The purpose of the review is to determine the effectiveness of mealtime interventions on the elderly living in residential care.

The primary aim is to review the impact of mealtime interventions on nutritional status.

Secondary aims include reviewing the evidence of mealtime interventions on other health outcomes, including functional status, health-related quality of life, hospital admission rates and mortality.

The following electronic databases will be searched: AMED, CINAHL, EMBASE, British Nursing Index, MEDLINE, Web of Science, PsycINFO, the Cochrane Database of systematic reviews, Social Sciences Citation Index, Social Care Online, ASSIA amd AgeInfo.

Relevant grey literature will be searched for through: EThOS (British Library), OpenGrey , and the Conference Proceedings Citation Index from Web of Knowledge.

Current research will be checked through the Current Controlled Trials Register, MRC Clinical Trials Register and PROSPERO.

Include: Cluster randomised controlled trials, controlled studies, and pre and post study designs

Exclude: Qualitative studies, case studies

Malnutrition is of particular concern in those living in care homes. Elderly individuals identified as at risk of malnutrition are more likely to be admitted to hospital. Moreover, malnutrition has a considerable impact on recovery and is associated with impaired immune response, impaired respiratory function, delayed wound healing, overall increased complications and increased mortality. Whilst the need to improve the nutrition of the elderly living in care homes/nursing homes is clearly recognised, how this can best be achieved, and whether (and which) intervention is successful in reducing morbidity is less well understood. This review will assess the effectiveness of mealtime interventions on elderly people living in residential care.

Elderly people living in residential care .

Inclusion: adults over 65 years, living in either care homes or nursing homes. No gender restriction.

Exclusion: adults over 65 years in a hospital setting.

Mealtime interventions refer to interventions that impact on the eating/dining experience of meal times through increasing choice, access, support, or altering the mealtime environment.

Include: interventions that modify the dining environment; interventions that modify the type of food and mode of food delivery available at mealtimes; interventions that provide assistance with eating; and interventions that address nutrition education of residential care home staff.

Exclude: interventions that fortify usual food intake through commercial sip-feeds or micronutrient/vitamin supplements, interventions that assess the fortification of usual food using milk powders or simple energy sources; and interventions that assess the impact of immuno-modulatory diets.

Usual care (no intervention) or a non-mealtime comparative intervention.

Include: studies in care homes or nursing homes

Exclude: studies in hospitals, palliative care homes and studies taking place within individual's homes within the community

Primary outcomes

Nutritional status, functional status, health-related quality of life, mortality, hospital admission rates

Secondary outcomes

Resource use.

Data will be extracted from included studies by one reviewer into a bespoke database and checked by another reviewer. Discrepancies will be resolved by discussion, with the involvement of a third reviewer if necessary.

The precise data to be extracted is still to be finalised but will include standard demographic information on the participants and setting, information regarding the nature of the intervention, and quantitative information where possible on the primary outcomes.

The quality of individual studies will be assessed by one reviewer, and checked by a second reviewer. Any disagreement will be resolved by consensus and if necessary a third reviewer will arbitrate. Appropriate quality assessment criteria will be used depending on the design of the included studies using the general principles published by the NHS Centre for Reviews and Dissemination and the Cochrane Collaboration.

If appropriate, a meta-analysis will be employed to estimate the effectiveness of the interventions, based on intention to treat analyses. If a meta-analysis is not possible, a narrative approach will be undertaken to summarise the effectiveness of the different mealtime intervention approaches.

If the data allow, we will explore the difference in intervention effects between care homes and nursing homes.

Findings from the review will be disseminated through the PCMD website, through PCMD presentations and through publication of the findings in a peer-reviewed journal.

Rebecca Abbott

PenCLAHRC

PCMD

Veysey Building

Salmon Pool Lane

Exeter EX2 4SG

rebecca.abbott@pcmd.ac.uk

PenCLAHRC, Peninsula College of Medicine and Dentistry, University of Exeter

www.pcmd.ac.uk

Dr Rebecca Abbott, PCMD, University of Exeter
Ms Rebecca Whear, PCMD, University of Exeter
Dr Jo Thompson Coon, PCMD, University of Exeter
Ms Morwenna Rogers, PCMD, University of Exeter
Ms Alison Bethel, PCMD, UNIversity of Exeter
Professor Ken Stein, PCMD, UNiversity of Exeter
Dr Anthony Hemsley, Royal Devon and Exeter Hospital, NHS Devon

01 August 2012

01 May 2013

The National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for the South West Peninsula - known as PenCLAHRC

None known

None

English

England

Subject indexing assigned by CRD

Aged; Aged, 80 and over; Food Services; Humans; Residential Facilities

None

02 August 2012

13 November 2012