The feasibility of serving liquid yoghurt supplemented with probiotic bacteria, Lactobacillus rhamnosus LB 21, and Lactococcus lactis L1A — A pilot study among old people with dementia in a residential care facility Comparison of Trained Clinician Ratings with Expert Ratings of Aspiration on Videofluoroscopic Images from a Randomized Clinical Trial A prospective study of nutrition education and oral nutritional supplementation in patients with Alzheimer's disease High-intensity functional exercise program and protein-enriched energy supplement for older persons dependent in activities of daily living: a randomised controlled trial. Efficacy of Souvenaid in mild Alzheimer's disease: results from a randomized, controlled trial. Concord grape juice supplementation improves memory function in older adults with mild cognitive impairment. Three-week Nutritional Supplementation Effect on Long-term Nutritional Status of Patients With Mild Alzheimer Disease Accuracy of prediction equations for serum osmolarity in frail older people with and without diabetes1234 The Boston FICSIT study: the effects of resistance training and nutritional supplementation on physical frailty in the oldest old. Dysphagia in elderly nursing home residents with severe cognitive impairment can be attenuated by cervical spine mobilization. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials Effect of a high-intensity functional exercise program on functional balance: preplanned subgroup analyses of a randomized controlled trial in residential care facilities. A randomized, crossover trial of high-carbohydrate foods in nursing home residents with Alzheimer's disease: associations among intervention response, body mass index, and behavioral and cognitive function. The effect of oral nutritional supplements on habitual dietary quality and quantity in frail elders. Health, wellbeing and nutritional status of older people living in UK care homes: an exploratory evaluation of changes in food and drink provision The effect of nutritional intervention in elderly subjects residing in group-living for the demented A randomized study of three interventions for aspiration of thin liquids in patients with dementia or Parkinson's disease. Efficacy of a medical food in mild Alzheimer's disease: A randomized, controlled trial Efficacy of a medical food on cognition in Alzheimer’s Disease: Results from secondary analyses of a randomized, controlled trial Cost-effectiveness of nutrition interventions in nursing home residents: A pilot intervention Energy-containing nutritional supplements can affect usual energy intake postsupplementation in institutionalized seniors with probable Alzheimer's disease. Protein-energy oral supplementation in malnourished nursing-home residents. A controlled trial. Effect of oral administration of a whole formula diet on nutritional and cognitive status in patients with Alzheimer's disease. Study of the effect of a liquid nutrition supplement on the nutritional status of psycho-geriatric nursing home patients Early nutritional supplementation immediately after diagnosis of infectious disease improves body weight in psychogeriatric nursing home residents Effects of high-intensity exercise and protein supplement on muscle mass in ADL dependent older people with and without malnutrition—A randomized controlled trial Comparison of 2 Interventions for Liquid Aspiration on Pneumonia Incidence Home-made oral supplement as nutritional support of old nursing home residents, who are undernourished or at risk of undernutrition based on the MNA. A pilot trial Translating clinical research into practice: a randomized controlled trial of exercise and incontinence care with nursing home residents. The effectiveness of interventions to reduce undernutrition and promote eating in older adults with dementia: A systematic review Providing nutrition supplements to institutionalized seniors with probable Alzheimer's disease is least beneficial to those with low body weight status. Challenges in the design and conduct of a randomized study of two interventions for liquid aspiration The effect of a nutrient dense drink on mental and physical function in institutionalized elderly people Improvement of weight and fat-free mass with oral nutritional supplementation in patients with Alzheimer's disease at risk of malnutrition: a prospective randomized study. An intervention to increase fluid intake in nursing home residents: prompting and preference compliance. Physical and social functional abilities seem to be maintained by a multifaceted randomized controlled nutritional intervention among old (>65 years) Danish nursing home residents. Frailty and injuries in later life: the FICSIT trials. Exercise training and nutritional supplementation for physical frailty in very elderly people. Multifaceted nutritional intervention among nursing-home residents has a positive influence on nutrition and function.
Background Constipation and body weight loss are prevalent among old people . Treatment with different species of lactic acid bacteria has been suggested for various forms of gastrointestinal disorders . Objective , participants and interventionThis pilot study was performed to assess the feasibility of administering and consuming a drinkable yoghurt containing Lactobacillus rhamnosus LB 21 and Lactococcus L1A , and to evaluate the influence on bowel movements and body weight in 15 people with dementia , aged 65–95 years in residential care facility . Design A drinkable yoghurt ( Verum Drickyoghurt © ) with added bacteria was served daily for 6 months in conjunction with ordinary food intake .  Body weight , bowel movement frequency and consistency , food and fluid intake and time spent in various activities were recorded for two weeks preintervention , and 3 times during the follow-up period . Result This study showed that the yoghurt was easy to serve , with few side effects for the participants and that the various recording forms and diaries were easy for the staff to complete . The extra intake of yoghurt did not have any detectable beneficial effect on bowel movements . The overnight fast was almost 15 hours per day . Body weight decreased by 0.65 kg/month ( 95 % confidence interval . 0.27–0.97 ) . Conclusions The present study design was feasible in this group of old people with dementia . The absence of any detectable effect of the supplement on constipation , but rather a considerable loss in body weight , indicate that further research is needed in a large r and omised controlled trial , if associations between dementia , constipation and energy balance are to be understood Accurate detection and classification of aspiration is a critical component of videofluoroscopic swallowing evaluation , the most commonly utilized instrumental method for dysphagia diagnosis and treatment . Currently published literature indicates that interjudge reliability for the identification of aspiration ranges from poor to fairly good depending on the amount of training provided to clinicians . The majority of extant studies compared judgments among clinicians . No studies included judgments made during the use of a postural compensatory strategy . The purpose of this study was to examine the accuracy of judgments made by speech- language pathologists ( SLPs ) practicing in hospitals compared with unblinded expert judges when identifying aspiration and using the 8-point Penetration/Aspiration Scale .  Clinicians received extensive training for the detection of aspiration and minimal training on use of the Penetration/Aspiration Scale . Videofluoroscopic data were collected from 669 patients as part of a large , r and omized clinical trial and include judgments of 10,200 swallows made by 76 clinicians from 44 hospitals in 11 states . Judgments were made on swallows during use of dysphagia compensatory strategies : chin-down posture with thin liquids and head-neutral posture with thickened liquids ( nectar-thick and honey-thick consistencies ) . The subject population included patients with Parkinson ’s disease and /or dementia .  Kappa statistics indicate high accuracy for all interventions by SLPs for identification of aspiration ( all κ > 0.86 ) and variable accuracy ( range = 69–76 % ) using the Penetration/Aspiration Scale when compared to expert judges . It is concluded that while the accuracy of identifying the presence of aspiration by SLPs is excellent , more extensive training and /or image enhancement is recommended for precise use of the Penetration/Aspiration Scale Background Weight loss in patients with Alzheimer 's disease ( AD ) is a common clinical manifestation that may have clinical significance . Objectives To evaluate if there is a difference between nutrition education and oral nutritional supplementation on nutritional status in patients with AD . Methods A r and omized , prospect i ve 6-month study which enrolled 90 subjects with probable AD aged 65 years or older divided into 3 groups : Control Group ( CG ) [ n = 27 ] , Education Group ( EG ) [ n = 25 ] , which participated in an education program and Supplementation Group ( SG ) [ n = 26 ] , which received two daily servings of oral nutritional supplementation . Subjects were assessed for anthropometric data ( weight , height , BMI , TSF , AC and AMC ) , biochemical data ( total protein , albumin , and total lymphocyte count ) , CDR ( Clinical Dementia Rating ) , MMSE ( Mini-mental state examination ) , as well as dependence during meals . Results The SG showed a significant improvement in the following anthropometric measurements : weight ( H calc = 22.12 , p = < 0.001 ) , BMI ( H calc = 22.12 , p = < 0.001 ) , AC ( H calc = 12.99 , p = < 0.002 ) , and AMC ( H calc = 8.67 , p = < 0.013 ) compared to the CG and EG . BMI of the EG was significantly greater compared to the CG . There were significant changes in total protein ( H calc = 6.17 , p = < 0.046 ) , and total lymphocyte count in the SG compared to the other groups ( H cal = 7.94 , p = 0.019 ) . Conclusion Oral nutritional supplementation is more effective compared to nutrition education in improving nutritional status The aims of this r and omised controlled trial were to determine if a high-intensity functional exercise program improves balance , gait ability , and lower-limb strength in older persons dependent in activities of daily living and if an intake of protein-enriched energy supplement immediately after the exercises increases the effects of the training . One hundred and ninety-one older persons dependent in activities of daily living , living in residential care facilities , and with a Mini-Mental State Examination ( MMSE ) score of ? 10 participated . They were r and omised to a high-intensity functional exercise program or a control activity , which included 29 sessions over 3 months , as well as to protein-enriched energy supplement or placebo .  Berg Balance Scale , self-paced and maximum gait speed , and one-repetition maximum in lower-limb strength were followed-up at three and six months and analysed by 2 x 2 factorial ANCOVA , using the intention-to-treat principle . At three months , the exercise group had improved significantly in self-paced gait speed compared with the control group ( mean difference 0.04 m/s , p = 0.02 ) . At six months , there were significant improvements favouring the exercise group for Berg Balance Scale ( 1.9 points , p = 0.05 ) , self-paced gait speed ( 0.05 m/s , p = 0.009 ) , and lower-limb strength ( 10.8 kg , p = 0.03 ) . No interaction effects were seen between the exercise and nutrition interventions . In conclusion , a high-intensity functional exercise program has positive long-term effects in balance , gait ability , and lower-limb strength for older persons dependent in activities of daily living . An intake of protein-enriched energy supplement immediately after the exercises does not appear to increase the effects of the training Souvenaid aims to improve synapse formation and function . An earlier study in patients with Alzheimer 's disease ( AD ) showed that Souvenaid increased memory performance after 12 weeks in drug-naïve patients with mild AD . The Souvenir II study was a 24-week , r and omized , controlled , double-blind , parallel-group , multi-country trial to confirm and extend previous findings in drug-naïve patients with mild AD . Patients were r and omized 1:1 to receive Souvenaid or an iso-caloric control product once daily for 24 weeks . The primary outcome was the memory function domain Z-score of the Neuropsychological Test Battery ( NTB ) over 24 weeks . Electroencephalography ( EEG ) measures served as secondary outcomes as marker for synaptic connectivity . Assessment s were done at baseline , 12 , and 24 weeks . The NTB memory domain Z-score was significantly increased in the active versus the control group over the 24-week intervention period ( p = 0.023 ; Cohen 's d = 0.21 ; 95 % confidence interval [-0.06]-[0.49 ] ) . A trend for an effect was observed on the NTB total composite z-score ( p = 0.053 ) . EEG measures of functional connectivity in the delta b and were significantly different between study groups during 24 weeks in favor of the active group . Compliance was very high ( 96.6 % [ control ] and 97.1 % [ active ] ) . No difference between study groups in the occurrence of ( serious ) adverse events . This study demonstrates that Souvenaid is well tolerated and improves memory performance in drug-naïve patients with mild AD . EEG outcomes suggest that Souvenaid has an effect on brain functional connectivity , supporting the underlying hypothesis of changed synaptic activity Concord grape juice contains polyphenol compounds , which have antioxidant and anti-inflammatory properties and influence neuronal signalling . Concord grape juice supplementation has been shown to reduce inflammation , blood pressure and vascular pathology in individuals with CVD , and consumption of such flavonoid-containing foods is associated with a reduced risk for dementia . In addition , preliminary animal data have indicated improvement in memory and motor function with grape juice supplementation , suggesting potential for cognitive benefit in ageing humans . In this initial investigation of neurocognitive effects , we enrolled twelve older adults with memory decline but not dementia in a r and omised , placebo-controlled , double-blind trial with Concord grape juice supplementation  for 12 weeks . We observed significant improvement in a measure of verbal learning and non-significant enhancement of verbal and spatial recall . There was no appreciable effect of the intervention on depressive symptoms and no effect on weight or waist circumference . A small increase in fasting insulin was observed for those consuming grape juice . These preliminary findings suggest that supplementation with Concord grape juice may enhance cognitive function for older adults with early memory decline and establish a basis for more comprehensive investigations to evaluate potential benefit and assess mechanisms of action Short-term nutritional supplements enable an improvement in Alzheimer patients ’ nutritional status , but it remains to be seen whether they will be sufficient to improve long-term nutritional status . The aim of this study was to evaluate the long-term impact of a 3-week nutritional supplementation on the nutritional status of undernourished patients with probable mild Alzheimer disease . A 21-day prospect i ve r and omized nonblinded controlled trial was conducted . Patients were followed-up for an additional period until the 90th day after the beginning of the intervention . Intervention result ed in significant improvements in Mini Nutritional Assessment ( MNA ) score [ Mean=1.4 , st and ard deviation (SD)=0.8 vs. 0.0 ( 0.1 ) in the control group , P<0.001 ] and also in anthropometrical and serum biomarkers of Alzheimer disease ( AD ) patients ’ nutritional status . Further improvements in the AD patients ’ MNA mean score=1.4 ( SD=2.3 ) versus —0.5 ( SD=0.6 ) in the control group ( P=0.003 ) were seen at 90 days follow-up . Data show that a 3-week nutritional supplementation has a positive long-term impact on the nutritional status of undernourished patients with mild probable AD Background : Serum osmolality is an accurate indicator of hydration status in older adults . Glucose , urea , and electrolyte concentrations are used to calculate serum osmolarity , which is an indirect estimate of serum osmolality , but which serum osmolarity equations best predict serum osmolality in the elderly is unclear . Objective : We assessed the agreement of measured serum osmolality with calculated serum osmolarity equations in older people . Design : Serum osmolality was measured by using freezing point depression in a cross-sectional study .  Plasma glucose , urea , and electrolytes were analyzed and entered into 38 serum osmolarity-prediction equations . The Bl and -Altman method was used to evaluate the agreement and differential bias between measured osmolality and calculated osmolarity . The sensitivity and specificity of the most-promising equations were examined against serum osmolality ( reference st and ard ) . Results : A total of 186 people living in UK residential care took part in the Dehydration Recognition In our Elders study ( 66 % women ; mean ± SD age : 85.8 ± 7.9 y ; with a range of cognitive and physical impairments ) and were included in analyses . Forty-six percent of participants had impending or current dehydration ( serum osmolality ≥295 mmol/kg ) . Participants with diabetes ( n = 33 ; 18 % ) had higher glucose ( P < 0.001 ) and serum osmolality ( P < 0.01 ) . Of 38 predictive equations used to calculate osmolarity , 4 equations showed reasonable agreement with measured osmolality . One [ calculated osmolarity = 1.86 × ( Na+ + K+ ) + 1.15 × glucose + urea + 14 ; all in mmol/L ] was characterized by narrower limits of agreement and the capacity to predict serum osmolality within 2 % in > 80 % of participants , regardless of diabetes or hydration status . The equation 's sensitivity ( 79 % ) and specificity ( 89 % ) for impending dehydration ( ≥295 mmol/kg ) and current dehydration ( > 300 mmol/kg ) ( 69 % and 93 % , respectively ) were reasonable . Conclusions : The assessment of a panel of equations for the prediction of serum osmolarity led to identification of one formula with a greater diagnostic performance . This equation may be used to predict hydration status in frail older people ( as a first-stage screening ) or to estimate hydration status in population studies . This trial was registered at the Research Register for Social Care ( http://www . research register.org.uk ) as 122273 Research indicates that lower extremity muscle weakness in the elderly is consistently related to impaired mobility and fall risk . Reversible components of the muscle weakness of aging include underuse syndromes and undernutrition , both of which are prevalent in nursing home population s. The Boston FICSIT study is a nursing home-based intervention to improve muscle strength through progressive resistance training of the lower extremities and /or multi-nutrient supplementation in chronically institutionalized subjects aged 70 - 100 . Baseline measurements of falls , medical status , psychological variables , functional status , nutritional intake and status , body composition , muscle mass and morphology , muscle function , and gait and balance are taken . The nursing home residents are then r and omly assigned to one of four treatment groups for 10 weeks : ( 1 ) high intensity progressive resistance training of the hip and knee extensors 3 days per week ; ( 2 ) multi-nutrient supplementation with a 360-kcal high carbohydrate , low fat liquid supplement every day ; ( 3 ) a combination of groups ( 1 ) and ( 2 ) ; and ( 4 ) a control group . Both non-supplemented groups receive a liquid placebo every day , and both non-exercising groups attend three sessions of " leisure activities " every week in order to control for the attentional aspects of the exercise and nutritional interventions . At the end of the 10-week period , all baseline measurements are re-assessed OBJECTIVE To investigate the feasibility of cervical spine mobilization in elderly dementia patients with dysphagia , and its effect on swallowing capacity . METHODS Fifteen nursing home residents ( 9 women , 6 men , age range 77 - 98 years ) with severe dementia ( median Mini Mental State Examination score=8/30 , percentile (P)25 - 75=4 - 13 ) and known dysphagia participated in a r and omized controlled trial with cross-over design . Cervical spine mobilization was administered by trained physiotherapists . Control sessions consisted of socializing visits .  Feasibility ( attendance , hostility , complications ) and maximal swallowing volume ( water bolus 1 - 20 ml ) were assessed following one session and one week ( 3 sessions ) of treatment and control . RESULTS Ninety percent of cervical spine mobilization sessions were completed successfully ( 3 sessions could not be carried out due to the patient 's hostility and 2 due to illness ) and no complications were observed . Swallowing capacity improved significantly after cervical spine mobilization ( from 3 ml ( P25 - 75=1 - 10 ) to 5 ml ( P25 - 75=3 - 15 ) after one session p=0.01 and to 10 ml ( P25 - 75=5 - 20 ) ( + 230 % ) after one week treatment p=0.03 ) compared with control ( no significant changes , difference in evolution after one session between treatment and control , p=0.03 ) . CONCLUSION Cervical spine mobilization is feasible and can improve swallowing capacity in cognitively impaired residents in nursing homes . Given the acute improvements following treatment , it is probably best provided before meals Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more OBJECTIVES To evaluate whether age , sex , depression , dementia disorder , nutritional status , or level of functional balance capacity influences the effect of a high-intensity functional weight-bearing exercise program on functional balance . DESIGN Preplanned subgroup analyses of a r and omized controlled trial . SETTING Nine residential care facilities . PARTICIPANTS One hundred ninety-one people aged 65 to 100 dependent in activities of daily living and with Mini-Mental State Examination scores of 10 or greater . INTERVENTION A high-intensity functional weight-bearing exercise program or a control activity , each comprising 29 sessions over 3 months . MEASUREMENTS Functional balance capacity was assessed blindly using the Berg Balance Scale ( BBS ) at baseline , 3 months , and 6 months . The BBS consists of 14 tasks , common in everyday life , such as st and ing up from sitting and , while st and ing , reaching forward or turning 360 ° . Interactions between allocation to activity group and each subgroup were evaluated according to the intention-to-treat principle . RESULTS The subgroup analyses revealed no statistically significant interaction for age , sex , depression , dementia disorder , nutritional status , or level of functional balance capacity at 3 ( P=.65 , .65 , .51 , .78 , .09 , .67 , respectively ) or 6 ( P=.69 , .62 , .20 , .94 , .48 , .85 , respectively ) months . In addition , at 3 and 6 months there was no significant interaction for cognitive level ( P=.28 , .47 , respectively ) or number of depressive symptoms ( P=.85 , .49 , respectively ) . CONCLUSION Older age , female sex , depression , mild to moderate dementia syndrome , malnutrition , and severe physical impairment do not seem to have a negative effect on functional balance from a high-intensity functional weight-bearing exercise program . Consequently , people with these characteristics in residential care facilities should not be excluded from offers of rehabilitation including high-intensity exercises BACKGROUND Despite recognition that weight loss is a problem in elderly persons with probable Alzheimer 's disease ( AD ) , increasing their food intake remains a challenge . To effectively enhance intake , interventions must work with individuals ' changing needs and intake patterns . Previously , the authors reported greater food consumption at breakfast , a high-carbohydrate meal , compared with dinner , and shifts toward carbohydrate preference at dinner in those with increased behavioral difficulties , low body mass index , or both . METHODS Thirty-four nursing home residents with probable AD who ate independently participated in a r and omized , crossover , nonblinded study of two nutrition interventions . The intervention described here included replacing 12 nonconsecutive " traditional " dinners with meals high in carbohydrate but comparable to traditional dinners in protein . Measures included weighed food intake , body weight , cognitive function ( as assessed using the Severe Impairment Battery and Global Deterioration Scale ) , behavioral disturbances ( as assessed using the Neuropsychiatric Inventory-Nursing Home Version ) , and behavioral function ( as assessed using the London Psychogeriatric Rating Scale ) . RESULTS Group mean dinner and 24-hour energy intake increased during the intervention phase compared with baseline , protein intake was unaffected , and carbohydrate intake increased . Increased dinner intake , attributable to intervention foods , was achieved in 20 of 32 of participants who completed the study and was associated with increased carbohydrate preference , poorer memory , and increased aberrant motor behavior . Those with low body mass indices were the most resistant to the intervention . CONCLUSIONS Providing a high-carbohydrate meal for dinner increases food intake in seniors at later stages of the disease who are experiencing cognitive and behavioral difficulties , possibly as a result of a shift in preference for high-carbohydrate foods BACKGROUND Frail institutionalized elders have a high prevalence of nutritional risk factors , undernutrition , weight loss , and nutrition-related morbidity and excess mortality . Little information is available on effective means to intervene in this setting . HYPOTHESES We tested the hypothesis that addition of multinutrient oral supplements to the diet of frail elders would improve their overall nutritional status and functional level . METHODS Fifty nursing home residents aged 88+/-1 yr . were followed for 10 weeks in the course of a r and omized controlled trial of supplementation with a multinutrient liquid supplement vs. a non-nutritive placebo drink . Three-day food weighing was used to analyze their habitual dietary intake before and during the final week of the intervention . Nutritional status was further assessed with nutritional biochemistries , anthropometric measurements , and body composition analysis as well as physical and functional performance tests . RESULTS The nutritional supplement was consumed with high compliance , but did not significantly augment total caloric intake . Supplementation was associated with significant reductions in total energy , protein , fat , water , fiber , and many vitamins and minerals in the habitual diet of these nursing home residents . Nutritional status improved in terms of folate levels in serum , but no other measured vitamin or mineral indices . Body composition analysis revealed a small gain in weight , increases in fat stores , but no improvement in lean tissue mass associated with supplemention . No physical performance or functional gains were associated with supplementation . CONCLUSION Short-term nutritional supplementation in elders at nutritional risk is offset by simultaneous reduction in voluntary food intake . It seems likely that changing other components of energy expenditure such as physical activity levels or basal metabolism may be required to produce overall improvements in nutritional intake in this setting Background Food and drink are important determinants of physical and social health in care home residents . This study explored whether a pragmatic methodology including routinely collected data was feasible in UK care homes , to describe the health , wellbeing and nutritional status of care home residents and assess effects of changed provision of food and drink at three care homes on residents '  falls ( primary outcome ) , anaemia , weight , dehydration , cognitive status , depression , lipids and satisfaction with food and drink provision . Methods We measured health , wellbeing and nutritional status of 120 of 213 residents of six care homes in Norfolk , UK . An intervention comprising improved dining atmosphere , greater food choice , extended restaurant hours , and readily available snacks and drinks machines was implemented in three care homes . Three control homes maintained their previous system . Outcomes were assessed in the year before and the year after the changes . Results Use of routinely collected data was partially successful , but loss to follow up and levels of missing data were high , limiting power to identify trends in the data .This was a frail older population ( mean age 87 , 71 % female ) with multiple varied health problems . During the first year 60 % of residents had one or more falls , 40 % a wound care visit , and 40 % a urinary tract infection . 45 % were on diuretics , 24 % antidepressants , and 43 % on psychotropic medication . There was a slight increase in falls from year 1 to year 2 in the intervention homes , and a much bigger increase in control homes , leading to a statistically non-significant 24 % relative reduction in residents ' rate of falls in intervention homes compared with control homes ( adjusted rate ratio 0.76 , 95 % CI 0.57 to 1.02 , p = 0.06 ) . Conclusions Care home residents are frail and experience multiple health risks . This intervention to improve food and drink provision was well received by residents , but effects on health indicators ( despite the relative reduction in falls rate ) were inconclusive , partly due to problems with routine data collection and loss to follow up . Further research with more homes is needed to underst and which , if any , components of the intervention may be successful . Trial registration Trial registration : IS RCT N86057119 Objectives : We studied the nutritional status and the effects of nutritional intervention on body weight , cognition and activities of daily life (ADL)-function in demented individuals . Design : Controlled non-r and omised study . Setting : Group-living for demented elderly ( GLD ) , ie community assisted housing . Subjects and interventions : Twenty-two residents living in one of two units ( GLD-I ) , received oral liquid supplements ( 1720 kJ/410 kcal/day ) and the personnel of the GLD-I were given nutritional education .  Fourteen residents in the other unit ( GLD-C ) served as controls . After 6 months 21 ( 83 ( 4 ) y , 81 % women ) and 12 ( 85 ( 4 ) y , 100 % women ) of the participants , respectively , were re-examined according to body mass index ( BMI , kg/m2 ) , cognitive function ( Mini Mental State Examination ( MMSE , 0–30 p ) and Clinical Dementia Rating Scale ( CDR ) and the Katz ' ADL index . Results : Body mass index ( BMI ) ≤20 was found in 19 % of the participants and 44 % had BMI ≤23 . BMI correlated with MMSE ( r=0.43 , P<0.01 ) . The weight of the residents in the intervention group increased by 3.4 ( 3 ) kg ( P=0.001 ) at follow-up , whereas the weight remained unchanged in the control group . The cognitive function was low at the start in both groups , ie MMSE∼9 and no apparent positive effect of the nutritional intervention was seen . In addition , the ADL functions appeared to deteriorate in both groups . Conclusions : Being underweight was common among demented elderly in group-living and was related to low cognitive capacity . Five months of oral supplementation , along with education of personnel , was followed by a weight gain . In this study the nutritional treatment did not affect the rate of decline in cognitive function or Katz ' ADL index . Sponsorship : Supported by grants from the Swedish National Board of Health and Social Welfare . Semper Foods AB provided the liquid supplements PURPOSE This study was design ed to identify which of 3 treatments for aspiration on thin liquids-chin-down posture , nectar-thickened liquids , or honey-thickened liquids- results in the most successful immediate elimination of aspiration on thin liquids during the videofluorographic swallow study in patients with dementia and /or Parkinson 's disease . METHOD This r and omized clinical trial included 711 patients ages 50 to 95 years who aspirated on thin liquids as assessed videofluorographically .  All patients received all 3 interventions in a r and omly assigned order during the videofluorographic swallow study . RESULTS Immediate elimination of aspiration on thin liquids occurred most often with honey-thickened liquids for patients in each diagnostic category , followed by nectar-thickened liquids and chin-down posture .  Patients with most severe dementia exhibited least effectiveness on all interventions . Patient preference was best for chin-down posture followed closely by nectar-thickened liquids . CONCLUSION To identify best short-term intervention to prevent aspiration of thin liquid in patients with dementia and /or Parkinson 's disease , a videofluorographic swallow assessment is needed . Evidence -based practice requires taking patient preference into account when design ing a dysphagic patient 's management plan . The longer-term impact of short-term prevention of aspiration requires further study To investigate the effect of a medical food on cognitive function in people with mild Alzheimer 's disease ( AD ) Objective To investigate the extent that baseline cognitive impairment and intake adherence affected the 13-item Alzheimer ’s Disease Assessment Scale — cognitive subscale ( ADAS-cog ) intervention response of a medical food in Alzheimer ’s Disease ( AD ) patients .Desigrt/ setting / participants /intervention/ measurements This analysis was performed on data from a proof-of-concept study , consisting of a 12-week , double-blind , r and omized , controlled , multicenter trial , followed by a similarly design ed 12-week extension study . Patients with mild AD ( Mini-Mental State Examination [ MMSE ] score of 20–26 ) were r and omized to receive active or control product as a 125 ml daily drink . One of the co- primary outcome measures was the 13-item ADAS-cog . In this analysis , the study population was divided into two subgroups : patients with ‘ low ’ baseline ADAS-cog scores ( < 25.0 ) and patients with ‘ high baseline ADAS-cog scores ( ≥25.0 ) . Repeated Measures Models ( RMM ) were used to determine the relationship between ADAS-cog score and intervention . Results A significant treatment effect ( F[1,319]=4.0 , p=0.046 ) was shown in patients with ‘ high baseline ADAS-cog , but not in patients with ‘ low ’ baseline ADAS-cog ( F[1,250]= 1.25 , p=0.265 ) . Overall , intake adherence was significantly correlated with ADAS-cog improvement in the active product group ( correlation coefficient=−0.260 ; p=0.019 ) , but not the control group . Conclusion These data indicate that baseline ADAS-cog significantly influenced the effect of Souvenaid intervention on ADAS-cog outcome . A higher intake of active study product was also associated with greater cognitive benefit . These findings highlight the potential benefits of Souvenaid in AD patients and warrant confirmation in larger , controlled studies 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 R and omized , controlled trial . Setting Three long-term care facilities . Participants Sixty-three long-stay residents who had an order for nutrition supplementation . Intervention Participants were r and omized 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 OBJECTIVES To determine whether increases in caloric intake associated with consumption of a mid-morning nutritional supplement for 3 weeks were maintained in the week after stopping the supplement and to investigate the effects of body mass index ( BMI ) and cognitive and behavioral measures on this response . DESIGN Secondary analysis of a previously published r and omized , crossover , nonblinded clinical trial . SETTING A fully accredited geriatric care facility affiliated with the University of Toronto . PARTICIPANTS Thirty institutionalized seniors with probable Alzheimer 's disease ( AD ) who ate independently .  MEASUREMENTS Investigator-weighed food intake , body weight , cognitive ( Severe Impairment Battery ; Global Deterioration Scale ) and behavioral ( Neuropsychiatric Inventory -- Nursing Home version ; London Psychogeriatric Rating Scale ) assessment s. RESULTS Individuals who responded successfully to supplementation as indicated by increases in daily energy intake were likely to maintain 58.8 % of that increase postsupplementation , although stopping the supplement was associated with decreased habitual energy intake in low- BMI individuals who reduced their daily intakes during supplementation in response to the extra calories . Cognitive/behavioral tests were not reliable predictors of postsupplement intake . CONCLUSION Institutionalized seniors with probable AD are likely to alter their usual energy intakes to maintain changes result ing from 3 weeks of supplementation . This effect may allow for rotating supplementation schedules in nursing homes that could reduce staff burden , but only for those individuals who are most likely to respond favorably . These data indicate that nutritional supplements and diet plans should be carefully prescribed in low- BMI individuals to limit variability in total energy provided and thus prevent lower-than-normal intake OBJECTIVES To vali date a nutritional intervention programme for elderly people living in nursing homes . DESIGN In a prospect i ve , r and omized , controlled study of 88 residents , we determined nutritional status at day 0 and day 60 using a record of dietary intake , anthropometry , h and -grip strength and mini-nutritional assessment . Dietary intake , grip strength and body weight were also recorded at day 30 . We divided subjects into four groups according to their mini-nutritional assessment score . Those with a score 24 received no oral supplementation .  Those at risk of malnutrition ( with a score of 17 - 23.5 ) were r and omized to oral supplementation . Those with a score < 17 received oral supplementation . We recorded the amount of oral supplements consumed daily . RESULTS Compliance with oral supplementation was good , and daily intake averaged about 400 kcal . The total energy intake on day 60 was significantly higher in both of the groups that received supplements . Following supplementation , most subjects at risk of malnutrition improved their mini-nutritional assessment score and increased their weight ( by 1.4 + /- 0.5 kg ) . Neither the mini-nutritional assessment score nor weight improved in subjects at risk of malnutrition who did not receive supplements . Supplementation in the malnourished group result ed in a mean mini-nutritional assessment score increase ( from 13.9 + /- 2.6 to 17.1 + /- 3.9 ) and a mean weight gain of 1.5 + /- 0.4 kg . CONCLUSION Oral nutritional supplements are well accepted and result in increased daily protein and energy intake , body weight and nutritional status in most malnourished patients and in those at risk of malnutrition AIMS To evaluate the effect of a whole formula diet on nutritional and cognitive status in Alzheimer 's disease patients . METHODS Patients were r and omly assigned to two interventions : a whole formula diet based on lyophilised foods ( Treatment Group , n=24 ) or nutritional advice ( Control Group , n=29 ) . Energy intake , body weight , biochemistry , Mini Nutritional Assessment ( MNA ) and Pfeiffer 's tests were determined at baseline and at 3 months of treatment . RESULTS No differences were observed between groups at baseline . Energy intake tended to increase in the Treatment Group and to decrease in the Control Group , although differences were not significant . The improvement in MNA and Pfeiffer test scores was not significantly different between groups . Body weight increased by 2.06+/-1.9 kg in the Treatment Group and by 0.32+/-3.04 kg in the Control Group ( P=0.007 ) . The increases in albumin ( P=0.007 ) , haemoglobin ( P=0.002 ) and serum ferritin ( P=0.009 ) were higher in the Treatment Group than in controls . A similar rate of serious adverse events ( hospitalisation or death ) was observed in both groups . CONCLUSIONS Administration of this whole formula has a positive impact on nutritional status . The great diversity in textures and tastes enable these formulations to be administered to a wide range of patients with or without liquid dysphagia Objectives : To evaluate the acceptance of a multinutrient liquid nutrition supplement in psycho-geriatric nursing home patients and the effect on weight , plasma nutrients and activities of daily life . Design : Double-blind , placebo-controlled 12-week intervention study . Setting : Two nursing homes in Boxtel , The Netherl and s . Subjects : Forty-two ( body mass index ( BMI ) < 23 kg/m2 for men or < 25 kg/m2 for women ) psycho-geriatric nursing home patients aged 60 y or over . Interventions : Provision with a complete micronutrient-enriched liquid nutrition supplement of 125 ml and 0.6 MJ ( 135 kcal ) or placebo twice daily during daytime between main meals . Study parameters were assessed at 0 , 6 and 12 weeks . Main Outcome for Measures : Weight , Barthel index of daily activities , several plasma values ( albumin , C-reactive protein ( CRP ) , homocysteine , thiamine , thiamine diphosphate ( TDF ) , vitamin B6 , vitamin B12 , folic acid , vitamin D ) , bowel function . Results : The supplement was well accepted . Thirty-five patients completed the intervention period ( 16 control group ; 19 supplement group ) . Baseline daily nutrient intake was low . A statistically significant improvement was observed for body weight ( difference between groups 2.2 kg , P=0.03 ) , and homocysteine , vitamin B1 , TDF , vitamin B6 , vitamin B12 , folate and vitamin D in the supplement group compared to the placebo group . No significant difference was observed in the Barthel index ( mean difference −0.3±1.1 for both groups ) . No difference in occurrence of diarrhoea was observed . Conclusions : The study shows that nutritional supplementation is well accepted and can improve the nutritional status of psycho-geriatric nursing home patients .Sponsorship : Numico Research BV Background and aims : Many elderly people with Alzheimer ’s disease experience weight loss . Illness and inadequate regain after a period of illness are considered as contributory causes of progressive weight loss in psychogeriatric patients . We studied whether early use of a liquid nutrition supplement immediately after onset of acute illness from infection can prevent weight loss in elderly psychogeriatric nursing home residents . Methods : R and omised controlled trial of 5 weeks after the onset of illness . Thirty-four psychogeriatric nursing home residents ( aged ±65 yrs ) completed the study period . A liquid nutrition supplement ( 200 ml ) once daily immediately after diagnosis of infection or st and ard treatment ( enriched food after referral to a dietician ) were provided . Body weight , mid-upper arm circumference , calf circumference , triceps skin fold thickness , dietary energy intake , and need for care were measured . Results : Weight change during the study period was significantly different between the st and ard ( −0.4 kg ) and supplement ( + 0.8 kg ) groups ( p=0.040 ) . No significant differences were observed in changes of midupper arm circumference , triceps skin fold thickness , calf circumference or energy intake between groups . Conclusions : Early provision of a liquid nutrition supplement immediately after onset of acute illness from infection leads to weight gain in elderly psychogeriatric nursing home residents Background Loss of muscle mass is common among old people living in institutions but trials that evaluate interventions aim ed at increasing the muscle mass arc lacking . Objective , participants and interventionThis r and omized controlled trial was performed to evaluate the effect of a high intensity functional exercise program and a timed protein-enriched drink on muscle mass in 177 people aged 65 to 99 with severe physical or cognitive impairments , and living in residential care facilities . Design Three-month high-intensity exercise was compared with a control activity and a protein-enriched drink was compared with a placebo drink A bioeicctrical impedance spectrometer ( BIS ) was used in the evaluation The amount of muscle mass and body weight ( BW ) were followed-up at three and six months and analyzed in a 2 × 2 factorial ANCOVA , using the intention to treat principle , and controlling for baseline values . Results At 3-month follow-up there were no differences in muscle mass and BW between the exercise and the control group or between the protein and the placebo group . No interaction effects were seen between the exercise and nutritional intervention . Long term negative effects on muscle mass and BW was seen in the exercise group at the 6-month follow-up . Conclusion A three month high-intensity functional exercise program did not increase the amount of muscle mass and an intake of a protein-enriched drink immediately after the exercise did not induce any additional effect on muscle mass . There were negative long term effects on muscle mass and BW , indicating that it is probably necessary to compensate for an increased energy dem and when offering a high-intensity exercise program Context Patients with dysphagia are at increased risk for aspiration pneumonia . Contribution This trial involved 515 adults with dementia or Parkinson disease and videofluoroscopically demonstrated aspiration . Participants were r and omly assigned to drink thin liquids with a chin-down posture or to drink nectar- or honey-thick liquids in a head-neutral position . At 3 months , the cumulative incidence of pneumonia was about 10 % , 8 % , and 15 % in the thin , nectar-thick , and honey-thick liquid groups . Dehydration was more common with thick than thin liquids . Caution Findings were inconclusive . The incidence of pneumonia was lower than expected , and confidence bounds around differences between groups were wide . The Editors Swallowing disorders are associated with increased morbidity and mortality . An estimated 18 million adults will require care for dysphagia-related malnutrition , dehydration , pneumonia , and reductions in quality of life by 2010 ( 13 ) . Patients with dysphagia have an increased incidence of aspiration pneumonia because the aspirated material is heavily colonized with bacteria . Pneumonia is the fifth leading cause of infectious death in the United States among persons age 65 years or older and the third leading cause of death for persons age 85 years or older ( 4 ) . One hospital admission for pneumonia is estimated to cost $ 7166 ( 5 ) . Rates of hospital discharge for Medicare beneficiaries with pneumonia as a primary diagnosis have increased by 93.5 % in the past decade ( 6 ) , along with length of stay and death rates ( 4 ) . Liquid aspiration is the most common type of aspiration in elderly persons ( 1 ) . Relative risk for pneumonia is highest in patients with dementia , followed by those who are institutionalized ( 7 ) . As many as 50 % of patients with parkinsonism are estimated to have dysphagia ( 8) , and one third aspirate silentlythat is , with no external sign ( such as coughing ) to eject material or alert caregivers ( 9 ) . Many short- and long-term care facilities use thickened liquid diets to treat aspiration ( 10 ) . In these diets , thin liquids ( for example , water , tea , and coffee ) are eliminated , even in the absence of efficacy data , at a substantial cost in financial and quality -of-life terms . It costs approximately $ 200 per month for an individual to drink thickened liquids ( 11 , 12 ) . A common alternative to thickened liquids is use of a chin-down posture ( 1317 ) . Welch and coworkers ( 13 ) noted that posterior shift of anterior pharyngeal structures with the chin-down posture improved airway protection . Whereas previous studies have provided a basis for the widespread clinical use of chin-down posture , none has provided long-term health outcome data . Results from a previously reported portion of this study ( 18 ) demonstrated that short-term elimination of aspiration during the videofluorographic swallowing evaluation occurred most often with honey-thick liquids , followed by nectar-thick liquids and chin-down position . We sought to compare the effectiveness of chin-down posture and thickened liquids ( nectar thick and honey thick ) on the incidence of pneumonia in participants with dementia or Parkinson disease during 3 months of treatment . Methods Design The study design and methods are described in detail elsewhere ( 19 ) . In brief , between enrollment initiation on 9 June 1998 and closure on 16 September 2005 , 47 acute-care hospitals and 79 subacute residential facilities combined their patients to enroll 515 participants , a total that was 65 participants short of the recruitment goal . Follow-up was completed on 9 December 2005 . The Data and Safety Monitoring Committee recommended discontinuing enrollment , on the basis of a futility analysis suggesting that enrolling additional participants would not change the findings . Participants were enrolled in this 3-month follow-up study if they were observed to aspirate when swallowing 3 mL of thin liquids from a spoon or when drinking from a cup without an intervention during videofluoroscopy of swallowing . Aspiration was defined as barium observed below the vocal folds . Participants who qualified were then given boluses to perform 3 conditions in r and om order : thin liquid ( 15 centipoise ) swallowed in a chin-down posture , nectar-thick liquid ( 300 centipoise ) swallowed in a head-neutral position , and honey-thick liquid ( 3000 centipoise ) swallowed in a head-neutral position . Participants who did equally well ( all conditions eliminated aspiration ) or equally poorly ( no conditions eliminated aspiration ) but wished to continue oral intake , despite being warned about risk for pneumonia , were r and omly assigned to 1 of the conditions as an intervention and followed for 3 months . Participants who aspirated during 1 or 2 of the conditions were not r and omly assigned . On-site speech- language pathologists , nurses , and direct care and dietary staff who completed rigorous training about facilitation of the chin-down posture and proper techniques to thicken liquids supervised administration of the interventions . The number of participants under supervision by a speech- language pathologist ranged from 1 to 93 ( median , 4 participants ) . Clinicians were instructed to refrain from using concomitant active or compensatory interventions with participants during the study period . Research staff made monthly site visits to monitor protocol adherence . All participants or their representatives provided written informed consent . Each facility 's institutional review board of record , as approved by the Office for Human Research Protections , Department of Health and Human Services , approved the study . Setting and Participants Inclusion criteria were a physician-identified diagnosis of dementia ( Alzheimer type , single or multistroke type , or other nonresolving types ) or Parkinson disease and patient age ( 50 to 95 years ) . Exclusion criteria were tobacco use in the past year , current alcohol abuse , history of head or neck cancer , insulin-dependent diabetes for 20 years or more , nasogastric tube , other progressive or infectious neurologic diseases , or pneumonia within 6 weeks of enrollment . Out patients and in patients from participating acute and subacute care facilities who were suspected of aspirating liquids by their physicians and speech- language pathologists during st and ard clinical care were referred for a videofluoroscopic swallowing study at a participating acute-care facility . The speech- language pathologist or research personnel completed the informed consent process with the patient and care provider before the swallowing study . After the swallowing study , participants returned to their living situation ( acute care , subacute care , or home ) while the videofluoroscopic images were analyzed . Participants were r and omly assigned to an intervention group within 24 hours . R and omization and Interventions The primary interventions were  chin-down posture  while consuming thin liquids versus consuming thickened liquids ( nectar thick or honey thick ; Re source ThickenUp , Nestl HealthCare Nutrition [ formerly Novartis Medical Nutrition ] , St. Louis Park , Minnesota ) in a head-neutral position . The thin , nectar-thick , and honey-thick barium solutions ( Varibar , E-Z-EM , Lake Success , New York ) were manufactured in a st and ardized formulation for this study . St and ardized recipes matching the viscosities of the barium products were developed for a wide variety of thickened beverages . Participants were r and omly assigned central ly by a telephone system controlled by the Statistical and Data Center at the EMMES Corporation ( Rockville , Maryl and ) . A study speech- language pathologist called a central telephone number and entered participant criteria when prompted to , by using the telephone keys . If the patient was eligible , an intervention was assigned and a summary page that included intervention assignment and meal-monitoring was faxed to the speech- language pathologist . R and omization sequences for primary assignment ( chin-down posture vs. thickened liquids ) were developed by a statistician at the Statistical and Data Center . The sequences were stratified by participant age ( 50 to 79 years or 80 to 95 years ) and diagnosis ( Parkinson disease with or without dementia , or dementia only ) and included r and omly assigned block sizes of 32 , 40 , or 48 within each of the 4 strata . If a participant was assigned to thickened liquids , a second r and omization was done to assign the participant to nectar-thick liquids or honey-thick liquids with equal probability . Neither the participants nor direct caregivers were blinded to intervention assignment , but neither group made outcome judgments . We expected that all liquids , regardless of amount or frequency of administration , would be provided to participants consistent with the intervention to which the participant was r and omly assigned . All participants continued nonliquid nutritional intake in the same manner as before enrollment . Eight percent received nutrition by means of a gastrostomy tube . Measurements and Outcomes Primary Outcome The primary outcome for the study was definite pneumonia . Definite pneumonia was defined as evidence of pneumonia on chest radiography or 3 or more of the following : sustained fever ( temperature > 100F [ 38C ] ) , rales or rhonchi on chest auscultation , sputum Gram stain showing substantial leukocytes , or sputum culture showing a respiratory pathogen . Suspected pneumonia was defined as at least 2 of the 4 features of definite pneumonia ( except evidence of pneumonia on a chest radiograph ) . The primary care physician determined the need for chest radiography or sputum culture as part of st and ard clinical care . Chest radiography was done in all 52 patients with pneumonia ; 2 of these patients did not have evidence of pneumonia on chest radiography but had 3 or 4 of the features of definite pneumonia . Secondary Outcomes and Comparisons A secondary outcome of interest was definite pneumonia or death . Secondary comparisons of interest were relative effectiveness of the 2 Aims : The aim of this pilot study was to examine the effect of a home-made oral supplement on body weight and energy intake of old people residing in a nursing home . Methods : Sixty-six old ( 65 + years ) nursing home residents were included and divided into three classes according to their Mini Nutritional Assessment ( MNA ) scores . Participants who scored 17–23.5 MNA points ( at risk of undernutrition ) and had a BMI < 24 kg/m2 were r and omly allocated ( block r and omization ) to two groups : B and C. Participants with < 17 MNA-points ( undernourished ) were allocated to group A. The participants allocated to groups A and B received a home-made oral supplement every evening for two consecutive months . Results : The results after two months showed that compliance with the supplement was good and daily intake from the supplement averaged 1.6 MJ . The total energy intake in group A significantly increased ( p<0.001 ) , without suppressing the intake of energy from normal food . Group B experienced a decrease in the intake of normal food and hence no overall change in food intake . Body weight was unchanged in all groups . Conclusions : Our limited data suggest that a home-made oral supplement can improve the total energy intake of nursing home residents who are undernourished according to the MNA OBJECTIVES To examine clinical outcomes and describe the staffing requirements of an incontinence and exercise intervention . DESIGN R and omized controlled trial with blinded assessment s of outcomes at three points over 8 months . SETTING Four nursing homes . PARTICIPANTS Two hundred fifty-six incontinent residents . INTERVENTION Research staff provided the intervention , which integrated incontinence care and exercise every 2 hours from 8:00 a.m. to 4:00 p.m. 5 days a week . MEASUREMENTS Average and maximum distance walked or wheeled , level of assistance required to st and , maximum pounds lifted by arms , fecal and urinary incontinence frequency , and time required to implement intervention . RESULTS Intervention residents maintained or improved performance whereas the control group 's performance declined on 14 of 15 outcome measures . Repeated measures analysis of variance group-by-time significance levels ranged from P < .0001 to.05 . The mean time required to implement the intervention each time care was provided was 20.7 + /- 7.2 minutes . We estimate that a work assignment of approximately five residents to one aide would be necessary to provide this intervention . CONCLUSIONS The incontinence care and exercise intervention result ed in significant improvement for most residents , and most who could be reliably interviewed expressed a preference for such care . Fundamental changes in the staffing of most nursing homes will be necessary to translate efficacious clinical interventions into everyday practice Executive summary Background Older adults with dementia may have feeding difficulties for several reasons : they may experience deterioration in motor and cognitive skills making eating difficult , they may forget to eat , fail to recognise food or they may suffer from dysphagia . Food intake is often poor and malnutrition is common , leading to adverse health outcomes . This review specifically focussed on how best to promote and achieve ‘ normal ’ eating and feeding in older adults with dementia , in order that undernutrition and its consequences could be avoided . Review Objectives The aim was to identify and assess the effectiveness of interventions that encouraged eating and minimised risk of undernutrition in older adults with dementia . Types of Participants Adults over the age of sixty with dementia in any care setting ( who were not living independently ) . People receiving enteral tube feeding were excluded . Types of Interventions Any intervention that promoted dietary intake e.g. changes in practice of health care workers , family or volunteers , educational interventions , changes in food service . Types of Outcomes The primary outcomes were improvement in dietary intake and /or nutritional status . Measurements included : dietary intake , anthropometry , clinical outcomes , functional indicators . Types of Studies R and omised controlled trials , controlled trials and quasi‐experimental studies with a ‘ before and after ’ design . Search Strategy The search strategy aim ed to find both published and unpublished studies using a three‐step approach . Papers were limited to the English language and a date restriction of 1999 to 2009 was set . Critical appraisal Papers selected for retrieval were assessed by two independent review ers for method ological validity prior to inclusion in the review . Disagreements that arose between the review ers were resolved through discussion . Data Extraction For quantitative studies , data was extracted using a data extraction form developed to include specific details about the interventions , population s , study methods and outcomes of significance to the review question and specific objectives . This was based on the JBI data extraction tool from MAStARI and 2 review ers extracted data independently . Data synthesis Heterogeneity in study design s , interventions and outcomes meant meta‐ analysis was not possible . Findings were discussed in a narrative summary . Results The review included 11 studies . This included one RCT , 1 r and omised crossover study , 3 controlled non‐r and omised trials , 6 quasi‐experimental studies . None of the studies provided robust evidence , however there was moderate evidence ( Level 3 ) to support a Grade B recommendation for improvements in dietary intake and /or nutritional status with the following interventions : education of healthcare staff , simple environmental manipulations such as the use of high contrast tableware or small dining rooms , the introduction of something of interest such as an aquarium or background music , or the provision of feeding assistance , provision of enhanced menus , use of a de central ised food service , enhanced nutritional screening combined with increased dietetic time .  Conclusion There is moderate ( Level 3 ) evidence to support each of the interventions appraised in this review . Implication s for Practice There is moderate support that warrants consideration of the interventions listed above . Careful monitoring of weight of individual residents would help to determine the effectiveness of any such change in delivery of care . Implication s for Research Future research into interventions to improve eating and minimise undernutrition in older people with dementia should feature the following : inclusion of reliable outcome measures , full details of interventions , r and omisation of participants , inclusion of control groups , adequate sample sizes , longitudinal follow up , consideration of baseline demographics of intervention groups , and experimental design that allows the determination of the effectiveness of individual definable changes in delivery of care OBJECTIVES To examine whether providing a midmorning nutrition supplement increases habitual energy intake in seniors with probable Alzheimer 's disease ( AD ) and to investigate the effects of body weight status and cognitive and behavioral function on the response to the intervention . DESIGN R and omized , crossover , nonblinded clinical trial . SETTING A fully accredited geriatric teaching facility affiliated with the University of Toronto 's Medical School with a home for the aged . PARTICIPANTS Thirty-four institutionalized seniors with probable AD who ate independently . INTERVENTION Nutrition supplements were provided between breakfast and lunch for 21 consecutive days and compared with 21 consecutive days of habitual intake . MEASUREMENTS Investigator-weighed food intake , body weight , cognitive function ( Severe Impairment Battery and Global Deterioration Scale ) , behavioral disturbances ( Neuropsychiatric Inventory-Nursing Home Version ) , and behavioral function ( London Psychogeriatric Rating Scale ) . RESULTS Relative to habitual intake , group mean analyses showed increased 24-hour energy , protein , and carbohydrate intake during the supplement phase , but five of 31 subjects who finished all study phases completely compensated for the energy provided by the supplement by reducing lunch intake , and 24-hour energy intake was enhanced in only 21 of 31 subjects . Compensation at lunch was more likely in subjects with lower body mass indices , increased aberrant motor behavior , poorer attention , and increased mental disorganization/confusion . CONCLUSION Nutrition supplements were least likely to enhance habitual energy intake in subjects who would normally be targeted for nutrition intervention-those with low body weight status . Those likely to benefit include those with higher body mass indices , less aberrant motor problems , less mental disorganization , and increased attention Background Liquid aspiration during swallowing has been linked to pneumonia , the most common cause of infectious death in the elderly . This paper examines the key issues in the design and implementation of the first multisite , r and omized behavioral trial in dysphagia in an aging population . The study evaluated two commonly used treatments with respect to short-term and long-term management of liquid aspiration and subsequent pneumonia in dysphagic geriatric participants with dementia and /or Parkinson 's disease . Methods Discussed are lessons learned during the conduct of this trial and include ( 1 ) ethical and method ological design issues , ( 2 ) pragmatic implementation of procedures and forms , ( 3 ) importance of multiple communication and monitoring strategies , ( 4 ) response to funding issues , and ( 5 ) changes in staff and facilities . Results In order to complete this trial the research ers were required to provide more support than anticipated in tasks such as completion of regulatory requirements by sites , supplementing site staff to identify potential study participants using a ‘ circuit rider ’ approach , continued recruitment of new sites and staff throughout the course of the trial , adapting forms and procedures and managing within economic constraints in a changing trial environment . Limitations Many of the challenges faced by the research ers were not anticipated when the study began . Successful strategies are described for these unanticipated difficulties , based on retrospective evaluation . Conclusions Successful conduct of clinical trials in long-term care environments that are heavily impacted by changes extraneous to the trial design and with staff typically new to clinical trials is possible but success depends on logistical flexibility Objectives To determine whether in the current study the supply of a nutrient dense drink has a positive effect on mental and physical function of institutionalized elderly people . Design A 24-week , r and omized , double-blind , placebo-controlled , parallel-group , intervention trial . Setting Homes for the elderly and nursing homes in the Netherl and s. Participants Institutionalized elderly people older than 60 years , with a BMI ≤ 30 kg/m2 , and a Mini-Mental State Examination score of at least 10 points . InterventionIn addition to their usual diet the participants ( n=176 ) received either a nutrient dense drink or a placebo drink twice a day during 24 weeks . Measurements The functionality measures included cognitive function , mood , physical performance and the ability to perform activities of daily living . Results In the supplement group a favorable effect of the intervention drink on body weight ( 1.6 kg difference in change ; P = .035 ) , calf circumference ( 0.9 cm difference in change ; P = .048 ) , and blood values ( e.g. Hcy decreased from 16.8 to 11.2 µmol/L in the supplement group ) was found . In the total group no significant effect was found on functionality outcomes . However , a subgroup of participants with BMI at baseline below 24.4 kg/m2 performed better on the cognitive subscale of Alzheimer ’s Disease Assessment Scale ( P = .09 ) , and its language sub score ( P = .01 ) after 24 weeks of intervention . Conclusion The results in the total group of this trial suggest that the nutritional supplement used in this study improves nutritional status . 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 OBJECTIVES To study the effects of oral nutritional supplements ( OS ) on body weight , body composition , nutritional status , and cognition in elderly patients with Alzheimer 's disease ( AD ) . DESIGN Prospect i ve , r and omized , controlled study . SETTING Geriatric wards and day care centers in the Toulouse area , France . PARTICIPANTS Ninety-one subjects with AD aged 65 and older at risk of undernutrition as evaluated using the Mini Nutritional Assessment . INTERVENTION After r and omization , 46 patients ( intervention group ) received 3-month OS . The other 45 patients ( control group ) received usual care . MEASUREMENTS Weight , body composition ( evaluated using dual-energy x-ray absorptiometry ) , cognitive function , activities of daily living , eating behavior , and dietary intakes were evaluated at the beginning of the study and at 3 months and 6 months . Supplement compliance was recorded each day . RESULTS Between baseline and 3 months , energy and protein intakes significantly improved in the intervention group , result ing in a significant increase in weight and fat-free mass , but no significant changes were found for dependence , cognitive function , or biological markers . The nutritional benefit was maintained in the intervention group after discontinuation of OS at 3 months . CONCLUSION Three-month daily OS significantly improves body weight . It is practicable and effective , and the patients accepted it well . The improvement that was observed even in the control group showed that caregiver education is an important factor in maintaining the nutritional status of patients with AD . Moreover , regular courses of OS may help to maintain the increase in fat-free mass and improve the nutritional status of these patients OBJECTIVE To evaluate a three-phase , behavioral intervention to improve fluid intake in nursing home ( NH ) residents . DESIGN Controlled clinical intervention trial . SETTING Two community NHs . PARTICIPANTS Sixty-three incontinent NH residents . INTERVENTION Participants were r and omized into intervention and control groups . The intervention consisted of three phases for a total of 32 weeks : ( 1 ) 16 weeks of four verbal prompts to drink per day , in between meals ; ( 2 ) 8 weeks of eight verbal prompts per day , in between meals ; and ( 3 ) 8 weeks of eight verbal prompts per day , in between meals , plus compliance with participant beverage preferences . MEASUREMENTS Between-meal fluid intake was measured in ounces by research staff during all three phases of the intervention . Percentage of fluids consumed during meals was also estimated by research staff for a total of nine meals per participant ( 3 consecutive days ) at baseline and at 8 and 32 weeks into the intervention . Serum osmolality , blood urea nitrogen , and creatinine values were obtained for all participants in one of the two sites at the same three time points . RESULTS The majority ( 78 % ) of participants increased their fluid intake between meals in response to the increase in verbal prompts ( phase 1 to 2 ) . A subset of residents ( 21 % ) , however , only increased their fluid intake in response to beverage preference compliance ( phase 3 ) . There was a significant reduction in the proportion of intervention participants who had laboratory values indicative of dehydration compared with the control participants . Cognitive and nutritional status were predictive of residents ' responsiveness to the intervention . CONCLUSIONS A behavioral intervention that consists of verbal prompts and beverage preference compliance was effective in increasing fluid intake among most of a sample of incontinent NH residents . Verbal prompting alone was effective in improving fluid intake in the more cognitively impaired residents , whereas preference compliance was needed to increase fluid intake among less cognitively impaired NH residents The purpose was to test the hypothesis that a multifaceted 11 weeks r and omized controlled intervention would have a significant influence of functional abilities in old nursing home residents . Participants were 121 old ( > 65 years ) residents in seven Danish nursing homes . The intervention consisted of nutrition ( chocolate , homemade oral supplements ) , group exercise ( moderate intensity ) and oral care . Measurements taken were weight , body mass index ( BMI ) , energy and protein intake , and functional abilities ( activities of daily living = ADL , cognitive performance , and social engagement ) . The results showed that the nutrition and exercise were well accepted . After 11 weeks the change in % weight ( 1.3 vs. -0.6 % , p=0.005 ) , % BMI ( 0.4 vs. -0.2 % , p=0.003 ) , energy intake ( 0.7 vs. -0.3 MJ/day , p=0.084 ) and protein intake ( 5 vs. -2g/day , p=0.012 ) was higher in the intervention group than in the control group . Also , after 11 weeks , social and physical function had decreased in the control group but was unchanged in the intervention group . The difference between groups was significant in relation to social engagement ( p=0.009 ) . After the end of the intervention both groups had lost weight and physical function . Cognitive performance did not change , at any time . In conclusion , it seems possible to maintain social ( and physical ) functional abilities in old nursing home residents by means of a multifaceted intervention Physical frailty and fall-related injuries present two of the biggest threats to older people 's functioning and quality of life . The Frailty and Injuries :  Cooperative Studies of Intervention Techniques ( FICSIT ) trials represent a set of eight different clinical trials concerning physical frailty and injuries in later life . This report documents the history and organization of the trials and provides an overview of the measures being collected at multiple sites and the analytic strategies to be used for multi-site investigations BACKGROUND Although disuse of skeletal muscle and undernutrition are often cited as potentially reversible causes of frailty in elderly people , the efficacy of interventions targeted specifically at these deficits has not been carefully studied . METHODS We conducted a r and omized , placebo-controlled trial comparing progressive resistance exercise training , multinutrient supplementation , both interventions , and neither in 100 frail nursing home residents over a 10-week period . RESULTS The mean ( + /- SE ) age of the 63 women and 37 men enrolled in the study was 87.1 + /- 0.6 years ( range , 72 to 98 ) ; 94 percent of the subjects completed the study .  Muscle strength increased by 113 + /- 8 percent in the subjects who underwent exercise training , as compared with 3 + /- 9 percent in the nonexercising subjects ( P < 0.001 ) . Gait velocity increased by 11.8 + /- 3.8 percent in the exercisers but declined by 1.0 + /- 3.8 percent in the nonexercisers ( P = 0.02 ) . Stair-climbing power also improved in the exercisers as compared with the nonexercisers ( by 28.4 + /- 6.6 percent vs. 3.6 + /- 6.7 percent , P = 0.01 ) , as did the level of spontaneous physical activity . Cross-sectional thigh-muscle area increased by 2.7 + /- 1.8 percent in the exercisers but declined by 1.8 + /- 2.0 percent in the nonexercisers ( P = 0.11 ) . The nutritional supplement had no effect on any primary outcome measure . Total energy intake was significantly increased only in the exercising subjects who also received nutritional supplementation . CONCLUSIONS High-intensity resistance exercise training is a feasible and effective means of counteracting muscle weakness and physical frailty in very elderly people . In contrast , multi-nutrient supplementation without concomitant exercise does not reduce muscle weakness or physical frailty OBJECTIVE We tested the hypothesis that a multifaceted 11-wk intervention comprising nutrition , group exercise , and oral care would have a significant influence on nutrition and function in elderly ( > or=65 y ) nursing-home residents . METHODS The study was an 11-wk r and omized controlled intervention study with nutrition ( chocolate and homemade oral supplements ) , group exercise twice a week ( 45 - 60 min , moderate intensity ) , and oral care intervention one to two times a week , with the aim of improving nutritional status and function in elderly nursing-home residents . A follow-up visit was made 4 mo after the end of the intervention . Assessment s were weight , body mass index , dietary intake , h and grip strength , Senior Fitness Test , Berg 's Balance Scale , and the prevalence of plaque . RESULTS A total of 121 subjects ( 61 % ) accepted the invitation and 62 were r and omized to the intervention group . Six of these dropped out during the 11 wk . At the 4-mo follow-up there were 15 deaths in the intervention group and 8 in the control group . The nutrition and exercise were well tolerated . After 11 wk the change in percentage of weight ( P = 0.005 ) , percentage of body mass index ( P = 0.003 ) , energy intake ( P = 0.084 ) , protein intake ( P = 0.012 ) , and Berg 's Balance Scale ( P = 0.004 ) was higher in the intervention group than in the control group . In addition , the percentage of subjects whose functional tests improved was higher in the intervention group . Both groups lost the same percentage of weight after the intervention ( P = 0.908 ) . The total percentage of weight loss from baseline to follow-up was higher in the control group ( P = 0.019 ) . Oral care was not well accepted and the prevalence of plaque did not change . CONCLUSION It is possible to improve nutrition and function in elderly nursing-home residents by means of a multifaceted intervention consisting of chocolate , homemade supplements , group exercise , and oral care
Background Eating and drinking difficulties are recognised sources of ill health in people with dementia .
In the EDWINA ( Eating and Drinking Well IN dementiA ) systematic review we aim ed to assess effectiveness of interventions to directly improve , maintain or facilitate oral food and drink intake , nutrition and hydration status , in people with cognitive impairment or dementia ( across all setting s , levels of care and support , types and degrees of dementia ) .
Interventions included oral nutrition supplementation , food modification , dysphagia management , eating assistance and supporting the social element of eating and drinking .