Addressing nutritional risk and dehydration in vulnerable older adults in the emergency department: a single-arm feasibility study on detection, treatment, and follow-up

BACKGROUND AND AIM: Dehydration and malnutrition are highly prevalent among older adults in the emergency department (ED). To date, there is no evidence regarding targeted nutrition and hydration interventions initiated directly in the ED setting. The primary aim of the study was to assess the feasibility of such an intervention, defined in terms of eligibility, recruitment rate, retention, representativeness, compliance to and effect of the intervention, and completeness of outcome data collection. This information will help establish the parameters required to design an eventual future definitive randomized controlled trial (RCT).

METHODS: The study was a feasibility study conducted at the ED and in cooperation with four municipalities. Older patients at nutritional risk (defined by a nutritional risk score of minimum 3 according to NRS 2002) and/or dehydrated (p-osmolarity >295 mmol/L) were provided with individual dietary counselling initiated in the emergency department and followed-up by a dietitian or other health care professionals in the municipalities. Data were collected on eligibility, recruitment, and retention of the older participants and completeness of data collection. Compliance was assessed as change in intake of energy, protein and fluids, self-efficacy, quality of life, prevalence of readmissions, and mortality within 30 days.

RESULTS: Of those 326 screened for the study, 314 (96%) were eligible due to either dehydration or nutritional risk. It was possible to recruit more than half (58%) of those invited to participate and the retention rate was high (90%). Completeness of data collection was above 80% for most of those assessed. There was an increase in intake of energy (p=0.0012), protein (p=0.0002), and fluid (p=0.0040), quality of life (p=0.0007), and self-efficacy (p=0.0498). The prevalence of readmissions was 19%, and 7% had died.

CONCLUSION: The detection, treatment and follow-up of nutritional risk and dehydration in vulnerable older patients in the ED was proven to be feasible in relation to eligibility, recruitment, and retention. Further, most of the chosen outcomes had a high rate of completeness and hence may be relevant parameters to include in an eventual future RCT. The explorative nature of the study limits firm conclusions; however, the positive findings support the initiation of a definitive RCT.