Does Mode of Meal Delivery Contribute to Nursing Home Admissions?

A pilot pragmatic clinical trial from Kali S. Thomas, PhD, Brown University Public Health, Providence, Rhode Island, and colleagues sought to determine if the mode of delivery for premade meals contributes to the admission of older adults with dementia into nursing homes. This included investigating any difference in nursing home placement for older adults receiving daily delivered meals vs drop-shipped, frozen meals.

Because older homebound adults with dementia are at higher risk of experiencing social isolation, loneliness, malnutrition, and cognitive decline, the authors wanted to gauge the impact of the informal socialization that occurs with daily delivered meals. Following the Consolidated Standards of Reporting Trials, Dr Thomas and colleagues enrolled 243 participants in the study between April 7 and October 8, 2021, and concluded the final 6-month follow ups on April 8, 2022. Of the enrolled participants, 128 were randomized to receive daily delivered meals (5 meals delivered by a driver 2-5 times per week) and 115 to receive drop-shipped meals (10 frozen meals delivered every 2 weeks). A total of 119 (49.0%) participants lived alone; 152 (62.2%) were female; and 43 (17.7%) were Black, 62 (25.5%) were Latino or Hispanic, 128 (52.7%) were White, and 10 (4.1%) were categorized as “other.”

The primary outcome for the study was the number of days from randomization in the trial to nursing home admission within 6 months of randomization. Dr Thomas and colleagues linked data from enrolled patients with Centers for Medicare & Medicaid Services (CMS) data through a study-specific usage agreement. Overall, 93.4% of the 243 participants were able to be linked to their CMS data.

The researchers used a pooled analysis of the 200 probabilistically CMS-linked data sets and found that 6 months after randomization, 25 participants had been admitted to a nursing home (10.1%; 95% CI, 6.3%-14.0%). While those in the daily delivered meals group were less likely to be admitted to a nursing home, the difference between the two groups was not significant (6.0 percentage point difference; 95% CI, –14.0 to 1.5 percentage points). During the study, 17 participants died, and the difference in mortality between the two groups was also not statistically significant (0.1 percentage point; 95% CI, –6.0 to 6.0 percentage points).

"While this pilot trial was not adequately powered to detect effects that were as large as the observed differences at a 5% nominal level, the results suggest that there may be lower nursing home placement among individuals with self- or proxy-reported dementia who received daily-delivered meals with socialization and a safety check compared with individuals who received drop-shipped frozen meals," the authors wrote.

Although this study had some limitations, including relying on self- and proxy-reported dementia and that more participants in the drop-shipped group lived alone, the researchers were able to demonstrate the feasibility of conducting a full-scale randomized clinical trial that enrolls older adults with dementia, monitors their fidelity to a meal delivery program, measures participants’ outcomes, and links their data to CMS. Such a fully powered trial could help inform decision-making in health systems on providing home-delivered meals to older adults living with dementia.

Reference:

Thomas KS, Bunker J, Gadbois E, et al. Home-delivered meals and nursing home placement among people with self-reported dementia: a pilot pragmatic clinical trial. JAMA Netw Open. 2023;6(12):e2347195. doi:10.1001/jamanetworkopen.2023.47195