JOURNAL ARTICLE
RANDOMIZED CONTROLLED TRIAL

Effects of two models of nutritional intervention on homebound older adults at nutritional risk

Alison J Kretser, Theresa Voss, Wendell W Kerr, Claude Cavadini, Janet Friedmann
Journal of the American Dietetic Association 2003, 103 (3): 329-36
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OBJECTIVE: To test the feasibility of two models of home meal delivery with Meals-on-Wheels (MOW) applicants who were identified as being malnourished or "at-risk" as determined by the validated Mini Nutritional Assessment (MNA).

DESIGN: A 6-month, prospective comparative study of two nutrition intervention models with data collection at baseline, 3 months, and 6 months. Randomized treatment assignment was followed, with a few exceptions linked to particular client circumstances.

SUBJECTS: A total of 203 older adults (age range = 60 to 90 years) newly applying for homebound meal service were enrolled. At baseline, the body mass index (BMI) was 26.3+/-7.2 (mean+/-SD) in the "Traditional" MOW model (101 subjects including 30 malnourished), and the BMI was 27.6+/-9.0 in the "New" MOW model (102 subjects including 26 malnourished) (P = ns).

INTERVENTION: Study participants received either the Traditional MOW program of five hot meals per week, meeting 33% of the Daily Reference Intake (DRI) or the restorative, comprehensive New MOW program of three meals and two snacks per day, 7 days a week, meeting 100% of the DRI. Assessments were conducted in the home of the participants. Main outcome measures The MNA was used to evaluate nutritional risk and status of participants at baseline, 3 months, and 6 months. Standardized functional impairment scales, Activities of Daily Living (ADL), and Instrumental Activities of Daily Living (IADL) evaluated limitations in activities of daily living and life management skills. Statistical analysis Comparisons between treatment groups were calculated with t tests or Wilcoxon rank-sum tests when appropriate. Comparisons among time periods between treatment groups were conducted with repeated measures analysis of variance. A general linear model was used to evaluate the relationship between change in functional status and BMI, controlling for sex.

RESULTS: The New MOW group gained significantly more weight between baseline and 3 months than did the Traditional MOW group (2.78 lb vs -1.46 lb, respectively, P =.0120) and again between baseline and 6 months (4.30 lb vs -1.72 lb, respectively, P =.0004). MNA improved faster in the New MOW group. Functional change appeared to be related more to BMI and age than to treatment intervention. The malnourished participants in both groups took longer to affect positive change in nutrition measurements, with the New MOW group showing the most improvement over the 6-month measurement period. Both delivery models were well accepted.

CONCLUSIONS: Applicants for home meal delivery have varying nutrition needs. By addressing nutritional risk, interventions can be targeted to meet these needs. A new, restorative, comprehensive meal program improved nutritional status and decreased nutritional risk and can possibly impact independence and functionality.

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