Technological nursing interventions on nutritional status of middle-aged and older adults undergoing hemodialysis: A systematic review.

Objective: Malnutrition is common in hemodialysis patients, increasing mortality and significantly impacting quality of life. This study aimed to identify technological nursing interventions that promote self-care and improve the nutritional status of middle-aged and older adults undergoing hemodialysis. Methods: A systematic literature review was conducted in accordance with the Joanna Briggs Institute (JBI) and PRISMA guidelines. Searches were conducted in Medline, CINAHL, the Cochrane Library, Scopus, Web of Science, and grey literature. Studies published between 2018 and 2024, involving patients aged 40 years or more undergoing regular hemodialysis, and available in Portuguese, English, or Spanish, were included. JBI's critical appraisal tools were used to conduct a rigorous analysis and methodological quality assessment of the articles. Results: Out of a total of 738 articles, 10 were included for analysis. Five key dimensions of technology-driven self-care interventions were established. 1) Mobile applications and digital platforms with features like nutritional databases, food logging, and personalized feedback; 2) E-learning and virtual education using social media and chat-based communication; 3) Telenursing employing a hybrid follow-up model of face-to-face, telephone, and SMS contact; 4) Educational strategies focused on nutritional status, utilizing methods such as teach-back and pictorial learning within a multidisciplinary team; and 5) Comprehensive assessment tools evaluating treatment adherence (hemodialysis, medication, diet, fluid) and laboratory markers. Significant improvements were reported across several outcomes: eight studies showed enhanced biochemical markers (e.g., phosphorus, sodium, potassium, calcium, iron, albumin, urea, and hemoglobin) and nutritional status, three demonstrated increased self-efficacy, and two reported improved quality of life. Conclusion: Integrating technology and face-to-face education enhances nutritional status, highlighting the importance of comprehensive strategies to improve treatment adherence and prevent malnutrition in hemodialysis patients.