The NHS spends around £14million per month on oral nutritional supplements (ONS) for older care home residents. Now a new study, the largest of its kind, is measuring whether ONS are actually effective for them.
Co-led by Bournemouth University and Plymouth University, the REFRESH study (nutRition intervEntions For malnouRished oldEr adultS in care Homes) will establish if and how ONS impact quality of life, compared with a fortified diet or usual care alone.
The trial will work with 90 care homes across Devon, Cornwall, Birmingham and Wessex and is funded by £2.78m from the National Institute for Health and Care Research (NIHR).
The project starts in January 2025 and will be co-delivered by the University of Plymouth’s Peninsula Clinical Trials Unit (PenCTU), the Universities of Coventry, Exeter and Southampton, Royal Devon and Exeter NHS Foundation Trust, and Harbour Healthcare.
Oral nutritional supplements (ONS) are liquids, powders, or semi-solids designed to provide additional nutrients to people who are unable to meet their nutritional needs through food alone.
There is limited academic evidence underpinning if and how they can be used effectively among older people in care homes, which is the main reason the study is taking place.
Professor of Dietetics at the University of Plymouth, Mary Hickson, who is co-lead for the REFRESH project said: “People who live in care homes are more at risk of malnutrition. Malnutrition harms their health, reduces their quality of life, and increases the risk of falls and infections, which each come with associated time and money costs.
“This trial is so important because each care home will be allocated at random to receive a different type of nutritional care – either ONS, fortified diet, or usual care – which will give us a strong set of comparisons. This will then enable us to build up a very good picture of how outcomes vary and inform how we can support older people in care home settings to improve their nutrition in future.”
Professor of Nutrition at Bournemouth University and co-lead, Jane Murphy, added: “We’re really pleased this much-needed work funded at a large scale by the NIHR, and we’re committed to working with care homes to ensure we’re working towards the best outcomes for older people.
“We also know there’s limited evidence around ONS so it’ll be good to get some much-needed evidence and clarity on if and how they should be used in care homes.”
Aidan Foy (right) with his late father-in-law and sonAidan Foy, from Bournemouth, saw his late father-in-law taken into a care home June 2023 where he was given ONS for nutritional support.
Having also looked after his own father at the latter stages of life, he is a key public applicant on the project, and hopes the outcomes will benefit care home residents and families in future.
“My father-in-law had a number of underlying health conditions,” he said. “He passed away March 2024, ten months after being taken into a care home.
“While he was there, my wife spoke with the doctor as we had a concern with his decline in energy and not eating and asked if he could be prescribed energy drinks; he was assessed for malnutrition, doctors suggested he should go on oral nutritional supplements. He wasn’t a big eater and the thought behind it was to help boost his energy levels, but we don’t know whether they worked.
“It’s great to be a part of this research team, and to see the work funded in the first place, as we can really help people in care homes, staff and their families to make important informed choices. It’s vital that everyone is supported to have the best quality of life possible.”
The research team will collect information from residents at the start of the trial, and at six and after 12 months. Measures include quality of life, food intake, appetite, muscle strength, weight, activities of daily living, as well as costs including use of prescribed oral nutritional supplements and use of NHS services.
