A Clinical Trial to Determine Outcomes and Cost Effectiveness of Nutritional Intervention in Elderly Patients

With the introduction of the National Insurance Law in Israel in 1995, there have been increased efforts to reduce hospitalization in general and length of stay in the hospital in particular. Under nourished patients have been shown to have a longer mean length of stay and they are more likely to suffer from complications, which significantly increase cost of care. Intense nutritional intervention programs, aimed at decreasing rehospitalizations and post hospitalization complications, are not clearly currently included in the basket of services provided under the law. Nutritional intervention has been shown to be clinically efficacious and cost-effective. Demonstration of the benefits of such intervention, both in terms of reduced expenditures and quality of care, may open a path for specific nutritional intervention programs that are needed for older persons during and after discharge from Acute Care. Given the effort made to reduce the length of hospitalization time, even in frail elderly patients, it is clear that full scale nutritional intervention cannot be completed during their hospitalization. Therefore, there is a need to create continuity between in-patient and follow-up nutritional intervention. This combined policy has the potential to improve general health, reduce the rates of under nutrition and its associated complications, and thus reduce future hospitalization, along with the mortality and morbidity associated. It is plausible that improved general health and less frequent hospitalization will eventuate in cost reduction and allow the intervention to be cost effective. Furthermore, the descriptive information regarding the nutritional status of older patients admitted to an Acute Care department may be important for policy makers in their development of nutritional intervention programs to support the elderly before, during and after hospitalization.

Study Hypothesis:

We hypothesize that multidisciplinary nutritional intervention, during and following hospitalization, will improve dietary intake and nutritional status. Improvement in nutritional status will, in turn, cut health care costs by decreasing the use of health services. In-hospital nutritional care will be beneficial, but combined in-hospital and community care will be more clinically efficacious and more cost effective in the long run.