The journal of nutrition, health & aging

, Volume 14, Issue 5, pp 367–372 | Cite as

Cost-effectiveness of nutrition interventions in nursing home residents: A pilot intervention

  • Sandra F. Simmons
  • X. Zhuo
  • E. Keeler



Unintentional weight loss is a prevalent and costly clinical problem among nursing home (NH) residents. One of the most common nutrition interventions for residents at risk for weight loss is oral liquid nutrition supplementation. The purpose of this study was to determine the cost effectiveness of supplements relative to offering residents’ snack foods and fluids between meals to increase caloric intake.


Randomized, controlled trial.


Three long-term care facilities.


Sixty-three long-stay residents who had an order for nutrition supplementation.


Participants were randomized into one of three groups: (1) usual NH care control; (2) supplement, or (3) between-meal snacks. For groups two and three, trained research staff provided supplements or snacks twice daily between meals, five days per week, for six weeks with assistance and encouragement to promote consumption.


Research staff observed residents during and between meals for two days at baseline, weekly, and post six weeks to estimate total daily caloric intake. For both intervention groups, research staff documented residents’ caloric intake between meals from supplements or snack items, refusal rates and the amount of staff time required to provide each intervention.


Both interventions increased between meal caloric intake significantly relative to the control group and required more staff time than usual NH care. The snack intervention was slightly less expensive and more effective than the supplement intervention.


Offering residents a choice among a variety of foods and fluids twice per day may be a more effective nutrition intervention than oral liquid nutrition supplementation.

Key words

Nursing homes weight loss intervention nutrition supplementation 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Blaum CS, Fries BE, Fiatarone MA. Factors associated with low body mass index and weight loss in nursing home residents. J Gerontol A:Biol Sci Med Sci 1995;50A:M162–M168.Google Scholar
  2. 2.
    Ferguson RP, O’Conner P, Crabtree B, et al. Serum albumin and prealbumin as predictors of clinical outcomes of hospitalized elderly nursing home residents. J Am Geriatr Soc 1993;41:545–549.PubMedGoogle Scholar
  3. 3.
    Gilmore SA, Robinson G, Posthauer ME, et al. Clinical indicators associated with unintentional weight loss and pressure ulcers in elderly residents in nursing facilities. J Am Diet Assoc 1995;95(9):984–992.CrossRefPubMedGoogle Scholar
  4. 4.
    Simmons SF, Garcia EF, Cadogan MP, et. al. The Minimum Data Set weight loss quality indicator: Does it reflect differences in care processes related to weight loss? J Am Geriatr Soc 2003;51(10):1410–1418.CrossRefPubMedGoogle Scholar
  5. 5.
    Minimum Data Set, Version 2: User’s Manual. Health Care Financing Administration: Natick, MA: Eliot Press, April 1999.Google Scholar
  6. 6.
    Kayser-Jones J, Schell E, Porter C, et al. Reliability of percentage figures used to record the dietary intake of nursing home residents. Nursing Home Medicine 1997;5(3):69–76.Google Scholar
  7. 7.
    Pokrywka HS, Koffler KH, Remsburg R, et. al. Accuracy of patient care staff in estimating and documenting meal intake of nursing home residents. J Am Geriatr Soc 1997;45:1223–1227.PubMedGoogle Scholar
  8. 8.
    Simmons SF, Reuben D. Nutritional intake monitoring for nursing home residents: A comparison of staff documentation, direct observation, and photography methods. J Am Geriatr Soc 2000;48:209–213.PubMedGoogle Scholar
  9. 9.
    Milne, AC, Potter J, Avenell A. Protein and energy supplementation in elderly people at risk from malnutrition. The Cochrane Collaboration, The Cochrane Library Issue 1: John Wiley & Sons, Ltd. Publishers, 2008.Google Scholar
  10. 10.
    Simmons SF, Schnelle JF. Individualized feeding assistance care for nursing home residents: Staffing requirements to implement two interventions. J Gerontol A:Biol Sci Med Sci 2004;59A(9):966–973.Google Scholar
  11. 11.
    Wilson MG, Purushothaman R, Morley JE. Effect of liquid dietary supplements on energy intake in the elderly. Am J Clin Nutr 2002;75:944–947.PubMedGoogle Scholar
  12. 12.
    Kayser-Jones J, Schell ES, Porter C, A prospective study of the use of liquid oral dietary supplements in nursing homes. J Am Geriatr Soc 1998;46:1378–1386.PubMedGoogle Scholar
  13. 13.
    Simmons SF, Patel AV. Nursing home staff delivery of oral liquid nutritional supplements to residents at risk for unintentional weight loss. J Am Geriatr Soc 2006;54(9):1372–1376.CrossRefPubMedGoogle Scholar
  14. 14.
    Simmons SF, Alessi C, Schnelle JF. An intervention to increase fluid intake in nursing home residents: Prompting and preference compliance. J Am Geriatr Soc 2001;49(7):926–933.CrossRefPubMedGoogle Scholar
  15. 15.
    Simmons SF, Osterweil D, Schnelle JF. Improving food and fluid intake in nursing home residents with feeding assistance: A staffing analysis. J Gerontol A:Biol Sci Med Sci 2001;56A(12):M790–M794.Google Scholar
  16. 16.
    Thomas DR, Ashmen W, Morley JE, et al. Nutritional management in long term care: Development of a clinical guideline. J Gerontol A:Biol Sci Med Sci 2000;55A(12):M725–M734.Google Scholar
  17. 17.
    Molloy, D. W., Alemayehu, E., Roberts, R. A standardized Mini-Mental State Examination (SMMSE): Its reliability compared to the traditional Mini-Mental State Examination (MMSE). Am J Psychiatry 1991;148:102–105.PubMedGoogle Scholar
  18. 18.
    Simmons SF, Babinou S, Garcia E, et al. Quality assessment in nursing homes by systematic direct observations: Feeding assistance. J Gerontol A:Biol Sci Med Sci 2002;57A(10):M665–M671.Google Scholar
  19. 19.
    Schnelle JF, Cretin S, Saliba D, et al. Minimum nurse aide staffing required to implement best practice care in nursing homes. Chapter in report to congress: Appropriateness of Minimum Nurse Staffing Ratios in Nursing Homes. Health Care Financing Administration, Summer, Vol. 2: Chapter 14: pages 14.1–14.68; Abt Associates, Inc: Cambridge, MA, 2000.Google Scholar
  20. 20.
    U. S. Department of Labor National Occupational Employment and Wage Estimates, May 2006, Bureau of Labor Statistics, (Accessed on 2/01/2008).
  21. 21.
    Lothgren M, Zethraeus N. Definition, interpretation and calculation of costeffectiveness acceptability curves. Health Economics 2000;9:623–630. doi: 10._1002/1099-1050.CrossRefPubMedGoogle Scholar
  22. 22.
    Stinnett A, Mullahy J. Net Health Benefits: A New Framework for the Analysis of Uncertainty in Cost-Effectiveness Analysis. Medical Decision Making 1998;18(2):S68–S80.CrossRefPubMedGoogle Scholar
  23. 23.
    Efron B, Tibshirani RJ. An introduction to the Bootstrap. Chapman and Hall, 1993, pp 10–28.Google Scholar
  24. 24.
    Simmons SF, Keeler E, Zhuo X, et al. Prevention of unintentional weight loss in nursing home residents: A controlled trial of feeding assistance. J Am Geriatr Soc 2008;56:1466–1473.CrossRefPubMedGoogle Scholar
  25. 25.
    Simmons SF, Peterson E, You C. The accuracy of monthly weight assessments in nursing homes: Implications for the identification of weight loss. J Nutr Health Aging, 13(3):284–288.Google Scholar
  26. 26.
    Hu TW, Huang LF, Cartwright WS. Evaluation of the costs for caring for the senile demented elderly: A pilot study. Gerontologist 1986;26(2):158–163.PubMedGoogle Scholar
  27. 27.
    Simmons SF, Schnelle JF. Feeding assistance needs of long-stay nursing home residents and the staff time to provide care. J Am Geriatr Soc 2006;54(6):919–924.CrossRefPubMedGoogle Scholar
  28. 28.
    Steele CM, Greenwood C, Ens I, et al. Mealtime difficulties in a home for the aged: Not just dysphagia. Dysphagia 1997;12:43–50.CrossRefPubMedGoogle Scholar
  29. 29.
    Interpretive Guidelines State Operations Manual. Appendix P- Survey Protocol for Long Term Care Facilities. Part 1. Revision 26, 08-17-07. Retrieved February 22, 2008 from

Copyright information

© Serdi and Springer Verlag France 2010

Authors and Affiliations

  1. 1.School of Medicine, Division of General Internal Medicine and Public Health, Center for Quality AgingVanderbilt UniversityNashvilleUSA
  2. 2.Geriatric Research, Education, and Clinical CenterVA Medical CenterNashvilleUSA
  3. 3.Rand CorporationSanta MonicaUSA
  4. 4.Medical Center North, Center for Quality AgingVanderbilt UniversityNashvilleUSA

Personalised recommendations