title: Comprehensive care improves physical recovery of hip-fractured elderly Taiwanese patients with poor nutritional status.
abstract: OBJECTIVE
  The effects of nutritional management among other intervention components have not been examined for hip-fractured elderly persons with poor nutritional status. Accordingly, this study explored the intervention effects of an in-home program using a comprehensive care model that included a nutrition-management component on recovery of hip-fractured older persons with poor nutritional status at hospital discharge.
  
  
  METHODS
  A secondary analysis of data from a randomized controlled trial with 24-month follow-up.
  
  
  METHODS
  A 3000-bed medical center in northern Taiwan.
  
  
  METHODS
  Subjects were included only if they had "poor nutritional status" at hospital discharge, including those at risk for malnutrition or malnourished. The subsample included 80 subjects with poor nutritional status in the comprehensive care group, 87 in the interdisciplinary care group, and 85 in the usual care group.
  
  
  METHODS
  The 3 care models were usual care, interdisciplinary care, and comprehensive care. Usual care provided no in-home care, interdisciplinary care provided 4 months of in-home rehabilitation, and comprehensive care included management of depressive symptoms, falls, and nutrition as well as 1 year of in-home rehabilitation.
  
  
  METHODS
  Data were collected on nutritional status and physical functions, including range of motion, muscle power, proprioception, balance and functional independence, and analyzed using a generalized estimating equation approach. We also compared patients' baseline characteristics: demographic characteristics, type of surgery, comorbidities, length of hospital stay, cognitive function, and depression.
  
  
  RESULTS
  Patients with poor nutritional status who received comprehensive care were 1.67 times (95% confidence interval 1.06-2.61) more likely to recover their nutritional status than those who received interdisciplinary and usual care. Furthermore, the comprehensive care model improved the functional independence and balance of patients who recovered their nutritional status over the first year following discharge, but not of those who had not yet recovered.
  
  
  CONCLUSIONS
  An in-home program using the comprehensive care model with a nutritional component effectively improved the nutritional status of hip-fractured patients with poor nutrition. This comprehensive care intervention more effectively improved recovery of functional independence and balance for patients with recovered nutritional status.
authors.affiliation: Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Hsin-Yun
authors.initials: HY
authors.lastname: Liu
authors.affiliation: Department of Nursing, Meiho University, Pingtung, Taiwan.
authors.forename: Ming-Yueh
authors.initials: MY
authors.lastname: Tseng
authors.affiliation: School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Hsiao-Juan
authors.initials: HJ
authors.lastname: Li
authors.affiliation: Traumatological Division, Department of Orthopedics, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
authors.forename: Chi-Chuan
authors.initials: CC
authors.lastname: Wu
authors.affiliation: Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
authors.forename: Huey-Shinn
authors.initials: HS
authors.lastname: Cheng
authors.affiliation: Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Ching-Tzu
authors.initials: CT
authors.lastname: Yang
authors.affiliation: Fit Great Clinic, Taipei, Taiwan.
authors.forename: Shih-Wei
authors.initials: SW
authors.lastname: Chou
authors.affiliation: Section of General Psychiatry, Department of Psychiatry, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
authors.forename: Ching-Yen
authors.initials: CY
authors.lastname: Chen
authors.affiliation: Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan; School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan. Electronic address: yeaing@mail.cgu.edu.tw.
authors.forename: Yea-Ing L
authors.initials: YI
authors.lastname: Shyu
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control; D000368:Aged; D003191:Comprehensive Health Care; D003863:Depression / Q000628:therapy; D005060:Europe / Q000453:epidemiology; D015577:Geriatric Assessment; D006620:Hip Fractures / Q000453:epidemiology / Q000628:therapy*; D018575:Home Care Services, Hospital-Based; D006801:Humans; D057187:Independent Living; D044342:Malnutrition / Q000517:prevention & control*; D053580:Muscle Strength; D009752:Nutritional Status; D026741:Physical Therapy Modalities; D004856:Postural Balance; D016059:Range of Motion, Articular; D020127:Recovery of Function
keywords: Hip-fractured elders; nutrition intervention; physical function; poor nutrition