Tackling malnutrition in residential aged care (RAC) with a new compact oral nutritional supplement (ONS) : a thesis presented in partial fulfilment of the requirements for the degree of Master of Science in Nutrition and Dietetics, Massey University, Albany, New Zealand

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Background: Malnutrition has several negative health consequences for older adults. Nutrition interventions using oral nutritional supplements (ONSs) are part of the solution and outcomes may be enhanced with the Medication Pass Nutrition Supplement Program (Med Pass). Aim: To determine whether 60 ml of a new compact ONS consumed four times daily with the medication round (Med Pass protocol) for 18-weeks is effective in improving nutrition status, physical strength (hand grip strength) and quality of life (QoL) measures. A secondary aim was to determine levels of compliance to the compact ONS following the Med Pass protocol. Methods: An 18-week, pilot intervention study was undertaken among 20 residential aged care (RAC) residents (mean age: 86.65 ± 6.8 y; 50 % female) assessed as being malnourished or at risk of malnutrition using the Mini Nutritional Assessment-short form (MNA-SF). Residents received 4x60 ml ONS (576 kcal/ml and 35 g protein) daily with the medication round. ONS intake and participant compliance were recorded daily. BMI, fat, and muscle mass (Bioelectrical Impedance Analysis [BIA]), grip strength (handgrip dynamometer), nutrition risk (MNA-SF), QoL (SF-12 tool) and depressive symptoms (Geriatric Depression Scale [GDS-15]) were assessed at baseline and at post intervention. Results: Median overall compliance was 98.6%. Median nutrition status (MNA-SF scores) improved by 10% (+1 [-1 , 1], p=0.197, d=0.288) along with a mean increase in body weight (1.5 ± 5.9 kg , p=0.259, d=0.260) and muscle mass (0.8 ± 2.2 kg, p=0.137 , d=0.390). Improved scores for SF-12 physical (+ 5.9 ± 11.1) and mental (2.8 ± 12.0) components and depressive symptoms (-1 [-3.5, 1.0]) were also observed. Conclusion: We found compliance to a new nutrient- and energy dense ONS using the Med Pass protocol was 98.6 %, demonstrating its acceptability among RAC residents. We observed an improvement in nutrition risk status, weight, muscle mass, GDS-15 score and SF-12 score. Providing nutrient and energy dense ONS using the Med Pass protocol may be an effective method of improving nutrition status in RAC residents and warrants further investigation among a larger group of RAC residents.