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Post-discharge nutritional support in malnourished ill elderly patients: Effectiveness and cost-effectiveness

Post-discharge nutritional support in malnourished ill elderly patients – effectiveness and cost-effectiveness Contents Chapter 1 General introduction 9-18 Chapter 2 Study design: effectiveness and cost-effectiveness of post-discharge nutritional support in malnourished elderly patients in comparison with usual care 19-34 Chapter 3 Post-discharge nutritional support in malnourished elderly patients decreases functional limitations 35-48 Chapter 4 Post-discharge nutritional support in malnourished elderly patients decreases functional limitations with no extra costs 49-68 Chapter 5 Short-term oral nutritional intervention with protein and vitamin D decreases falls in malnourished elderly patients 69-86 Chapter 6 Effects of nutritional intervention on immune markers in malnourished elderly 87-106 Chapter 7 Resting energy expenditure in malnourished elderly patients at hospital admission and three months after discharge: predictive equations versus measurements 107-128 Chapter 8 Should we feed malnourished cognitively impaired hospitalized elderly patients? Our population is aging, and the number of Europeans aged between 65-79 years is expected to increase approximately 35% between 2010 and 2030(1). With the probability, the number of malnourished elderly people will increase proportionally. Aging comes with an increase in health challenges. As elderly people are vulnerable to malnutrition, they often have several co-morbidities that are chronic and progressive. However, malnutrition is not always caused by a disease, it also leads to vulnerability to illness. According to the literature, malnutrition is estimated to occur in 25-61% of all elderly patients suffering from various diseases(2;3). We expect that a post-discharge nutritional intervention in malnourished elderly patients will be beneficial for their health and may result in lower health care costs. Figure 1 presents a simplified overview of relations depicted in this thesis. General introduction 11 Causes of malnutrition The World Health Organization (WHO) defines malnutrition as "the cellular imbalance between supply of nutrients and energy and the body's demand for them to ensure growth, maintenance, and specific functions ". Previous studies have identified several determinants for malnutrition in elderly individuals, such as disease Some of these causes of malnutrition are irreversible. However, others, e.g. physical functioning, could be improved by accurate nutritional interventions. Malnutrition also increases ones vulnerability to illness due to the combination of disease and malnutrition. The metabolism weakens and give rise to a vicious circle of infection and undernourishment. Consequences of malnutrition in elderly Disease-related malnutrition is associated with adverse effects on clinical outcomes, as has been shown in a large number of studies. These in-hospital adverse effects vary, from impaired wound healing and …