Enhancing Nutrition to Attenuate Acute Sarcopenia in Older Adults with Hip Fractures: Laying the Groundwork for Future Interventions

Hip fractures (HFs) are the leading cause of accident-related mortality among older people, with 70,000 to 75,000 cases reported annually in the UK alone. These fractures result in significant hospitalisations, accounting for 1.8 million hospital bed days and £2 billion health costs every year. The mortality rates are alarming high, with approximately 10% of individuals dying within the first month and one-third within a year following their fracture. HF patients often face malnutrition and muscle disuse, with approximately 63% malnourished on hospital admission. Energy and protein intake are often suboptimal, and compliance to oral nutritional supplements is poor, contributing to worsened outcomes. Malnutrition and muscle disuse make HF patients particularly vulnerable to acute sarcopenia, a recently recognised subcategory of sarcopenia, defined as incident sarcopenia within six months, triggered by acute illness or injury. During hospitalisation, the combination of increased inflammatory burden and muscle disuse leads to a sharp decline in muscle mass and function within the first 28 days, though some recovery is possible. Despite its serious implications, acute sarcopenia has not been studied in older adults with HF. Nutrition, especially adequate protein intake, combined with exercise can preserve muscle mass, strength and function. Understanding how nutritional intake changes is essential for developing interventions to mitigate acute sarcopenia. Furthermore, research exploring the facilitators and barriers towards nutritional interventions from the perspectives of HF patients, their carer’s/relatives and healthcare professionals is lacking. Addressing these barriers can help in the development of effective strategies to promote the uptake of dietary interventions and improve the health outcomes of older adults. This research will be the first to fill these critical gaps, mapping nutritional intake over six weeks and exploring nutritional intervention targeted at attenuating acute sarcopenia in HF patients. Overarching aim The overarching aim is to develop and refine a nutritional intervention in older adults with a HF and determine the feasibility of future definitive trial investigating its effectiveness to attenuate acute sarcopenia. Methods Methods have been reviewed and co-designed with Patient Public Involvement, of whom have lived experience of recovering from a HF or caring for someone with a HF. Older adults admitted to hospital with a HF will be recruited. Chapter 1) A systematic review will be conducted to identify the optimal protein type, timing, and dosage for maintaining muscle mass, strength, and physical function in older adults. Chapter 2) A mixed-methods sequential explanatory design study using 24-hour diet histories to record dietary intake before, during and after hospitalisation, along with weight, mid-upper arm circumference, and calf circumference over the first six weeks of HF recovery. Observational data collection between food service assistance and patient, in addition to mealtime audit will also be undertaken. At six weeks interviews will be undertaken with patients, carers and ward staff to explore facilitators and barriers towards nutritional intervention. Chapter 3) A three-month intervention development phase will involve meetings with key stakeholders, including patients and caregivers, to develop a tailored nutritional intervention. Chapter 4) A single-arm feasibility study will test the intervention, involving the use of a protein-enriched supplement ("N-ICE Cream") over six weeks. Compliance will be monitored, and changes in muscle mass (measured via ultrasound and bioelectrical impedance analysis), muscle strength (via handgrip strength), and physical performance (using the New Mobility Score) will be assessed at baseline, weekly until discharge, and at six weeks. This project aims to have immediate benefit to those participating by enhancing understanding of acute sarcopenia. By developing targeted nutritional interventions, it has the potential to enhance rehabilitation, physical function, and patient outcomes. In the long term, reduced hospital stays, and lower readmission rates may lead to decreased healthcare costs.