The need for improved nutrition in older adults requiring care has been acknowledged, but, to the best of our knowledge, there is a lack of systematic review and integration of nutritional care studies with older adults in nursing homes. This scoping review aimed to examine the scope and nature of nutritional care research for older adults in nursing homes and to identify research gaps, following the guidelines of the Joanna Briggs Institute. We found varied nutritional care for older adults living in nursing homes, including individualized sessions, such as nutrition counseling, the addition of foods and preparations for increased nutritional intake, and the maintenance of an eating environment, such as feeding assistance and calling. The nutritional care identified in this scoping review also included studies that have improved the nutritional status of older adults in nursing homes by implementing educational programs for care staff. For future research on effective nutritional care for older adults in nursing homes, we suggest evaluating both short- and long-term intervention effects with an adequate sample size.
Older adults living in hospitals and nursing homes are more likely to be undernourished than community-dwelling older adults [1]. Undernutrition in older adults leads to adverse functional and clinical outcomes [2]. Internal and external factors, including environmental factors, influence the meals and nutrition of older adults [3, 4]. The prevalence of undernutrition is 15% and 36–85% among community-dwelling older adults and long-term nursing home residents, respectively [5, 6].
The European Society for Clinical Nutrition and Metabolism guidelines for clinical nutrition in geriatrics recommend routine nutritional care in clinical practice for maintaining or improving the nutritional status of older adults [7]. Nutritional care is defined as “an overarching term to describe the form of nutrition, nutrient delivery, and the system of education that is required for meal service or to treat any nutrition-related condition in both preventative and clinical nutrition” [8]. Management for undernutrition may include single or multiple nutritional care, including dietary counseling; dietary changes; oral nutritional supplements; enteral or intravenous nutrition; the use of specific nutrients, such as vitamin D, protein, and omega-3 fatty acid supplements; and psychological support [9]. Nutritional care should be evidence-based, individualized, and comprehensive. A review of individualized nutritional care for disease-related malnutrition has concluded that evidence supports its practical use; however, to determine achievable delivery and outcomes across different patient populations and care settings, further examination is needed [9].
While the need for improved nutrition in older adults requiring care has been previously acknowledged [6, 10], studies on how to achieve this are limited. Thus, a comprehensive review of the existing knowledge on the types of nutritional care practiced to enhance the nutritional status of nursing home residents is imperative. A systematic review of mealtime interventions in nursing home residents over the age of 65 has shown improved nutritional outcomes with improved food, food service interventions, and dietary environment adjustments [11]. It has also been reported that nutritional education and guidance for community-dwelling older adults are useful for increasing dietary intake and improving physical function [12], although, to the best of our knowledge, there is a lack of systematic review and integration of nutritional care studies with older adults in nursing homes. A review of this field could provide available evidence of nutritional care research to improve the nutritional status of older adults in nursing homes with a high prevalence of undernutrition. The results of this review will also be useful in identifying unresolved areas requiring research. For that purpose, this scoping review aimed to examine the scope and nature of nutritional care research for older adults in nursing homes and to identify research gaps and potential areas for innovative approaches.
Study design
This scoping review was conducted to map the broad literature and identify research gaps in nutritional care for older adults in nursing homes. The methodology and stages of this scoping review followed the guidelines of the Joanna Briggs Institute (JBI) [13]. The final output adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews checklist [14].
Eligibility criteria
Population/studies
The target population was nursing home residents aged 65 years and older (or their mean age was 65 years and older), their caregivers, and healthcare workers.
Concept
This scoping review focused on nutritional care research to improve the nutritional status of nursing home residents. In this study, nutritional care to improve nutritional status refers to the provision of foods and preparations (e.g., serving snacks, food fortification, and oral nutrition supplements) to increase nutritional intake, and individual sessions (e.g., nutritional guidance and counseling) to improve nutritional status [9, 15]. Improvements in nutritional status were defined as increases in nutritional intake and improvements in body weight, body composition, and physical function.
Context
All studies on nutritional care aimed at improving the nutritional status of older adults in nursing homes were included, without being limited to geographic region, ethnicity, or gender. The nursing homes in this review included both public and private facilities.
Study types
This scoping review evaluated major published studies using mixed, quantitative, and qualitative methods. The study design covered controlled trials and excluded case reports and theses. This review included studies on nutritional care for improved nutritional status among older adults in nursing homes identified by a literature search, with the following inclusion criteria:
・studies focused on older adults living in nursing homes
・studies that examined changes in nutritional status due to nutritional care interventions
The following were the exclusion criteria:
・studies focused on older inpatients in acute and subacute hospitals
・studies focused on older adults living in the community
・studies focused on older adults attending day care
Search strategy
The search aimed to identify studies on nutritional care interventions for older adults in nursing homes published since 2000. The search strategy was developed utilizing key terms relating to the concept within our research question. A three-step search method was employed to identify relevant literature. First, the database was searched using keywords related to our topic. Second, we analyzed the terms contained in the titles and abstracts of retrieved articles as well as keywords described in the articles, after which a second search was performed using the revealed keywords and search terms. Third, additional sources were searched on the basis of citations in the identified literature. We searched the following databases: PubMed, Ichushi-Web, and Cochrane Central Register of Controlled Trials (CENTRAL). The search strategy for PubMed is shown in Table 1. We removed all duplicates when screening publications.
| Search | Query |
|---|---|
| #5 | #3 AND #4 |
| #4 | ((“Clinical Trial”[PT] OR “Comparative Study”[PT] OR “Evaluation study”[PT] OR “Cross-Over Studies”[MeSH] OR “Clinical Trials as Topic”[MeSH] OR random*[TIAB] OR controll*[TIAB] OR “intervention study”[TIAB] OR “experimental study”[TIAB] OR trial[TIAB] OR trials[TIAB] OR evaluat*[TIAB] OR repeat*[TIAB] OR compar*[TIAB] OR versus[TIAB] OR “before and after”[TIAB] OR “interrupted time series”[TIAB]) NOT (“Animals”[MeSH] NOT (Animals[MeSH] AND “Humans”[MeSH]))) |
| #3 | #1 AND #2 |
| #2 | “Nutrition Therapy”[Mesh] OR “Nutritional Support”[Mesh] OR “Dietary Supplements”[Mesh] OR “Diet Therapy”[Mesh] OR Nutrition*[ti] OR Diet[ti] OR Food[ti] OR Supplement*[ti] OR Energy[ti] OR Protein[ti] OR Snack*[ti] OR Feed*[ti] OR Cooking[ti] OR Dietitian[ti] OR Mealtime[ti] |
| #1 | “Residential Facilities”[Mesh] OR “long-term care”[Mesh] OR “Housing for the Elderly”[Mesh] OR “Homes for the Aged”[Mesh] residential facilit*[tiab] OR “nursing home”[tiab] OR “group home”[tiab] OR “long-term care”[tiab] |
Data extraction
Using the scoping review methodology developed by the JBI, we extracted data from all included articles [13]. A data extraction form that was aligned with the research objectives and goals of this study was used to document the data.
Data management
We managed the literature retrieved from the electronic database using Rayyan online software (https://rayyan.qcri.org) [16]. Using this software enables easy detection and extraction of duplicates; conducts and has a clear trail of the document screening process; classifies articles that will be included or excluded from the bibliographic reviews; and efficiently manages the full-text versions of articles to be included. A second author (RM) managed the Rayyan software and ensured independent review of titles and abstracts by blinding the decisions of the reviewers.
Presentation of the results/data mapping
Data were presented as tables or figures, consistent with the objectives of this review. We present the results in a table, followed by a narrative summary explaining their relevance to the purpose of the review (Table 2).
| Basic data | author, year, country |
| Study design | methods, intervention target |
| Subjects | setting, recruitment strategy, sample size |
| Description of intervention | snack serving, food fortification, oral nutritional supplements, enteral nutrition, parenteral nutrition |
| outcome | nutritional intake, weight, BMI, body composition, physical function |
| Basic data | author, year, country |
| Study design | methods, intervention target |
| Subjects | setting, recruitment strategy, sample size |
| Description of intervention | nutritional education, nutritional advice, nutritional counseling, telenutrition |
| outcome | nutritional intake, weight, BMI, body composition, physical function |
A total of 2,154 articles were initially identified and screened for titles and abstracts, and 29 full-text articles were evaluated by applying eligibility criteria. Ultimately, we included 22 full-text articles in this review. We excluded articles from this review for the following reasons based on our pre-defined exclusion criteria: living in the community (n = 3), in hospital (n = 2), and older adults attending day care (n = 2) (Figure 1).
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram for search strategy and study selection.
The studies that we included were published by authors from eight countries. Most were from Japan (9/22, 40.9%) [17–25], followed by the United States of America (5/21, 23.8%) [26–30] and Sweden (2/21, 9.5%) [31, 32]. The remaining five studies were conducted by researchers from Canada [33], Finland [34], Taiwan [35], Australia [36], Denmark [37], and Germany [38]. Randomized controlled trial (7/22, 31.8%) was the most frequently observed study design in the included studies. This was followed by non-randomized controlled trials (4/22, 18.2%), pre- and post-design studies (6/22, 27.3%), and prospective intervention studies (4/22, 18.2%). One study utilized a crossover trial design. The study sample sizes ranged from 9 to 430 participants, including both residents and care staff. Notably, three studies recruited both residents and care staff for their investigations.
| Study | Country | Study design | Participants | n (I/C) | Intervention | Control | Outcomes |
|---|---|---|---|---|---|---|---|
| Faxen-Irving G et al, 2002 [31] | Sweden | Non-randomized controlled trial | Group-living for demented elderly | 36(22/14) | The residents in community assisted housing received two 200 ml oral liquid supplements daily during a 5-month period. The personnel at community assisted housing attended a 12-h educational program about nutrition and diet for the elderly. | Regular diet, no educational program |
BMI, triceps skin fold (TSF) and arm muscle circumference (AMC), Katz ’ADL index |
| Splett PL et al, 2003 [26] | USA | Randomized controlled trial |
Volunteer dietitians /Nursing home residents |
Dietitians36 (20/16) Residents394 (233/171) |
Protocol nutrition care | Usual nutrition care | Dietitian questionnaire, midpoint dietitian feedback survey, medical record audit form |
| Keller HH et al, 2003 [33] | Canada | Non-randomized controlled trial | Dementia residents of special care units (SCUs) | 82(33/49) | A 9-month period, during which dietitian time was enhanced and the menu was modified/enhanced at the intervention facility; and the 12 months after the intervention, during which only the enhanced menu was continued at the intervention site and the dietitian time was returned to the norm of 15 minutes per resident per month. | comprehensive intervention | Body weight patterns, a detailed nutritional assessment (body composition measurements, laboratory tests, and weighed food records), BI, time and number of visits by clinical dietitians. |
| Simmons SF et al, 2004 [27] | USA | Prospective interventional trial | Nursing home residents | 134 | Individual assistance (1 staff member to 1 resident), proper positioning for eating, compliance with dining location preferences, and optional meal tray substitutions. Participants who did not increase their oral food and fluid intake by at least 15% in response to the one-on-one mealtime feeding assistance intervention received a 2-day or 6-snack trial of the between-meal snack intervention. For participants with a 15% or more increase in oral intake, 4 days of mealtime feeding assistance intervention with 1 staff member to 3 residents. | None | The frequency of verbal and physical prompts rendered by staff, the total amount of time staff spent providing assistance, and the total time that residents had access to foods and fluids, each food and fluid item and the amount consumed by the participant and the amount of time spent with the participant during each snack period. |
| Faxen-Irving G et al, 2005 [32] | Sweden | Non-randomized controlled trial | Nursing home care staff and residents |
Staff45(25/20) Residents80(37/43) |
Staff: At the start, a 12-h education program | Staff: No education program | BMI, SGA, grip strength, appetite (VAS), Katz ADL index |
| Kikutani T, et al, 2005 [17] | Japan | Non-randomized controlled trial | Older adults residing in a nursing home with a serum albumin level of 4.0 mg/dl or less | 51(feeding assistance care27/Oral function training and feeding assistance care24) | Feeding assistance: Assessing the eating situation and changing the food form by multiple professions, using auxiliary aids, teaching pacing, calling out during meals, feeding assistance, environmental maintenance, Oral function training at lunch twice a week. | None | Assessment of oral function (tongue pressure) |
| Crogan NL et al, 2006 [28] | USA | Non-randomized controlled trial | Residents had to be at least 65 years of age | 81(41/40) | The 6-month Individualized Nutrition Rx (INRx) assessment process. | Routine care specific to the nursing home | BMI, Katz ADL Scale |
| Kikutani T et al, 2006 [18] | Japan | Randomized controlled trial | Residents of nursing homes with serum albumin levels of 3.8 mg/dl or less | 14(7/7) | Protein and energy were supplemented by substituting a part of the diet with defined nutrients. Professional care on oral hygiene was individually given by a dental hygienist once a week. | No oral training | Body weight, nutrient intakes, tongue pressure |
| Suominen MH et al, 2007 [34] | Finland | Prospective interventional trial | Nursing home residents in dementia wards and professionals | Of the 21 residents and professionals, 23 are nurses and 5 are food service personnel | Six training sessions with lectures, small group discussions, homework tasks and personal feedback. | None | BMI, food consumption of the residents, energy intake, MNA |
| Kikutani T et al, 2008 [19] | Japan | Prospective interventional trial | Nursing home residents | 50 | Conduct feeding support conferences in multiple occupations, assess feeding function, and provide dental care as needed. | None | Nutrient intakes, nutrition screening in nutritional care management. |
| Simmons SF et al, 2008 [29] | USA | Crossover controlled trial | Nursing home residents to be long-stay (non-Medicare) | 69(35/34) | Mealtime assistance or between meal snacks. | Regular diet | BMI, Average total daily calories |
| Gaskill D et al, 2009 [36] | Australia | Randomized controlled trial | Nursing home residents | 279(134/145) | The program encompassed training a staff member from each residential aged care facility to take the role of Nutrition coordinator. | Routine care | Subjective Global Assessment (SGA), dietary information (prescribed diet, oral hygiene status and referrals to a dietitian or speech pathologist) |
| Lin WY et al, 2010 [35] | Taiwan | Randomized controlled trial | Residents 65 years of age and older (age range: 65–101 years) living in eight different long-term care facilities | 374(125/249) | A dietitian gave each resident their dietary suggestions, with follow-up every 2 weeks. | Usual care; team members including a medical doctor, nurse, and pharmacist visited residents every two weeks | Body weight, BMI, waist circumference, hip circumference |
| Kishida M et al, 2010 [20] | Japan | Prospective interventional trial | Nursing home residents | 34(17/17) | Oral care before meals, adjusting posture during feeding, changing to brightly colored tableware, changing to self-help devices based on the patient’s opinion, devising ways to serve side dishes, discontinuing unnecessary aprons. | Normal feeding environment | Dietary intake, BMI |
| Sasaki R et al, 2015 [21] | Japan | Before-after study | Older adults requiring nursing care who are admitted to nursing home and for whom a request for evaluation of feeding and swallowing has been received | 31 | Based on the results of the assessment of feeding and swallowing function, we proposed to improve the feeding environment, such as modifying the dietary pattern and changing the feeding assistance method and took action. | Before intervention | BMI, Food form, dietary intake, time required to eat meals, posture while eating, feeding assistance method, presence or absence of semi-solidification of water, dietary independence, weight change before and after intervention. |
| Kikutani T et al, 2015 [22] | Japan | Before-after study | Older adults requiring nursing care who are admitted to nursing home and for whom a request for evaluation of feeding and swallowing has been received | 31 | Based on the results of external observation at mealtime using the original mastication and eating behavior evaluation sheet and swallowing video endoscopy, feeding guidance was provided, including dietary pattern, eating posture, and feeding assistance. | Before intervention | Body weight, BMI, food form, dietary intake, time required to eat meals, dietary independence |
| Beck AM et al, 2016 [37] | Denmark | Randomized controlled trial | Older adults (65 years of age or older) receiving home care or residing in two nursing homes who meet the Eating Validation Scheme (EVS) and be able to complete the test. | 95(55/40) | In addition to the educated nutrition coordinator, the participants assigned to the intervention group strategy received the new model for multidisciplinary nutrition support during the 11-week study. | The nutrition coordinators were present in both the control and the intervention group. Also, in both groups’, standard interventions from physiotherapist, registered dietitian, occupational therapist, and care dentistry was requested through the municipality’s normal assessment, and referral system was maintained. | Physical performance by means of a 30-second chair-stand, nutritional status by means of weight and hand-grip strength. |
| Sakashita R et al, 2016 [23] | Japan | Before-after study | Nursing home residents | 100 |
The intensive program (from the start of intervention to 3 months later) (1) tailor-made individual programs Intervention content: devising ways to savor and enjoy food, modifying dietary patterns and foods, modifying eating posture, etc. (2) Group hands-on learning program (lectures and exercises) i)For residents and their families ii)For facility staff The continuation program (3 to 6 months after intervention) |
Before intervention | Calorie intake, fluid intake, food form, BMI, appetite |
| Simmons SF et al, 2017 [30] | USA | Randomized controlled trial | Long-stay residents of nursing homes where oral intake is available | 128(63/65) | Participants randomized to the intervention group were assigned to trained staff for between-meal assistance following baseline assessments. Trained staff were asked to provide supplements and/or snacks twice per day, five weekdays per week, for 24 consecutive weeks. Trained staff were also encouraged to offer a variety of food, beverage and supplement options in conjunction with assistance to promote consumption. | Participants randomized to the control group continued to receive routine care as it was usually provided by nurse aide staff. | Impact of trained staff on frequency of between-meal delivery and staff time, meal and total caloric intake, weight |
| Fujio Y et al, 2018 [24] | Japan | Before-after study | Fee-based assisted living homes users with an Alb value < 3.8 g/dl | 9 | Registered dieticians, nurses, and care workers collaborated to create favorable dietary environments to meet all nutrient requirements. At the same time, counselors identified the users’ food preferences, with cooperation of their families, and purchased their favorite foods to promote their dietary intake. In addition, multiple professionals provided opportunities for the users to lead an enjoyable dietary life by helping them eat out and actively communicate with other users. | None | BMI, dietary intake, motor functions: the 25-question geriatric locomotive function scale (Locomo-25; a self-administered questionnaire, consisting of questions to be answered on a 5-point scale.), Timed Up & Go Test (TUG) score, functional reach (FR), hand grip strength (both sides), maximum number of steps, and the time needed to walk 5 m. |
| Morikawa I, 2022 [25] | Japan | Before-after study | Older adults with dementia in an care facility | 12 | Music therapy for about 45 minutes before lunch once a week for a total of 4 times. | Before intervention | Dietary intake |
| Seemer J et al, 2022 [38] | Germany | Before-after study | Nursing home residents at risk of malnutrition | 50 | The intervention consists of reshaped texture-modified meals and combinations of three food supplements. In Addition, based on energy and protein deficiency levels residents were assigned to the corresponding level of supplementation during structured individual case discussions within the study team taking BMI, weight objective, dietary habits and expected acceptance into account. | Before intervention | Energy and protein intake, Body weight, handgrip strength |
ADL: Activities of Daily Living, BI: Barthel Index, MNA: Mini Nutritional Assessment.
This review included the following two types of nutritional care to improve nutritional status: individual sessions only (14/22, 63.6%), and individual sessions combined with foods and preparations to increase nutritional intake (8/22, 36.4%) (Table 4). All of the studies included nursing home residents; however, three studies evaluated how the educational interventions for care staff influenced nursing home residents [26, 32, 34]. In more than half of the studies included in this review, a control group was set up to provide usual care or diet to nursing home residents or no education program for the staff (12/22, 54.6%). Other studies included pre- and post-intervention comparisons (5/22, 22.7%) and no control group (5/22, 22.7%).
| The number of pertinent articles (percentage) | |
|---|---|
| Setting | |
| Nursing home | 20 (90.9%) |
| Group living homes for older people with dementia | 1 (4.5%) |
| private nursing home | 1 (4.5%) |
| Intervention category | |
| Individualized sessions to improve nutritional status | 14 (63.6%) |
| Individualized sessions and provision of foods and preparations to improve nutritional status | 8 (36.4%) |
| Subjects of intervention | |
| Nursing home residents | 15 (68.2%) |
| Nursing home residents and staff | 5 (22.7%) |
| Nursing home staff | 2 (9.1%) |
Nutritional outcomes in the included studies comprised body mass index (BMI), weight trends, anthropometry, and body composition, accounting for more than 70% (16/22, 72.7%), followed by dietary intake assessment (13/22, 59.0%). The Subjective Global Assessment and The Mini Nutritional Assessment were the only nutritional assessment tools used for outcomes [34, 36]. Appetite was assessed using the Visual analogue scale in one study (1/22, 4.5%) [32]. We observed that studies that set physical function as an outcome varied in terms of Katz ADL index, 30-s chair-stand test, the 25-question Geriatric Locomotive Function Scale, Timed Up and Go test, functional reach, the maximum number of steps, the time needed to walk 5 m, tongue pressure, and grip strength [17, 18, 24, 28, 31, 32, 37, 38].
This scoping review showed that nutritional care for older adults in nursing homes is diverse and complex. Keller et al conducted a study wherein a registered dietitian offered individual counseling to nursing home residents, and reported that menu changes effectively increased or maintained body weight [33]. Gaskill et al reported that one of the staff members participated in an educational program on nutritional care as a nutrition coordinator. These nutrition coordinators provided nutrition training within the facility, thereby leading to the maintenance or improvement of residents’ nutritional status [36]. As in these studies, there have been studies involving older adults living in nursing homes and studies examining the impact of educational interventions for care staff on nursing home residents.
This review also showed that nutritional care for older adults living in nursing homes extends beyond nutritional counseling or educational interventions for care staff. Some studies implemented combined interventions, including the addition of nutritional supplements. Faxen-Irving et al reported weight gain among older adults when lectures on nutrition were provided to care staff and energy-dense nutritional supplements were provided twice a day to nursing home residents [31]. A meta-analysis on enhanced food- and drink-based nutrition interventions for older adults requiring care concluded that fortified menus can significantly increase energy and protein intake compared with standard menus [39]. Based on these findings, we consider that research focusing on individualized sessions, including nutritional counseling, is required because it is clear that the addition of fortified foods and formulas improves nutritional intake.
Among the articles included in this review, BMI and weight gain or loss were the most commonly used nutrition-related outcome measures. Although changes in BMI and weight are feasible nutritional assessment measures in the nursing home setting, they are static and require time to exhibit changes. We also identified studies that use nutritional intake and food forms for nutrition-related outcomes. A scoping review of nutrition assessment in patients with dysphagia used dietary intake per day, time to resume eating, and food forms in the acute setting, suggesting that these parameters could be used as short-term nutrition indicators [40]. These findings suggest the inclusion of not only body weight and BMI but also dietary intake and food forms as nutritional outcome measures in assessing the short-term effects of nutritional care for older adults requiring care.
This scoping review had some limitations. First, we did not include blood test results, including increased albumin or specific nutrient levels, to assess improvements in nutritional status; therefore studies focusing solely on blood tests were not captured. According to a position paper from the American Society for Parenteral and Enteral Nutrition [41], serum visceral protein levels are not reliable indicators of nutritional status as they primarily reflect inflammation. Consequently, in our review, blood testing was not considered as a means of assessing nutritional status improvements. Second, our literature searches were limited to only three databases: PubMed, CENTRAL, and Ichushi-web. The literature encompassed in MEDLINE, which is recognized as the most important database for literature searches, was accessible on PubMed. Nor did we include EMBASE in the search because of its coverage of basic medicine and clinical pharmacology, areas that were not deemed to be highly relevant for nutritional care–related reviews. We identified CINAHL, which covers nursing and allied health fields, as an appropriate database for our investigation, but it has been reported that when searching on MEDLINE, only one or two articles are added, even when searching in CINAHL [42]. Consequently, we concluded that there was little need for a search in CINAHL. Although it was a thorough and rigorous search process, the selection of databases, search strategy, and article selection method may have potentially excluded relevant studies from our review. Third, our study did not differentiate between facility characteristics, including the characteristics of residents, but the setting of each study was used as a reference for classifying the articles.
In this review, we noted varied nutritional care for older adults living in nursing homes, including individualized sessions, such as nutrition counseling, the addition of foods and preparations for increased nutritional intake, and the maintenance of an eating environment, such as feeding assistance and calling. The nutritional care identified in this scoping review also included studies that have improved the nutritional status of older adults in nursing homes by implementing educational programs for care staff. This review also found that studies of nutritional care for older adults in nursing homes vary in the number of cases and have biased outcome measures. For future research on effective nutritional care for older adults in nursing homes, we recommend including analyses to assess the short- and long-term effects of interventions in an adequate sample size.
This scoping review maps the evidence of nutritional care for enhancing the nutritional status of older adults in nursing homes. Nutritional care for older adults in nursing homes exhibits significant variation, with studies frequently employing multiple interventions. Employing both short- and long-term indicators for nutrition-related outcomes can facilitate comprehensive and continuous evaluation of nutritional care effectiveness. In conclusion, more controlled and randomized trials and other systematic reviews and meta-analyses are needed for the exploration of effective nutritional care for older adults in nursing homes.
The authors’ responsibilities were as follows: Research Supervisors/Mentors: RM and KM; Research conception and design: RM and KM; Conduction of the systematic literature search, performance of the data extraction, and data collection: YS, RM, YK, and AH; Interpretation of the data: YS, RM, YK, and AH. All of the authors contributed to writing and reviewing the manuscript and read and approved the final manuscript.
The authors declare that there are no conflicts of interest.
The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
