Lack of nutritional and functional effects of nutritional supervision by nurses: a quasi-experimental study in geriatric patients

BACKGROUND: Undernutrition affects recovery from disease and regaining functional abilities; however, it frequently occurs in elderly hospitalized patients. OBJECTIVE: To study whether identification of geriatric patients at nutritional risk followed by individualized nursing care could improve their nutritional and activities of daily living (ADL) status. DESIGN: The design was quasi-experimental. In total, 345 rehabilitation patients (aged 84±7 years, 72% women) were allocated, according to bed availability, to either an intervention or a control ward. Nurses on the intervention ward attended a short class on nutrition and were supervised in nutritional care by trained nurses. In the intervention unit, the nursing staff identified patients at risk of undernutrition through systematic assessment of risk factors, e.g. body mass index (BMI) <24 kgm(−2), and treated them according to individual care plans. On the control ward routine nutritional care was offered. Functional status was assessed by the Barthel ADL index. RESULTS: Mean BMI was 24±5 on both wards. Fifty-five per cent of the patients had BMI <24. On average, patients were weight stable from admission to discharge, irrespective of allocation. No difference was found in ADL status as a result of the intervention. However, patients who gained weight improved more in ADL status than patients who remained stable or lost weight. CONCLUSIONS: In this geriatric setting standard care and care by trained and supervised nurses were equally effective in maintaining weight stability and functionality in rehabilitation patients with a mean BMI of 24. Weight increase was associated with improved functionality.