title: Study protocol: cost-effectiveness of multidisciplinary nutritional support for undernutrition in older adults in nursing home and home-care: cluster randomized controlled trial.
abstract: BACKGROUND
  Older adults in nursing home and home-care are a particularly high-risk population for weight loss or poor nutrition. One negative consequence of undernutrition is increased health care costs. Several potentially modifiable nutritional risk factors increase the likelihood of weight loss or poor nutrition. Hence a structured and multidisciplinary approach, focusing on the nutritional risk factors and involving e.g. dieticians, occupational therapists, and physiotherapist, may be necessary to achieve benefits. Up till now a few studies have been done evaluating the cost-effectiveness of nutritional support among undernourished older adults and none of these have used such a multidisciplinary approach.
  
  
  METHODS
  An 11 week cluster randomized trial to assess the cost-effectiveness of multidisciplinary nutritional support for undernutrition in older adults in nursing home and home-care, identified by screening with the Eating validation Scheme. Before start of the study there will be performed a train-the-trainer intervention involving educated nutrition coordinators.In addition to the nutrition coordinator, the participants assigned to the intervention group strategy will receive multidisciplinary nutrition support. Focus will be on treatment of the potentially modifiable nutritional risk factors identified by screening, by involving physiotherapist, registered dietician, and occupational therapist, as relevant and independent of the municipality's ordinary assessment and referral system.The primary outcome parameter will be change in quality of life (by means of Euroquol-5D-3L). Secondary outcomes will be: physical performance (chair stand), nutritional status (weight, Body Mass Index and hand-grip strength), oral care, fall incidents, hospital admissions, rehabilitation stay, moving to nursing homes (for participants from home-care), use of social services and mortality.An economic evaluation will be conducted to evaluate the cost-effectiveness of the multidisciplinary support.Furthermore, interviews with nursing home and home-care management, nursing staff and nutrition coordinators in both the control and intervention groups, participants in the intervention group and the involved multidisciplinary team will be performed.
  
  
  CONCLUSIONS
  In this study we will evaluate in a randomized controlled trial whether multidisciplinary nutritional support is cost-effective, in undernourished older adults in home-care and nursing home and contribute to important research.
  
  
  BACKGROUND
  ClinicalTrials.gov 2013 NCT01873456.
authors.affiliation: EFFECT, The Nordic Kitchen, University Hospital Herlev, Herlev Ringvej 75, DK-2730 Herlev, Denmark. Anne.Marie.Beck@regionh.dk.
authors.forename: Anne Marie
authors.initials: AM
authors.lastname: Beck
authors.forename: Annette
authors.initials: A
authors.lastname: Gøgsig Christensen
authors.forename: Birthe
authors.initials: B
authors.lastname: Stenbæk Hansen
authors.forename: Signe
authors.initials: S
authors.lastname: Damsbo-Svendsen
authors.forename: Tina
authors.initials: T
authors.lastname: Kreinfeldt Skovgaard Møller
authors.forename: Eigil
authors.initials: E
authors.lastname: Boll Hansen
authors.forename: Hans
authors.initials: H
authors.lastname: Keiding
mesh_terms: D000368:Aged; D015992:Body Mass Index; D016000:Cluster Analysis; D003362:Cost-Benefit Analysis; D019468:Disease Management; D018737:Hand Strength; D017048:Health Care Costs; D006707:Homes for the Aged; D006801:Humans; D044342:Malnutrition / Q000628:therapy*; D009043:Motor Activity; D009735:Nursing Homes; D009752:Nutritional Status; D018529:Nutritional Support / Q000379:methods*; D064686:Nutritionists; D010349:Patient Compliance; D011446:Prospective Studies; D011788:Quality of Life; D012307:Risk Factors; D012959:Socioeconomic Factors; D016896:Treatment Outcome; D015431:Weight Loss