Older adults in nursing home and home-care are a particularly high-risk population for weight loss or poor nutrition
. In Denmark as many as 50% of older adults in nursing homes suffer from unintended weight loss and, app. 20% of the residents and 12% of the clients have a body mass index (BMI) below 18.5
The negative consequences of undernutrition, i.e. increased risk for morbidity and mortality, impaired cognitive, physical, and social function and hence reduced quality of life, and increased health care costs, hospital stays, more general practitioner visits, more intensive nursing care, increased requirement of nursing home-care etc.
. The increased need for care and social services leads to costs of billions of euro’s every year
. A Dutch study showed extra cost for managing nursing home residents at risk of undernutrition at 8.000 euro per nursing home resident and 10.000 Euro for undernourished residents
. And a Danish, Swedish and a Norwegian study have shown that older adults in respectively, nursing homes and home-care, who are undernourished, need more assistance with Activities of Daily Living (ADL) than older adults who are in good nutritional status and due to that, may add to the substantial and costly burden of care
[3, 5, 6].
Several potentially modifiable nutritional risk factors increase the likelihood of weight loss or poor nutrition
[7, 8]. Even though there is increasing evidence that the use of oral nutritional support (ONS) among nursing home residents improves weight and reduces mortality
, the evidence for a benefit among older adults in home-care is very limited
. In addition, a much more structured and multidisciplinary approach, focusing on the significant modifiable nutritional risk factors and involving e.g. dieticians, occupational therapists, physiotherapist, may achieve additional benefits. Recently, we therefore developed and validated a nutritional risk screening tool, Eating Validation Scheme (EVS), which is designed for use among nursing home residents and home-care clients and includes eating habits, recent weight loss and the potentially modifiable nutritional risk factors, eating dependency, leaves 25% or more of food uneaten at most meals, chewing and swallowing problems with the aim of using these information in a multidisciplinary approach as needed
. The plan is to implement EVS all over Denmark. However, the EVS has only been tested in a small unpublished pilot study, including a train-the-trainer intervention and nutrition coordinators. However the results need to be confirmed by a proper randomized controlled trial, where the benefits of a multidisciplinary nutritional intervention aimed at residents and clients, who are identified by means of EVS, are assessed.
According to a recent systematic review, there is actually published some such multidisciplinary intervention among undernourished adults
. Unfortunately the 15 studies included in the systematic review had reported very few relevant outcomes and it was therefore not possible to conclude if multidisciplinary interventions were effective
. Only two of the studies included in the systematic review were performed among nursing home residents (and none among home-care clients). One of these actually documented a positive effect nutritional and functional status of a multidisciplinary intervention consisting of energy- and protein dense home-made oral supplements, exercise and oral care
. While the other found that a multidisciplinary intervention consisting of education of nutrition coordinators including train-the-trainer sessions were able to maintain nutritional status
Up till now a few studies have been done evaluating the cost-effectiveness of nutritional support among frail older adults. Recently these studies were summarized in a systematic review
. The authors concluded that the use of nutritional support, mainly in the form of ONS or enteral feeding nutrition in the management of undernutrition could be efficient from a health economic perspective
. Two of the studies included in the review were performed among nursing home residents and home-care clients. However, none of the studies included in the review used a multidisciplinary approach. It could be expected that such a multidisciplinary approach would be accompanied by higher health care costs than usual care, due to the additional staff and assistance of physiotherapist, registered dietician, occupational therapist, etc. But it could also be expected that these higher costs are negligible compared with increased quality of life and the cost-savings this can potentially generate.
The aim of this study is to assess the cost-effectiveness of multidisciplinary nutritional support for undernutrition in older adults in nursing home and home-care.