HOMEFOOD Study - Home Delivered Food and Nutrition Therapy for Discharged Geriatric Hospital Patients (HOMEFOOD)

Because of short hospital stays, and nutritional status worsening for geriatric patients, time to improve this is limited. It seems necessary to integrate nutritional support after discharge, to prevent the consequences of malnutrition on health and physical capability. This study tests whether nutrition support using NCP (Nutrition Care Process) (1) in combination with delivered meals designed for old adults, improves nutritional status, muscle strength, physical function, quality of life and rehospitalization and mortality rates after discharge, compared to currently used care (2 = control) along with historical data. Participants (N = 200), will be randomized into two groups, the intervention will last 24 weeks. A dietitian (Ph.D. student) visits participants in the intervention group 5 times during the study period. Outcome parameters will be measured before discharge from the hospital, at 12 weeks and at 24 weeks. Data on hospital readmission and mortality will be followed up at 6 months after the intervention.

Condition or disease: Malnutrition Intervention/treatment: NCP by a dietitian and free food constructed to fulfill protein and energy needs for the group.

Study Overview

• Status: Completed
• Conditions: Malnutrition
• Intervention / Treatment: Other: NCP and home-delivered meals

Detailed Description

Malnutrition is common in older people admitted to the hospital and can worsen after discharge. Therefore, it seems necessary to integrate nutritional support not only during the hospital stay but also in the period after discharge. The aim of this Randomized Controlled Trial (RCT) is to test whether nutritional support provided by a dietitian, using Nutrition Care Process in combination with delivered meals designed for the needs of older adults (group 1), improves nutritional status, muscle strength, physical function, quality of life and as a secondary outcome re-hospitalization and/or mortality of geriatric patients with malnutrition risk after discharge compared to currently used standard care (group 2 = control).

Time and work plan:

After 12 months

• Need identification and product ideas ready
• Packaging material ready
• Estimate of the feasibility of meals for old adults
• Allowances from the ethical committee, the data protection committee, the Ph.D. committee of the Faculty of Food Science and Nutrition at the University of Iceland.

After 24 months

• The last participant recruited
• End of intervention

After 36 months

• End of follow up
• Database ready
• First paper submitted

Methods-Intervention

This 24-week randomized controlled trial will randomize the participants (N = 200) to two groups. The dietitian (Ph.D. student) will perform a total of 5 home visits during the study period to participants in the intervention group. Meals will be delivered weekly to the participants. Outcome parameters will be measured just before discharge from the hospital and after 12 weeks and at 24 weeks in the home of the participants. Data on hospital re-admission and mortality will also be followed up at 12 months.

The aim of the intervention is to implement individual dietetic advice and optimize participants' nutritional status by following the Nutritional Care Process*, involving nutritional assessment, diagnosis, intervention, monitoring, and evaluation. Dietary counseling, motivation, and education will help to maintain participants' body weight, and ensure that energy and protein requirements as well as for other critical nutrients are achieved.

*The Nutrition Care Process (NCP) reflects the current state of the art in nutrition care and is designed to improve the consistency and quality of individualized care for patients and the predictability of the patient outcomes. It is not intended to standardize nutrition care for each patient, but to establish a standardized process for providing care.

To achieve the aim, the dietitian (Ph.D. student) will meet the participants in the intervention group, six times.

• The day before discharge where baseline measurements will be done,
• 1 week after discharge,
• 3 weeks after discharge,
• 6 weeks after discharge,
• 9 weeks after discharge, and
• 12 weeks after discharge where endpoint measurements will be done. The dietitian (Ph.D. student) will perform an individual nutritional assessment focusing on dietary intake, activity level and weight of each participant, as a basis for developing an individualized nutrition care plan consistent with estimated nutritional requirements and nutritional rehabilitation goals. Total fluid, energy- and protein requirements will be estimated for each patient. To assess dietary intake, the dietitian will perform a dietary history interview at each visit to determine fluid, energy and protein intake of the participant. Strategies for achieving fluid, energy and protein requirements and achieving compliance included dietary counseling with attention to nutritional risk factors, timing, size and frequency of meals, recommendations for nutrient dense foods and drinks, and provision of educational material.

If relevant, the dietitian will:

• initiate the prescription of oral nutritional supplements with high energy and protein density that will be reimbursed by Health Insurance.
• Contact providers of meals-on-wheels to change the meals to high energy and protein dense menu or to mashed/puréed food.
• Recommend use of vitamin D, calcium and other vitamins-minerals considered necessary to achieve optimal nutritional status,
• Invite home care and community nursing staff to participate in home visits to achieve the best possible outcome for the patient by interdisciplinary collaboration.

If considered relevant the participants will receive a short consultation by telephone by the dietitian to give advice and to stimulate compliance to the proposed nutritional care plan in-between the home visits.

The control group will meet the dietitian/staff for baseline, 12 weeks and at the 24-week endpoint measurements. The control group will not receive any dietary counseling or education during the study period which reflects current clinical practice.

The Ph.D. students' contributions A Ph.D. student in clinical nutrition (Berglind Soffía Blondal) will be the project manager of the intervention study on a day-to-day base. The student will be supervised by Prof. Alfons Ramel and Assoc. Prof. Ólöf Guðný Geirsdóttir, both on the Faculty of Food Science and Nutrition. The student will be involved in application work to the ethical committee, screening, conduct of the intervention study, data work and writing of scientific papers.

Ethics The study has been approved by the Ethics Committee of Landspitali- University Hospital of Iceland and informed written consent will be obtained from all participants. The study can only improve the nutritional status of geriatric patients that take part in the intervention groups. The participants in the control group, however, won't get any nutritional interventions and therefore have a greater risk of re-admissions and a worse overall outcome compared to the intervention groups.

• Study Type: Interventional
• Enrollment (Actual): 106
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Iceland
  • Non-US
    • Reykjavík, Non-US, Iceland, 101
      • Geriatric Unit of Landspitali - University Hospital of Iceland

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 65 years and older (Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Patients of the geriatric units at the University Hospital of Iceland discharging home to independent living
• A score of 20 or above on the Mini-Mental State Evaluation (MMSE) form
• Being at nutritional risk according to the validated nutritional risk screening tool (NRS-2002, score 3+)
• The capability of eating orally

Exclusion Criteria:

• Living at a nursing home
• MMSE score of under 20
• No nutritional risk

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: NCP and home-delivered meals; Preventing malnutrition with NCP by a registered dietician and home-delivered meals	Other: NCP and home-delivered meals; The dietitian (Ph.D. student) will perform an individual nutritional assessment focusing on dietary intake, activity level and weight of each participant, as a basis for developing an individualized nutrition care plan consistent with estimated nutritional requirements and nutritional rehabilitation goals. Total fluid, energy- and protein requirements will be estimated for each patient. Giving the group free food to fulfill protein-and energy needs.; Other Names: NCP and delivered meals
No Intervention: Current practice; Current practice after discharge from the University Hospital of Iceland.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Body weight	Body weight in kilograms	Measurement at discharge, baseline
Body weight	Body weight in kilograms	Measurement at 12 weeks
Body weight	Body weight in kilograms	Measurement at 24 weeks
Five Times Sit to Stand Test	Part of short physical performance battery, yes vs no	Measurement at discharge, baseline
Five Times Sit to Stand Test	Part of short physical performance battery, yes vs no	Measurement at 12 weeks
Five Times Sit to Stand Test	Part of short physical performance battery, yes vs no	Measurement at 24 weeks
Balance test	Part of short physical performance battery, yes vs no	Measurement at discharge, baseline
Balance test	Part of short physical performance battery, yes vs no	Measurement at 12 weeks
Balance test	Part of short physical performance battery, yes vs no	Measurement at 24 weeks
Energy intake	Energy in kilocalories per 24 hours	Measurement at discharge, baseline
Energy intake	Energy in kilocalories per 24 hours	Measurement at 12 weeks
Energy intake	Energy in kilocalories per 24 hours	Measurement at 24 weeks
Protein intake	Protein intake in g/day	Measurement at 12 weeks
Protein intake	Protein intake in g/day	Measurement at discharge, baseline
Protein intake	Protein intake in g/day	Measurement at 24 weeks
Fluid intake	Fluid intake evaluated	Measurement at discharge, baseline
Fluid intake	Fluid intake evaluated	Measurement at 12 weeks
Fluid intake	Fluid intake evaluated	Measurement at 24 weeks
Upper arm circumference	Measured in centimeters	Measurement at discharge, baseline
Upper arm circumference	Measured in centimeters	Measurement at 24 weeks
Waist circumference	Measured in centimeters	Measurement at discharge, baseline
Waist circumference	Measured in centimeters	Measurement at 24 weeks
calf circumference	Measured in centimeters	Measurement at discharge, baseline
calf circumference	Measured in centimeters	Measurement at 24 weeks
lean body mass	Measured with BIA (kg)	Measurement at discharge, baseline
lean body mass	Measured with BIA (kg)	Measurement at 24 weeks
Grip strength	Measured in kg	Measurement at discharge, baseline
Grip strength	Measured in kg	Measurement at 12 weeks
Grip strength	Measured in lbs	Measurement at 24 weeks
Health Related Quality of Life (HRQL)	EQ-5D including SRH	Measurement at discharge, baseline
Health Related Quality of Life (HRQL)	EQ-5D including SRH	Measurement at 12 weeks
Health Related Quality of Life (HRQL)	EQ-5D including SRH	Measurement at 24 weeks
Depression	Center for Epidemiologic Studies Depression scale	Measurement at discharge, baseline
Depression	Center for Epidemiologic Studies Depression scale	Measurement at 24 weeks
Cognitive function	MMSE	Measurement at discharge, baseline
Cognitive function	MMSE	Measurement at 24 weeks
Nutrition status	Icelandic Nutrition Screening Tool (score)	Measurement at discharge, baseline.
Nutrition status	Icelandic Nutrition Screening Tool (score)	Measurement at 24 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Re-hospitalization	Number of participants who were re-hospitalized	at 12 months from recruitment to trial
Mortality	Number of participants who deceased	at 12 months from recruitment to trial

Collaborators and Investigators

• Sponsor: University of Iceland
• Investigators: Principal Investigator: Alfons Ramel, Ph.D., University of Iceland; Principal Investigator: Olof G Geirsdottir, Ph.D., University of Iceland; Principal Investigator: Berglind S Blondal, MSc, University of Iceland

Publications and helpful links

General Publications

• Blondal BS, Geirsdottir OG, Beck AM, Halldorsson TI, Jonsson PV, Sveinsdottir K, Ramel A. HOMEFOOD randomized trial-beneficial effects of 6-month nutrition therapy on body weight and physical function in older adults at risk for malnutrition after hospital discharge. Eur J Clin Nutr. 2023 Jan;77(1):45-54. doi: 10.1038/s41430-022-01195-2. Epub 2022 Aug 26.

Study record dates

Study Major Dates

• Study Start (Actual): January 1, 2019
• Primary Completion (Actual): August 26, 2020
• Study Completion (Actual): August 26, 2020

Study Registration Dates

• First Submitted: January 9, 2019
• First Submitted That Met QC Criteria: June 21, 2019
• First Posted (Actual): June 24, 2019

Study Record Updates

• Last Update Posted (Actual): November 17, 2021
• Last Update Submitted That Met QC Criteria: November 16, 2021
• Last Verified: November 1, 2021

More Information

Terms related to this study

• Keywords: Malnutrition; Food; Old adults; Home-delivered meals; NCP - Nutrition Care Process
• Additional Relevant MeSH Terms: Nutrition Disorders; Malnutrition
• Other Study ID Numbers: UI-2018-HOMEFOOD

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No