Enhanced Meal Program for Quality of Life

Overseen By Brie Tyler, MPH

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of Connecticut

Disqualifiers: Cognitive, physical limitations, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

Duration: 12 weeks

1640 Participants Needed

Trial Summary

What is the purpose of this trial?

Meals on Wheels of Rhode Island (MOWRI), in partnership with the University of Connecticut (UConn), will implement and evaluate an enhanced version of its Home-Delivered Meals Program (HDMP). The project goal is to implement and test the effectiveness of an enhanced Home-Delivered Meals (HDM) service delivery approach. The enhanced approach includes community health worker (CHW) interactions and supplemental healthy grocery bags to address diet quality, food and nutrition security, loneliness, and health-related quality of life for older adults. MOWRI participants at the highest nutritional risk will be randomized to receive standard or enhanced services in order to test the effect of the intervention on health-related outcomes. Anticipated outcomes for individuals receiving enhanced services are improvements in measures of diet quality, food and nutrition security, loneliness, and health-related quality of life compared with those receiving standard HDM services.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It seems focused on meal delivery and nutrition, so it's unlikely that medication changes are required.

What data supports the effectiveness of the Enhanced Meal Program for Quality of Life treatment?

Research shows that home-delivered meal services, like Meals on Wheels, can improve energy and protein intake, nutritional status, and satisfaction among older adults. These services help people stay in their homes longer and can improve quality of life, especially when meals are enriched or supplemented with snacks. ^{1 2 3 4 5}

Is the Enhanced Meal Program for Quality of Life safe for humans?

The Enhanced Meal Program, which includes home-delivered meals and nutrition support, has been used safely in various community settings, including for people with HIV/AIDS and older adults. No specific safety concerns have been reported in the studies, suggesting it is generally safe for human use. ^{6 7 8 9 10}

How is the Enhanced Meal Program for Quality of Life treatment different from other treatments?

The Enhanced Meal Program for Quality of Life is unique because it involves home-delivered meals and support from community health workers, who are trusted community members providing health-related services. This approach focuses on improving quality of life through nutrition and personalized support, which is different from traditional medical treatments that may not address these aspects. ^{11 12 13 14 15}

Research Team

Kim Gans, PhD

Principal Investigator

University of Connecticut

Caitlin Caspi, ScD

Principal Investigator

University of Connecticut

Eligibility Criteria

This trial is for older adults in Rhode Island who are at nutritional risk, eligible for Meals on Wheels assistance, and can communicate in Spanish or English. It's not specified who cannot join the trial.

Inclusion Criteria

I am considered at nutritional risk according to a recent assessment.

I live in Rhode Island.

I can read and speak either Spanish or English.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive enhanced home-delivered meals with community health worker interactions and supplemental grocery bags

12 weeks

Regular interactions with community health workers

Follow-up

Participants are monitored for improvements in diet quality, food security, nutrition security, loneliness, and health-related quality of life

4 weeks

Treatment Details

Interventions

• Community Health Worker calls
• Home-delivered meals
• Supplemental grocery bag
• Wellness check and socialization visit

Trial Overview The study tests an enhanced Home-Delivered Meals Program by Meals on Wheels with added community health worker calls, wellness visits, and extra grocery bags to improve diet quality, food security, loneliness, and life quality of older adults.

Participant Groups

Group I: Enhanced Experimental Treatment 4 Interventions

Home-delivered meals plus Community Health Worker Calls and supplemental grocery bags

Group II: Usual care Active Control 2 Interventions

Home-delivered meals

Who Is Running the Clinical Trial?

University of Connecticut

Lead Sponsor

Trials

194

Recruited

162,000+

Department of Health and Human Services (DHHS) Administration for Community Living (ACL)

Collaborator

Trials

1

Recruited

1,600+

Meals on Wheels Rhode Island (MOWRI)

Collaborator

Trials

1

Recruited

1,600+

Department of Health and Human Services

Collaborator

Trials

240

Recruited

944,000+

Findings from Research

Older adults receiving home-delivered meals are at a high risk of undernutrition, highlighting a significant nutritional concern for this population.

Improving home-delivered meal services, such as by adding dietetic counseling or enriched food options, can enhance nutritional status and intake, but even these improvements may not fully meet the recommended nutritional needs of all recipients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Nutritional Issue of Older People Receiving Home-Delivered Meals: A Systematic Review. Fleury, S., Tronchon, P., Rota, J., et al.[2021]

Home-delivered meal services, like Meals on Wheels, can enhance energy and protein intake for older adults by including protein-enriched options and providing full-day meal plans, according to a systematic review of 19 studies.

Despite the positive outcomes, none of the studies were rated as high quality, highlighting the need for further research to optimize these meal services for better nutritional care at home.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effective elements of home-delivered meal services to improve energy and protein intake: A systematic review. IJmker-Hemink, VE., Dijxhoorn, DN., Briseno Ozumbilla, CM., et al.[2020]

A pilot study involving 12 Meals on Wheels clients showed that providing high protein, high energy snacks significantly improved nutritional status, with a notable increase in energy and protein intake, and a reduction in the number of clients categorized as malnourished.

The study found that while the additional snacks led to increased body weight and BMI, only half of the participants expressed interest in continuing the program, indicating that not all clients recognized the benefits of the snacks for their health.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

"It could probably help someone else but not me": a feasibility study of a snack programme offered to meals on wheels clients. Charlton, KE., Walton, K., Moon, L., et al.[2021]

The Visiting Nurse Service HIV/Home Delivered Meals Program provided 50 clients with HIV/AIDS energy-enhanced meals and nutrition support over 6 months, leading to improved food consumption and weight management for many participants.

Out of 35 participants assessed, 13 gained weight on average by 6 pounds, and the program helped increase the number of participants considered to be 'doing well' from 14 to 19, demonstrating the effectiveness of dietitian-led medical nutrition therapy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A community-based, interagency approach by dietitians to provide meals, medical nutrition therapy, and education to clients with HIV/AIDS. Topping, CM., Humm, DC., Fischer, RB., et al.[2006]

Home-delivered meal programs can significantly support the health and independence of older adults, particularly those facing food insecurity or transitioning from care settings to home, as highlighted by a systematic review of 80 studies.

Most studies reviewed were descriptive and lacked rigorous outcomes, indicating a need for more comprehensive research to understand barriers to access and to optimize meal delivery models for older adults.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Does Participation in Home-Delivered Meals Programs Improve Outcomes for Older Adults? Results of a Systematic Review. Campbell, AD., Godfryd, A., Buys, DR., et al.[2022]

In a study involving 1310 mother-infant pairs in rural Eastern Cape, home visits by community health workers (CHWs) led to important improvements in maternal health behaviors, such as increased antenatal visits and exclusive breastfeeding for 6 months (OR: 1.8).

Children of mothers who received CHW support were less likely to experience wasting (OR: 0.5) and had fewer symptoms of common childhood illnesses, indicating that while the effects were limited compared to urban settings, CHWs still play a beneficial role in rural health outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Community health workers impact on maternal and child health outcomes in rural South Africa - a non-randomized two-group comparison study. le Roux, KW., Almirol, E., Rezvan, PH., et al.[2023]

Providing performance feedback to community health workers (CHWs) significantly improved their counseling duration, with a large effect size (Glass's delta=0.97) during the initial 6 weeks, and this improvement was sustained even after the intervention ended (Glass's delta=1.69).

While the feedback did not lead to significant improvements in case activity or form submissions, the supportive supervision aspect of the calls helped maintain CHW motivation, indicating that regular feedback can enhance overall performance in health programs.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effect of Performance Feedback on Community Health Workers' Motivation and Performance in Madhya Pradesh, India: A Randomized Controlled Trial. Kaphle, S., Matheke-Fischer, M., Lesh, N.[2019]

Community health workers play a crucial role in bridging the gap between health providers and the community by offering various services such as health education, outreach, and case management, which enhances access to healthcare.

The study of community health worker programs across seven sites provides valuable insights and lessons that can help improve the effectiveness and implementation of similar programs in other communities.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Impact of community health workers on access, use of services, and patient knowledge and behavior. Zuvekas, A., Nolan, L., Tumaylle, C., et al.[2019]

References

1. Switzerland pubmed.ncbi.nlm.nih.gov

The Nutritional Issue of Older People Receiving Home-Delivered Meals: A Systematic Review. [2021]

2. United States pubmed.ncbi.nlm.nih.gov

Effective elements of home-delivered meal services to improve energy and protein intake: A systematic review. [2020]

3. France pubmed.ncbi.nlm.nih.gov

"It could probably help someone else but not me": a feasibility study of a snack programme offered to meals on wheels clients. [2021]

4. United States pubmed.ncbi.nlm.nih.gov

Improvements in nutritional intake and quality of life among frail homebound older adults receiving home-delivered breakfast and lunch. [2015]

5. United States pubmed.ncbi.nlm.nih.gov

A Model Home-Delivered Meals Program to Support Transitions from Hospital to Home. [2016]

6. United States pubmed.ncbi.nlm.nih.gov

A community-based, interagency approach by dietitians to provide meals, medical nutrition therapy, and education to clients with HIV/AIDS. [2006]

7. Australia pubmed.ncbi.nlm.nih.gov

Audit of the national meal guidelines for home-delivered and centre-based meal programs. [2021]

8. Switzerland pubmed.ncbi.nlm.nih.gov

Implementing a Community-Based Initiative to Improve Nutritional Intake among Home-Delivered Meal Recipients. [2022]

9. United States pubmed.ncbi.nlm.nih.gov

Does Participation in Home-Delivered Meals Programs Improve Outcomes for Older Adults? Results of a Systematic Review. [2022]

10. United States pubmed.ncbi.nlm.nih.gov

The Healthy Meal Program: A food insecurity screening and referral program for urban dwelling older adults. [2021]

11. United States pubmed.ncbi.nlm.nih.gov

Cost-effectiveness analysis of a community health worker intervention for low-income Hispanic adults with diabetes. [2022]

12. England pubmed.ncbi.nlm.nih.gov

Community health workers impact on maternal and child health outcomes in rural South Africa - a non-randomized two-group comparison study. [2023]

13. Canada pubmed.ncbi.nlm.nih.gov

Effect of Performance Feedback on Community Health Workers' Motivation and Performance in Madhya Pradesh, India: A Randomized Controlled Trial. [2019]

14. United States pubmed.ncbi.nlm.nih.gov

Impact of community health workers on access, use of services, and patient knowledge and behavior. [2019]

15. England pubmed.ncbi.nlm.nih.gov

Community-based health workers: head start or false start towards health for all? [2019]