• Intervention
    What is the relationship between modified texture diets and weight gain in adults over age 65?
    • Conclusion

      Seven studies were evaluated regarding the use of modified texture diets in older adults with dysphagia.  People consuming modified texture diets report an increased need for assistance with eating, dissatisfaction with foods, and decreased enjoyment of eating, resulting in decreased food intake and weight loss. Recognition of the social and psychological burden of dysphagia, an individualized treatment approach and the provision of eating assistance may contribute to increased food intake and weight maintenance or weight gain.

    • Grade: I
      • Grade I means there is Good/Strong evidence supporting the statement;
      • Grade II is Fair;
      • Grade III is Limited/Weak;
      • Grade IV is Expert Opinion Only;
      • Grade V is Not Assignable.
      • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
      • Moderate (B) means we are moderately confident in the effect estimate;
      • Low (C) means our confidence in the effect estimate is limited;
      • Very Low (D) means we have very little confidence in the effect estimate.
      • Ungraded means a grade is not assignable.
    What is the relationship between nutrient-dense oral supplements/fortified foods and weight gain in adults over age 65?
    • Conclusion

      Two positive-quality systematic reviews (including 70 studies) were evaluated regarding nutritional supplementation in older adults. Both concluded that oral protein and energy supplementation produces a small but consistent weight gain in older adults.

    • Grade: I
      • Grade I means there is Good/Strong evidence supporting the statement;
      • Grade II is Fair;
      • Grade III is Limited/Weak;
      • Grade IV is Expert Opinion Only;
      • Grade V is Not Assignable.
      • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
      • Moderate (B) means we are moderately confident in the effect estimate;
      • Low (C) means our confidence in the effect estimate is limited;
      • Very Low (D) means we have very little confidence in the effect estimate.
      • Ungraded means a grade is not assignable.
    What is the relationship between diet liberalization (selective diets, non-restrictive diets) and weight gain in adults over age 65?
    • Conclusion

      Seven studies were evaluated regarding liberalized diets, meal patterns and composition in older adults. Three studies report little scientific evidence to support the use of restrictive diets in the elderly. Resident involvement in menu planning, as well as flexibility of the meal pattern and composition, may result in improved intake of food and fluid. 

    • Grade: I
      • Grade I means there is Good/Strong evidence supporting the statement;
      • Grade II is Fair;
      • Grade III is Limited/Weak;
      • Grade IV is Expert Opinion Only;
      • Grade V is Not Assignable.
      • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
      • Moderate (B) means we are moderately confident in the effect estimate;
      • Low (C) means our confidence in the effect estimate is limited;
      • Very Low (D) means we have very little confidence in the effect estimate.
      • Ungraded means a grade is not assignable.
    What is the relationship between eating assistance and weight gain in adults over age 65?
    • Conclusion

      Seventeen studies were evaluated regarding eating assistance in older adults. Four studies report that residents needing assistance to eat are more likely to receive assistance when staffing levels are adequate. Eight studies report a positive association between eating dependency and poor nutritional status. Five studies evaluating the impact of eating assistance on food intake and weight status report conflicting findings due to study length and degree of comorbidity; studies of longer duration in residents with different levels of illness acuity are needed.        

    • Grade: II
      • Grade I means there is Good/Strong evidence supporting the statement;
      • Grade II is Fair;
      • Grade III is Limited/Weak;
      • Grade IV is Expert Opinion Only;
      • Grade V is Not Assignable.
      • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
      • Moderate (B) means we are moderately confident in the effect estimate;
      • Low (C) means our confidence in the effect estimate is limited;
      • Very Low (D) means we have very little confidence in the effect estimate.
      • Ungraded means a grade is not assignable.
    What is the relationship between dining environment and weight gain in adults over age 65?
    • Conclusion

      Nine studies were evaluated regarding dining environment in older adults. Three studies report improved food intake and nutritional status in residents eating in a socially stimulating common dining area. Two studies focusing on improved dining ambience (such as physical environment and atmosphere of the dining room, food service and meals, and organization of the nursing staff assistance) resulted in resident weight gain. Two studies based on creative dining programs (such as buffet-style dining and meal portioning on resident floors) demonstrate improvements in quality of life and food intake. Studies of longer duration in residents with different levels of illness acuity are needed.

    • Grade: II
      • Grade I means there is Good/Strong evidence supporting the statement;
      • Grade II is Fair;
      • Grade III is Limited/Weak;
      • Grade IV is Expert Opinion Only;
      • Grade V is Not Assignable.
      • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
      • Moderate (B) means we are moderately confident in the effect estimate;
      • Low (C) means our confidence in the effect estimate is limited;
      • Very Low (D) means we have very little confidence in the effect estimate.
      • Ungraded means a grade is not assignable.
    What is the evidence regarding the use of appetite stimulants in older adults with unintended weight loss?
    • Conclusion

      There is no research on the effectiveness of appetite stimulants for older adults that meets the American Dietetic Association criteria for evidence analysis.

    • Grade: V
      • Grade I means there is Good/Strong evidence supporting the statement;
      • Grade II is Fair;
      • Grade III is Limited/Weak;
      • Grade IV is Expert Opinion Only;
      • Grade V is Not Assignable.
      • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
      • Moderate (B) means we are moderately confident in the effect estimate;
      • Low (C) means our confidence in the effect estimate is limited;
      • Very Low (D) means we have very little confidence in the effect estimate.
      • Ungraded means a grade is not assignable.