Hospital dietitian driving global changes in nutrition care

The passion of a Brisbane hospital dietitian is driving global change in how many older adults are being cared for in hospital following a hip fracture.

For the last decade, Adjunct Prof Jack Bell, a dietitian at The Prince Charles Hospital (TPCH), has been leading a series of research and implementation projects in collaboration with researchers, clinicians, and patients from hospitals around the world to examine the role that nutrition care plays in the health outcomes of patients who’ve fractured their hip.

Jack, who is also a Principal Research Fellow with TPCH’s Allied Health Research Collaborative, said that around half the people who break their hip are malnourished at time of fracture.

“Hip fracture usually occurs in people with multiple medical conditions which often require increased protein and energy intake. This can make it harder for people to purchase, prepare, and eat enough foods and fluids to meet their body’s needs,” Jack said.

“So, malnutrition does not occur because these people, or their loved ones, aren’t trying their hardest to look after themselves. It’s because it’s hard for them to meet their nutritional needs.”

Jack’s passion to improve the health outcomes of the frail older person comes from his earlier career years working in the orthopaedic units of a large hospital.

“Twenty years ago, nutrition in hip fracture patients was not a focus. I watched so many people come into hospital with a hip fracture who would deteriorate waiting for surgery because they would have to fast for days,” Jack said.

“While the patient was receiving high quality medical and nursing care, and we fixed their hip, their nutritional care was not nearly as good as it could have been, which ultimately affected their long-term outcomes.”

Conducting his early research as part of the multidisciplinary team in TPCH’s Hip Fracture Unit, which has been rated in the top 10 hip fractures services in Australia for the last three years, Jack showed that malnutrition is one of the most significant predictors of poor outcomes.

“Malnutrition can lead to other hospital acquired complications such as delirium, pressure injuries, skin tears, and harmful falls. It can also cause delayed mobility, placement in a nursing home and sadly, higher mortality rates,” Jack said.

“We proved that a patient’s nutrition status was just as important as their surgery and their other medical conditions.”

Jack’s ground-breaking research, initially tested through dedicated studies in Australia and Canada has positively impacted over 11,000 patients across 24 hospitals globally.

His robust advocacy and passion have had a far-reaching impact with his research serving as a cornerstone for international model of care reforms, policies, guidelines, audits, toolkits, educational texts, and curricula. Nutrition is now a focus in the Fragility Fracture Network’s 5-year global strategy as well as in the Australian Commission on Safety and Quality in Health Care Hip Fracture Clinical Care Standards.

Jack is excited about his research creating real change for the care and recovery of hip fracture patients around the world.

“It’s hard to believe that what started as a small study in our very own hip fracture unit here at Prince Charles Hospital in Chermside is now changing the lives of patients in countries like Canada and Iceland,” he said.

“It’s satisfying to know that around the world, many vulnerable patients can now get the nutrition they need and live a better life.”
Jack acknowledges the support he has received from The Prince Charles Hospital Foundation who funded his initial research.