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Nutritional Supplements Aid Hospitalized Elderly

But they don't benefit healthy seniors, study finds

WEDNESDAY, Jan. 4, 2006 (HealthDay News) -- Nutritional supplements bolster the health of malnourished seniors in hospitals or long-term care settings, but are of little benefit to the well-fed elderly living at home, researchers say.

"No evidence in our review suggested any improvement in mortality and morbidity for well-nourished (older) people who are given oral supplements of protein and energy," report a team of Australian and Scottish researchers in the Jan. 3 issue of the Annals of Internal Medicine.

The finding was drawn from a large-scale analysis of nutritional studies conducted over the past 40 years.

The authors initially screened more than 34,000 English and non-English language studies that had focused on elderly patients living either for a short while in a hospital; in a long-term care facility, such as a nursing home; or at home in their community.

While many of the participants suffered from a range of ailments -- including age-related frailty, stroke, pulmonary disease, heart failure and hip fracture -- none had been in critical care or recovering from cancer at the time of the study.

Ultimately settling on 55 studies for a full analysis, the researchers noted that all involved groups of patients averaging at least 65 years of age.

All the men and women had been administered diets enhanced with commercial supplements, milk-based supplements, or fortified versions of their usual meals. Daily supplementation usually contained some vitamins and minerals, ranged between 175 and 1,000 calories, and included between 10 and 36 grams of protein.

Anne C. Milne, of the University of Aberdeen's Health Services Research Unit, and her colleagues tallied the impact that such supplementation had on a variety of factors, such as death rates and cause of death, length of hospital stay, quality of life and ability to function, body weight and muscle mass changes, and ability to tolerate the enhanced diet.

The researchers noted that nearly three-quarters of the more than 9,100 patients they tracked had received supplements while hospitalized. Another 16 percent lived at home, while 10 percent resided at long-term care institutions.

Supplementation periods varied widely, lasting as little as 10 days and as long as 18 months.

Regardless of duration, the researchers found that supplementation did not improve survival rates for the at-home elderly.

While unable to definitively comment on the survival rate of long-term care patients, the researchers found that supplements did, however, appear to improve the survival rate of the hospitalized elderly, and may have reduced the incidence of health complications among this group. Hospitalized patients nevertheless did not experience a reduced hospital stay as a result.

The researchers concluded that older people are an extremely heterogeneous group, and that supplements do not affect all seniors in the same way.

The researchers also suggested that a distinction be made between the benefits that supplements can confer on those who are both malnourished and hospitalized, and the negligible impact supplements seem to have on the health of well-nourished, at-home elders.

"Physicians sometimes recommend commercial oral protein and energy supplements for sick older people who have difficulty eating enough normal food," Milne said. "This systematic review of the evidence from 55 trials suggests that oral supplements can produce a small increase in weight for most people. Oral supplements also seem to increase survival and reduce complications for undernourished elderly people in hospital. There is no evidence, however, to suggest an improved outcome or survival for older people living at home or for well-nourished people in any setting."

"It is important that undernourished elderly patients in hospital are recognized and treated," she added. "Furthermore, improving the nutritional intake particularly of frail older people living at home presents a major challenge, as acceptance rates for oral supplements may be low. The best methods have still to be established."

Judith Finkelstein, head of the Office of Nutrition at the National Institute on Aging, expressed little surprise at the findings.

"It's common sense," she said. "I do not find it surprising that if an elderly person is in a malnourished state that they might benefit from supplementation."

"But I think the analysis clearly indicates that there's no compelling reason for every elderly person to take supplementation," she added. "There are certainly some supplements -- calcium along with vitamin D -- which the elderly should be consuming in greater quantities than younger people. And the kind of supplementation the study looked at might be helpful for certain people in certain categories, particularly those who are under-nourished. But if they're healthy enough to be living in the community, and they're eating a healthy diet, it's clear from the study that they don't need to be taking supplementation."

More information

For more on nutrition and the elderly, visit the U.S. Department of Health and Human Services.

SOURCES: Anne C. Milne, MSc, University of Aberdeen's Health Services Research Unit, Aberdeen, Scotland; Judith Finkelstein, head, Office of Nutrition, National Institute on Aging, Bethesda, Md.; Jan. 3, 2006, Annals of Internal Medicine
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