title: "It could probably help someone else but not me": a feasibility study of a snack programme offered to meals on wheels clients.
abstract: OBJECTIVE
  Community-based services, such as Meals on Wheels (MOW), allow older adults to remain in their homes for as long as possible. Many MOW recipients experience decreased appetite that limits intake at mealtimes. This pilot study aimed to determine the feasibility of providing high protein high energy snacks to improve nutrient intakes of MOW clients in a regional centre of New South Wales, Australia.
  
  
  METHODS
  A convenience sample of 12 MOW clients.
  
  
  METHODS
  Participants received snacks five times a week, in addition to their usual MOW order, for four weeks.
  
  
  METHODS
  Nutritional status was assessed using the Mini Nutritional Assessment tool. Pre-post changes in dietary intake were assessed using a diet history and food frequency questionnaire. Qualitative interviews conducted in clients' homes were digitally recorded, transcribed verbatim, and themes identified.
  
  
  RESULTS
  Post-intervention, there was a trend for an increased energy (mean = +415kJ (SD=1477) /day) and protein (+7.2 (±14.06) g/day) intake. MNA scores significantly increased (P= 0.036) and proportion of respondents categorised as 'malnourished' or 'at risk of malnutrition' decreased from 17% to 8%, and 67% to 25%, respectively (P <0.05). Mean body weight increased from 67.1 (±14.3) to 67.8 (±14.8) (P= 0.008), while Body Mass Index (BMI) increased by a mean of 0.78 (±1.16) kg/m2 (P = 0.039). Only half of participants indicated interest in continuing with the program. Reasons included the role of snacks serving as a reminder to eat, as well as their perceived nutritional value. Identified barriers included perceived lack of need for additional food, ability to self-provide such items, and a perceived adequate health status.
  
  
  CONCLUSIONS
  Provision of an additional daily mid-meal snack may be a useful addition to existing MOW services, for improved energy and protein intakes. However, not all MOW clients at risk of malnutrition perceived the snacks to be beneficial to them.
authors.affiliation: School of Health Sciences, University of Wollongong, NSW, Australia. karenc@uow.edu.au
authors.forename: K E
authors.initials: KE
authors.lastname: Charlton
authors.forename: K
authors.initials: K
authors.lastname: Walton
authors.forename: L
authors.initials: L
authors.lastname: Moon
authors.forename: K
authors.initials: K
authors.lastname: Smith
authors.forename: A T
authors.initials: AT
authors.lastname: McMahon
authors.forename: F
authors.initials: F
authors.lastname: Ralph
authors.forename: M
authors.initials: M
authors.lastname: Stuckey
authors.forename: F
authors.initials: F
authors.lastname: Manning
authors.forename: J
authors.initials: J
authors.lastname: Krassie
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D001835:Body Weight; D004044:Dietary Proteins / Q000008:administration & dosage; D002149:Energy Intake; D005240:Feasibility Studies; D005260:Female; D005522:Food Services; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000517:prevention & control; D008875:Middle Aged; D009517:New South Wales; D015596:Nutrition Assessment; D009752:Nutritional Status; D009753:Nutritive Value; D010865:Pilot Projects; D015203:Reproducibility of Results; D062410:Snacks; D011795:Surveys and Questionnaires
chemical_list: D004044:Dietary Proteins
references.citation: J Am Diet Assoc. 2003 Mar;103(3):329-36
references.pmid: 12616254
references.citation: J Am Geriatr Soc. 2003 Jul;51(7):1007-11
references.pmid: 12834523
references.citation: Scand J Caring Sci. 2002 Mar;16(1):86-90
references.pmid: 11985754
references.citation: Hum Nutr Clin Nutr. 1985;39 Suppl 1:5-41
references.pmid: 4044297
references.citation: J Nutr Health Aging. 2001;5(4):217-9
references.pmid: 11753481
references.citation: J Nutr Health Aging. 2010 Oct;14(8):622-8
references.pmid: 20922337
references.citation: J Am Diet Assoc. 1996 Jun;96(6):570-3
references.pmid: 8655903
references.citation: J Am Geriatr Soc. 2010 Sep;58(9):1734-8
references.pmid: 20863332
references.citation: Eur J Clin Nutr. 2012 Nov;66(11):1224-8
references.pmid: 22990853
references.citation: Cochrane Database Syst Rev. 2009 Apr 15;(2):CD003288
references.pmid: 19370584
references.citation: J Hum Nutr Diet. 2009 Dec;22(6):521-7
references.pmid: 19788707
references.citation: Asia Pac J Clin Nutr. 2010;19(3):440-9
references.pmid: 20805090
references.citation: J Nutr Health Aging. 2006 Nov-Dec;10(6):554-60
references.pmid: 17183428
references.citation: Nutr Rev. 1996 Jan;54(1 Pt 2):S59-65
references.pmid: 8919685
references.citation: J Nutr Health Aging. 2011 Aug;15(8):599-604
references.pmid: 21968852
references.citation: J Gerontol Nurs. 2006 Apr;32(4):12-7
references.pmid: 16615708
references.citation: J Nutr Gerontol Geriatr. 2011;30(2):105-21
references.pmid: 21598161
references.citation: Int Psychogeriatr. 2003 Mar;15(1):73-87
references.pmid: 12834202
references.citation: Int J Environ Res Public Health. 2011 Feb;8(2):514-27
references.pmid: 21556200
references.citation: J Am Diet Assoc. 2010 May;110(5):768-72
references.pmid: 20430139
references.citation: J Am Diet Assoc. 2004 Aug;104(8):1219-21
references.pmid: 15281037
references.citation: Aust Fam Physician. 2012 Sep;41(9):695-9
references.pmid: 22962646