Cost-effectiveness of an interdisciplinary intervention in geriatric inpatients to prevent malnutrition.
BACKGROUND
In order to reduce protein-energy malnutrition in older people during hospitalisation an early interdisciplinary intervention is needed. We developed a protocol which includes screening for malnutrition, dysphagia and dehydration on admission, followed by immediate interventions.


OBJECTIVE
To assess effectiveness of the protocol on nutritional status, hospital-acquired infections and pressure sores, and to evaluate the protocol s economical feasibility.


METHODS
Prospective, controlled study.


METHODS
The inpatient geriatric service of a university hospital (UMC Nijmegen) and a geriatric ward of a non-academic teaching hospital (Rijnstate Hospital, Arnhem).


METHODS
298 older patients (>60 years).


METHODS
One of the geriatric wards applied the protocol (N=140) while the other provided standard care (N=158). All non-terminally ill patients admitted for more than two days were included. Body mass was measured on admittance and discharge and hospital-acquired infections and pressure sores were scored and costs related to nutrition, infections and length of hospital stay were assessed.


RESULTS
There was a 0.8 kg loss (SEM 0.3 kg) in average weight in the standard care group and a 0.9 kg gain (SEM 0.2 kg) in the intervention group (p<0.001). The number of hospital acquired infections was significantly lower in the intervention group (33/140 versus 58/158, p=0.01) but no significant difference in number of patients with pressure sores (23/140 versus 33/158) was found. Costs were not significantly different: 7516 versus 7908 Euro/patient for intervention versus controls, respectively.


CONCLUSIONS
An early interdisciplinary intervention approach can be effective in reducing protein-energy malnutrition and related hospital-acquired infections and appears to be economically feasible.
Department of Geriatric Medicine, University Medical Centre Nijmegen, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
G
G
Rypkema
E
E
Adang
H
H
Dicke
T
T
Naber
B
B
de Swart
L
L
Disselhorst
G
G
Golüke-Willemse
M
M
Olde Rikkert
D000368:Aged; D000369:Aged, 80 and over; D001835:Body Weight; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D003428:Cross Infection / Q000191:economics / Q000517:prevention & control; D003680:Deglutition Disorders / Q000191:economics / Q000517:prevention & control; D003681:Dehydration / Q000191:economics / Q000517:prevention & control; D005260:Female; D006299:Health Services for the Aged / Q000191:economics*; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D008297:Male; D008403:Mass Screening / Q000191:economics; D003668:Pressure Ulcer / Q000191:economics / Q000517:prevention & control; D011446:Prospective Studies; D011502:Protein-Energy Malnutrition / Q000191:economics* / Q000517:prevention & control*; D016896:Treatment Outcome