The SIMPLER Nutrition Pathway for Fragility Fractures

Bell, Jack J., Geirsdottir, Olof Gudny, Johansen, Antony, Santy-Tomlinson, Julie, Frihagen, Frihagen, McGlasson, Rhona, Sutton, Emma and Hertz, Karen (2025) The SIMPLER Nutrition Pathway for Fragility Fractures. Nutrients, 17 (12). ISSN 2072-6643

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Abstract

Background/Objectives: Malnutrition is a key contributor to poor outcomes in older adults with fragility fractures, increasing the risk of complications, functional decline, prolonged hospital stays, mortality, and healthcare costs. Substantial evidence limited to hip fracture supports early, interdisciplinary nutrition care. However, global audits reveal that most hip fracture patients do not receive recommended interventions. This quality improvement (QI) project aimed to co-create and test a pathway and toolkit to help apply evidence-based nutrition care in different fragility fracture settings globally. Methods: The SIMPLER Pathway and toolkit (SIMPLER) were developed through a multiphase, co-creation QI initiative (2018–2025), guided by the Knowledge-to-Action framework. Global experts and clinical teams synthesized evidence, identified the “know-do” gap, and adapted SIMPLER to context through iterative action–reflection cycles. The Model for Improvement guided team building, goal setting, testing changes, and measuring outcomes at pilot sites. Results: Over 100 co-creation activities between 2018 and 2025 engaged staff and patients to shape and refine SIMPLER. A global clinician survey (n = 308, 46 countries), two bi-national audits (n = 965, 63 hospitals), and qualitative interviews (n = 15) confirmed a widespread evidence-practice gap. The pathway and toolkit were pilot-tested in five hospitals across four countries, with action–reflection cycles enabling continuous refinement of prioritized nutrition improvements tailored to the local context. Following endorsement in late 2024, 46 healthcare services in 23 countries have formally committed to implementing SIMPLER. Conclusions: The SIMPLER Nutrition Pathway provides a scalable, adaptable framework to support the delivery of evidence-based nutrition care in fragility fracture settings. A global evaluation is underway.

Item Type:	Article
Additional Information:	Data Availability Statement: Original site-specific data underpinning the aggregated findings presented in this article are not readily available because this manuscript is presented within the scope of a quality improvement project. Qualitative findings are part of an ongoing study planned for publication elsewhere. Requests to access the datasets should be directed to corresponding author.
Uncontrolled Keywords:	hip fracture,fragility fracture,nutritional support,malnutrition,implementation,hospitals,improvement,quality improvement,protocol
Faculty \ School:	Faculty of Medicine and Health Sciences > School of Health Sciences
Related URLs:	https://www.mdpi.com/2072-6643/17/12/198...
Depositing User:	LivePure Connector
Date Deposited:	27 Jan 2026 17:30
Last Modified:	27 Jan 2026 20:30
URI:	https://ueaeprints.uea.ac.uk/id/eprint/101756
DOI:	10.3390/nu17121987

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