Individually Tailored Dietary Counseling among Old Home Care Clients - Effects on Nutritional Status

Impact of food-based fortification on nutritional outcomes and acceptability in older adults: systematic literature review

Background

"Do it yourself" (DIY) food-based fortification involves adding fortificants into everyday foods. It is a flexible solution that allows older people with reduced appetite to meet their nutritional needs.

Objectives

The aims of the systematic review are (a) to describe DIY fortified recipes, (b) to evaluate their acceptability, and (c) to evaluate whether they are effective levers to improve nutritional outcomes in older people.

Methods

A systematic search of 3 databases (Web of Science, PubMed, Scopus, last searched on January 2022) was undertaken. Main eligibility criteria include older adults aged ≥60 years living at home, in an institution or in hospital. Studies carried out for a specific medical condition or targeting only micronutrient fortification were excluded. After reviewing all titles/abstracts then full-text papers, key data were extracted and synthesized narratively. The quality of included studies was assessed using Kmet et al.

Results

Of 21,493 papers extracted, 44 original studies were included (3,384 participants), with 31 reporting nutritional outcomes, 3 reporting acceptability outcomes and 10 reporting both nutritional and acceptability outcomes. The review highlighted a wide variety of DIY fortified recipes, with additional energy ranging from 23 to 850 kcal/d (M = 403; SE = 62) and/or protein ranging from 4 to 40 g/d (M = 19; SE = 2). Compared to a standard diet, DIY fortification seems to be a valuable strategy for increasing energy and protein intake in older people. However, no strong evidence was observed on the nutritional status.

Implication for future

Further acceptability studies are crucial to ensure that DIY fortified foods are palatable and thus have a significant impact on the nutritional status. In addition, it would be useful for studies to better describe DIY recipes. This information would result in a better understanding of the factors that maximize the impact of DIY fortification on nutritional outcomes. Study registration: PROSPERO no. CRD42021244689.Systematic review registration: PROSPERO: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021244689.

Effect of individually tailored nutritional counselling on protein and energy intake among older people receiving home care at risk of or having malnutrition: a non-randomised intervention study

Background

With ageing, food intake may decrease and lead to an insufficient nutrient intake causing protein-energy malnutrition (PEM) which is associated with adverse health effects and increased mortality. The aim of this study was to investigate the effects of individually tailored dietary counseling focused on protein intake among home care clients with PEM or at risk of developing PEM. The secondary aim was to study the intake of energy and other nutrients.

Methods

This intervention study is part of the non-randomised population-based multidisciplinary Nutrition, Oral Health and Medication study (NutOrMed study). The intervention group comprised 112 and the control group 87 home care clients (≥75 years) with PEM or risk of PEM. PEM was defined by Mini Nutritional Assessment score < 24 and/or plasma albumin < 35 g/L. The nutrients intake was assessed from 24-hour dietary recall at the baseline and after the six-month intervention. The intervention consisted of an individually tailored dietary counseling; the persons were instructed to increase their food intake with protein and energy dense food items, the number of meals and consumption of protein-, energy- and nutrient-rich snacks for six months.

Results

After the six-month nutritional intervention, the mean change in protein intake increased 0.04 g/kgBW (95% CI 0.05 to 0.2), fibre 0.8 g (95% CI 0.2 to 4.3), vitamin D 8.5 μg (95% CI 0.7 to 4.4), E 0.6 mg (95% CI 0.4 to 2.2), B12 0.7 μg (95% CI 0.02 to 2.6), folate 8.7 μg (95% CI 1.5 to 46.5), iron 0.4 mg 95% CI 0.6 to 2.4), and zinc 0.5 mg (95% CI 0.6 to 2.2) in the intervention group compared with the control group. The proportion of those receiving less than 1.0 g/kg/BW protein decreased from 67 to 51% in the intervention group and from 84 to 76% in the control group. Among home care clients with a cognitive decline (MMSE< 18), protein intake increased in the intervention group by 0.2 g/kg/BW (p = 0.048) but there was no change in the control group.

Conclusion

An individual tailored nutritional intervention improves the intake of protein and other nutrients among vulnerable home care clients with PEM or its risk and in persons with cognitive decline.

Trial registration

ClinicalTrials.gov: NCT02214758. Date of trial registration: 12/08/2014.

Nutrition Assessment and Interventions for the Prevention and Treatment of Malnutrition in Older Adults: An Evidence Analysis Center Scoping Review

Older adults living in the community or long-term residence such as a nursing home are at increased risk for malnutrition due to factors such as depression and isolation. The purpose of this scoping review is to identify the best available research that evaluates the validity and reliability of nutrition assessment tools, and the effectiveness of nutrition interventions to prevent or treat malnutrition among older adults. A literature search was conducted in Medline, Embase, CINAHL, and Cochrane Central databases to identify clinical trials, published in the English language, evaluating assessment and intervention methods aimed to treat or prevent malnutrition among older adults living in the community or their long-term residence such as nursing homes. Articles were screened by 2 reviewers, then data were extracted and narratively synthesized. The literature search retrieved 20,937 articles and 197 articles were included in narrative synthesis. A total of 73 assessment articles were identified, 36 of which were validity and reliability trials. A total of 122 intervention articles were identified, the majority of which were randomized controlled trials. A few of the most commonly evaluated interventions were oral nutrition supplements, medical nutrition therapy, fortification and enrichment, and nutrition education. Several systematic reviews were identified, however, that did not meet the criteria of this review. There is a need to conduct systematic reviews for nutrition assessment and intervention trials to guide development of evidence-based nutrition practice recommendations for older adults living in the community or their long-term residence.

Optimizing nutrition and oral health for caregivers-intervention protocol

BACKGROUND

The focus of care has shifted from institutional care to home care. Family caregivers provide the majority of home care that allows an opportunity for their care recipients to live at home and avoid costly institutional care. The aim of this study is to describe the nutritional status, oral health, and quality of life of family caregivers over the age of 65 and their care recipients, and to evaluate the impact of individually tailored diet and oral health advice to their nutritional status and oral health.

METHODS/DESIGN

Altogether, 250 family caregivers aged 65 or over, and their care recipients are studied in this prospective randomized population-based multidisciplinary 6-month intervention study. Participants are randomly allocated to the intervention groups or the control group. Data collection is performed at three time-points: at baseline and 6 months and after a 6-month follow-up at 12 months. Caregivers' and their care recipients' nutritional and oral health status as a primary outcome, and functional ability, cognitive status, quality of life, depression symptoms, sense of coherence, morbidity, and medication of family caregivers as secondary outcomes will be measured using validated self-administered questionnaires and clinical examinations.

DISCUSSION

To our knowledge, this is the first experiment to determine whether caregivers and their care recipients benefit from individual nutritional intervention and oral health intervention in terms of nutrition status, oral health status, and quality of life.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04003493 . Registered on June 28, 2019.

Digitally Supported Dietary Protein Counseling Changes Dietary Protein Intake, Sources and Distribution in Community-Dwelling Older Adults

Digitally supported dietary counselling may be helpful in increasing the protein intake in combined exercise and nutritional interventions in community-dwelling older adults. To study the effect of this approach, 212 older adults (72.2 ± 6.3 years) were randomised in three groups: control, exercise, or exercise plus dietary counselling. The dietary counselling during the 6-month intervention was a blended approach of face-to-face contacts and videoconferencing, and it was discontinued for a 6-month follow-up. Dietary protein intake, sources, product groups, resulting amino acid intake, and intake per eating occasion were assessed by a 3-day dietary record. The dietary counselling group was able to increase the protein intake by 32% at 6 months, and the intake remained 16% increased at 12 months. Protein intake mainly consisted of animal protein sources: dairy products, followed by fish and meat. This resulted in significantly more intake of essential amino acids, including leucine. The protein intake was distributed evenly over the day, resulting in more meals that reached the protein and leucine targets. Digitally supported dietary counselling was effective in increasing protein intake both per meal and per day in a lifestyle intervention in community-dwelling older adults. This was predominantly achieved by consuming more animal protein sources, particularly dairy products, and especially during breakfast and lunch.

Type of Care and Living Situation Are Associated with Nutritional Care but Not Nutritional Status of Older Persons Receiving Home Care

Nutritional care and nutritional status may differ in older persons receiving informal (IC) or professional (PC) home care and further depend on the living situation, but little is known in this regard. In this analysis of a cross-sectional multicenter study, type of care, living situation, and nutritional care were enquired in 353 older adults (≥65) receiving IC or PC, living either with partner (LP), with others (LO) or alone (LA), and the nutritional status was determined by BMI and MNA^®. For IC receivers, food shopping (IC-LP 94%, IC-LO 96%, IC-LA 92%) and warm meals (IC-LP 89%, IC-LO 90%, IC-LA 71%) were mainly provided by relatives, whereas 47% of PC-LA prepared warm meals by themselves and 22% received meals on wheels. Thirteen percent were underweight, 13% malnourished, and 57% at risk of malnutrition without differences between the groups. Adjusted odds ratios (OR) of being malnourished were also not different (IC-LP 2.2 [95% CI 0.5–9.7], IC-LO 1.4 [0.3–6.6], IC-LA 1.4 [0.3–6.6]) compared to PC-LA. In conclusion, provision of nutritional care obviously differed according to the type of care and living situation, whereas nutritional status does not seem to be affected by these aspects. More research is clearly needed in this field.

Effectiveness of Tailored Dietary Counseling in Treating Malnourished Outpatients with Chronic Obstructive Pulmonary Disease: A Randomized Controlled Trial

BACKGROUND

Malnutrition in patients with chronic obstructive pulmonary disease (COPD) is common and associated with poor prognosis. Nutrition interventions are necessary, but there is a lack of evidence regarding the effectiveness of tailored nutrition advice.

OBJECTIVE

This study investigated whether tailored nutrition counseling could improve dietary intake, nutritional status, functional outcomes, and health-related quality of life (QoL) of malnourished outpatients with COPD.

DESIGN

We conducted a randomized controlled trial in which participants were randomly assigned to either the intervention group (IG) or the control group (CG).

PARTICIPANTS/SETTING

One hundred and twenty malnourished outpatients with COPD participated in the study between May and November 2017 at the National Lung Hospital, Hanoi, Vietnam.

INTERVENTION

The IG received tailored nutrition counseling once per month for 3 months based on a specifically developed written nutrition resource for COPD. The CG received the same educational resource at baseline without any discussion.

MAIN OUTCOME MEASURES

The main outcome measures were energy and protein intakes, body weight change, nutritional status (Subjective Global Assessment score), muscle strength, and QoL.

STATISTICAL ANALYSES

Differences between groups before and after the intervention were assessed using two-way repeated measures analysis of variance. Generalized estimating equation modeling was used to investigate the differences between groups over time.

RESULTS

At baseline, there were no significant differences in outcomes of interest between the two groups. After 3 months of intervention, time-intervention interactions for energy intake, protein intake, and body weight change were significant (945 kcal/day, 95% CI 792 to 1,099 kcal/day, P<0.001; 50.0 g protein/day, 95% CI 43.9 to 56.1 g protein/day, P<0.001; and 1.0 kg, 95% CI 0.5 to 1.5 kg, P<0.001, respectively). Subjective Global Assessment scores improved in the IG and worsened in the CG. Significant improvements were found in inspiratory muscle strength in the IG (5.4 cmH₂O, 95% CI 2.3 to 8.6 cmH₂O, P=0.001) and significant decreases in handgrip strength were found in the CG after 3 months of the intervention (1.4 kg, 95% CI 0.4 to 2.4 kg, P=0.007). There was a significant interaction effect for all QoL scores (analysis of variance two-way repeated, P≤0.003). The IG also significantly improved all QoL scores from baseline to 3 months (P<0.004).

CONCLUSIONS

Tailored nutritional counseling has the potential to improve dietary intakes, nutritional status, functional outcomes, and QoL in malnourished outpatients with COPD.

The combined effect of individually tailored xerostomia and nutritional interventions on dry mouth among nutritionally compromised old home care clients

OBJECTIVE

To examine the effectiveness of tailored xerostomia and nutritional 6-month interventions on xerostomia among home care clients aged 75 years or over who were malnourished or at risk of malnutrition.

BACKGROUND

A subjective feeling of dry mouth (xerostomia) is common among older adults and affects their quality of life, nutrition and oral health. Medical conditions, polypharmacy, dehydration and malnutrition are often underlying causes of xerostomia.

MATERIALS AND METHODS

The data are based on the NutOrMed study with a dietary intervention group of 119 patients and control group of 97 patients. In-home interviews were carried out by home care nurses, nutritionists, dental hygienists and pharmacists and tailored interventions by nutritionist and dental hygienists. Xerostomia intervention included individual counselling on dry mouth care and was applied to all those suffering occasionally or continuously from xerostomia (57%, n = 66) in the intervention group. Nutritional intervention was applied to all participants in the intervention group, and it included instructions on increasing the number of meals, energy, protein intake and liquid intake.

RESULTS

Among participants who received both interventions, xerostomia decreased by 30% and malnutrition or risk of malnutrition decreased by 61%. The interventions were highly significant (OR 0.1, 95% CI: 0.06; 0.2) in reducing xerostomia.

CONCLUSIONS

Home care clients suffering from xerostomia profited significantly from tailored xerostomia and dietary interventions. Evaluation and treatment of xerostomia are important among older persons who are malnourished or at risk of malnutrition as a part of a comprehensive health intervention to improve their nutrition and oral health.

Dairy-Based and Energy-Enriched Berry-Based Snacks Improve or Maintain Nutritional and Functional Status in Older People in Home Care

OBJECTIVE

Consumption of energy- and nutrient-dense snacks are recommended for older people to maintain adequate nutrition. We evaluated the effects of dairy-based and energy-enriched berry products consumed as snacks on nutritional and functional status among vulnerable older people receiving home care services.

DESIGN

Randomised controlled study.

SETTING AND PARTICIPANTS

The study sample consisted of 85 home care clients, with mean age of 81.9 (SD 7.1) years in the intervention group (n=50) and 83.7 (SD 8.1) years in the control group (n=35), and 72% women in both groups.

INTERVENTION

In the intervention group, the participants consumed both high-protein dairy-based products and energy-enriched berry purées for three months. The snack products provided nearly 300 kcal and 14 g protein per day.

MEASUREMENTS

The Mini Nutritional Assessment (MNA), body mass index (BMI), mid-arm muscular area (MAMA) and concentrations of plasma albumin and prealbumin and blood haemoglobin were used to determine nutritional status, and handgrip strength was used to determine functional status at baseline and after the intervention.

RESULTS

After adjustment for age and gender, the intervention showed a significant effect on MNA scores (2.1, 95% [CI]: 1.0 to 3.3) (p=0.003), albumin concentration (2.0 g/L, 95% [CI]: 1.1 to 3.2) (p=0.006) and handgrip strength of the right hand in women (2.4 kg, 95% [CI]: 1.2 to 3.3) (p=0.007). The MNA scores improved in the intervention group, while albumin concentration and handgrip strength decreased in the control group.

CONCLUSIONS

Regular use of dairy- and energy-enriched berry-based snacks may improve or maintain nutritional and functional status among older people in home care.