The global phenomenon of an aging population poses challenges in caring for older people for societies worldwide. In Finland, family caregiving has risen in recent decades. Older spouses redominantly undertake the role of family caregivers (FCs) while facing their own health concerns, notably an increased risk of malnutrition. Despite the critical role of FCs, the effects of nutrition intervention on their nutritional status and dietary intake have been inadequately explored in existing studies.
The aim of this study was to investigate nutritional status, associated factors, and dietary intake of older FCs aged 60 years and above in Eastern Finland. Additionally, the study examined the impact of individually tailored nutritional guidance on the dietary intake and nutritional status of older FCs and on the nutritional status of their care recipients (CRs). Factors that influence the success of nutritional intervention were also studied.
The study population included 125 older FCs and 120 CRs living in
Eastern Finland, in a randomized controlled LENTO (Lifestyle, Nutrition, and Oral health in caregivers) intervention study conducted in 2019 - 2020. Participants were randomly allocated to either an intervention or a control group. The intervention involved a clinical nutritionist and a dental hygienist providing individualized nutritional and oral health guidance to the intervention group at baseline and two months. The individually tailored nutritional guidance was based on the established nutritional recommendations for older people. Assessments of changes in nutritional status and dietary intake occurred at the end of a 6-month intervention (6
months), and nutritional status was further evaluated after a 6-month follow-up (12 months).
The findings indicated that a noteworthy proportion of older FCs had an increased risk of malnutrition, as identified by the Mini Nutritional
Assessment (MNA). Factors, such as a higher number of comorbidities, diminished quality of life, and lower energy intake were significantly associated with increased risk of malnutrition. Furthermore, more than half of older FCs exhibited lower-than-recommended intakes of energy and essential nutrients, including protein, vitamin A, folate, and fiber. Lower-than-recommended intake levels of vitamin D, vitamin E, thiamine, magnesium, iron, and selenium were also prevalent.
Individually tailored nutritional guidance emerged as a positive force,
significantly impacting the dietary intake of older FCs. Notably, the
intervention group demonstrated significant increases in the intake of protein, riboflavin, calcium, potassium, phosphorus, and iodine compared to the control group. Moreover, the intervention contributed positively to the nutritional status of CRs, showing a significant improvement from baseline to the end of the 6-month follow-up at 12 months.
Despite these positive outcomes, certain factors prevented the
effectiveness of the intervention. Male sex, younger age, lower net income, lower hand grip strength, fewer teeth, and absence of removable dentures were identified as barriers preventing an increase in protein intake among older FCs. Additionally, a higher perception of depressive symptoms prevented improvement in MNA scores of FCs during the intervention.
Further analyses revealed nuanced patterns regarding the factors
influencing plasma albumin (P-Alb) and plasma pre-albumin (P-Prealb) concentrations of FCs during the intervention. Older age, higher education, higher body mass index (BMI), higher P-hs-CRP concentration at the end of the intervention (6 months), lower presence of depressive symptoms, higher Sense of Coherence (SOC) -13, more teeth, and use of removable dentures prevented increase in those concentrations during the intervention.
In conclusion, regular monitoring of the nutritional status and dietary
intake of older FCs is important to prevent adverse effects of poor
nutrition. Individually tailored nutritional guidance emerged as a promising approach, positively impacting the dietary intake of older FCs, particularly protein and essential micronutrients. The findings also suggest potential improvements in the nutritional status of older CRs. However, recognizing and addressing factors such as poor oral health, depressive symptoms, and inflammation through multidisciplinary approaches is crucial for the success of individually tailored nutritional guidance. This research provides valuable insights that can inform policies and interventions aimed at improving the well-being of aging populations, especially older FCs, and their CRs.