High-intensity functional exercise program and protein-enriched energy supplement for older persons dependent in activities of daily living: a randomised controlled trial. Good nutritional oral intake is associated with equal survival in demented and nondemented very old patients. The effect of nutritional intervention in elderly subjects residing in group-living for the demented 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. Nutritional status of elderly female nursing home residents; the effect of supplementation with a physiological dose of water-soluble vitamins. 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 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 Providing nutrition supplements to institutionalized seniors with probable Alzheimer's disease is least beneficial to those with low body weight status. A prospective study of the use of liquid oral dietary supplements in nursing homes. 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. Dementia and Nutrition. Intervention study in institutionalized patients with Alzheimer disease.
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 OBJECTIVE To evaluate the association of oral food intake with survival in very old demented nursing home patients . DESIGN A prospect i ve cohort study . SETTING A nursing home in northern Italy . MEASUREMENTS  Anthropometric and laboratory nutritional indicators and nutrient intake  were assessed in 33 demented ( age 85.7 + /- 5.7 years ) and 25 nondemented ( age 84.9 + /- 5.7 years ) patients .  Mortality data were collected over a 28-month follow-up period . Association of survival with dementia was estimated by Kaplan-Meyer analysis and multivariate Cox proportional hazard models . RESULTS Nutrient intake and nutritional status were good compared with data in the literature and were similar in demented and nondemented patients , except for smaller triceps skinfold thickness in the demented . The cumulative annual death rate was 0.23 deaths per subject per year , similar in the demented ( 0.23 ) and the nondemented ( 0.22 ) . Unadjusted survival by Kaplan-Meyer analysis was similar in the two groups , and correction for-age , gender , cognition , triceps skinfold thickness , and number of drugs in a Cox model did not alter the relationship . CONCLUSIONS Dementia developing in very old age is not necessarily associated with malnutrition and decreased life expectancy 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 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 OBJECTIVE To assess the nutritional status of female elderly nursing home residents and to study the effect of dietary supplementation with a physiological dose of water-soluble vitamins . DESIGN Single-blind , r and omised , placebo-controlled intervention trial . Daily consumed supplement consisted of fortified fruit juice containing 50 g carbohydrate and 50 % of the daily dietary recommendations of water-soluble vitamins . Regular fruit juice was used as placebo .  Dietary intake assessment at baseline . Fasting blood sample , anthropometric measurements and medical record at baseline and after 4 and 12 weeks of supplementation . SETTING Three nursing homes within 40 km of the coordination centre ( Department of Human Nutrition , Wageningen Agricultural University , the Netherl and s ) . SUBJECTS Forty-two female nursing home residents aged 60 years and older , in relatively stable health condition , at least 3 months resident at baseline . In each nursing home , 14 subjects were r and omly assigned to the supplement or control group . INTERVENTIONS Twelve weeks of supplementation . RESULTS Participants had a poor nutritional status . Dietary supplementation significantly improved the concentrations of thiamin pyrophosphate and pyridoxal 5'-phosphate , increased body weight and decreased serum homocysteine concentration in the supplement group . Plasma vitamin C levels were significantly increased in both supplement and control group . CONCLUSIONS Even in this heterogeneous population of female nursing home elderly it is possible to improve the nutritional status through dietary intervention with a physiological dose of water-soluble vitamins 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 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 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 OBJECTIVE To investigate the use of liquid oral dietary supplements among nursing home residents who were eating poorly and losing weight . DESIGN A prospect i ve , descriptive , anthropological study . SETTING Two proprietary nursing homes with 105 and 138 beds . PARTICIPANTS Purposive sampling was used to select 40 residents from among the 100 residents who were not eating well .  Dietary data  were collected on this sub- sample of 40 residents . MEASUREMENTS  Participant observation , in-depth interviews , event analysis , bedside dysphagia screenings , oral health examinations , body weight , body mass index ( BMI ) , and chart review  were used to collect data . Dietary data were collected over a 3-day period , and data were gathered on how supplements were ordered , served , and consumed . RESULTS Supplements had been ordered for 29 of the sub sample of 40 residents . Only nine of 29 residents were served the correct number and type of supplements as ordered by their physicians , and only two residents consumed the full amount of supplement as ordered . The overall mean percentage of supplement consumed compared with that ordered was 55.1 % . Although supplements were ordered primarily to prevent weight loss and to facilitate weight gain , nearly half ( n = 14 ) of the residents continued to lose weight . Supplements were ordered without investigating the underlying factors contributing to weight loss , such as inadequate staffing and lack of supervision at mealtime , undiagnosed dysphagia , and poor oral health . Without evaluation of these factors , it is unknown which residents might benefit from oral supplements . CONCLUSION Findings indicate that supplements were used nonspecifically as an intervention for weight loss in nursing home residents without regard to dose , diagnosis and management of underlying problem(s ) , amount of supplement consumed , and outcome . Further research is needed to establish when supplements should be ordered , how to ensure that they will be taken , and whether they are effective 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 OBJECTIVES To know nutritional status of a group of institutionalized patients with moderate Alzheimer 's Disease ( AD ) , and to ascertain the effects of an intervention with nutritional supplements on morbidity and mortality after one year follow-up . PATIENTS AND METHODS 99 patients ( mean age : 86.5 years ) , 80 women , with a diagnosis of AD according with NINCDS/ADRDA criteria , were recruited from 8 nursing-homes . 25 were included in an intervention group and received a nutritional supplements along 12 months . Evolution was evaluated according to the Functional Assessment Staging Test ( FAST ) . Patients with FAST levels 5 - 6 were included . General clinical variables as well as variables reflecting cognitive state and nutritional status : anthropometric , biochemical data and Mini Nutritional Assessment ( MNA ) were analysed . Statistical analysis was carry out with the SPSS 10.0 package . RESULTS Mean time since diagnosis was 49 months , with a 20.2 months duration of institutionalization . Mean value of MNA was 20.1 3.5 . 16.5 % of patients had a BMI equal o lower than 21 . After one year the intervention group showed higher levels of albumin ( P=05 ) , pre-albumin ( P=05 ) , iron ( P=01 ) , zinc ( P=05 ) , and beta-carotene ( P=05 ) than the control group . The same response in BMI ( P=05 ) , MNA ( P=05 ) , and triceps skinfold ( P=01 ) . Mortality was lower ( 16 % vs. 22.7 % ) , without statistical significance , in the intervention group , as it was the number of infectious events ( 47 % vs. 66 % P=05 ) , and the days in bed ( 7.5 2.1 vs. 17.3 5.6 P=05 ) . CONCLUSION Nutritional supplements applied to a group of patients with AD living in nursing-homes can reduce morbidity and mortality after one year follow-up
EXECUTIVE SUMMARY This systematic review investigated the prescription , administration and effectiveness of oral liquid nutritional supplements ( OLNS ) for people with dementia in residential aged care facilities ( RACF ) .
Dementia is an umbrella term for a large group of conditions that cause a progressive decline in a person 's functioning .
There are different forms of dementia and each has its own causes .
Residents with Alzheimer 's disease and dementia are particularly vulnerable to malnutrition and weight loss because of increased energy dem and s due to pacing or w and ering ; food refusal due to lack of appetite , agitation or memory loss ; or physical deterioration leading to inability to self-feed , chew or swallow , though these symptoms are not unique to persons with dementia .
Maintaining adequate nutrition for persons with dementia in residential care , in the context of these special needs , presents an increased challenge .