# 3-month oral nutritional supplementation adherence impacts positively on survival in malnourished older patients following hip fracture: a real-life study

## TL;DR

This study shows that older patients who stick to nutritional supplements after a hip fracture have better survival rates than those who don't.

## Contribution

The study provides real-world evidence that adherence to oral nutritional supplements improves survival in malnourished older hip fracture patients.

## Key findings

- Non-adherent malnourished patients had 3.67 times higher risk of death than adherent ones.
- Adherent malnourished patients showed a trend toward lower mortality than well-nourished patients.
- Severe malnutrition was present in 19.7% of the 300 studied patients.

## Abstract

Several factors influence mortality and survival after hip fracture, including nutritional status, which is associated with both incidence and prognosis. However, there is little evidence on the impact of oral nutritional supplements (ONS) on the survival of these patients, and the available results are mixed. Our aim was to analyze the effect of adherence to ONS treatment on post-hospital mortality, with the hypothesis that this would be lower in an adherent group.

Prospective study of patients aged 65 years or older, admitted for fragility hip fracture. Follow-up was carried out at 3, 6 and 12 months to evaluate retrieval of ONS in pharmacies and survival. Adherence was considered if ONS were withdrawn for 3 months or longer. The sample was divided into four groups: (1) well-nourished patients without prescription of ONS, (2) moderately malnourished patients without prescription of ONS, (3) moderate or severely malnourished patients with prescription of ONS but without adherence, and (4) moderately or severely malnourished patients with prescription of ONS and adherence. Mortality between groups was compared by means of a Cox regression, adjusted for confounding variables.

300 patients were included (mean age 82.9 years; 79.3% female), with severe malnutrition in 19.7%. Non-adherent malnourished patients showed a significantly higher risk of death than adherent malnourished patients (HR = 3.67; 95% CI: 1.41–9.57; p = 0.008). Non-adherent malnourished patients had a significantly higher risk of death compared to well-nourished patients (HR = 2.95; 95% CI: 1.31–6.65; p = 0.009). Malnourished patients without ONS had a non-significant higher mortality risk than well-nourished patients (HR = 1.66; 95% CI: 0.72–3.84, p = 0.236). Adherent malnourished patients showed a non-significant trend toward lower mortality than well-nourished patients (HR = 0.80; 95% CI: 0.25–2.56; p = 0.712).

In our study, 3-month adherence to ONS is associated with a reduction in 3, 6 and 12-month mortality in older patients with a hip fracture when compared to non-adherent patients and shows a trend toward an improved survival rate than that of well-nourished patients.