Nutritional interventions among community-dwelling frail elderly : a systematic review

Abstract

Background: The worldwide ageing demographic trend has resulted in a growing number of frail elderly who are in the last stages of autonomous living. Oral nutritional interventions for the frail elderly address the body’s natural weight loss, sometimes reversing weight loss, though the literature is not of one accord. No review of nutritional interventions has been conducted for community-dwelling frail elderly, who are most likely to benefit from these interventions and delay adverse outcomes.

Objective: (i) This systematic review analyzes results from randomized controlled trials of oral nutrition interventions for the community-dwelling frail elderly to determine their efficacy in making gains in nutritional and functional status.

(ii) The secondary objective is to analyze the quality of the studies in this review and draw conclusions for further areas of development in the field of nutrition in elderly care.

Methods: Randomized controlled trials of oral nutritional supplements were searched in The Cochrane Library and PubMed, and hand searched in reference lists of systematic reviews. These interventions targeted protein-energy deficiency and included oral supplementation or supplementation paired with exercise compared to a placebo or usual practice. Community-dwelling frail elderly not institutionalized or hospitalized were eligible. Studies targeting disease-specific elderly were excluded.

Results: Out of 120 search results, six trials were included in this review. A small weight gain from oral nutritional interventions among frail community-dwelling elderly was reported in five out of six studies. Functional status did not improve significantly with the interventions. Studies used unstandardized definitions and different ways to measure outcomes, resulting in heterogeneity.

Conclusions: The few and poor quality of studies demonstrates the need for more studies of better quality and homogeneity assessing oral nutritional interventions for nutritional and functional gain in frail elderly who are not yet suffering from adverse outcomes.