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Influence of Nutritional Status on a Family-Centered Care Intervention for Older Adults with Cognitive Impairment following Hip-Fracture Surgery: Secondary Data Analysis of a Randomized Controlled Trial

  • Original Research
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The journal of nutrition, health & aging

Abstract

Objectives

In Taiwan, older adults with cognitive impairment who undergo hip-fracture surgery are routinely cared for by family members. This study aimed to determine if nutritional status influenced the effects of a family-centered intervention for older adults with cognitive impairment recovering from hip-fracture surgery.

Design

Secondary data analysis of data from a randomized controlled trial was conducted to examine the influences of nutritional status 1 month after hospital discharge on the effects of a family-centered care intervention model, which was designed for older adults with hip fracture and cognitive impairment. Outcomes were compared among participants according to nutrition status (well-nourished/poorly-nourished) and treatment approach (control/intervention).

Setting

The original study was conducted at a 3000-bed medical center from July 2015 to October 2019.

Participants

Participants were older adults with cognitive impairment who had undergone hip-fracture surgery. Participants were assessed as poorly-nourished or well-nourished with the Mini-Nutritional Assessment (MNA) 1-month post-discharge and were then randomly assigned to either the intervention group or control group. Intervention: A family-centered intervention model for family caregivers of older adults with cognitive impairment recovering from hip-fracture surgery was implemented. The intervention was delivered by geriatric nurses, which included instructions for family caregivers in overseeing exercises for strengthening the hip, understanding dietary requirements, and managing behavioral problems associated with cognitive impairment.

Measurements

Outcome measures included activities of daily living (ADLs), instrumental ADLs, hip range of motion, hip muscle strength, depression, measured with the Geriatric Depressive Scale, and physical and mental health related quality of life, measured with the Short Form Survey (SF-36), Taiwanese version. Participants were assessed at 1-, 3-, 6-, and 12-months post-discharge.

Results

Most of the 134 participants were assessed as poorly nourished (n = 122); 57 were the control group and 65 received the intervention. For the well-nourished participants (n = 12), four were in the intervention group and eight were controls. There were no significant differences in any outcome variables for poorly nourished participants who received the intervention compared with controls. For the sample of well-nourished participants, those who received the intervention performed significantly better in outcomes of IADLs (b = 1.74, p <.05), hip muscle strength (b = 9.64, p <.01), and physical health related quality of life (b = 10.47, p <.01).

Conclusion

The family-centered care intervention was only effective for older adults with cognitive impairment recovering from hip-fracture surgery who were well-nourished at 1 month following hospital discharge, but not for those at risk of malnutrition. Interventions should focus on enhancing nutritional status following hip surgery which could allow the family-centered in-home intervention to be beneficial for more older adults with cognitive impairment recovering from hip-fracture surgery.

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Funding

Funding sources: The study was supported by grants (National Health Research Institutes, Taiwan (NHRI-EX106-10405PI), the Healthy Aging Research Center, Chang Gung University from the Featured Areas Research Center Program within the Framework of the Higher Education Sprout Project by the Ministry of Education (MOE) in Taiwan (EMRPD1K0401), Chang Gung Medical Foundation (Grant No. BMRP297, CMRPD1H0221-2), and the Ministry of Science and Technology (MOST 106-2314-B-182-008-MY3), Taiwan. Clinical Trial Registration Number and name of trial register. ClinicalTrials.gov (NCT03894709). A Care Model for Elderly Hip-fractured Persons with Cognitive Impairment and Their Family Caregivers

Author information

Authors and Affiliations

  1. Post-Baccalaureate Program in Nursing, College of Nursing, Asia University, 500, Lioufeng Rd., Wufeng, Taichung, 41354, Taiwan

    M.-Y. Tseng

  2. Department of Health Management and Policy, School of Public Health, University of Michigan, 1420 Washington Heights, SPH II M3007, Ann Arbor, MI, 48109, USA

    J. Liang

  3. Department of Orthopedic Surgery, Division of Orthopedic Traumatology, Linkou Chang Gung Memorial Hospital, 5 Fuxing Street, Guishan District, Taoyuan, 33305, Taiwan

    C.-C. Wu & Y.-H. Yu

  4. Department of Internal Medicine, Linkou Chang Gung Memorial Hospital, 5 Fuxing Street, Guishan District, Taoyuan, 33305, Taiwan

    H.-S. Cheng

  5. Department of Psychiatry, Keelung Chang Gung Memorial Hospital, No. 200, Lane 208, Jijin 1st Road, Anle District, Keelung, 20445, Taiwan

    C.-Y. Chen

  6. Department of Nursing, Linkou Chang Gung Memorial Hospital, 5 Fuxing Street, Guishan District, Taoyuan, 33305, Taiwan

    Y.-E. Lin

  7. Department of Orthopedic Surgery, Division of Sports Medicine, Linkou Chang Gung Memorial Hospital, 5 Fuxing Street, Guishan District, Taoyuan, 33305, Taiwan

    C.-J. Weng

  8. School of Nursing, College of Medicine, Healthy Aging Research Center, Chang Gung University, 259 Wenhua 1st Road, Guishan District, Taoyuan, 33302, Taiwan

    Yea-Ing L. Shyu

  9. Department of Gerontology and Health Care Management, College of Nursing, Chang Gung University of Science and Technology, 261 Wenhwa 1st Road, Guishan District, Taoyuan, 33303, Taiwan

    Yea-Ing L. Shyu

  10. Dementia Center, Department of Neurology, Chang Gung Memorial Hospital, No. 123, Dinghu Rd., Guishan Dist., Taoyuan, 333008, Taiwan

    Yea-Ing L. Shyu

  11. School of Nursing, Chang Gung University, 259 Wenhua 1st Road, Guishan District, Taoyuan, 33302, Taiwan

    Yea-Ing L. Shyu

Authors
  1. M.-Y. Tseng
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  2. J. Liang
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  3. C.-C. Wu
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  4. H.-S. Cheng
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  5. C.-Y. Chen
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  6. Y.-E. Lin
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  7. C.-J. Weng
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  8. Y.-H. Yu
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  9. Yea-Ing L. Shyu
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Corresponding author

Correspondence to Yea-Ing L. Shyu.

Ethics declarations

Ethics approval and consent to participate: The study was conducted with the approval for human subject research of the study hospital ethics committee (Chang Gung Medical Foundation, Institutional Review Board; approval number: No:103-1035A3). Informed consent were obtained from the participants. All methods were carried out in accordance with relevant guidelines and regulations.

Conflicts of Interest: The authors have no conflicts of interest to declare. The funding agency had no role in the study design, methods, subject recruitment, data collections, analysis, and preparation of this article.

Electronic supplementary material

Supplemental Table 1

. Intrapersonal and interpersonal differences in outcome variables for older persons with hip fracture and cognitive impairment (Time centered at 3 months) (N = 134)

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Tseng, MY., Liang, J., Wu, CC. et al. Influence of Nutritional Status on a Family-Centered Care Intervention for Older Adults with Cognitive Impairment following Hip-Fracture Surgery: Secondary Data Analysis of a Randomized Controlled Trial. J Nutr Health Aging 26, 1047–1053 (2022). https://doi.org/10.1007/s12603-022-1864-y

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  • DOI: https://doi.org/10.1007/s12603-022-1864-y

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