Tackling malnutrition and dehydration in older people in nursing homes (FA4 module 1)

Malnutrition and dehydration are common in nursing home residents. Due to a multifactorial origin of both problems, the underlying causes may differ between individual residents, making individualized intervention strategies necessary to ensure adequate food and fluid intake.

Previous studies addressing prevention and treatment of malnutrition and dehydration in nursing home residents almost exclusively focused on single strategies, mainly oral nutritional supplements and food enrichment. Individualized and multimodal intervention concepts are scarce up to now.

During the first funding period of enable several products and concepts aiming at improving food and fluid intake of older adults were developed and pilot tested: a protein-rich drink, texture-modified, reshaped, and enriched meals for people with chewing and swallowing difficulties, and technical devices (games, smartMug) to increase fluid intake. As these strategies address different problems they are suitable to be combined in a multimodal and individualized nutritional care concept to increase energy and protein intake and/or fluid intake of older people.


The general aim of the project is to prevent and treat malnutrition and dehydration in older people living in nursing homes.

Detailed objectives of the present project are

  • to optimise the products from the 1st enable funding period as a basis for their use in an intervention study.
  • to develop a concept for the assessment of individual nutritional problems and needs in order to derive appropriate nutritional interventions.
  • to investigate the effects of a multimodal individualised nutrition intervention compared to usual care on dietary intake and nutritional status of nursing home residents with (risk of) malnutrition.
  • to evaluate the practicability of the intervention in terms of time and workload.

to identify major motivators and barriers for successful intervention

Implementation and first results

Intervention modules:

In this Module of the enable-Focus Area 4, the products from the 1st enable funding period were optimised for their use in an intervention study together with the partners from Fraunhofer IVV and Hochschule Weihenstephan-Triesdorf:

            3 enrichment modules

  • Protein-energy drink (orange-mango flavour, 250 mL, 220 kcal, 22 g protein)
  • Sweet protein cream (with icing sugar and cinnamon, 40 g, 125 kcal, 10 g protein)
  • Savoury protein cream (with maltodextrin, pepper and broth, 40 g, 125 kcal, 10 g protein)

and reshaped texture-modified meals.

Intervention concept:

The products were combined to an individualised multimodal nutritional intervention concept. Enrichment modules were offered single or in combination in 5 levels to compensate for residents' individual energy and protein deficiencies, taking BMI, body weight objectives and individual preferences into account. The regular pureed diet was reshaped during the intervention by texturisers and silicon moulds (1).

Intervention study:

The nutritional concept was implemented and applied in 2 nursing homes in Nuremberg. Following six weeks of usual care, fifty study participants received six weeks of individualised intervention in order to investigate the effects on energy and protein intake as well as on body weight, physical function and quality of life. Overall, energy and protein intake and quality of life in one subscale (care relationship) significantly increased. Body weight, handgrip strength and other quality of life subscales did not change (2).


After the intervention, practicability, acceptance by nursing staff as well as motivators and barriers of a successful implementation in the nursing homes were assessed. Practicability and acceptance of the intervention modules varied considerably. Acceptance and practicability ratings were higher in registered nurses compared to other staff groups (nursing aides and social care workers). In addition, established interventions such as an additional drink and texture-modified meals seem to be better accepted compared to innovative interventions such as the protein creams (1,3).

Due to the Corona pandemic, the technical strategies to improve fluid intake by nursing home residents could not yet be put into practice. The corresponding pilot study will be carried out as soon as studies in nursing homes are possible again.


  1. Seemer J, Kiesswetter E, Blawert A, Fleckenstein D, Gloning M, Bader-Mittermaier S, et al. An Individualised Nutritional Intervention Concept for Nursing Home Residents with or at Risk of Malnutrition: An enable Study. Geriatrics. 2021; 6(1):12. https://doi.org/10.3390/geriatrics6010002.
  2. Seemer J, Kiesswetter E, Fleckenstein D, Gloning M, Lötzbeyer T, Mittermaier S, Sieber CC, Wurm S, Volkert D. Effects of an individualised nutritional intervention on dietary intake and quality of life in nursing homes residents with (risk of) malnutrition: An enable study. Clinical Nutrition ESPEN. 2020; 40:681-2. https://doi.org/https://doi.org/10.1016/j.clnesp.2020.09.833. (Conference abstract)
  3. Seemer J, Blawert A, Kiesswetter E, Sieber CC, Wurm S, Volkert D. Evaluation einer individualisierten Ernährungsintervention zur Bewältigung von Mangelernährung bei Pflegeheimbewohnern durch Pflegekräfte: Ergebnisse einer enable-Studie. Proc Germ Nutr Soc 2021; 27: 51 (Conference abstract)