Individualized therapy for elderly patients using exercise and nutrition to reduce dependence post discharge trial

INTERVENTION: A community extended individualised nutrition and exercise care plan that spans 3‐months post discharge. They will receive both nutrition and exercise intervention during admission. After discharged, they will be supported through an ambulatory service in the form of home visits and telephone calls. Nutrition therapy – The FMC dietitian will formulate an individualised nutrition care plan tailored to their medical conditions, nutritional requirements and food preferences, which will be provided while patient is admitted. The medical nutrition therapy (MNT) will aim at providing 100 per cent of their energy and protein requirements to achieve ideal body weight, estimated from the Harris Benedict equation used in acute setting (Roza & Shizgal 1984). Medical nutrition therapy provided can include the use of commercial oral nutrition supplements (selected within hospital’s inpatient formulary where costs are covered), mid‐meal snacks (limited to hospital’s food service menu) and food fortification strategies, catered to the individual patient’s preferences and tolerance. Optimal care in terms of frequency of reviews and input will be left to the discretion of the dietitian as individualised therapy will vary between patients. The dietitian will suggest a multivitamin/mineral if deemed necessary, but prescription will be left to the discretion of treating clinicians. Dietetic counselling, with an aim to augment energy and protein intake, will be provided to patients and their caregivers prior to discharge to ensure continuity of the nutritional care plan at home. If patient is not seen by the ward dietitian, he/she will be assessed at the initial home visit. If the patient is to be discharged to a nursing home, the recommended nutritional care plan will be forwarded to the respective care managers. Exercise therapy – In addition to any usual physiotherapy care, patients will also receive a daily supervised chair stand and heel‐raise exercise‐training progr CONDITION: Diet and Nutrition ‐ Other diet and nutrition disorders Frailty in hospitalised elderly patients; ; Frailty in hospitalised elderly patients Physical Medicine / Rehabilitation ‐ Physiotherapy Public Health ‐ Health service research PRIMARY OUTCOME: Frailty score as assessed with the Edmonton Frail Scale[Baseline, 3‐ and 6‐months] SECONDARY OUTCOME: EQ‐5D[Baseline, 3‐ and 6‐months] Geriatric Depression Scale[Baseline, 3‐ and 6‐months] Handgrip strength with a dynamomter[Baseline, 3‐ and 6‐months] Hospital Admission Risk Profile[Baseline, 3‐ and 6‐months] Mini mental state examination[Baseline, 3‐ and 6‐months] Nutrition status as assessed by the patient generated subjective global assessment[Baseline, 3‐ and 6‐months] Short Physical Performance Battery[Baseline, 3‐ and 6‐months] INCLUSION CRITERIA: • 65 years or older • able to understand verbal/nonverbal instructions (MMSE score 24 and above) • Not bed or wheelchair‐bound • have access to a telephone or mobile phone at home • Have an Edmonton Frail Scale (EFS) of 6 and above