Effect of non-meat, high protein supplementation on quality of life and clinical outcomes for older people living in care homes: systematic review and meta-analysis

CONTEXT: Care home residents are at risk of malnutrition through reduced overall food intake, ‘anabolic resistance’ in ageing muscle and high prevalence of medical morbidity and functional dependency. There has been limited consensus regarding effectiveness of a high protein diet on quality of life or clinical outcomes for care home residents. OBJECTIVE: To evaluate the effectiveness of non-meat, high protein supplementation on Health-Related Quality of Life (HRQOL) and relevant clinical and nutritional outcomes in older people in the care home setting. DATA SOURCES: We searched EMBASE, AMED, CINAHL, MEDLINE, and the Cochrane Registry of Clinical Trials, OpenGrey, clinicaltrials.gov, the WHO clinical trial registry and the ISRCTN and NIHR trial portfolio (to February 2018) for randomised controlled trials. DATA EXTRACTION: We extracted data from included trials if they assessed people aged 65 years and over living in care homes, who received a protein supplementation compared to not. DATA ANALYSIS: We assessed trial quality using Cochrane Risk of Bias tool and meta-analysis was undertaken when appropriate. RESULTS: 17 papers with 1,246 participants fulfilled the inclusion criteria. All studies were low or moderate quality. No evidence of improving HRQOL when the SF-36 was used (Standardised Mean Difference (SMD: -0.10; 95% CI: -0.51 to 0.31; p=0.62), although significant improvement was seen in the single trial using EQ-5D (SMD: 2.58; 95% CI: 2.05 to 3.10; p<0.00001). CONCLUSIONS: Non-meat, high-protein oral supplements can improve markers of nutritional status in care home residents. However, there is insufficient high-quality evidence to determine the effect of such interventions for older adults in care homes with regard to HRQOL.