Adherence to nutrition supplements among patients with a fall-related lower limb fracture.
BACKGROUND
The purpose of this study was to provide a detailed evaluation of adherence to nutrition supplements by patients with a lower limb fracture.


METHODS
These descriptive data are from 49 nutritionally "at-risk" patients aged 70+ years admitted to the hospital after a fall-related lower limb fracture and allocated to receive supplementation as part of a randomized, controlled trial. Supplementation commenced on day 7 and continued for 42 days. Prescribed volumes aimed to meet 45% of individually estimated theoretical energy requirements to meet the shortfall between literature estimates of energy intake and requirements. The supplement was administered by nursing staff on medication rounds in the acute or residential care settings and supervised through thrice-weekly home visits postdischarge.


RESULTS
Median daily percent of the prescribed volume of nutrition supplement consumed averaged over the 42 days was 67% (interquartile range [IQR], 31-89, n = 49). There was no difference in adherence for gender, accommodation, cognition, or whether the supplement was self-administered or supervised. Twenty-three participants took some supplement every day, and a further 12 missed <5 days. For these 35 "nonrefusers," adherence was 82% (IQR, 65-93), and they lost on average 0.7% (SD, 4.0%) of baseline weight over the 6 weeks of supplementation compared with a loss of 5.5% (SD, 5.4%) in the "refusers" (n = 14, 29%), p = .003.


CONCLUSIONS
We achieved better volume and energy consumption than previous studies of hip fracture patients but still failed to meet target supplement volumes prescribed to meet 45% of theoretical energy requirements. Clinicians should consider alternative methods of feeding such as a nasogastric tube, particularly in those patients where adherence to oral nutrition supplements is poor and dietary intake alone is insufficient to meet estimated energy requirements.
Miller
Michelle D
MD
Flinders University Department of Rehabilitation and Aged Care, C-Block, Repatriation General Hospital, Daws Road, Daw Park, South Australia 5041, USA.
Daniels
Lynne A
LA
Bannerman
Elaine
E
Crotty
Maria
M
D000058:Accidental Falls; D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D001835:Body Weight; D004044:Dietary Proteins / Q000008:administration & dosage; D019587:Dietary Supplements; D002149:Energy Intake; D005260:Female; D005527:Food, Fortified; D050723:Fractures, Bone / Q000150:complications* / Q000628:therapy; D006801:Humans; D007869:Leg Injuries / Q000150:complications* / Q000628:therapy; D008297:Male; D009748:Nutrition Disorders / Q000209:etiology / Q000517:prevention & control*; D009751:Nutritional Requirements; D010349:Patient Compliance; D015431:Weight Loss
D004044:Dietary Proteins