Nutrient rich daily hot meal delivery for older adults at home
Research type
Research Study
Full title
Randomised crossover trial to assess the effects of provision of a daily high protein and high energy meal on the physical and psychological wellbeing of community-dwelling malnourished elderly adults
IRAS ID
299790
Contact name
Joanna Bowtell
Contact email
Sponsor organisation
University of Exeter
Clinicaltrials.gov Identifier
TBC, Open Research Exeter
Duration of Study in the UK
1 years, 5 months, 31 days
Research summary
Research Summary:
There is high prevalence of under-nourishment and malnutrition in older adults living in the community, including Torbay with its ageing demographic. The factors that contribute to malnutrition in this population include loss of appetite and taste, reduced capacity to access and prepare food, financial hardship, social isolation and deterioration in psychological wellbeing. Malnourished older adults are at increased risk of frailty and loss of independence, and at increased risk of a range of health conditions. Therefore, we will comprehensively evaluate the impact of providing a daily high energy (40 % requirements) and protein (50% requirements) meal for 12 weeks on the physical and psychological wellbeing of under-nourished adults in the Torbay area.
We will recruit 60 older adults (>70y) at risk of under-nourishment living independently in the community via two GP practices in Dawlish and Newton Abbot. Participants will be randomised to receive the 12 week intervention after a 12 week control period with no intervention, or to receive the 12 week intervention followed by a 12 week control period with no intervention. This will allow assessment of change in outcomes compared to a baseline control period, and to determine whether any benefits achieved are retained 12 weeks beyond the intervention period. Our randomisation will take into account whether participants are living alone or with a spouse. Before and after each 12 week block (meal intervention or control period), one of our research team will visit participants in their homes to measure psychological wellbeing using a number of questionnaire based tools, physical wellbeing (handgrip strength, timed up and go test, physical activity levels using an accelerometer), nutritional status using dietary recall and questionnaire based tools. We will also measure body composition, blood pressure, and take a fasted blood sample so that the can assess the effects of the meal intervention.Summary of Results:
Malnutrition and undernourishment are pressing issues in the increasingly aging population of the UK, with significant negative consequences for overall health and quality of life. Research has previously shown that malnutrition can lead to frailty, a loss of independence and increased risk of mortality in older adults. Ensuring older adults consume highly nutritious and energy dense meals can positively improve health and wellbeing of individuals.
We investigated the effects of a 12-week daily meal provision service on community dwelling elderly adults at risk of malnutrition. The aim of this research was to determine whether providing meals that provided >40% daily energy requirements and >50% daily protein requirements, could lead to improvements in; a) nutritional status, b) physical function and c) psychological wellbeing.
We recruited 60 participants, and 56 participants decided to take part and were randomised to one of two groups. The meals first group received their 12-week meal provision service for the first 12 weeks, followed by a 12-week follow up period with no meal provision. The meals second (control group) were asked to consume their normal diet for the first 12-weeks before then receiving 12-weeks of meal provision. 49 of the 56 randomised participants with an average age of 82 years completed the study. We took a variety of measurements at the beginning of the study, after the first 12 weeks, and after the full 24-week study period. These include the mini-nutritional assessment (MNA), body composition, blood pressure, handgrip strength, mobility, and psychological wellbeing including social support, health, and self-esteem.
The meal provision service resulted in a significant improvement in MNA score, signifying an improvement in nutritional status. Interestingly, participants asked to consume their normal diet in the control period, actually increased their energy and protein intake during the control period which compromised our planned statistical analysis. We therefore also calculated change in response to the 12 weeks of meals in both groups and found even larger improvements in MNA score as well as significant improvements in handgrip strength, indicating enhanced physical function. Importantly, the benefits observed during the meal intervention period were largely lost after 12 weeks of returning to usual meals; suggesting that ongoing meal provision will be necessary for sustained improvement in this population.
In conclusion, the 12-week high-energy, high-protein meal provision service had a positive impact on nutritional status of participants. Improvements in MNA scores are associated with reduced risk of frailty and mortality. This research highlights the importance of providing highly nutritious meals to elderly adults at risk of malnutrition and highlights the need for continued support to maintain these benefits over time.
REC name
South West - Frenchay Research Ethics Committee
REC reference
21/SW/0123
Date of REC Opinion
18 Oct 2021
REC opinion
Further Information Favourable Opinion