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HOMEFOOD Randomised Trial–Six-Month Nutrition Therapy in Discharged Older Adults Reduces Hospital Readmissions and Length of Stay at Hospital Up to 18 Months of Follow-Up

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The journal of nutrition, health & aging



Malnutrition is frequently observed in older adults and is associated with hospital readmissions, length of stay (LOS), and mortality in discharged patients.


The aim of this study was to investigate effects of six-month nutrition therapy on hospital readmissions, LOS, mortality and need for long-term care residence 1-, 6-, 12- and 18-months post-discharge in older Icelandic adults.


Secondary analysis of a randomized controlled trial.


Participants (>65 years) were randomised into intervention (n=53) and control (n=53) before discharge from a geriatric unit.


The intervention group received nutrition therapy based on the Nutrition Care Process, including home visits, phone calls, freely delivered energy- and protein-rich foods and supplements for six months after hospital discharge.


The Icelandic electronic hospital registry was accessed to gain information on emergency room visits (ER), hospital readmissions, LOS, mortality and need for long-term care residence.


The intervention group had a lower proportion of participants with at least one readmission compared to control (1 month: 1.9% vs 15.8%, P=0.033; 6 months: 25.0% vs 46.2%, P=0.021; 12 months: 38.5% vs 55.8%, P=0.051; and 18 months: 51.9% vs 65.4%, P=0.107). There was also a lower total number of readmissions per participant (1 month: 0.02 vs 0.19, P=0.015; 6 month: 0.33 vs 0.77, P=0.014; 0.62 vs 1.12, P=0.044) and a shorter LOS (1 month: 0.02 vs 0.92, P=0.013; 6 months: 2.44 vs 13.21; P=0.006; 12 months: 5.83 vs 19.40, P=0.034; 18 months: 10.42 vs 26.00, P=0.033) in the intervention group. However, there were no differences between groups in ER visits, mortality and need for long-term care residence.


A six-month nutrition therapy in older Icelandic adults discharged from hospital reduced hospital readmissions and shortens LOS at the hospital up to 18-months post-discharge. However, it did neither affect mortality, ER, nor need of long-term care residence in this group.

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  1. Admi H, Shadmi E, Baruch H, Zisberg A. From research to reality: minimizing the effects of hospitalization on older adults. Rambam Maimonides Med J. 2015 Apr;6:e0017 DOI:

    Article  PubMed  PubMed Central  Google Scholar 

  2. Allard JP, Keller H, Jeejeebhoy KN, Laporte M, Duerksen DR, Gramlich L, Payette H, Bernier P, Davidson B, Teterina A, Lou W. Decline in nutritional status is associated with prolonged length of stay in hospitalized patients admitted for 7 days or more: A prospective cohort study. Clinical Nutrition. 2016 2016/02/01/;35:144–152 DOI:

    Article  PubMed  Google Scholar 

  3. Coca DJ, Castelblanco SM, Chavarro-Carvajal DA, Venegas-Sanabria LC. In-hospital complications in an acute care geriatric unit. Biomedica. 2021 Jun 29;41:293–301 DOI:

    Article  PubMed  PubMed Central  Google Scholar 

  4. Duan-Porter W, Vo TN, Ullman K, Langsetmo L, Strotmeyer ES, Taylor BC, Santanasto AJ, Cawthon PM, Newman AB, Simonsick EM, Waters TM, Ensrud KE. Hospitalization-Associated Change in Gait Speed and Risk of Functional Limitations for Older Adults. J Gerontol A Biol Sci Med Sci. 2019 Sep 15;74:1657–1663 DOI:

    Article  PubMed  PubMed Central  Google Scholar 

  5. Alley DE, Koster A, Mackey D, Cawthon P, Ferrucci L, Simonsick EM, Yu B, Hardy S, Goodpaster B, Sarkisian C, Houston DK, Kritchevsky SB, Cummings S, Lee JS, Tylavsky FA, Newman A, Harris T. Hospitalization and change in body composition and strength in a population-based cohort of older persons. J Am Geriatr Soc. 2010 Nov;58:2085–2091 DOI:

    Article  PubMed  PubMed Central  Google Scholar 

  6. Mudge AM, Kasper K, Clair A, Redfern H, Bell JJ, Barras MA, Dip G, Pachana NA. Recurrent readmissions in medical patients: a prospective study. J Hosp Med. 2011 Feb;6:61–67 DOI:

    Article  PubMed  Google Scholar 

  7. Allaudeen N, Vidyarthi A, Maselli J, Auerbach A. Redefining readmission risk factors for general medicine patients. J Hosp Med. 2011 Feb;6:54–60 DOI:

    Article  PubMed  Google Scholar 

  8. Söderström L, Rosenblad A, Thors Adolfsson E, Bergkvist L. Malnutrition is associated with increased mortality in older adults regardless of the cause of death. The British journal of nutrition. 2017 Feb;117:532–540 DOI:

    Article  PubMed  Google Scholar 

  9. Volkert D, Beck AM, Cederholm T, Cruz-Jentoft A, Goisser S, Hooper L, Kiesswetter E, Maggio M, Raynaud-Simon A, Sieber CC, Sobotka L, van Asselt D, Wirth R, Bischoff SC. ESPEN guideline on clinical nutrition and hydration in geriatrics. Clinical nutrition (Edinburgh, Scotland). 2019 Feb;38:10–47 DOI:

    Article  PubMed  Google Scholar 

  10. Lærum-Onsager E, Molin M, Olsen CF, Bye A, Debesay J, Hestevik CH, Bjerk M, Pripp AH. Effect of nutritional and physical exercise intervention on hospital readmission for patients aged 65 or older: a systematic review and meta-analysis of randomized controlled trials. International Journal of Behavioral Nutrition and Physical Activity. 2021 2021/05/10;18:62 DOI:

    Article  PubMed  PubMed Central  Google Scholar 

  11. Lindegaard Pedersen J, Pedersen PU, Damsgaard EM. Nutritional Follow-Up after Discharge Prevents Readmission to Hospital - A Randomized Clinical Trial. The journal of nutrition, health & aging. 2017;21:75–82 DOI:

    Article  CAS  Google Scholar 

  12. Terp R, Jacobsen KO, Kannegaard P, Larsen AM, Madsen OR, Noiesen E. A nutritional intervention program improves the nutritional status of geriatric patients at nutritional risk-a randomized controlled trial. Clinical rehabilitation. 2018 Jul;32:930–941 DOI:

    Article  PubMed  Google Scholar 

  13. Deutz NE, Matheson EM, Matarese LE, Luo M, Baggs GE, Nelson JL, Hegazi RA, Tappenden KA, Ziegler TR. Readmission and mortality in malnourished, older, hospitalized adults treated with a specialized oral nutritional supplement: A randomized clinical trial. Clinical nutrition (Edinburgh, Scotland). 2016 Feb;35:18–26 DOI:

    Article  PubMed  Google Scholar 

  14. Deer RR, Dickinson JM, Baillargeon J, Fisher SR, Raji M, Volpi E. A Phase I Randomized Clinical Trial of Evidence-Based, Pragmatic Interventions to Improve Functional Recovery After Hospitalization in Geriatric Patients. J Gerontol A Biol Sci Med Sci. 2019 Sep 15;74:1628–1636 DOI:

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Holyday M, Daniells S, Bare M, Caplan GA, Petocz P, Bolin T. Malnutrition screening and early nutrition intervention in hospitalised patients in acute aged care: a randomised controlled trial. The journal of nutrition, health & aging. 2012;16:562–568 DOI:

    Article  CAS  Google Scholar 

  16. Sharma Y, Thompson CH, Kaambwa B, Shahi R, Hakendorf P, Miller M. Investigation of the benefits of early malnutrition screening with telehealth follow up in elderly acute medical admissions. Qjm. 2017 Oct 1;110:639–647 DOI:

    Article  CAS  PubMed  Google Scholar 

  17. Kaegi-Braun N, Kilchoer F, Dragusha S, Gressies C, Faessli M, Gomes F, Deutz NE, Stanga Z, Mueller B, Schuetz P. Nutritional support after hospital discharge improves long-term mortality in malnourished adult medical patients: Systematic review and meta-analysis. Clinical nutrition (Edinburgh, Scotland). 2022 Nov;41:2431–2441 DOI:

    Article  PubMed  Google Scholar 

  18. Kaegi-Braun N, Mueller M, Schuetz P, Mueller B, Kutz A. Evaluation of Nutritional Support and In-Hospital Mortality in Patients With Malnutrition. JAMA Netw Open. 2021 Jan 4;4:e2033433 DOI:

    Article  PubMed  PubMed Central  Google Scholar 

  19. Griffin A, O’Neill A, O’Connor M, Ryan D, Tierney A, Galvin R. The prevalence of malnutrition and impact on patient outcomes among older adults presenting at an Irish emergency department: a secondary analysis of the OPTI-MEND trial. BMC geriatrics. 2020 Nov 7;20:455 DOI:

    Article  PubMed  PubMed Central  Google Scholar 

  20. Blondal BS, Geirsdottir OG, Beck AM, Halldorsson TI, Jonsson PV, Sveinsdottir K, Ramel A. HOMEFOOD randomized trial—beneficial effects of 6-month nutrition therapy on body weight and physical function in older adults at risk for malnutrition after hospital discharge. European Journal of Clinical Nutrition. 2022:1–10 DOI:

  21. Blondal BS, Geirsdottir OG, Halldorsson TI, Beck AM, Jonsson PV, Ramel A. HOMEFOOD randomised trial–Six-month nutrition therapy improves quality of life, self-rated health, cognitive function, and depression in older adults after hospital discharge. Clinical Nutrition ESPEN. 2022 2022/04/01/;48:74–81 DOI:

    Article  CAS  PubMed  Google Scholar 

  22. Boutron I, Altman DG, Moher D, Schulz KF, Ravaud P. CONSORT Statement for Randomized Trials of Nonpharmacologic Treatments: A 2017 Update and a CONSORT Extension for Nonpharmacologic Trial Abstracts. Annals of internal medicine. 2017 Jul 4;167:40–47 DOI:

    Article  PubMed  Google Scholar 

  23. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. J Int Bioethique. 2004 Mar;15:124–129.

  24. Fridriksdottir A JB, Gunnarsdottir I, Kristinsson JO, Sigvaldason, Moller PH. Klínískar leiðbeiningar um næringu sjúklinga [Clinical guidelines on patients nutrition] 2011.

  25. Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. Journal of psychiatric research. 1975 Nov;12:189–198.

    Article  CAS  PubMed  Google Scholar 

  26. Swan WI, Vivanti A, Hakel-Smith NA, Hotson B, Orrevall Y, Trostler N, Beck Howarter K, Papoutsakis C. Nutrition Care Process and Model Update: Toward Realizing People-Centered Care and Outcomes Management. J Acad Nutr Diet. 2017 Dec;117:2003–2014 DOI:

    Article  PubMed  Google Scholar 

  27. Gisladottir E TH, Geirsdottir OG, Jonsdottir AB, Jensdottir AB, Jonsdottir G, Hilmisdottir HB, Vilmundardottir VK, Geirsdottir Th. Ráðleggingar um mataræði fyrir hrumt eða veikt eldra fólk - ætlað fagfólki og öðrum umönnunaraðilum [Dietary advice for frail or sick old adults - for professionals and other caregivers]. 2018.

  28. Thorsdottir I, Gunnarsdottir I, Eriksen B. Screening method evaluated by nutritional status measurements can be used to detect malnourishment in chronic obstructive pulmonary disease. J Am Diet Assoc. 2001 Jun;101:648–654 DOI:

    Article  CAS  PubMed  Google Scholar 

  29. Bauer JM, Kaiser MJ, Sieber CC. Evaluation of nutritional status in older persons: nutritional screening and assessment. Current opinion in clinical nutrition and metabolic care. 2010 Jan;13:8–13 DOI:

    Article  PubMed  Google Scholar 

  30. Thorgeirsdottir H VH, Gunnarsdottir I, Gisladottir E, Gunnarsdottir BE, Thorsdottir I, et al.. What do Icelanders eat 2010–2011. Main results. In: Embætti Landlæknis MoRín, editor.æknir; 2012.

  31. Gunnarsdottir I, Tryggvadottir EA, Birgisdottir BE, Halldorsson TI, Medek H, Geirsson RT. [Diet and nutrient intake of pregnant women in the capital area in Iceland]. Laeknabladid. 2016 Sep;102:378–384 DOI:

    PubMed  Google Scholar 

  32. Guralnik JM, Simonsick EM, Ferrucci L, Glynn RJ, Berkman LF, Blazer DG, Scherr PA, Wallace RB. A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol. 1994 Mar;49:M85–94 DOI:

    Article  CAS  PubMed  Google Scholar 

  33. Radloff LS. The CES-D Scale:A Self-Report Depression Scale for Research in the General Population. Applied Psychological Measurement. 1977;1:385–401 DOI:

    Article  Google Scholar 

  34. Thorsdottir I, Tomasson H, Gunnarsdottir I, Gisladottir E, Kiely M, Parra MD, Bandarra NM, Schaafsma G, Martinéz JA. Randomized trial of weight-loss-diets for young adults varying in fish and fish oil content. Int J Obes (Lond). 2007 Oct;31:1560–1566 DOI:

    Article  CAS  PubMed  Google Scholar 

  35. Blondal BS. Nutritional status of the elderly after discharge from the acute geriatric unit, a pilot study: Socioeconomic status, food security and food availability. Digital repository of academic and research documents: University of Iceland; 2017.

  36. Alper E, O’Malley TA, Greenwald J, Aronson M, Park L. Hospital discharge and readmission. UpToDate Waltham, MA: UpToDate. 2017.

    Google Scholar 

  37. Kirkland LL, Kashiwagi DT, Brantley S, Scheurer D, Varkey P. Nutrition in the hospitalized patient. Journal of hospital medicine. 2013;8:52–58.

    Article  PubMed  Google Scholar 

  38. Hartley P, Romero-Ortuno R, Wellwood I, Deaton C. Changes in muscle strength and physical function in older patients during and after hospitalisation: a prospective repeated-measures cohort study. Age and ageing. 2021;50:153–160.

    Article  PubMed  Google Scholar 

  39. Freijer K, Tan SS, Koopmanschap MA, Meijers JM, Halfens RJ, Nuijten MJ. The economic costs of disease related malnutrition. Clinical nutrition (Edinburgh, Scotland). 2013 Feb;32:136–141 DOI:

    Article  PubMed  Google Scholar 

  40. Naylor MD, Aiken LH, Kurtzman ET, Olds DM, Hirschman KB. The importance of transitional care in achieving health reform. Health affairs. 2011;30:746–754.

    Article  PubMed  Google Scholar 

  41. Kootaka Y, Kamiya K, Hamazaki N, Nozaki K, Ichikawa T, Nakamura T, Yamashita M, Maekawa E, Reed JL, Yamaoka-Tojo M, Matsunaga A, Ako J. The GLIM criteria for defining malnutrition can predict physical function and prognosis in patients with cardiovascular disease. Clinical nutrition (Edinburgh, Scotland). 2021 Jan;40:146–152 DOI:

    Article  PubMed  Google Scholar 

  42. Hettiarachchi J, Reijnierse EM, Soh CH, Agius B, Fetterplace K, Lim WK, Maier AB. Malnutrition is associated with poor trajectories of activities of daily living in geriatric rehabilitation inpatients: RESORT. Mechanisms of ageing and development. 2021 2021/07/01/;197:111500 DOI:

    Article  PubMed  Google Scholar 

  43. Verbrugghe M, Beeckman D, Van Hecke A, Vanderwee K, Van Herck K, Clays E, Bocquaert I, Derycke H, Geurden B, Verhaeghe S. Malnutrition and associated factors in nursing home residents: a cross-sectional, multi-centre study. Clinical nutrition (Edinburgh, Scotland). 2013 Jun;32:438–443 DOI:

    Article  PubMed  Google Scholar 

  44. Mantzorou M, Vadikolias K, Pavlidou E, Serdari A, Vasios G, Tryfonos C, Giaginis C. Nutritional status is associated with the degree of cognitive impairment and depressive symptoms in a Greek elderly population. Nutr Neurosci. 2020 Mar;23:201–209 DOI:

    Article  PubMed  Google Scholar 

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Acknowledgement: The authors want to thank the study staff for their dedicated work, i.e., Ósk Guðmundsdóttir, Elfa Björk Rúnarsdóttir, and Gunnhildur Olga Jónsdóttir as well as the Icelandic food companies Sláturfélag Suðurlands Ltd., Grimur kokkur Ltd., and MS Iceland Dairies for the collaboration and delivery of food items. The authors want to state that neither the above-mentioned funding entities nor the food companies were involved in study design, -conduct, statistical analysis, or paper writing.


Funding statements: The study was funded by the Icelandic Research Fund (174250-051), the Research Fund of the University of Iceland, the Research Fund of Hrafnista, Research Fund of Hrafnista, and the Helga Jonsdottir and Sigurlidi Kristjansson Geriatric Research Fund. The grants were provided without any conditions.

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Correspondence to Berglind Soffia Blondal.

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Conflict of interest: Blondal BS: no conflict of interest. Geirsdottir OG: no conflict of interest. Halldorsson TI: no conflict of interest. Beck AM: no conflict of interest. Jonsson PV: no conflict of interest. Ramel A: no conflict of interest.

Ethical standards’ declaration: This study complied with the current laws of Iceland in which it was conducted.

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Statement of Authorship: BSB and AR did the investigation; BSB and AR performed formal analysis; BSB and AR were accountable for project administration; BSB, OGG, AMB, PVJ, TIH, and AR wrote the paper; OGG, AMB, and AR were responsible for conceptualisation; OGG and AR were responsible for supervision; OGG, AMB, PVJ, and TIH reviewed the paper; BSB and AR did the funding acquisition; AR was responsible for methodology.

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Blondal, B.S., Geirsdottir, O.G., Halldorsson, T.I. et al. HOMEFOOD Randomised Trial–Six-Month Nutrition Therapy in Discharged Older Adults Reduces Hospital Readmissions and Length of Stay at Hospital Up to 18 Months of Follow-Up. J Nutr Health Aging 27, 632–640 (2023).

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