Cost‐Effectiveness of Nutrition Intervention in Long‐Term Care

Abstract

OBJECTIVES To determine the cost-effectiveness of two nutrition interventions on food, beverage, and supplement intake and body weight. DESIGN Randomized, controlled trial. SETTING Five skilled nursing home facilities. PARTICIPANTS Long-stay residents with orders for nutrition supplementation (N = 154). INTERVENTION Participants were randomized into a usual care control group, an oral liquid nutrition supplement (ONS) intervention group, or a snack intervention group. Research staff provided ONS, according to orders or a variety of snack foods and beverages twice per day between meals, 5 days per week for 24 weeks and assistance to promote consumption. MEASUREMENTS Research staff independently weighed residents at baseline and monthly during the 24-week intervention. Resident food, beverage and supplement intake and the amount of staff time spent providing assistance were assessed for 2 days at baseline and 2 days per month during the intervention using standardized observation and weighed intake procedures. RESULTS The ONS intervention group took in an average of 265 calories more per day and the snack intervention group an average of 303 calories more per day than the control group. Staff time required to provide each intervention averaged 11 and 14 minutes per person per offer for ONS and snacks, respectively, and 3 minutes for usual care. Both interventions were cost-effective in increasing caloric intake, but neither intervention had a significant effect on body weight, despite positive trends. CONCLUSION Oral liquid nutrition supplements and snack offers were efficacious in promoting caloric intake when coupled with assistance to promote consumption and a variety of options, but neither intervention resulted in significant weight gain.

Training Nonnursing Staff to Assist with Nutritional Care Delivery in Nursing Homes: A Cost‐Effectiveness Analysis

“…Although significantly greater than the usual care that nurse aides provide, it is likely that the amount of trained staff time spent providing assistance between meals remained inadequate for the intervention group, most of whom required some level of staff assistance to eat (supervision to total dependence). Prior studies have shown that research staff spent an average of 10 to 15 minutes per person per offer and achieved even higher between‐meal caloric gains when offers were made consistently two to three times daily . In contrast, trained staff and nurse aide staff in this study averaged less than 5 minutes per person per offer.…”

“…Each observation period lasted from the time of meal, snack, or supplement delivery to the time staff removed items, which averaged 1.5 hours per period for meals and between‐meal snacks. Research staff recorded the amount of NH staff time (nurse aides or trained staff) spent providing any type of assistance to promote consumption (e.g., setup, verbal cueing, physical assistance) using a stop watch (to record minutes and seconds) . Assistance could be provided continuously throughout the entire meal or snack period or intermittently (interrupted by other care tasks).…”

“…The rationale for primarily using trained staff between meals as part of this study was twofold. First, prior studies have shown that most residents with inadequate intake will increase their caloric intake in response to supplement or snack delivery between meals . Second, this approach requires less time than mealtime assistance, which makes it more feasible to implement in daily care practice, in particular for staff with other primary job roles in the facility.…”

“…Inadequate food and fluid intake and associated unintentional weight loss continue to be prevalent in nursing home (NH) residents, despite multiple intervention studies that have demonstrated that behavioral interventions are efficacious in improving dietary intake or increasing body weight when dedicated research staff administer them . Specifically, improvements in mealtime assistance, as provided by research staff, have been shown to increase caloric intake during meals in 40% to 50% of long‐stay NH residents with inadequate intake .…”

“…Specifically, improvements in mealtime assistance, as provided by research staff, have been shown to increase caloric intake during meals in 40% to 50% of long‐stay NH residents with inadequate intake . Similarly, improvements in the delivery of oral liquid nutrition supplements or snacks between meals, as provided by research staff, have been shown to increase total daily caloric intake in as much as 80% of NH residents, including those who do not otherwise increase their intake in response to mealtime assistance . Unfortunately, these intervention studies also have revealed that efficacious mealtime assistance and between‐meal caloric supplementation require significantly more time than routine NH care practices during and between meals, which is typically the responsibility of nurse aide staff.…”