Three Nurse-administered Protocols Reduce Nutritional Decline and Frailty in Older Gastrointestinal Surgery Patients: A Cluster Randomized Trial.
Cheryl Chia-Hui Chen, Yi-Ting Yang, I-Rue Lai and 10 others
PMID 30424980WHAT IT FOUND
Nurse-led protocols for early mobilization, oral care, and orientation reduced weight loss and prevented new frailty in older gastrointestinal surgery patients.
The intervention required about 58 minutes of nursing time per day. Family members were coached to assist with daily activities.
Key findings
01Patients receiving the nurse-led protocols lost significantly less weight (2.1 lb) than those receiving usual care (4.0 lb).
02The intervention reduced the risk of developing new frailty during hospitalization by 45% compared to usual care.
03Among patients who were already frail at admission, the intervention significantly reduced the likelihood of remaining frail at discharge (50.0% vs. 92.9%).
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPsWhat it means for RNs
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What it does not show
This was a secondary analysis of a previous trial, meaning the outcomes were not the primary focus of the original study design. The definition of frailty was modified; physical measurements for slowness and low activity were replaced with self-reported questions, which may have overestimated the intervention's effect on frailty incidence. The study was conducted at a single medical center with specific exclusion criteria, limiting generalizability to other populations or settings. Blinding of research nurses may have been compromised if they encountered the mHELP nurse at the bedside. The study did not assess the specific dose or level of care provided by each individual protocol component, nor did it evaluate the impact of polypharmacy or other geriatric syndromes.
Declared interests
The study was supported by the National Institutes of Health (N.I.H., Extramural). No other conflicts of interest were declared.
The easy way to misread this
Do not attribute the reduction in frailty solely to the nurse-administered protocols without considering the role of family involvement and the modified frailty assessment criteria, which may have inflated the perceived effect size.