Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Oct 29;12(21):2157.
doi: 10.3390/healthcare12212157.

Oral Nutritional Supplementation in Older Adults with a Hip Fracture-Findings from a Bi-National Clinical Audit

Jack J Bell  1 , Rebecca J Mitchell  2 , Ian A Harris  3 , Hannah Seymour  4 , Elizabeth Armstrong  5 , Roger Harris  6 , Stewart Fleming  7 , Sarah Hurring  8 , Jacqueline Close  9   10
Affiliations

Oral Nutritional Supplementation in Older Adults with a Hip Fracture-Findings from a Bi-National Clinical Audit

Jack J Bell et al. Healthcare (Basel). .

Abstract

Background/objectives: Evidence-based guidelines and care standards recommend offering oral nutrition supplements to all older adults with hip fracture, not just those already malnourished. This study aimed to identify the proportion of inpatients in a sample of hospitals in two countries that were provided with oral nutritional supplementation (ONS) following a hip fracture and to identify factors associated with ONS provision.

Methods: An analysis of prospectively collected data from a bi-national Hip Fracture Registry nutrition sprint and registry audit data limited to older adults (≥65 years) undergoing surgical intervention for a fractured hip from 1 to 31 August 2021. Multivariable logistic regression was used to identify factors associated with providing ONS.

Results: Patient-level data was available for 385 older adults (median 85 years; 60.5% female) admitted to twenty-nine hospitals. Less than half (n = 47.3%) of the audited inpatients were provided ONS. After adjusting for covariates, ONS was more likely to be provided to older adults who were identified as malnourished on formal testing (OR 11.92; 95%CI 6.57, 21.69). Other factors associated with prescription of ONS included those who did not have a preoperative medical assessment (OR 2.26; 95%CI 1.19, 4.27) or were cognitively impaired (OR 1.83; 95%CI 1.01, 3.32), severely frail, or terminally ill (OR 3.17; 95%CI 1.10, 9.17).

Conclusions: ONS was provided in line with evidence-based recommendations for less than half of the older adults with a hip fracture in 29 hospitals in two countries. A structured approach to implementation may be required to reduce complications and improve outcomes for all older adults after a hip fracture, not just those assessed as cognitively impaired, frail, and/or malnourished.

Keywords: clinical audit; dietary supplements; frailty; hip fractures; hospitals; malnutrition; nutrition risk assessment; nutritional support.

PubMed Disclaimer

Conflict of interest statement

Jack Bell is the current chair of the Australian and New Zealand Hip Fracture Registry Research Sub-Committee and co-chair of the Fragility Fracture Network (FFN) Fragility Fracture Recovery Research Special Interest Group. FFN receives corporate and advisory council and project funds from industry partners, including Nutricia. Jacqueline Close is the current orthogeriatric co-chair of the Australian and New Zealand Hip Fracture Registry. Ian Harris was previously the orthopaedic co-chair of the Australian and New Zealand Hip Fracture Registry from 2012 until 2021. Stewart Fleming was employed by OperaIT Pty Ltd. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Participant flow diagram.
Figure 2
Figure 2
Oral nutritional supplementation provided to patients by jurisdiction.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Nikkel L.E., Fox E.J., Black K.P., Davis C., Andersen L., Hollenbeak C.S. Impact of comorbidities on hospitalization costs following hip fracture. J. Bone Jt. Surg. Am. 2012;94:9–17. doi: 10.2106/JBJS.J.01077. - DOI - PubMed
    1. Bell J.J., Pulle R.C., Crouch A.M., Kuys S.S., Ferrier R.L., Whitehouse S.L. Impact of malnutrition on 12-month mortality following acute hip fracture. ANZ J. Surg. 2016;86:157–161. doi: 10.1111/ans.13429. - DOI - PubMed
    1. Malafarina V., Reginster J.-Y., Cabrerizo S., Bruyère O., Kanis J.A., Martinez J.A., Zulet M.A. Nutritional Status and Nutritional Treatment Are Related to Outcomes and Mortality in Older Adults with Hip Fracture. Nutrients. 2018;10:555. doi: 10.3390/nu10050555. - DOI - PMC - PubMed
    1. Chiavarini M., Ricciotti G.M., Genga A., Faggi M.I., Rinaldi A., Toscano O.D., D’Errico M.M., Barbadoro P. Malnutrition-Related Health Outcomes in Older Adults with Hip Fractures: A Systematic Review and Meta-Analysis. Nutrients. 2024;16:1069. doi: 10.3390/nu16071069. - DOI - PMC - PubMed
    1. Australian and New Zealand Hip Fracture Registry . Annual Report of Hip Fracture Care 2022. Australian and New Zealand Hip Fracture Registry; Sydney, NSW, Australia: 2022.

LinkOut - more resources