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Nutritional intervention reduces falls in malnourished older adults

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Malnourished adults aged 60 and older who started an energy- and protein-enriched nutritional plan plus calcium and vitamin D supplements following hospital discharge were less apt to fall over three months than their peers who did not, researchers from the Netherlands found in a secondary analysis of a randomized controlled trial.

The nutritional intervention provided an additional 600 kcal, 24 g of protein, and about 600 IU of vitamin D per day and included telephone counseling by a dietitian. In the primary study, the intervention (as opposed to usual care) led to weight gain and a decrease in functional impairment.

In the secondary analysis, the researchers found that far fewer patients in the nutritional invention group than the usual care group fell at least one time three months after discharge (10 of 105 [10%] vs 24 of 105 [23%]; hazard ratio, 0.41). Overall, there were 57 fall incidents – 16 in the intervention group vs 41 in the usual care group.

In a report online February 8 in the Journal of the American Geriatrics Society, the authors note that roughly 30% of community-dwelling persons aged 65 and older fall once a year, and 15% fall at least two times a year. They say the percentage of falls in intervention participants (10% in 3 months) was as expected, but was higher than expected in the control group (30% in 3 months).

They also point out that there were no statistically significant differences in physical activity between the groups and activity levels did not change during the study, suggesting that changes in activity level did not account for the between-group difference in falls.

The researchers say there no statistically significant differences between intervention participants and controls in terms of functional limitations, body weight, grip strength, and physical performance at baseline. They note, however, that they didn’t have data on all well-known risk factors for falls. They also lacked data on polypharmacy and vision impairment, which may have influenced the results.

A strength of the study is that the adherence to the nutritional intervention was higher than 80%, which may explain the better results than in other studies, the researchers surmise. They believe the high adherence to the intervention may be due to the counseling component of the study.

Summing up, they say, “This is one of the first studies showing these effects in such a short period and in a participant sample consisting of exclusively malnourished individuals. It would be of interest to study the cost effectiveness of this intervention in the future.”


Short-Term Oral Nutritional Intervention with Protein and Vitamin D Decreases Falls in Malnourished Older Adults

Journal of the American Geriatrics Society, 2012