Nutritional supplementation for hip fracture aftercare in older people.

Systematic review of randomized trials in older adults recovering from hip fracture, with interventions initiated before or soon after surgery and generally within the first month after fracture. Participants were mainly elderly and female, often treated in hospital or rehabilitation settings, and many were malnourished or at risk of malnutrition.

The review evaluated nutritional supplementation started within the first month after hip fracture, including oral multinutrient supplements, nasogastric multinutrient feeding, and protein-enriched oral feeds given alongside usual hospital or ward diets. Examples from the extracted trials included oral Ensure Plus or Glucerna, 1 L/day Clinifeed Iso via nasogastric tube, and a once-daily 250 mL multinutrient oral supplement for about 32 days.

Overall, the evidence is low to very low quality, so firm conclusions cannot be drawn. Oral multinutrient supplements started before or soon after surgery may reduce complications and possibly other unfavourable outcomes within 12 months after hip fracture, but they do not show a clear mortality benefit. Nasogastric or intravenous multinutrient feeding has very limited evidence and does not show a clear mortality benefit, and may be poorly tolerated. Increasing protein intake in oral feeds showed no clear effect on mortality or complications, while dietetic assistance showed possible mortality benefit signals that were inconsistent.

The evidence base is small, heterogeneous, and mostly low or very low quality. Interventions varied by route, formulation, and timing, and some approaches had very limited data or poor tolerance. Important outcomes such as function, quality of life, and costs were not comprehensively and consistently assessed, limiting generalizability and certainty.