Clinical and Medico-economic Evaluation of Taken Care Associating Nutritional Support and Adapted Physical Activity for Malnourished, or at Risk of Undernutrition, Elderly People on Discharge From Hospital
试验速览
- 阶段
- 不适用
- 状态
- 终止
- 发起方
- 入组人数
- 47
- 试验地点
- 1
- 主要终点
- Assessment of level of autonomy according Activities of Daily Living (ADL) score
研究概览
简要总结
In the hospital, one out of every two elderly people is malnourished. This condition of undernutrition generally worsens during hospitalization, where the effects of polypathology and psychological distress are added. Muscle loss due to inadequate dietary intake, hypermetabolism and immobilization results in the onset or worsening of mobility disorders and functional decline. After hospitalization, 30-50% of elderly people hospitalized in emergency in medical departments have lost autonomy in daily life. Nutritional management and adaptive physical activity (APA) could have synergistic action to improve the nutritional status and mobility of elderly patients. The short duration of the average stay the acute geriatric units (10-15 days) is not enough to renew, nor to re-educate patients. It seems important to continue these actions at home. The implementation of programs combining nutrition and adapted physical activity (APA) at the hospital exit has not been studied to date. We formulate the hypothesis that in elderly people who are malnourished or at risk of undernutrition, after hospitalization, a personalized home intervention combining nutritional advice and appropriate physical activity will limit their loss of autonomy.
详细描述
Interventional study with minimal risk and constraints, prospective, multicentre, randomised and controlled.
Population of interest:
- Older people at least 70 years, malnourished or at risk of malnutrition, on discharge from hospital
- Informal caregivers of patients included in study
Intervention at home of professionals:
Mixed intervention: nutritional support, carried out by the dieticians of " Saveurs et Vie ", in seven sessions over three months, combined with an adapted physical activity intervention (APA), carried out by " Siel Bleu " professionals, also at a frequency of seven sessions over three months, for a total of fourteen sessions.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Prevention
- 盲法
- None
入排标准
- 年龄范围
- 70 Years 至 —（Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Men or women aged at least 70
- •Hospitalized in acute geriatrics (UGA), with expected return to home directly after the UGA
- •Undernourished or at risk of undernutrition (MNA SF12)
- •Able to walk 4 metres without third party assistance
- •Able to understand and consent to the study
- •Good understanding of the French language
- •Living in Paris (department 75)
- •Patient affiliated with a social security scheme
- •Having read the information note and having agreed to participate in the study by signing the consent.
排除标准
- •Life expectancy less than 6 months
- •Chronic inflammatory pathology
- •Progressive cancer
- •Severe renal failure (creatinine clearance < 30ml/min/1.73 m2)
- •NYHA Stage III or IV Dyspnea
- •Chronic respiratory failure (oxygen therapy at home)
- •Liver failure (TP < 50%)
- •Severe depression
- •severe dementia, according to DSM V criteria
- •swallowing disorders with inhalation pneumonia
- •corticosteroids (> 10 mg prednisone/day long-term or equivalent)
- •Systolic blood pressure >200 mmHg
- •Unstabilized acute coronary syndrome
- •decompensated heart failure
- •Severe, uncontrolled ventricular rhythm disorders
- •High risk embolic intracardiac thrombus
- •Presence of medium to large pericardial effusion
- •Recent history of thrombophlebitis with or without pulmonary embolism
- •Obstacle to severe and/or symptomatic left ventricular ejection
- •Severe and symptomatic pulmonary hypertension
- •Inability to perform appropriate physical activities
- •Subject participating or having participated in a therapeutic trial within the last 3 months
- •Refusal to participate
- •Person under guardianship, guardianship or safeguard of justice
研究组 & 干预措施
Control
The control group will benefit from the usual support (depending on the practices of the department, prescription or not of oral nutritional supplements and physiotherapy at home, but without home intervention of adapted physical activity professionals or dieticians).
In addition to screening/inclusion visits (D0), three follow-up home visits are scheduled at D7, D45 and D90 for both study groups.
Nutrition intervention with appropriate physical activity
Intervention at home of professionals:
Patients in this arm will benefit from 14 home interventions
- 7 home nutrition support (NS) sessions in 3 months or 1 session every 10 days (+/-4 days). These sessions will be conducted by a dietician from the company "Saveurs et Vie".
- 7 home sessions of adaptive physical activity (APA) in 3 months, one session every 10 days (+/-4 days). These sessions will be conducted by professionals from association group "Siel Bleu".
In addition to screening/inclusion visits (D0), three follow-up home visits are scheduled at D7, D45 and D90 for both study groups.
干预措施: Intervention (Other)
结局指标
主要结局
Assessment of level of autonomy according Activities of Daily Living (ADL) score
时间窗: 18 months
To assess the effect of taken care associating nutritional support and adapted physical activity (APA) on the independence of elderly people who are malnourished or at risk of malnutrition at the end of their stay in hospital.
次要结局
- Assessment of comorbidity according Cumulative Illness Rating Scale-Geriatric (CIRS-G) scale(18 months)
- Assessment of of dependency according Gerontological autonomy group iso-resources (AGGIR ) score(18 mois)
- Assessment of undernutrition according Mini Nutritional Assessment (MNA)(18 months)
- Assessment of gait, balance and muscle according Short Physical Performance Battery (SPPB) score(18 months)
- Measuring quality of life according EuroQol- 5 Dimension (EQ-5D) scale(18 months)
- Assessment caregiver burden according Caregiver Subjective and Objective Burden (Zarit) scale(18 months)