Abstract
Objectives
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.
Design
Randomized, controlled trial.
Setting
Three long-term care facilities.
Participants
Sixty-three long-stay residents who had an order for nutrition supplementation.
Intervention
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.
Measurements
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.
Results
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.
Conclusions
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.
Similar content being viewed by others
References
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.
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.
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.
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.
Minimum Data Set, Version 2: User’s Manual. Health Care Financing Administration: Natick, MA: Eliot Press, April 1999.
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.
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.
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.
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.
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.
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.
Kayser-Jones J, Schell ES, Porter C, et.al. A prospective study of the use of liquid oral dietary supplements in nursing homes. J Am Geriatr Soc 1998;46:1378–1386.
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.
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.
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.
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.
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.
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.
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.
U. S. Department of Labor National Occupational Employment and Wage Estimates, May 2006, Bureau of Labor Statistics, http://www.bls.gov/oes/current/oes311012.htm (Accessed on 2/01/2008).
Lothgren M, Zethraeus N. Definition, interpretation and calculation of costeffectiveness acceptability curves. Health Economics 2000;9:623–630. doi: 10._1002/1099-1050.
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.
Efron B, Tibshirani RJ. An introduction to the Bootstrap. Chapman and Hall, 1993, pp 10–28.
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.
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.
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.
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.
Steele CM, Greenwood C, Ens I, et al. Mealtime difficulties in a home for the aged: Not just dysphagia. Dysphagia 1997;12:43–50.
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 http://www._cms.thhs.gov/manuals/.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Simmons, S.F., Zhuo, X. & Keeler, E. Cost-effectiveness of nutrition interventions in nursing home residents: A pilot intervention. J Nutr Health Aging 14, 367–372 (2010). https://doi.org/10.1007/s12603-010-0082-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12603-010-0082-1