Nutritional care in old age: the effect of supplementation on nutritional status and performance

Malnutrition is frequently observed in elderly people living in nursing homes and homes for the elderly. Anorexia resulting in inadequate dietary intake is often a cause of malnutrition. Malnutrition in old age affects several aspects of functioning. Earlier research has shown that a complete supplement improves nutritional status. These studies were however not sufficiently powerful to investigate an effect of such a supplement on functioning. Yet, positive results of a pilot study pointed in that direction. In this thesis we assumed that improving nutritional status by nutritional supplementation could lead to improvement in functioning, following improved total dietary intake, without affecting habitual intakes.In the current study residents of nursing homes and homes for the elderly were participating in a 24-week, randomised, double-blind, placebo-controlled intervention trial (n=176). They randomly received either a nutrient dense drink or a placebo drink twice a day in addition to their usual diet. Two packages of the nutrient dense drink contained 250 kcal and vitamins, minerals and trace elements at the level of 25 to 175% of the Dutch RDA. The placebo drink contained no energy and no vitamins and minerals.Using the complete supplement appeared to have a beneficial effect on dietary intake. The change in total energy intake was some 0.8 MJ/day higher in the supplement group than that in the control group (p=0.166). Moreover, a significantly favourable effect (p<0.001) was observed for the intake of vitamins and minerals. Hereby the supplement group did not appear to compensate their regular intakes for the energy content of the provided supplements. The positive effect on dietary intake was supported by changes in nutritional status, because markers of nutritional status of the intervention group compared favourably with those of the placebo group. These changes showed amongst others a positive effect of the intervention drink on body weight (1.6 kg difference in change; p=0.035), calf circumference (0.9 cm difference in change; p=0.048), and blood values (e.g. Hcy decreased from 16.8 to 11.2 μmol/L in the supplement group). In the study population no significant effect was found on functionality outcomes, including cognitive function, mood, physical performance and the ability to perform activities of daily living. However, a subgroup of participants with BMI at baseline below 24.4 kg/m 2 performed better on the cognitive subscale of the Alzheimer's Disease Assessment Scale (p=0.09), and its language sub score (p=0.01) after 24 weeks of intervention.To prevent serious malnutrition it is advocated to regularly weigh institutionalised elderly and use a short questionnaire for decreased appetite. With these instruments the development of malnutrition can be detected early and if indicated preventive action can be taken. Future research should be focused on efficient implementation of the used food supplement in every day practice. Nutrition policy should be focused on improvement of usual diet as well as temporarily providing nutritional supplements if indicated. From the findings of our intervention trial we conclude that the applied supplement is effective for counteracting the development of malnutrition in this population. Furthermore, the results of this trial suggest that it is effective as treatment for decreasing function in a subgroup of institutionalized elderly people with low BMI.