Background
Hospitalisation is a critical event for older adults. In patients 65years and older, the combination of acute illness, invasive procedures, and changes in routine frequently leads to a decline in nutritional status and the emergence or worsening of dysphagia (difficulty swallowing). Both conditions are strongly associated with increased morbidity, prolonged length of stay, higher readmission rates, and reduced quality of life.
The NUTRIFRAG (NUTRitional status and FRagility after hospitalisation) study has been designed to systematically evaluate these issues in a realworld, prospective cohort of older adults admitted to acute care units in France. By characterising the trajectory of nutrition and swallowing function from admission through the first three months after discharge, the study aims to identify modifiable risk factors and inform evidencebased interventions.
Objectives
- Primary: To determine the prevalence and severity of malnutrition and dysphagia at hospital admission, discharge, and 3months postdischarge in patients aged65years.
- Secondary:
- Identify clinical and demographic predictors of nutritional decline and dysphagia.
- Assess the impact of these conditions on functional outcomes (ADL/IADL), length of stay, readmission, and mortality.
- Explore the relationship between frailty status, comorbidities, and nutritional trajectories.
Study Design
This is a multicentre, prospective observational study. Eligible participants are consecutive patients aged65years admitted to internal medicine, geriatric, or surgical wards of three tertiary hospitals in the ledeFrance region. Exclusion criteria include terminal illness with life expectancy<1month, severe cognitive impairment precluding informed consent, or prior enrolment in another interventional nutrition trial.
Data collection points are:
- Within 48hours of admission (baseline).
- At discharge (or at 14days if the stay exceeds this period).
- Three months postdischarge (telephone or outpatient visit).
Measurements
Nutritional Status
- Mini Nutritional Assessment Short Form (MNASF).
- Body Mass Index (BMI) and recent weight change.
- Serum albumin and prealbumin levels.
- Caloric and protein intake estimated by 24hour recall and foodfrequency questionnaire.
Dysphagia Assessment
- The 10item Eating Assessment Tool (EAT10).
- Clinical bedside swallowing evaluation (water swallow test).
- When indicated, fiberoptic endoscopic evaluation of swallowing (FEES) or videofluoroscopic swallow study (VFSS).
Other Variables
- Frailty: Clinical Frailty Scale (CFS) and Fried phenotype.
- Comorbidity burden: Charlson Comorbidity Index.
- Functional status: Barthel Index and Lawton IADL scale.
- Medication count, especially drugs known to affect appetite or swallowing.
- Hospital course details (diagnosis, invasive procedures, intensive care admission).
Statistical Approach
Descriptive statistics will summarise baseline characteristics. Prevalence rates of malnutrition and dysphagia will be calculated with 95% confidence intervals. Logistic regression models will identify independent predictors of nutritional decline and dysphagia at discharge and at three months. Linear mixedeffects models will explore longitudinal changes in MNASF scores and EAT10 scores over time, accounting for intrapatient correlation.
Sample size estimation was based on detecting a 10% difference in malnutrition prevalence between frail and nonfrail groups (=0.05, power=80%). Assuming a 20% attrition rate, 540 participants will be recruited.
Ethical Considerations
The protocol has been approved by the Institutional Review Board of each participating centre (IRB20250042). Written informed consent is obtained from all participants or their legal representatives. Data are anonymised and stored on secure encrypted servers in compliance with the EU GDPR.
Potential Impact
Understanding how hospitalisation precipitates or aggravates malnutrition and dysphagia can guide the development of targeted screening tools and early intervention pathways. Expected benefits include:
- Improved detection of atrisk patients on admission.
- Integration of multidisciplinary nutrition and speechlanguage pathology services.
- Reduction of complications such as aspiration pneumonia, pressureulcer development, and functional decline.
- Evidencebased recommendations for postdischarge followup and communitybased nutritional support.
Findings will be disseminated through peerreviewed journals, conference presentations, and a publicly accessible summary for clinicians and policy makers.
Contact & Further Information
Principal Investigator: Dr. ClaireM.Dupont, MD, PhD
Department of Geriatrics, Hpital SaintLouis, Paris, France
Email: claire.dupont@hsl.fr
Study registration: ClinicalTrials.gov Identifier NCT05897231.
