Protein energy supplements in unwell elderly patients - A randomized controlled trial

Background: To determine whether oral protein energy supplements, prescribe d during hospitalization to elderly medical admissions, affect nutritional status and if baseline nutritional state influences this status. We also co nsidered the effects on mortality, length of hospital stay, functional reco very, and institutionalization. Methods: A prospective randomized controlle d trial with no placebo. Consenting patients were stratified in 3 nutrition al categories, and patients from each stratum were randomized into treatmen t or control. Observers were blinded to randomization. The participants wer e emergency admissions from home to a Medicine for the Elderly Unit in a Sc ottish hospital. The inclusion criteria were as follows: no known malignanc y, the ability to swallow, and nonobesity (BMI < 75th percentile). The inte rvention was a prescription of 120 mL sip feed, 3 times daily (540 kcal, 22 .5 g protein per day) throughout hospitalization, using the medicine prescr iption chart. The trial was powered to detect change in mean percentage wei ght. The following outcomes were also considered: anthropometry; mortality, length of hospital stay, functional recovery, and rates of institutionaliz ation. Results: Included in the trial were 381 patients. Nutritional supple mentation was associated with significantly better energy intake (p = .001) and weight gain (p = .003) pooled across all nutritional categories. In th e most poorly nourished patients, the intervention was associated with redu ced mortality (5/34 versus 14/40, p < .05) and more patients improved funct ionally (17/25 versus 11/28, p < .04). Overall mortality results were 21/18 6 versus 33/195, odds ratio (OR) 0.62, 95% confidence interval (CI) 0.35, 1 .13. Conclusions: Prescribing sip feed supplements in the medicine prescrip tion chart during hospital stay reduces weight loss. Our data also support other evidence for a reduction in mortality noted in elderly patients on nu tritional supplementation. There were suggestions of other clinical benefit s.