A hip fracture is one of the most serious injuries that an older adult can sustain and
with the current projections from the NHS Long Term Workforce plan of an increase in
>85yrs by 55% and a current estimation of over 75,000 hip fractures per year in England,
Northern Ireland and Wales with a 6-8% mortality rate at 1 year, this warrants further
research to improve outcomes and look at methods beyond the National Hip Fracture
Database (NHFD) to ascertain what more can be done to optimise and improve this patient
group. Whilst ONS supplementation is used on an ad-hoc basis for patients with a
high-risk malnutrition screening score of 2 using the MUST screening method, such tools
can lack sensitivity and accuracy and are also not developed to identify the development
of malnutrition in-hospital.
The proposed study for this protocol is an observation study of the dietary intake of
older adult hip fracture patients. The study will comprise of a weighed food diary,
commencing on day zero after surgery. Potential participants that will be invited will be
older adult hip fracture patients (>60yrs) with a confirmed hip fracture diagnosis that
requires surgical repair. The diary will consist of the researcher weighing the plate of
food before and after the participant's meal as this is regarded as a more accurate
measure than relying on participant recall and does not place the participant under any
additional stress.
The researcher will not handle any food, and plates will be placed on a digital scale.
Should a food have a specified weight - for example a yoghurt, the weight on the product
will be recorded. Fluid intake will be recorded according to drinks served with meals and
jugs of water per day. After each meal the researcher will weigh the plate; if it is a
multiple item meal (for example meat, potatoes, and vegetables), the researcher will
weigh the leftover components individually to ensure the validity of the weighed food
method and to achieve the highest degree of accuracy possible. The researcher will not be
present nor disrupt the participant during their meal. After their meal, the researcher
will ask the participant if they have had any additional snacks and observe if they have
had any assistance with their meal. Data will also be obtained regarding the times of
meals, the ratio of staff to patients and if any complications have developed.
The aim of this study is to explore the postoperative dietary intake of older adult hip
fracture patients until day three after surgery. This builds on research where data on
hip fracture patients was taken in relation to diet, anthropometry, and biochemical
indices during inpatient stays. Whilst the study was commenced in the second week
post-surgery and compared against values at the week 1 admission as a baseline, the
researchers observed a longer length of stay, drops in energy intake that coincided with
a low BMI on admission and additionally, referrals for high-risk patients that were not
actioned.
Subsequent studies have used varied interventions to explore postoperative nutrition,
however a weighed food diary has yet to be used in the immediate postoperative period,
which justifies the need for this study to explore nutritional intake as accurately as
possible.