Rationale Falls are a common and serious cause of morbidity and mortality in elderly. This RCT evaluates the effects of a short-term nutritional intervention on falls in malnourished elderly patients. Methods
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Falls are a common and serious cause of morbidity and mortality in elderly. This RCT evaluates the effects of a short-term nutritional intervention on falls in malnourished elderly patients.
Malnourished elderly patients (≥60 y) received either nutritional intervention (energy and protein enriched diet, oral nutritional support (600 kcal/d, 24 g E/d), Ca/vitamin D supplement (400 IU D3, 500 mg Ca) supported by dietetic counselling) or usual care for 3 months post-discharge. Number of fallers, fall incidents, serum vitamin D levels, and dietary intake were measured at admission and at 3 months after discharge.
A total of 207 patients (55.2% female) was included. Mean age was 74.6 (SD 9.5) years (range 60-97 years). There were 16 fall incidents (in 10 patients) in the intervention group and 41 fall incidents (in 24 patients) in the control group, HR 0.41 (95% CI 0.19;0.86), p=0.018 (log rank). Fifty six patients were censored due to drop-out and death (Figure 1 and Table 1). Compliance to oral nutritional support, vitamin D supplementation and
dietetic counselling was 80%, 96% and 96%, respectively. At three months, energy intake (+280 kcal, 95% CI 37 to 524), protein intake (+11 g, 95% CI 1 to 25) and serum vitamin D levels (+10.9 nmol/L, 95% CI 2.9 ; 18.9) were significantly higher in intervention patients than in controls.
We assume that the increased intake attributed to the decreased number of falls in patients in the intervention group.
F Neelemaat1,2, PTAM Lips2,3, A Thijs4, JC Seidell2,5, MAE van Bokhorst-de van der Schueren1,2
Departments of 1 Nutrition and Dietetics, Internal Medicine 2 EMGO Institute for Health and Care Research
3 Internal Medicine, Section Endocrinology 4 Internal Medicine 5 Health Sciences, Faculty of Earth and Life Sciences
VU University Medical Center & VU University, Amsterdam, The Netherlands
Figure 1: Kaplan-Meier curve for the time to a fall incident
Table 1: Fallers and fall incidents after three months nutritional intervention in malnourished elderly patients.
I: intervention group, C: control group, #: Mann Whitney U