Need-based intervention is an effective strategy for improving the nutritional status of older people living in a nursing home: A randomized controlled trial

Lee, Li Chin; Tsai, Alan C.; Wang, Jiun Yi; Hurng, Baai Shyun; Hsu, Hui‐Chun; Tsai, Hsin Jen

doi:10.1016/j.ijnurstu.2013.04.004

Cited by 26 publications

(59 citation statements)

References 24 publications

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“…There is a tendency to avoid research in care homes because of the methodological issues involved [ 24 ], and the majority of epidemiological studies either exclude care home residents at the outset or fail to follow up participants when they move into institutional care [ 25 ]. The challenges inherent in care home research has led to nutritional intervention trials in this setting that have excluded those with advanced dementia or immobility [ 16 , 26 – 28 ], despite these being well-established risk factors for malnutrition. As a result, knowledge of the actual effectiveness of the dietetic interventions for malnutrition that are currently used with this vulnerable population is limited and the clinical applicability of findings to those residents most at risk is often questionable.…”

Section: Introductionmentioning

confidence: 99%

A cluster randomised feasibility trial evaluating nutritional interventions in the treatment of malnutrition in care home adult residents

Stow

Ives

Smith

et al. 2015

Trials

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BackgroundProtein energy malnutrition (PEM) predisposes individuals to disease, delays recovery from illness and reduces quality of life. Care home residents in the United Kingdom are especially vulnerable, with an estimated 30 to 42 % at risk. Evidence for nutritional interventions to address PEM in the care home setting is lacking. Widely used techniques include food-based intervention and/or the use of prescribed oral nutritional supplements. To define outcomes and optimise the design for an adequately powered definitive trial to compare the efficacy of established nutritional interventions in this setting, a cluster randomised feasibility trial with a 6-month intervention was undertaken.MethodsCare home residents with or at risk of malnutrition were identified across six UK care home sites from September to December 2013. Homes were cluster randomised to standard care (SC), food-based intervention (FB) or oral nutritional supplement intervention (ONS), for 6 months. Key outcomes were trial feasibility and the acceptability of design, allocated interventions and outcome assessments. Anthropometry, dietary intake, healthcare resource usage and participant-reported outcome measures were assessed at baseline and at 3 and 6 months.ResultsAll six care homes approached were recruited and retained. Of the 110 residents at risk of malnutrition, 85 % entered the trial, and 68 % completed the 6-month intervention. Pre-specified success criteria for feasibility were met for recruitment and retention, intervention acceptability (resident compliance ≥60 %) and measurement of weight, body mass index (BMI), mid-upper arm circumference and dietary intake (data completeness >80 %). Measurement of handgrip strength and triceps skinfold thickness was not found to be feasible in this population. The 95 % confidence interval (CI) data suggested sensitivity to change in dietary intake for weight, BMI and energy intake between baseline and 3 months when each intervention (FB and ONS) was compared with SC.ConclusionsA definitive trial comparing the efficacy of nutritional support interventions in increasing weight and BMI in malnourished care home residents can be conducted. However, whilst the design was feasible, this trial has highlighted the lack of clinically and patient-relevant outcome measures that are appropriate for use in this setting for both research and clinical practice. In particular, this trial identified a need for a more simple measure of functional status, which considers the limitations of functional tests in the care home population.Trial registrationCurrent Controlled Trials ISRCTN38047922, Date assigned: 22 April 2014.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-015-0952-2) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

A cluster randomised feasibility trial evaluating nutritional interventions in the treatment of malnutrition in care home adult residents

Stow

Ives

Smith

et al. 2015

Trials

View full text Add to dashboard Cite

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“…Resident adherence in consuming ONS is positively associated with improvements in nutritional parameters, such as weight and mid-arm circumference (118,123). Adherence has been found to improve when ONS is provided as a nutrient dense, low volume option, of approximately 50 -125ml with accompanying dietary counselling (116,118,123).…”

Section: Evidence For the Use Of Oral Nutritional Supplements In The mentioning

confidence: 99%

“…Adherence has been found to improve when ONS is provided as a nutrient dense, low volume option, of approximately 50 -125ml with accompanying dietary counselling (116,118,123). Adherence is also shown to be higher in residents who are malnourished or have chewing difficulties, but lower in residents who are depressed, are immobile or report gastrointestinal distress, indicating residents with these characteristics will require increased individualised support (118).…”

Section: Evidence For the Use Of Oral Nutritional Supplements In The mentioning

confidence: 99%

Optimising nutrition in residential aged care: A narrative review

et al. 2016

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“…Um estudo de intervenção realizado por Lee, et al (2013), em Taiwan, com 92 idosos institucionalizados, obteve resultados diferentes do presente estudo para CB e CP, cuja maioria apresentou risco para desnutrição. Os mesmos autores ressaltaram ainda que, após avaliação do estado nutricional, se houver risco, uma intervenção baseada na necessidade do idoso com uso de suplementação pode ser uma estratégia eficaz e útil para melhorar o estado nutricional e a qualidade de vida, devendo ser aplicada aos cuidados geriátricos institucionais, considerando-se que a proporção de idosos está aumentando nas populações do mundo.…”

Section: Segundo O Departamento De Informática Do Sistema úNico De Saúdeunclassified

Avaliação nutricional de idosos institucionalizados na Zona Sul de São Paulo

et al. 2016

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O envelhecimento populacional é um fenômeno mundial e deve ser tratado com prioridade no contexto social no Brasil. Este trabalho avaliou o estado nutricional de idosos institucionalizados utilizando-se a Mini-Avaliação Nutricional e a antropometria. Os resultados mostraram que o risco de desnutrição e desnutrição são condições de evidenciada importância entre os idosos desta instituição. Uma abordagem interdisciplinar da institucionalização é necessária, para melhorar a saúde e qualidade de vida dos idosos.

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Need-based intervention is an effective strategy for improving the nutritional status of older people living in a nursing home: A randomized controlled trial

Cited by 26 publications

References 24 publications

A cluster randomised feasibility trial evaluating nutritional interventions in the treatment of malnutrition in care home adult residents

A cluster randomised feasibility trial evaluating nutritional interventions in the treatment of malnutrition in care home adult residents

Optimising nutrition in residential aged care: A narrative review

Avaliação nutricional de idosos institucionalizados na Zona Sul de São Paulo

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