title: Multidisciplinary, multi-modal nutritional care in acute hip fracture inpatients - results of a pragmatic intervention.
abstract: OBJECTIVE
  Malnutrition is highly prevalent and resistant to intervention following hip fracture. This study investigated the impact of individualised versus multidisciplinary nutritional care on nutrition intake and outcomes in patients admitted to a metropolitan hospital acute hip fracture unit.
  
  
  METHODS
  A prospective, controlled before and after comparative interventional study aligning to the CONSORT guidelines for pragmatic clinical trials. Randomly selected patients receiving individualised nutritional care (baseline) were compared with post-interventional patients receiving a new model of nutritional care promoting nutrition as a medicine, multidisciplinary nutritional care, foodservice enhancements, and improved nutrition knowledge and awareness. Malnutrition was diagnosed using the Academy of Nutrition and Dietetics criteria.
  
  
  RESULTS
  Fifty-eight weighed food records were available for each group across a total of 82 patients (n = 44, n = 38). Group demographics were not significantly different with predominantly community dwelling (72%), elderly (82.2 years), female (70%), malnourished (51.0%) patients prone to co-morbidities (median 5) receiving early surgical intervention (median D1). Multidisciplinary nutritional care reduced intake barriers and increased total 24-h energy (6224 vs. 2957 kJ; p < 0.001) and protein (69.0 vs. 33.8 g; p < 0.001) intakes, reduced nutritional deterioration over admission (5.4 vs. 20.5%; p = 0.049), and increased discharge directly back to the community setting (48.0 vs. 17.6%; p = 0.012). Trends suggested a reduction in median length of stay (D13 vs. D14). Inpatient mortality remained low across groups (5.2%, 2.3%).
  
  
  CONCLUSIONS
  Multidisciplinary nutritional care improves nutrition intake and outcomes in acute hip fracture inpatients. Similar pragmatic study designs should be considered in other elderly inpatient populations perceived resistant to nutritional intervention.
authors.affiliation: The Prince Charles Hospital, Queensland Health, Brisbane, Australia; Centre for Dietetic Research, School of Human Movement Studies, University of Queensland, Brisbane 4072, Australia. Electronic address: jack_bell@health.qld.gov.au.
authors.forename: Jack J
authors.initials: JJ
authors.lastname: Bell
authors.affiliation: Centre for Dietetic Research, School of Human Movement Studies, University of Queensland, Brisbane 4072, Australia. Electronic address: j.bauer1@uq.edu.au.
authors.forename: Judith D
authors.initials: JD
authors.lastname: Bauer
authors.affiliation: Centre for Dietetic Research, School of Human Movement Studies, University of Queensland, Brisbane 4072, Australia. Electronic address: s.capra@uq.edu.au.
authors.forename: Sandra
authors.initials: S
authors.lastname: Capra
authors.affiliation: The Prince Charles Hospital, Queensland Health, Brisbane, Australia. Electronic address: ranjeev_pulle@health.qld.gov.au.
authors.forename: Ranjeev Chrys
authors.initials: RC
authors.lastname: Pulle
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002149:Energy Intake; D005260:Female; D015577:Geriatric Assessment; D006620:Hip Fractures / Q000150:complications* / Q000601:surgery; D006801:Humans; D007297:Inpatients; D016015:Logistic Models; D008297:Male; D044342:Malnutrition / Q000178:diet therapy* / Q000453:epidemiology*; D015596:Nutrition Assessment; D009752:Nutritional Status; D018529:Nutritional Support; D010351:Patient Discharge; D015995:Prevalence; D011446:Prospective Studies; D016896:Treatment Outcome
keywords: Elderly; Hip fractures; Hospitals; Malnutrition; Pragmatic