Nutrition in older adults: Factors influencing compliance to oral nutritional supplements and methods to improve compliance

Risk of malnutrition is prevalent in care home residents. Prescription of oral nutritional supplements is common practice in nutritional management of these residents; yet compliance rates in care homes are low. In the present studies risk of malnutrition was assessed, reasons for poor compliance investigated and an intervention developed to improve compliance in older adult care home residents. It was clear that nursing care residents were significantly more vulnerable to malnutrition risk than residential care; those with the lowest BMI experienced the greatest weight loss; and despite notification to carers, risk remained stable. Improvements in energy intake by enhancing meals with additional energy through food fortification or providing supplementation in covert versus overt presentation were assessed. There was no benefit of covert presentation relative to overt but food fortification and supplementation increased the energy density and nutrient quality of the meals consumed. ONS benefits depend on high compliance; carers acknowledged residents‟ need for additional support; residents wanted to exert control over the flavour and type of supplement given; and residents‟ knowledge about why they take ONS was identified as an important factor for compliance. These findings shaped the development of an intervention in which choice and variety were compared against motivation and education. In comparison with baseline, both arms of the intervention significantly improved compliance (from 60% to 93%). This indicates that personal choice which can enhance perceived efficacy and autonomy; motivation (through implementation intention and reward); and education (through information about the benefits of supplementation) can improve compliance. Therefore, compliance to ONS depends on three major components; the attributes of the resident taking the supplement; the support and education of the residents‟ carer; and the sensory properties of the products prescribed. The research confirmed the importance of the care environment in identification and action upon malnutrition risk, and that for the beneficial effects of ONS to be achieved, compliance must be enhanced through personal choice, variety, motivation and education.