Protein and energy supplementation can increase survival and reduce complications for hospitalized elderly patients who are undernourished at admission, but there is little or no evidence that it helps well-nourished patients who are hospitalized or older people who live in other settings, according to a review of 55 randomized controlled trials.
“Although the evidence is limited and generally of poor quality, we suggest that routine supplements should be considered” for undernourished elderly patients in the hospital, said Anne C. Milne, research fellow at the University of Aberdeen, Scotland, and her colleagues.
They used the methods of the international Cochrane Collaboration, an organization that evaluates medical research and draws evidence-based conclusions about medical practice, to conduct a metaanalysis of randomized or “quasirandomized trials” of oral protein and energy supplementation lasting at least 1 week in people older than 65 years. Supplementation included various commercial nutritional supplements, milk-based supplements, and fortification of normal food sources, but not special immunomodulatory supplements or supplements of specific amino acids.
The effects of supplementation on mortality and morbidity were statistically significant only in hospitalized patients who were deemed undernourished—and even then, the results were “borderline statistically significant,” the investigators said. Hospital stay was not reduced in patients who received supplements.
Supplementation may improve mortality in older patients in long-term care, but there's no evidence to suggest improvement in mortality and morbidity for older people at home or well-nourished older patients in any setting, they said (Ann. Intern. Med. 2006;144:37–48).