Occupational Therapy and Dietitian Services for Reducing Falls

Overseen By Lisa A Juckett, PhD, OTR/L

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Ohio State University

Disqualifiers: Receiving meals, Residential care, Hospice, others

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

Compensation: Varies

Number of Visits: 3

Duration: 12 weeks

750 Participants Needed

Trial Summary

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications.

What data supports the effectiveness of the treatment Occupational Therapy and Dietitian Services for Reducing Falls?

Research shows that a multidisciplinary approach, including dietitian services, can lead to more comprehensive care and reduce hospital readmissions in elderly patients. Additionally, involving dietitians in nutritional care planning has been shown to improve nutritional outcomes, which can be crucial for overall health and fall prevention. ^{1 2 3 4 5}

Is it safe to use occupational therapy and dietitian services for reducing falls?

Registered dietitians and dietetic technicians provide essential nutrition services that are safe and beneficial for people with various health needs, including those with developmental disabilities and special health care needs. These services are considered safe and effective in promoting health maintenance and reducing health risks. ^{6 7 8 9 10}

How is the treatment of Occupational Therapy and Dietitian Services for Reducing Falls different from other treatments for preventing falls?

This treatment is unique because it combines occupational therapy, which focuses on improving daily living skills and safety, with dietitian services that ensure proper nutrition, both of which are tailored to reduce falls by addressing functional and nutritional needs comprehensively. ^{3 6 11 12 13}

What is the purpose of this trial?

The purpose of this study is to determine which of the following four service models is most effective for reducing fall risk among home-delivered meal clients: (1) meals alone, (2) meals + registered dietitian services, (3) meals + occupational therapy services, (4) meals + registered dietitian + occupational therapy services.

Eligibility Criteria

This trial is for home-delivered meal clients who may be frail, have diabetes, weakness, cardiovascular disease or functional disability. It aims to find the best service model to reduce fall risk among these individuals.

Inclusion Criteria

Lives within LifeCare Alliance's 5-county service area

Has a working freezer to store between 7-14 frozen meals/week

Has a working microwave or oven to reheat meals

Exclusion Criteria

Individuals residing in residential care or a skilled nursing facility

Individuals whose dietary restrictions prohibit them from eating meals from LifeCare Alliance's frozen meal selection

Unable to independently answer LifeCare Alliance's in-take questions

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive meals and various combinations of registered dietitian and occupational therapy services for 3 months

12 weeks

Weekly meal deliveries, phone assessments by dietitians and occupational therapists

Follow-up

Participants are monitored for safety and effectiveness after treatment

3 months

Assessments at 3 and 6 months

Treatment Details

Interventions

• Occupational Therapy and Registered Dietitian Services

Trial Overview The study is testing four different combinations of services: meals alone; meals with dietitian (RD) services; meals with occupational therapy (OT); and meals with both RD and OT services to see which reduces fall risks most effectively.

Participant Groups

Group I: Arm 1: Meals only Active Control 1 Intervention

ARM 1: Meals only. Participants randomized to receive "meals only" will receive 7-14 frozen meals, delivered 1x/week, for 3-months. Participants will be provided with a menu of 42 meal options and instructions for how to select their meals and change weekly meal selections (if desired). Participants in this arm will also receive nutrition education and fall prevention handouts. Nutrition education handouts will indicate which of LifeCare Alliance's meals are considered to be "heart healthy" as well as "diabetic-friendly." Participants will have the autonomy to select their own meals according to their preferences and their ability to self-manage their own health conditions (e.g., diabetes, cardiovascular disease). Fall prevention education handouts will provide guidance on how to reduce fall risk at home and modify the home environment to eliminate fall hazards.

Group II: Arm 2: Meals + RD services Active Control 1 Intervention

ARM 2: Meals + registered dietitian services. Participants randomized to receive "meals + RD only" will receive 7-14 frozen meals, delivered 1x/week, for 3-months. In addition to receiving nutrition education and fall prevention handouts, participants in this arm will have a telephone-based nutrition assessment completed by one of LifeCare Alliance's registered dietitians who will assign participants a nutrition diagnosis (e.g., overconsumption of carbohydrates) within 60 days of study enrollment.

Group III: Meals + OT services Active Control 1 Intervention

ARM 3: Meals + occupational therapy services. Participants randomized to this arm will receive 7-14 frozen meals, delivered 1x/week, for 3-months and be able to make weekly meal selections from LifeCare Alliance's full list of 40 meals. In addition to receiving nutrition education and fall prevention handouts, participants in this arm will be contacted (within 30 days of study enrollment) by one of Lifecare Alliance's occupational therapists to complete a phone screen to determine each participant's occupational therapy needs (e.g., home safety/fall risk hazards, need for durable medical equipment).

Group IV: Arm 4: Meals + RD + OT services Active Control 1 Intervention

ARM 4: Meals + registered dietitian services + occupational therapy services. Participants in this arm will receive 7-14 frozen meals, delivered 1x/week, for 3-months as well as the same nutrition education and fall prevention handouts as provided in Arms 1-3. Additionally, participants will receive the combination of dietitian and OT services as provided in Arms 2 and 3 and have the same autonomy to make their own weekly meal selections from a curated list provided by the dietitian.

Who Is Running the Clinical Trial?

Ohio State University

Lead Sponsor

Trials

891

Recruited

2,659,000+

LifeCare Alliance

Collaborator

Trials

2

Recruited

810+

Findings from Research

A study of 117 malnourished older inpatients showed that multidisciplinary oral health management by a nutrition support team significantly improved their nutrition-intake methods and oral health, as indicated by better scores on the Functional Oral Intake Scale (FOIS), Dysphagia Severity Scale (DSS), and Oral Health Assessment Tool (OHAT).

The improvements in nutrition intake were positively correlated with the length of the intervention, suggesting that longer NST involvement leads to better outcomes in both nutrition intake and oral health.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Changes in Nutrition-Intake Method and Oral Health through a Multidisciplinary Team Approach in Malnourished Older Patients Admitted to an Acute Care Hospital. Suzuki, H., Furuya, J., Nakagawa, K., et al.[2023]

The study emphasizes the need for a collaborative approach between dietitians and speech therapists to improve swallowing training for elderly patients with oropharyngeal dysphagia in long-term care facilities.

By implementing a structured care model that includes specific protocols for swallowing training and dietary adjustments, the study aims to enhance the effectiveness of interventions, ultimately improving the quality of life for patients and meeting the expectations of their families.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Interprofessional Collaborative Practice in Long-Term Care: Swallow Training]. Liang, FC., Cho, MH.[2022]

The geriatric consultation team at Massachusetts General Hospital, established in 1980, provides comprehensive care for elderly patients, addressing their complex medical, psychological, and social needs to help them regain independence.

The multidisciplinary approach, including nutritional screening and collaboration among health professionals, has led to earlier identification of patient needs, more personalized care plans, and a reduction in hospital readmissions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Geriatric team dynamics: the dietitian's role. Delahanty, LM.[2008]

The study found that compliance with key nutritional support standards was low, with only 46% adherence to one standard and 82% to another, indicating significant gaps in the management of malnutrition among community-dwelling adults.

Despite high patient satisfaction (86%) with the community prescribing support service, the overall findings suggest a need for quality improvement initiatives to enhance the identification and management of malnutrition, as current practices vary widely among dietitians.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Research identified variation in nutrition practice by community prescribing dietitians with regards to the identification and management of malnutrition amongst community dwelling adults. Allmark, G., Calder, PC., Marino, LV.[2021]

A nutritional rehabilitation program for individuals with severe developmental disabilities successfully met weight management goals for residents in a long-term care facility over 6 months, with individualized menus created by a dietitian.

The program demonstrated that effective nutritional management can be achieved without increasing food quantity, highlighting the importance of dietitian involvement in enhancing the health of these residents.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A nutritional rehabilitation program for persons with severe physical and developmental disabilities. Hogan, SE., Evers, SE.[2017]

Collaboration with dietitians in functional rehabilitation services helps prevent recidivism and supports patients in regaining independence.

A coordinated care approach involving dietitians has shown benefits for patients with various conditions that lead to functional impairments.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Nurse and dietitian: effective collaboration in rehabilitation]. Poindessous, JL., Basta, M., Renaud, A., et al.[2018]

Registered dietitians (RDs) and dietetic technicians, registered (DTRs) play a crucial role in providing nutrition services for individuals with developmental disabilities and special health care needs, addressing various nutrition-related concerns throughout their lives.

Timely and effective nutrition interventions can help manage health risks and promote better health outcomes, highlighting the importance of RDs and DTRs in improving the quality of life for these individuals.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Position of the American Dietetic Association: Providing nutrition services for people with developmental disabilities and special health care needs. Van Riper, CL., Wallace, LS.[2019]

After allowing registered dietitians (RDs) to enter nutrition-related orders directly, error rates decreased by 15%, indicating improved patient safety.

The time delays for processing these orders were reduced by 39%, demonstrating that RDs can enhance the efficiency of nonmedication order entries in a hospital setting.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Diet order entry by registered dietitians results in a reduction in error rates and time delays compared with other health professionals. Imfeld, K., Keith, M., Stoyanoff, L., et al.[2018]

The employment of a part-time dietetic technician (D.T.) significantly improved the efficiency of the registered dietitian (R.D.) in a burn unit, as evidenced by an increase in the percentage of nutrition information charted and recommendations made for nutrition support from year 1 to year 2.

While the study showed that the R.D. was able to document more nutrition recommendations with the D.T.'s assistance, there was not enough data to assess the direct impact of this team on the nutritional status of burn patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effectiveness of the dietitian-technician team on a burn unit. Ptak, KM., Egenmaier, MC., Godfrey, LB., et al.[2018]

Registered dietitian nutritionists (RDNs) and nutrition and dietetics technicians, registered (NDTRs) are crucial for providing nutrition services to individuals with intellectual and developmental disabilities (IDD) and children and youth with special health care needs (CYSHCN), addressing various health risks and nutritional challenges throughout their lives.

Timely nutrition interventions by RDNs and NDTRs can significantly promote health maintenance and reduce the risk of comorbidities, highlighting the importance of their role in community-based care for these populations.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Position of the Academy of Nutrition and Dietetics: nutrition services for individuals with intellectual and developmental disabilities and special health care needs. Ptomey, LT., Wittenbrook, W.[2022]

Consultant dietitians in nursing homes play a crucial role in improving nutrition through menu planning, dietary consultations, and staff training, which are essential for resident health.

Administrators noted that the most significant impact of these consultants was in modifying diets and enhancing communication between foodservice and other departments, leading to better overall food safety and quality.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The consultant dietitian in nursing homes. II. Functions and change effectiveness. Spear, DM., Vaden, AG., Spears, MC.[2007]

Older adults should have access to evidence-based food and nutrition programs to ensure they receive safe and adequate food, which is essential for promoting optimal health, functionality, and quality of life.

Registered dietitian nutritionists and nutrition technicians should collaborate with other health professionals to create coordinated services that include nutritional screening, education, and monitoring, which are crucial for managing chronic diseases and reducing healthcare costs.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Position of the Academy of Nutrition and Dietetics and the Society for Nutrition Education and Behavior: Food and Nutrition Programs for Community-Residing Older Adults. Saffel-Shrier, S., Johnson, MA., Francis, SL.[2020]

A study involving 124 healthcare professionals (87 dietitians and 37 dietitian assistants) across eight hospitals in Queensland, Australia, revealed that dietitians felt there were inadequate guidelines for delegating malnutrition care activities, with less than 50% agreement on key areas like assessment and care coordination.

Despite dietitian assistants feeling adequately prepared for certain delegated tasks, the actual practice showed that dietitians routinely performed most nutrition care activities, indicating a need for clearer delegation processes and guidelines to enhance nutrition care delivery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Delegation Opportunities for Malnutrition Care Activities to Dietitian Assistants-Findings of a Multi-Site Survey. Rushton, A., Young, A., Keller, H., et al.[2021]

References

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

Changes in Nutrition-Intake Method and Oral Health through a Multidisciplinary Team Approach in Malnourished Older Patients Admitted to an Acute Care Hospital. [2023]

2. China (Republic : 1949- ) pubmed.ncbi.nlm.nih.gov

[Interprofessional Collaborative Practice in Long-Term Care: Swallow Training]. [2022]

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

Geriatric team dynamics: the dietitian's role. [2008]

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

Research identified variation in nutrition practice by community prescribing dietitians with regards to the identification and management of malnutrition amongst community dwelling adults. [2021]

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

A nutritional rehabilitation program for persons with severe physical and developmental disabilities. [2017]

6. France pubmed.ncbi.nlm.nih.gov

[Nurse and dietitian: effective collaboration in rehabilitation]. [2018]

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

Position of the American Dietetic Association: Providing nutrition services for people with developmental disabilities and special health care needs. [2019]

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

Diet order entry by registered dietitians results in a reduction in error rates and time delays compared with other health professionals. [2018]

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

Effectiveness of the dietitian-technician team on a burn unit. [2018]

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

Position of the Academy of Nutrition and Dietetics: nutrition services for individuals with intellectual and developmental disabilities and special health care needs. [2022]

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

The consultant dietitian in nursing homes. II. Functions and change effectiveness. [2007]

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

Position of the Academy of Nutrition and Dietetics and the Society for Nutrition Education and Behavior: Food and Nutrition Programs for Community-Residing Older Adults. [2020]

13. Switzerland pubmed.ncbi.nlm.nih.gov

Delegation Opportunities for Malnutrition Care Activities to Dietitian Assistants-Findings of a Multi-Site Survey. [2021]