Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

The effect of nutritional intervention in elderly subjects residing in group-living for the demented

Abstract

Objectives: We studied the nutritional status and the effects of nutritional intervention on body weight, cognition and activities of daily life (ADL)-function in demented individuals.

Design: Controlled non-randomised study.

Setting: Group-living for demented elderly (GLD), ie community assisted housing.

Subjects and interventions: Twenty-two residents living in one of two units (GLD-I), received oral liquid supplements (1720 kJ/410 kcal/day) and the personnel of the GLD-I were given nutritional education. Fourteen residents in the other unit (GLD-C) served as controls. After 6 months 21 (83 (4) y, 81% women) and 12 (85 (4) y, 100% women) of the participants, respectively, were re-examined according to body mass index (BMI, kg/m2), cognitive function (Mini Mental State Examination (MMSE, 0–30 p) and Clinical Dementia Rating Scale (CDR) and the Katz' ADL index.

Results: Body mass index (BMI) ≤20 was found in 19% of the participants and 44% had BMI≤23. BMI correlated with MMSE (r=0.43, P<0.01). The weight of the residents in the intervention group increased by 3.4 (3) kg (P=0.001) at follow-up, whereas the weight remained unchanged in the control group. The cognitive function was low at the start in both groups, ie MMSE9 and no apparent positive effect of the nutritional intervention was seen. In addition, the ADL functions appeared to deteriorate in both groups.

Conclusions: Being underweight was common among demented elderly in group-living and was related to low cognitive capacity. Five months of oral supplementation, along with education of personnel, was followed by a weight gain. In this study the nutritional treatment did not affect the rate of decline in cognitive function or Katz' ADL index.

Sponsorship: Supported by grants from the Swedish National Board of Health and Social Welfare. Semper Foods AB provided the liquid supplements.

This is a preview of subscription content, access via your institution

Relevant articles

Open Access articles citing this article.

Access options

Buy article

Get time limited or full article access on ReadCube.

$32.00

All prices are NET prices.

Figure 1

References

  • Abalan F, Manciet G, Dartigues J-F, Décamps A, Zapata E, Saumtally B, Galley P . 1992 Nutrition and SDAT Biol. Psychiatry 31: 99–105

    Article  Google Scholar 

  • Annerstedt L . 1997 Group-living care: an alternative for the demented elderly Dement. Geriatr. Cogn. Disord. 8: 136–142

    CAS  Article  Google Scholar 

  • Barrett-Connor E, Edelstein SL, Corey-Bloom J, Wiederholt WC . 1996 Weight loss precedes dementia in community-dwelling older adults J. Am. Ger. Soc. 44: 1147–1152

    CAS  Article  Google Scholar 

  • Beck AM, Ovesen L . 1998 At which body mass index and degree of weight loss should hospitalized elderly patients be considered at nutritional risk? Clin. Nutr. 17: 195–198

    CAS  Article  Google Scholar 

  • Burke WJ, Miller JP, Rubin EH, Morris JC, Coben LA, Duchek J, Wittels IG, Berg L . 1988 Reliability of the Washington University Clinical Dementia Rating Arch. Neurol. 45: 31–32

    CAS  Article  Google Scholar 

  • Burns A, Marsh A, Bender DA . 1989 Dietary intake and clinical, anthropometric and biochemical indices of malnutrition in elderly demented patients and nondemented subjects Psychol. Med. 19: 383–391

    CAS  Article  Google Scholar 

  • Carver AD, Dobson AM . 1995 Effects of dietary supplementation of elderly demented hospital residents J. Hum. Nutr. Diet. 8: 389–394

    Article  Google Scholar 

  • Cederholm T, Jägrén C, Hellström K . 1993 Nutritional status and performance capacity in internal medical patients Clin. Nutr. 12: 8–14

    CAS  Article  Google Scholar 

  • Corey-Bloom J, Galasko D, Hofstetter CR, Jackson JE, Thal LJ . 1993 Clinical features distinguish large cohorts with possible AD, probable AD, and mixed dementia J. Am. Geriatr. Soc. 41: 31–37

    CAS  Article  Google Scholar 

  • Cronin-Stubbs D, Beckett LA, Scherr PA, Field TS, Chown MJ, Pilgrim DM, Bennet DA, Evans DA . 1997 Weight loss in people with Alzheimer's disease: a prospective population based analysis Br. Med. J. 314: 178

    CAS  Article  Google Scholar 

  • Donaldson KE, Carpenter WH, Toth MJ, Goran MI, Newhouse P, Poehlman ET . 1996 No evidence for a higher resting metabolic rate in noninstitutionalized Alzheimer's disease patients J. Am. Geriatr. Soc. 44: 1232–1234

    CAS  Article  Google Scholar 

  • Elmståhl S, Steen B . 1987 Hospital nutrition in geriatric long-term care medicine: II. Effects of dietary supplements Age Ageing 16: 73–80

    Article  Google Scholar 

  • Estivariz CF, Ziegler TR . 1997 Nutrition and the insulin-like growth factor system Endocrine 7: 65–71

    CAS  Article  Google Scholar 

  • Faxén-Irving G, Andrén-Olsson B, Cederholm T . 1999 Nutritional and cognitive status in elderly subjects living in service flats and the effect of nutrition education on personnel Gerontology 45: 187–194

    Article  Google Scholar 

  • Flodin L, Svensson S, Cederholm T . 2000 Body mass index as a predictor of 1 y mortality in geriatric patients Clin. Nutr. 19: 121–125

    CAS  Article  Google Scholar 

  • Folstein MF, Folstein SE, McHugh PR . 1975 Mini Mental State. A practical method for grading the cognitive state of patients for the clinician J. Psychiatr. Res. 12: 189–198

    CAS  Article  Google Scholar 

  • Fratiglioni L, Grut M, Forsell Y, Viitanen M, Grafström M, Holmén K, Ericsson K, Bäckman L, Ahlbom A, Winblad B . 1991 Prevalence of Alzheimer's disease and other dementias in an elderly urban population: relationship with age, sex and education Neurology 41: 1886–1892

    CAS  Article  Google Scholar 

  • Gillette-Guyonnet S, Nourhashémi F, Andrieu S, de Gilsezinski I, Ousset PJ, Rivière D, Albarède JL, Vellas B . 2000 Weight loss in Alzheimer disease Am. J. Clin. Nutr. 71 Suppl: S637–642

    Article  Google Scholar 

  • Gillik MR . 2000 Rethinking the role of tube-feeding in patients with advanced dementia New Engl. J. Med. 342: 206–210

    Article  Google Scholar 

  • Grundman M, Corey-Bloom J, Jernigan T, Archibald S, Thal LJ . 1996 Low body weight in Alzheimer's disease is associated with mesial temporal cortex athrophy Neurology 46: 1585–1591

    CAS  Article  Google Scholar 

  • Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW . 1963 The index of ADL: a standardized measure of biological and psychological function J.A.M.A. 185: 94–99

    Article  Google Scholar 

  • Lewitt AJ, Karlinsky H . 1992 Folate, vitamin B12 and cognitive impairment in patients with Alzheimer's disease Acta Psychiatr. Scand. 86: 301–305

    Article  Google Scholar 

  • Minuto F, Barreca A, Adami GF, Fortini P, Del Monte P, Cella F, Scopinaro N, Giordano G . 1989 Insulin-like growth factor-I in human malnutrition: relationship with some body composition and nutritional parameters J. Parenter. Enteral. Nutr. 13: 392–396

    CAS  Article  Google Scholar 

  • Mitchell SL, Kiely DK, Lipsitz LA . 1997 The risk factors and impact on survival of feeding tube placement in nursing home residents with severe cognitive impairment Arch. Intern. Med. 157: 327–332

    CAS  Article  Google Scholar 

  • Pennington CR . 1998 Disease-associated malnutrition in the year 2000 Postgrad. Med. J. 74: 65–71

    CAS  Article  Google Scholar 

  • Poehlman ET, Toth MJ, Goran MI, Carpenter WH, Newhouse P, Rosen CJ . 1997 Daily energy expenditure in free-living non-institutionalized Alzheimer's patients: a doubly labeled water study Neurology 48: 997–1002

    CAS  Article  Google Scholar 

  • Poehlman ET, Dvorak RV . 2000 Energy expenditure, energy intake, and weight loss in Alzheimer disease Am. J. Clin. Nutr. 71 Suppl: S650–S655

    Article  Google Scholar 

  • Sandman PO, Adolfsson R, Nygren C, Hallmans G, Winblad B . 1987 Nutritional status and dietary intake in institutionalized patients with Alzheimer's disease and multi-infarct dementia J. Am. Ger. Soc. 35: 31–38

    CAS  Article  Google Scholar 

  • Singh S, Mulley GP, Losowsky MS . 1988 Why are Alzheimer patients thin? Age Ageing 17: 21–28

    CAS  Article  Google Scholar 

  • Symreng T . 1983 Arm anthropometry in a large reference population and in surgical patients Clin. Nutr. 1: 211–219

    Article  Google Scholar 

  • Tucker DM, Penland JG, Sandstead HH, Milne DB, Heck DG, Klevay LM . 1990 Nutrition status and brain function in aging Am. J. Clin. Nutr. 52: 93–102

    CAS  Article  Google Scholar 

  • Vetta F, Ronzoni S, Palleschi L, Bollea MR . 1997 Multidimensional approach for nutritional evaluation and restoration in the elderly Clin. Nutr. 16: 269–270

    CAS  Article  Google Scholar 

  • Wang H-X, Wahlin Å, Basun H, Fastbom J, Winblad B, Fratiglioni L . 2001 Vitamin B12 and folate in relation to the development of Alzheimer's disease Neurology 56: 1188–1194

    CAS  Article  Google Scholar 

  • Wang SY, Fukagawa N, Hossain M, Wee LO . 1997 Longitudinal weight changes, length of survival, and energy requirements of long-term care residents with dementia J. Am. Ger. Soc. 45: 1189–1195

    CAS  Article  Google Scholar 

  • White H, Pieper C, Schmader K . 1998 The association of weight change in Alzheimer's disease with severity of disease and mortality: a longitudinal analysis J. Am. Ger. Soc. 46: 1223–1227

    CAS  Article  Google Scholar 

  • Wimo A, Eriksson T, Mattsson T, Krakau I, Nelvig A, Karlsson G . 1995 Cost-utility analysis of group-living in dementia care Int. J. Technol. Assess. Health Care 11: 49–65

    CAS  Article  Google Scholar 

  • Wolf-Klein GP, Silverstone FA, Lansey SC, Tesi D, Ciampaglia C, O'Donnell M, Galkowski J, Jaeger A, Wallenstein S, Leleiko NS . 1995 Energy requirements in Alzheimer's disease patients Nutrition 11: 264–268

    CAS  PubMed  Google Scholar 

Download references

Acknowledgements

The work was carried out in co-operation with the Skärholmen and Brännkyrka District Council. We thank Mrs Sonia Mattsson, Mrs Eeva Eriksson, Mrs Marianne Popovski, Mrs Eira Granström, Mrs. Maj-Lis Styrwolt and Mr. Göran Henriksson for their committed involvement in the study.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to G Faxén-Irving.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Faxén-Irving, G., Andrén-Olsson, B., af Geijerstam, A. et al. The effect of nutritional intervention in elderly subjects residing in group-living for the demented. Eur J Clin Nutr 56, 221–227 (2002). https://doi.org/10.1038/sj.ejcn.1601304

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.ejcn.1601304

Keywords

  • aged
  • dementia
  • housing for the elderly
  • nutritional status
  • oral supplements

This article is cited by

Search

Quick links