Nutritional and functional effects of energy-dense food in the frail elderly

Abstract: Eating and nutritional problems are common in frail elderly individuals receiving care in municipalities and hospitals. The overall aim of the present thesis was to evaluate the effects of serving additional energy to frail elderly receiving different types of care. In particular the impact of food fortification was investigated on various outcomes associated with poor nutritional status. The effects of energy-dense food in geriatric long-term care were studied in 35 patients in two comparable wards, using a cross-over design (I). The patients were either served ordinary food (1670 kcal/day) or energy-dense food (2520 kcal/day) over a 6 weeks period. In study II, effects of energydense food were evaluated in nursing home residents. A control group (n=18) was served 1600 kcal/day and an intervention group (n=17), 2100 kcal/day for 15 weeks. In both studies energy density was increased by the addition of mainly fat in the form of butter, cream, cheese etc. When served energydense food, the energy intake increased in long-term care patients by 40% (p<0.0001) and in nursing home residents by 36% (p<0.001). While receiving energy-dense food body weight increased by 3.4% (p<0.001) in geriatric long-term care patients but no weight change was seen among nursing home residents. However, the control group in the nursing home deteriorated in their ADL functions, whereas the intervention group remained stable (p<0.001). The cost for the fortification of lunch and dinner was approximately EUR 0.1 per resident per day. Next, nutritional status and its relationship to cognition, well-being and functional ability was studied in 80 frail elderly service flat residents with regular need of care (III). Nine of ten residents were assessed to have impending nutritional problems. Malnourished residents had a significantly lower cognitive condition (p<0.001), poorer well-being (p<0.05), lower functional ability (p<0.01) and a greater need for daily assistance and care (p<0.05) compared to the well-nourished residents. Malnourished residents continued to lose weight over one year, while the well-nourished residents remained weight stable. Finally, the effects of an additional evening meal as a potential way to increase energy intake, body weight, nutritional status and health related quality of life were evaluated in frail elderly service flat residents (IV). The evening meal contained an average of 530 kcal/day and was served for 6 months to 23 residents in one service flat building while 26 residents in another service flat building served as controls. The serving of the evening meal slightly reduced night time fast, but in comparison to the control group, the additional meal had no significant effect on energy intake, nutritional status, body weight or health-related quality of life. The variations in the outcomes were large in both groups. In conclusion, it is possible to substantially increase energy intake with energy-dense food in elderly individuals receiving different types of institutional care. Serving energy-dense food had a positive impact on ADL function and it is an inexpensive and effective way of improving energy intake in longterm care residents. In service flat residents frailty and chronic illness were associated with impaired nutritional status. An additional evening meal served to service flat residents slightly reduced night time fast, but had no effect on energy intake, body weight or health related quality of life. Prevention and treatment of malnutrition in the elderly remains an important problem that needs more attention.