Fractured Neck of Femur (NOF) patients
Dietetic intervention is important as fractured NOF patients continue in a hypermetabolic state for three months following surgery which may lead to delayed hospital discharge, slower recovery rates or even readmission.
Paillaud, E. et al. (2000) Nutritional status and energy expenditure in elderly patients with recent hip fracture during a 2-month follow-up. British Journal of Nutrition. 83, 97–103.
Patients with fractured NOF are likely to be malnourished on admission and to show a rapid deterioration in nutritional status during admission. Energy needs were not met in up to 50% of patients. There is a need to screen, supplement and monitor fractured NOF patients.
Nematy, M., Hickson, M., Brynes, A.E., Ruxton, C.H.S., Frost, G.S. (2006). Vulnerable patients with a fractured neck of femur: nutritional status and support in hospital. Journal of Human Nutrition and Dietetics. 19, 209-218.
Given the high numbers of hip fracture patients with prior malnutrition, and the prolonged length of stay, it is surprising that nutrition, including the provision and uptake of basic foodstuffs, is often understated, or even overlooked, as a component of rehabilitative care programmes. Price et al (2006) showed that dietetic intervention is cost effective, with a snack based intervention providing 26% of daily energy needs, the average cost of one week’s supply of snacks was £4.22 per participant.
Eighty visits (pre-intervention assessment, counselling and final assessment visits lasting approximately 30 minutes) and 42 interim visits (to deliver snacks and check adherence lasting approximately 15 minutes) were carried out by the study dietitian amounting to a total of 50.5 hours, an average of two hours 12 min per patient over the entire four-week intervention. This equates to £34.80 of a Senior I dietitian’s salary and is equivalent to an average of £6.32 per patient per visit. The travel costs associated with monitoring and delivering the snacks amounted to £10.75, equivalent to 26.9 miles per visit. The overall cost of the intervention programme amounted to £21.29 per participant per weekly visit.
Avenell, A. and Handoll, H.H. (2010) Nutritional supplementation for hip fracture aftercare in older people, (Review)Cochrane. Database Syst. Rev. 2, CD001880. Price R.J.G., McMurdo M.E.T., Anderson A.S. (2006) A personalized snack-based intervention for hip fracture patients: development, feasibility and acceptability Journal of Human Nutrition and Dietetics. 19; 139-145