title: Need-based nutritional intervention is effective in improving handgrip strength and Barthel Index scores of older people living in a nursing home: a randomized controlled trial.
abstract: BACKGROUND
  Nutritional status is associated with physical functioning in older people. Protein-energy malnutrition can limit functional performance.
  
  
  OBJECTIVE
  This study examined the effectiveness of a "need-based intervention" on improving the physical functioning of older adults living in nursing homes.
  
  
  METHODS
  A 24-week randomized, double-blind, controlled trial.
  
  
  METHODS
  A privately managed geriatric nursing home in Taiwan.
  
  
  METHODS
  Ninety-two persons who were ≥65 years old, ≤25 kg/m(2), >1 month residence, non-bed-ridden, without acute infection, and able to self-feed or receive oral feeding.
  
  
  METHODS
  Qualified participants were stratified by gender and then randomly assigned to either the control group (n=45) or the intervention group (n=47). Each participant in the intervention group would receive a 50 g/day soy-protein-based nutritional supplement when he/she was rated as undernourished, defined as Mini Nutritional Assessment score ≤24 and body mass index ≤24 kg/m(2). The supplement contained 9.5 g protein, 250 kcal energy, and all essential micronutrients. The supplementation would be suspended if either one of the two "at risk" conditions was not met at the next measurement (every 4 weeks). Handgrip strength and Barthel Index were measured at baseline, mid-point (week 12), and end-point (week 24) of the trial. Results were analyzed with Student's t-test and by the Generalized Estimating Equations controlled for nutritional status.
  
  
  RESULTS
  The intervention significantly improved (a) handgrip strength of the older adults at weeks 12 and 24, and (b) the overall Barthel Index at week 24 (all p<0.05) according to the Generalized Estimating Equations.
  
  
  CONCLUSIONS
  "Need-based intervention" can be an effective and useful strategy for improving the physical functioning of older adults living in nursing homes, without adverse effects. The results probably are the indirect results of the improved nutritional status. The study highlights the importance of routine screening and timely intervention in geriatric care. The applicability of this need-based strategy to community-living older adults is an important issue and should be evaluated. We can probably reap a greater benefit by eliminating the risk of malnutrition at the emerging stage.
authors.affiliation: Department of Healthcare Administration, Asia University, Taichung 41354, Taiwan.
authors.forename: Li-Chin
authors.initials: LC
authors.lastname: Lee
authors.affiliation: Department of Healthcare Administration, Asia University, Taichung 41354, Taiwan; Department of Medical Research, China Medical University Hospital, China Medical University, Taichung 40402, Taiwan. Electronic address: atsai@umich.edu.
authors.forename: Alan C
authors.initials: AC
authors.lastname: Tsai
authors.affiliation: Department of Healthcare Administration, Asia University, Taichung 41354, Taiwan; Center for Health Policy and Management Research, Asia University, Taichung, Taiwan, ROC.
authors.forename: Jiun-Yi
authors.initials: JY
authors.lastname: Wang
mesh_terms: D000368:Aged; D004046:Dietetics; D005260:Female; D018737:Hand Strength; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000451:nursing* / Q000503:physiopathology; D009735:Nursing Homes
keywords: Barthel Index; Elderly people; Handgrip strength; Nutritional intervention; Physical functioning