Abstract
A degree of malnutrition is evident in many elderly patients on admission to hospital. The increased metabolic demands of surgery, and low food intake during the post operative period, can cause a further deterioration in nutritional status, with adverse effects on clinical outcome. Sip feed supplements offer a simple and inexpensive method of providing nutrition support. 'The present study has evaluated the efficacy of, and compliance to, sip feed supplements in elderly patients undergoing elective and emergency orthopaedic surgery. The feasibility study (Chapter 3) revealed that the patients who were not offered supplements throughout their hospital stay (NS group) demonstrated significant mean (+/- sd) losses in arm anthropometric measurements (-0.56 +/- 2.9 mm in TSF, -1.15 +/- 1.02 cm in MUAC and-1.04 +/- 1.28 cm in MUAMC). No such losses were observed in the group receiving the supplements (S group). Compliance to the regimen was 61%. In the long term evaluation study (Chapter 4) the period of supplementation was extended for a further four weeks into the discharge period, and patients were followed up for six months after discharge. Compared with the supplement (S) group, the non-supplemented (NS) patients showed adverse recovery, notably: 1) Significant losses in MUAC from admission to 8 weeks post discharge. 2) Longer duration of stay in hospital (total median hospital time in the NS group 33 days, compared with 22 in S group). 3) Higher rates of post-operative complications (six patients in the NS group developed chest infection, compared with one in the S group; 14 patients in the NS group developed pressure sores compared with 7 in the S group). 4) Higher rates of mortality in the period of study (20% in the NS group, compared with 9.5% in the S group). Compliance was poor, at 62%. Intake of normal foods was not adversely affected by supplement intake. In an attempt to improve compliance, a nutrition education programme (NEP) was implemented (Chapter 5). The NEP did not significantly improve the rate of compliance. Further detailed food intake assessments confirmed that the provision of nutritional supplements did not reduce the intake of normal foods. Sip feed supplements offer important measurable benefits to elderly patients recovering from orthopaedic surgery. Potential benefit was limited by poor patient acceptability. Compliance could not be improved by measures adopted in normal dietetic practice, not by the implementation of a patient and nurse nutrition education programme.