Individually tailored nutritional guidance improved dietary intake of older family caregivers: a randomized controlled trial

Sohvi Koponen, Irma Nykänen, Roosa-Maria Savela, Tarja Välimäki, Anna Liisa Suominen, Ursula Schwab, Sohvi Koponen, Irma Nykänen, Roosa-Maria Savela, Tarja Välimäki, Anna Liisa Suominen, Ursula Schwab

Abstract

Purpose: Older family caregivers (FCs) are vulnerable to insufficient dietary intake and risk of malnutrition. The aim of this study was to assess the impact of individually tailored nutritional guidance on the dietary intake and nutritional status of older FCs and their care recipients' (CRs') nutritional status.

Methods: This study was a randomized controlled 6-month nutrition intervention in Eastern Finland. The inclusion criteria for FCs were having a home-living CR aged 65 or above and a valid care allowance. The exclusion criterion was CR receiving end-of-life care at baseline. Participants were randomly assigned to an intervention (FCs n = 63, CRs n = 59) and a control (FCs n = 50, CRs n = 48) group. Individually tailored nutritional guidance targeted to FCs was given to an intervention group by a clinical nutritionist. The main outcomes were dietary intake (3-day food record).

Results: After the 6-month intervention, 63 FCs and 59 CRs in the intervention group and 50 FCs and 48 CRs in the control group were analyzed. In the intervention group of FCs, the intakes of protein, riboflavin, calcium, potassium, phosphorus, and iodine differed significantly (p < 0.05) compared to the control group. In addition, the intake of vitamin D supplementation improved in the intervention group of the FCs and CRs (p < 0.001).

Conclusion: Individually tailored nutrition guidance improves the intake levels of crucial nutrients, such as the intake levels of protein, vitamin D, and calcium of the FCs. Further studies are warranted to optimize the methods to improve the nutrition of FCs. Registration number of Clinical Trials: ClinicalTrials.gov NCT04003493 (1 July 2019).

Keywords: Dietary intake; Family caregiver; Nutritional guidance; Nutritional status; Older people.

Conflict of interest statement

Tarja Välimäki is a board member of Carers Finland. Carers Finland did not participate in this study (no involvement in the study design, content, conducting, analysis, or writing of the manuscript). The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Flow chart of the study population
Fig. 2
Fig. 2
Flow chart of the measurements of the family caregivers (FC) and care recipients (CR), and individually tailored nutritional guidance

References

    1. Rullier L, Lagarde A, Bouisson J, Bergua V, Barberger-Gateau P. Nutritional status of community-dwelling older people with dementia: associations with individual and family caregivers' characteristics. Int J Geriatr Psychiatry. 2013;28:580–588. doi: 10.1002/gps.3862.
    1. Tombini M, Sicari M, Pellegrino G, Ursini F, Insardá P, Di Lazzaro V. Nutritional status of patients with Alzheimer's disease and their caregivers. J Alzheimers Dis. 2016;54:1619–1627. doi: 10.3233/JAD-160261.
    1. Puranen TM, Pietila SE, Pitkala KH, Kautiainen H, Raivio M, Eloniemi-Sulkava U, Jyväkorpi SK, Suominen M. Caregivers' male gender is associated with poor nutrient intake in AD families (NuAD-trial) J Nutr Health Aging. 2014;18:672–676. doi: 10.1007/s12603-014-0499-z.
    1. Torres SJ, McCabe M, Nowson CA. Depression, nutritional risk and eating behaviour in older caregivers. J Nutr Health Aging. 2010;14:442–448. doi: 10.1007/s12603-010-0041-x.
    1. Leij-Halfwerk S, Verwijs MH, van Houdt S, Borkent JW, Guaitoli PR, Pelgrim T, Heymans MW, Power L, Visser M, Corish CA, de van der Schueren MAE. Prevalence of protein-energy malnutrition risk in European older adults in community, residential and hospital settings, according to 22 malnutrition screening tools validated for use in adults ≥65 years: a systematic review and meta-analysis. Maturitas. 2019;216:80–89. doi: 10.1016/j.maturitas.2019.05.006.
    1. Snyder SA, Vitaliano PP. Caregiver psychological distress: Longitudinal relationships with physical activity and diet. Am J Alzheimers Dis Other Demen. 2020;35:1533317520904554. doi: 10.1177/1533317520904554.
    1. Koponen S, Nykänen I, Savela R, Välimäki T, Suominen AL, Schwab U. Inadequate intake of energy and nutrients is common in older family caregivers. Nutrients. 2021;13:2763. doi: 10.3390/nu13082763.
    1. Moradell A, Fernández-García ÁI, Navarrete-Villanueva D, Sagarra-Romero L, Gesteiro E, Pérez-Gómez J, Rodríguez-Gómez I, Ara I, Casajús JA, Vicente-Rodríguez G, Gómez-Cabello A. Functional frailty, dietary intake, and risk of malnutrition are nutrients involved in muscle synthesis the key for frailty prevention? Nutrients. 2021;13:1231. doi: 10.3390/nu13041231.
    1. McLean RR, Mangano KM, Hannan MT, Kiel DP, Sahni S. Dietary protein intake is protective against loss of grip strength among older adults in the framingham offspring cohort. J Gerontol A Biol Sci Med Sci. 2016;71:356–361. doi: 10.1093/gerona/glv184.
    1. Ten Haaf DSM, Eijsvogels TMH, Bongers CCWG, Horstman AMH, Timmers S, de Groot LCPGM, Hopman MTE. Protein supplementation improves lean body mass in physically active older adults: a randomized placebo-controlled trial. J Cachexia Sarcopenia Muscle. 2019;10:298–310. doi: 10.1002/jcsm.12394.
    1. Englund DA, Kirn DR, Koochek A, Zhu H, Travison TG, Reid KF, von Berens Å, Melin M, Cederholm T, Gustafsson T, Fielding RA. Nutritional supplementation with physical activity improves muscle composition in mobility-limited older adults, the vive2 study: a randomized, double-blind, placebo-controlled trial. J Gerontol A Biol Sci Med Sci. 2017;73:95–101. doi: 10.1093/gerona/glx141.
    1. Park Y, Choi J, Hwang H. Protein supplementation improves muscle mass and physical performance in undernourished prefrail and frail elderly subjects: a randomized, double-blind, placebo-controlled trial. Am J Clin Nutr. 2018;108:1026–1033. doi: 10.1093/ajcn/nqy214.
    1. Dewansingh P, Melse-Boonstra A, Krijnen WP, van der Schans CP, Jager-Wittenaar H, van den Heuvel EGHM. Supplemental protein from dairy products increases body weight and vitamin D improves physical performance in older adults: a systematic review and meta-analysis. Nutr Res. 2018;49:1–22. doi: 10.1016/j.nutres.2017.08.004.
    1. Ge L, Yap CW, Heng BH. Association of nutritional status with physical function and disability in community-dwelling older adults: a longitudinal data analysis. J Nutr Gerontol Geriatr. 2020;39:131–142. doi: 10.1080/21551197.2020.1725711.
    1. Bakhtiari A, Pourali M, Omidvar S. Nutrition assessment and geriatric associated conditions among community dwelling Iranian elderly people. BMC Geriatr. 2020;20:278. doi: 10.1186/s12877-020-01668-8.
    1. Wei K, Nyunt MSZ, Gao Q, Wee SL, Ng TP. Long-term changes in nutritional status are associated with functional and mortality outcomes among community-living older adults. Nutrition. 2019;66:180–186. doi: 10.1016/j.nut.2019.05.006.
    1. Corish CA, Bardon LA. Malnutrition in older adults: screening and determinants. Proc Nutr Soc. 2019;78:372–379. doi: 10.1017/S0029665118002628.
    1. Gretebeck KA, Sabatini LM, Black DR, Gretebeck RJ. Physical activity, functional ability, and obesity in older adults: a gender difference. J Gerontol Nurs. 2017;43:38–46. doi: 10.3928/00989134-20170406-03.
    1. Yuan L, Chang M, Wang J. Abdominal obesity, body mass index and the risk of frailty in community-dwelling older adults: a systematic review and meta-analysis. Age Ageing. 2021;50:1118–1128. doi: 10.1093/ageing/afab039.
    1. Trevisan C, Crippa A, Ek S, Welmer A, Sergi G, Maggi S, Manzato E, Bea JW, Cauley JA, Decullier E, Hirani V, LaMonte MJ, Lewis CE, Schott A, Orsini N, Rizzuto D. Nutritional status, body mass index, and the risk of falls in community-dwelling older adults: a systematic review and meta-analysis. J Am Med Dir Assoc. 2019;20:569–582.e7. doi: 10.1016/j.jamda.2018.10.027.
    1. Dye L, Boyle NB, Champ C, Lawton C. The relationship between obesity and cognitive health and decline. Proc Nutr Soc. 2017;76:443–454. doi: 10.1017/S0029665117002014.
    1. Kunvik S, Valve R, Salonoja M, Suominen MH. Does tailored nutritional guidance encourage older caregivers to increase their protein intake? The Care Nutrition Trial (RCT) J Aging Res Clin Practice. 2018;7:136–142.
    1. Fernández-Barrés S, García-Barco M, Basora J, Martínez T, Pedret R, Arija V. The efficacy of a nutrition education intervention to prevent risk of malnutrition for dependent elderly patients receiving home care: A randomized controlled trial. Int J Nurs Stud. 2017;70:131–141. doi: 10.1016/j.ijnurstu.2017.02.020.
    1. Shatenstein B, Kergoat M, Reid I. Outcome of a targeted nutritional intervention among older adults with early-stage Alzheimer's disease: the nutrition intervention study. J Appl Gerontol. 2017;36:782–807. doi: 10.1177/0733464816628512.
    1. Suominen MH, Puranen TM, Jyväkorpi SK, Eloniemi-Sulkava U, Kautiainen H, Siljamäki-Ojansuu U, Pitkalä KH. Nutritional guidance improves nutrient intake and quality of life, and may prevent falls in aged persons with Alzheimer disease living with a spouse (NuAD trial) J Nutr Health Aging. 2015;19:901–907. doi: 10.1007/s12603-015-0558-0.
    1. Ten Haaf DSM, Nuijten MAH, Maessen MFH, Horstman AMH, Eijsvogels TMH, Hopman MTE. Effects of protein supplementation on lean body mass, muscle strength, and physical performance in nonfrail community-dwelling older adults: a systematic review and meta-analysis. Am J Clin Nutr. 2018;108:1043–1059. doi: 10.1093/ajcn/nqy192.
    1. Nykänen I, Välimäki T, Suominen L, Schwab U. Optimizing nutrition and oral health for caregivers — intervention protocol. Trials. 2021;22:625. doi: 10.1186/s13063-021-05589-8.
    1. Schulz KF, Altman DG, Moher D, the CONSORT Group CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials. BMC Med. 2010;8:18. doi: 10.1186/1741-7015-8-18.
    1. National Nutrition Council (2014) Finnish Nutritional Recommendations 2014. Helsinki
    1. Nordic Council of Ministers . Nordic Nutrition Recommendations 2012. Copenhagen: Integrating nutrition and physical activity; 2012.
    1. Guigoz Y. The Mini Nutritional Assessment (MNA) review of the literature–What does it tell us? J Nutr Health Aging. 2006;10:466–487.
    1. Guigoz Y, Lauque S, Vellas BJ. Identifying the elderly at risk for malnutrition. The mini nutritional assessment. Clin Geriatr Med. 2002;18:737–757. doi: 10.1016/s0749-0690(02)00059-9.
    1. Groll DL, To T, Bombardier C, Wright JG. The development of a comorbidity index with physical function as the outcome. J Clin Epidemiol. 2005;58:595–602. doi: 10.1016/j.jclinepi.2004.10.018.
    1. Tikkanen P, Nykänen I, Lönnroos E, Sipilä S, Sulkava R, Hartikainen S. Physical activity at age of 20–64 years and mobility and muscle strength in old age: a community-based study. The J of Gerontol: Ser A. 2012;67:905–910. doi: 10.1093/gerona/gls005.
    1. Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”: A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12:189–198. doi: 10.1016/0022-3956(75)90026-6.
    1. Yesavage JA, Sheikh JI. Geriatric Depression Scale (GDS) Clin Gerontol. 1986;5:165–173. doi: 10.1300/J018v05n01_09.
    1. Goldberg D. The Detection of Psychiatric Illness by Questionnaire. London: Oxford University Press; 1972.
    1. The WHOQOL Group Development of the World Health Organization WHOQOL-BREF quality of life assessment. Psychol Med. 1998;28:551–558. doi: 10.1017/s0033291798006667.
    1. Mahoney FI, Barthel DW. Functional Evaluation: The barthel index. Md State Med J. 1965;14:61–65.
    1. Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist. 1969;9:179–186. doi: 10.1093/geront/9.3_Part_1.179.
    1. Berendsen AAM, van de Rest O, Feskens EJM, Santoro A, Ostan R, Pietruszka B, Brzozowska A, Stelmaszczyk-Kusz A, Jennings A, Gillings R, Cassidy A, Caille A, Caumon E, Malpuech-Brugere C, Franceschi C, de Groot LCPGM. Changes in Dietary Intake and Adherence to the NU-AGE Diet Following a One-Year dietary intervention among european older adults-results of the nu-age randomized trial. Nutrients. 2018;10:1905. doi: 10.3390/nu10121905.
    1. van den Helder J, Verlaan S, Tieland M, Scholten J, Mehra S, Visser B, Kröse BJA, Engelbert RHH, Weijs PJM. Digitally supported dietary protein counseling changes dietary protein intake, sources and distribution in community-dwelling older adults. Nutrients. 2021;13:502. doi: 10.3390/nu13020502.
    1. Gray-Donald K, St-Arnaud-McKenzie D, Gaudreau P, Morais JA, Shatenstein B, Payette H. Protein intake protects against weight loss in healthy community-dwelling older adults. J Nutr. 2014;144:321–326. doi: 10.3945/jn.113.184705.
    1. Coelho-Júnior HJ, Rodrigues B, Uchida M, Marzetti E. Low protein intake is associated with frailty in older adults: a systematic review and meta-analysis of observational studies. Nutrients. 2018;10:1334. doi: 10.3390/nu10091334.
    1. Coelho-Junior HJ, Marzetti E, Picca A, Cesari M, Uchida MC, Calvani R. Protein intake and frailty: a matter of quantity, quality, and timing. Nutrients. 2020;12:2915. doi: 10.3390/nu12102915.
    1. Houston DK, Tooze JA, Garcia K, Visser M, Rubin S, Harris TB, Newman AB, Kritchevsky SB. Protein intake and mobility limitation in community-dwelling older adults: the Health ABC study. J Am Geriatr Soc. 2017;65:1705–1711. doi: 10.1111/jgs.14856.
    1. Bernstein A, Nelson ME, Tucker KL, Layne J, Johnson E, Nuernberger A, Castaneda C, Judge JO, Buchner D, Singh MF. A home-based nutrition intervention to increase consumption of fruits, vegetables, and calcium-rich foods in community dwelling elders. J Am Diet Assoc. 2002;10:1421–1427. doi: 10.1016/s0002-8223(02)90315-9.
    1. Deschasaux-Tanguy M, Druesne-Pecollo N, Esseddik Y, de Edelenyi FS, Allès B, Andreeva VA, Baudry J, Charreire H, Deschamps V, Egnell M, Fezeu LK, Galan P, Julia C, Kesse-Guyot E, Latino-Martel P, Oppert J, Péneau S, Verdot C, Hercberg S, Touvier M. Diet and physical activity during the coronavirus disease 2019 (COVID-19) lockdown (March-May 2020): results from the French NutriNet-Santé cohort study. Am J Clin Nutr. 2021;113:924–938. doi: 10.1093/ajcn/nqaa336.
    1. Lins Vieira NF, da Silva NJ, do Nascimento CQ, Barros Neto JA, Oliveira Dos Santo ACS, Association between bone mineral density and nutritional status, body composition and bone metabolism in older adults. J Nutr Health Aging. 2021;25:71–76. doi: 10.1007/s12603-020-1452-y.
    1. Remelli F, Vitali A, Zurlo A, Volpato S. Vitamin D deficiency and sarcopenia in older persons. Nutrients. 2019;11:2861. doi: 10.3390/nu11122861.
    1. Halfon M, Phan O, Teta D. Vitamin D: A Review on Its effects on muscle strength, the risk of fall, and frailty. Biomed Res Int. 2015;2015:953241. doi: 10.1155/2015/953241.
    1. Kocaer A, Sarpel T, Gökçen N, Başaran S, Coşkun Benlidayı İ. Proximal muscle strength as a predictor of vitamin D insufficiency in elderly. Turk J Phys Med Rehabil. 2021;67:84–90. doi: 10.5606/tftrd.2021.5323.
    1. Hawkley L, Zheng B, Hedberg EC, Huisingh-Scheetz M, Waite L. Cognitive limitations in older adults receiving care reduces well-being among spouse caregivers. Psychol Aging. 2020;35:28–40. doi: 10.1037/pag0000406.
    1. Ransmayr G, Hermann P, Sallinger K, Benke T, Seiler S, Dal-Bianco P, Marksteiner J, Defrancesco M, Sanin G, Struhal W, Guger M, Vosko M, Hagenauer K, Lehner R, Futschik A, Schmidt R. caregiving and caregiver burden in dementia home care: results from the prospective dementia registry (prodem) of the austrian alzheimer society. J Alzheimers Dis. 2018;63:103–114. doi: 10.3233/JAD-170657.
    1. Liu S, Li C, Shi Z, Wang X, Zhou Y, Liu S, Liu J, Yu T, Ji Y. Caregiver burden and prevalence of depression, anxiety and sleep disturbances in Alzheimer's disease caregivers in China. J Clin Nurs. 2017;26:1291–1300. doi: 10.1111/jocn.13601.
    1. Davison KM, Lung Y, Lin SL, Tong H, Kobayashi KM, Fuller-Thomson E. Psychological distress in older adults linked to immigrant status, dietary intake, and physical health conditions in the Canadian Longitudinal Study on Aging (CLSA) J Affect Disord. 2020;265:526–537. doi: 10.1016/j.jad.2020.01.024.
    1. Tana C, Lauretani F, Ticinesi A, Gionti L, Nouvenne A, Prati B, Meschi T, Maggio M. Impact of nutritional status on caregiver burden of elderly outpatients. A Cross-Sectional Study Nutrients. 2019;11:281. doi: 10.3390/nu11020281.
    1. Zhao W, Zhang Y, Jia S, Ge M, Hou L, Xia X, Liu X, Yue J, Dong B. The association of sleep quality and sleep duration with nutritional status in older adults: findings from the WCHAT study. Maturitas. 2021;145:1–5. doi: 10.1016/j.maturitas.2020.10.013.
    1. Volkert D, Beck AM, Cederholm T, Cruz-Jentoft A, Goisser S, Hooper L, Kiesswetter E, Maggio M, Raynaud-Simon A, Sieber CC, Sobotka L, van Asselt D, Wirth R, Bischoff SC. ESPEN guideline on clinical nutrition and hydration in geriatrics. Clin Nutr. 2019;38:10–47. doi: 10.1016/j.clnu.2018.05.024.

Source: PubMed

Patrocinadores e Colaboradores

Condições médicas

Intervenções de drogas

3
Se inscrever