed 2 weeks to 6 months post-hospitalization. The intervention included individualized ICU nutrition using indirect calorimetry, structured nutrition conversations, and a 30-day oral nutrition supplement (ONS) program after discharge. Interviews explored nutrition knowledge, behavior, and trust in information sources. Transcripts were analyzed thematically using NVivo 14 (Lumivero). Results: Only 7 participants (35%) recalled specific guidance from hospital teams about nutrition during recovery. Several (n = 6) described receiving generalized advice (e.g., “eat more protein”) without actionable recommendations. Participants frequently relied on non-clinical sources post-discharge, including family, internet searches, or past experiences. Trust in medical providers was high, but only 5 participants recalled being connected with a dietitian or receiving written guidance during admission. One participant shared, “I didn’t have a dietician. Nobody said anything about any specific diets or anything like that.” Notably, all patients received daily ICU nutritionist rounds, suggesting a disconnect between bedside interventions and patient recall. Conclusions: Despite receiving structured, individualized nutrition support during hospitalization and after discharge, many older trauma survivors struggled to recall or implement hospital-directed guidance. Improved discharge communication and integration of outpatient nutrition support may improve adherence and outcomes.