The impact of oral rehabilitation coupled with healthy dietary advice on the nutritional status of adults: A systematic review and meta-analysis

The impact of wearing complete denture in one or both arches, on eating-related quality of life and patients' perceived need for advice to support eating well: Results from a qualitative study

BACKGROUND

Wearing complete denture in one or both arches can impact enjoyment of eating and affect quality of life compared with being dentate. Clinicians focus on issuing technically sound dentures but ignore the impact of wearing dentures on the eating-related quality of life which affects the success of treatment.

OBJECTIVES

The aim of this research was to qualitatively explore ERQoL in Australian adults wearing complete dentures using a validated questionnaire and through focus groups.

METHODS

Complete denture wearers (n = 44) were recruited from dental clinics and invited to complete the self-administered Emotional and Social Issues Related to Eating questionnaire. Responses were categorised under the six questionnaire domains. A subsample of 20 participants who completed the questionnaire were invited to participate in focus groups to identify emerging themes.

RESULTS

Twenty-three participants (52.3%) completed the questionnaire. Most participants expressed a decline in enjoyment of eating due to reduced ability to eat, longer chewing times and the need to frequently clean dentures while eating. Focus groups (n = 2 × 4 participants) indicated educational materials on eating with dentures would increase recognition of eating problems with dentures and reduce trial and error approaches to dealing with these.

CONCLUSION

ERQoL is adversely affected by wearing complete dentures due to functional limitations, restricted food choices and adaptive eating behaviours. Patient support for eating well with a complete denture/s wearers is required.

Exploring the attitudes of general dental practitioners to providing dietary advice alongside oral rehabilitation for older adults

OBJECTIVE

We aimed to capture General Dental Practitioners' (GDPs) views on delivering dietary advice to older adults in combination with treatment to replace missing teeth and identify solutions to help inform the development and implementation of future dietary interventions within primary dental care.

BACKGROUND

As natural teeth are lost, older adults may need to choose softer, more manageable foods which might be of lower nutrient density. Previous research has indicated that prosthodontic rehabilitation can improve masticatory function but not the intake of nutrients, highlighting a potential need for a combined approach of oral rehabilitation and dietary counselling.

MATERIALS AND METHODS

Semi-structured telephone interviews were conducted with a purposive sampling strategy of 12 GDPs. Interviews were digitally recorded and transcribed verbatim. An iterative coding process using theme-analytic methods was used.

RESULTS

Twelve interviews were conducted with GDPs in the United Kingdom. The themes that emerged from the interviews included: the awareness of the importance of dietary advice among GDPs; the concerns GDPs had on patients' adherence to dietary advice; uncertainty over roles and responsibilities in the provision of dietary advice; and the limited time and remuneration for dietary advice in dental practice. A minor theme identified was the motivation of GDPs to implement dietary advice alongside oral rehabilitation. All reported that they were already providing dietary advice to their patients but that this was limited to caries prevention.

CONCLUSION

The GDPs interviewed expressed positive attitudes towards providing dietary advice alongside oral rehabilitation for older adults. However, a lack of confidence, awareness, time and remuneration are barriers to its provision in primary dental care. To facilitate the implementation of dietary advice alongside oral rehabilitation, clear guidance on and training in delivering dietary advice and multidisciplinary cooperation are required.

Evaluation of jaw function, oral health-related quality of life, and nutritional status during oral rehabilitation procedures - a pilot study

AIMS

To evaluate limitations in jaw function, oral health-related quality of life (OHRQoL), and nutritional status during extensive oral rehabilitation procedures.

MATERIAL METHODS

Fourteen participants (mean age ± SD: 70 ± 3.8) undergoing major oral rehabilitation involving the restoration of a minimum of eight teeth were recruited in the study. Jaw function limitations scores (JFLS), oral health-impact profile (OHIP), and nutritional status were measured at different time points during, six months, and one year after the rehabilitation procedures. Nutritional status was evaluated by measuring the body weight and arm and calf muscle circumference. The effect of time points on the measured variables was evaluated with Friedman's test. Trends in nutritional status were evaluated with linear regression analysis.

RESULTS

The results of the analysis showed significant main effects of time points on the JLFS (p < .001) and OHIP scores (p = .005). However, there was no effect of time points on the body weight (p = .917) and calf muscle circumference (p = .424), but a significant effect on arm circumference (p = .038). Further, there was a decreasing trend for body weight (64.3%), arm (71.4%), and calf circumference (64.3%) in the majority of the patients.

CONCLUSION

The results of the preliminary study suggest that people undergoing extensive oral rehabilitation procedures show improvement in jaw function and an increase in OHRQoL after the rehabilitation procedure. Despite no major changes in the nutritional indicators, most patients showed a negative trend in their body weight, arm circumference, and calf circumference, suggesting that they may be susceptible to nutritional changes.

Diet, Nutrition, and Oral Health in Older Adults: A Review of the Literature

Diet, nutrition, and oral health are closely linked. Malnutrition is a challenging health concern in older adults that is associated with physical decline affecting their daily activities and quality of life. The aim of this review is to provide an evidence-based summary of the relationship between diet and nutrition and oral health in older adults and its implications. The World Health Organization has declared healthy ageing a priority of its work on ageing. The American Dental Association confirmed the bidirectional relationship between diet and nutrition and oral health. The literature shows that diet and nutrition are related to oral diseases, including dental caries, periodontal diseases, tooth wear, and even oral cancer. Insufficient nutritional intake and poor dietary habits increase the risk of oral diseases, such as dental caries, in older adults. On the other hand, in older adults, poor oral conditions such as periodontal disease may induce pain, infection, and tooth loss, affecting nutritional intake. Surveys have shown that older adults, in particular, those in disadvantaged communities, suffered from nutritional deficiencies or imbalances affecting their oral health. In addition, the current literature shows that malnutrition is associated with frailty, hospitalization, mortality, and morbidity. Good oral health and functional dentition are essential to maintain sufficient nutritional intake among older adults and reduce the risk of malnutrition. Therefore, integrating oral health into general health care service in older adults is imperative to improve their nutritional and oral health status to achieve healthy ageing.

Tooth loss severity and core and non-core food consumption among older Brazilian adults

OBJECTIVE

To investigate the association between tooth loss severity and core and non-core food consumption in the older Brazilian population.

METHODS

We analysed data from 20 756 people aged 60 years or older who participated in the 2019 Brazilian National Health Survey. The average consumption days a week of core (8-item) and non-core (4-item) foods were the outcomes, measured using a Food Frequency Questionnaire. Tooth loss severity was the main exposure, using a four-category ordinal variable: mild (1-12 teeth missing), moderate (13-22), severe (23-31) and edentulous (all 32). Sociodemographic, tobacco smoking, use of dental prosthesis, difficulty in chewing and systemic conditions were among the covariates. Linear regression models estimated the association between tooth loss and food consumption.

RESULTS

Almost two-thirds of participants had moderate or worse levels of tooth loss. Older adults with more severe tooth loss reported an overall lower consumption of core and higher non-core foods than those with mild tooth loss. Worse tooth loss severity was associated with lower consumption of vegetables and/or legumes and fruits, and higher consumption of beans, artificial fruit juices and confectionery.

CONCLUSIONS

Older Brazilian adults with more severe tooth loss are consuming lower core and higher non-core foods. Our findings reinforce the importance of the common risk factor approach to tackle the adverse effects of tooth loss on diet.

Development of patient-centric eating advice for complete denture wearers

BACKGROUND

Edentulous people eat less healthily, and wearing dentures impairs eating function and enjoyment.

OBJECTIVE

To apply a sequential approach to integrate scientific evidence, and patient and professional experience to co-develop intervention to support better eating with dentures.

METHODS

Focus groups, two with purposive samples of patients and two with dental professionals, explored experiences and opinions about advice on eating with complete dentures. Findings were distilled with evidence from the literature to underpinned concepts for eating interventions. User engagement informed prioritisation of ideas and led to the development of a leaflet on eating with dentures.

RESULTS

Patients receive no advice on what they can realistically expect when eating with dentures, and professionals lacked confidence to provide eating advice. Patients did not think dentists a credible provider of eating advice, feeling peer support more appropriate and offering numerous strategies for eating with dentures. Concepts for eating intervention included a patient leaflet, Web-based eating interventions, patient support blogs, waiting room videos and improved nutrition training for dental professionals. User feedback informed prioritisation of ideas, leading to the development of a leaflet on eating with dentures. Justified by the data, the leaflet focused on patient-generated tips for overcoming the functional limitations of eating with dentures, and unobtrusive healthier eating advice. Face validity with users confirmed acceptability.

CONCLUSION

A systematic and rigorous integration of scientific evidence, expert experience and patient input has developed a patient-centric, evidence-based approach to a patent leaflet on eating with dentures that, based on initial face validity, is likely to be well received.

Impact of shortened dental arch therapy on nutritional status and treatment costs in older adults: a systematic review

OBJECTIVE

This review was undertaken to evaluate, whether a shortened dental arch (SDA) was a good alternative to a conventional prosthodontic rehabilitation (RPD) in older adults when nutritional and economic factors are compared.

DATA

A total of 92 studies were included for the full-text analysis, and finally 4 reports from two RCTs qualified for data extraction and analysis. The final search update was performed on 06.11.2022 and no further searches and updates were performed after this date.

SOURCES

Electronic databases [PubMed (MEDLINE), Embase, CENTRAL] were systematically searched to identify studies comparing nutritional and economic outcomes in partially edentate adults rehabilitated with conventional RPD and SDA therapy.

STUDY SELECTION

Studies were excluded if there were less than 10 participants per group, and if the subjects were not clinically followed up in recall visits. Two investigators performed the data extraction and were reciprocally blinded. Inter-investigator reliability was assessed using Cohen's unweighted kappa (κ). A meta-analysis could not be performed and the results were reported qualitatively.

RESULTS

The calculated κ ranged between 0.80 and 1.00. Three reports from two studies reported on nutritional outcomes and one report provided information on economic benefits, when comparing between the SDA therapy and conventional prosthodontic rehabilitation. No significant difference was recorded in the nutritional status of patients rehabilitated using the SDA concept compared with RPDs. Higher costs for treatment provision and maintenance for patients in the RPD group was found when compared to SDA treatment.

CONCLUSIONS

This systematic review identified the shortened dental arch concept as a reasonable alternative to the conventional prosthodontic rehabilitation where cost-effectiveness and nutrition are concerned based on the limited evidence obtained from current literature.

CLINICAL SIGNIFICANCE

SDA therapy may be considered as a feasible treatment concept in older adults especially in those with complex medical statuses and limited finances.

Establishing Healthy Eating 'Habits': A Pilot Randomised Controlled Trial of a Habit-Based Dietary Intervention following Oral Rehabilitation for Older Adults

An ageing population presents significant nutritional challenges, particularly for partially dentate adults. This two-armed pilot randomised controlled trial (RCT) compared habit formation (automaticity) for healthy eating behaviours between control and intervention groups after participation in a habit-based dietary intervention for older adults, following oral rehabilitation in the United Kingdom (UK). n = 54 participants were randomised to receive a habit-based dietary intervention (intervention group n = 27, IG) or standard dietary advice in a leaflet (control group n = 27, CG). The IG attended three sessions over six weeks, which focused on habit formation for three healthy eating behaviours (increasing fruit and vegetables, wholegrains, and healthy proteins). Participants were assessed for habit strength (using the Self-Report Behavioural Automaticity Index (SRBAI)) alongside health and nutrition outcomes at six weeks, four months and eight months. Forty-nine participants completed all follow-up visits. The IG compared to the CG had significant increases in automaticity at six weeks, four months (primary outcome) and eight months for eating ≥3 portions of fruit and vegetables; choosing wholegrain sources over white alternatives, and choosing healthy protein sources over red/processed meat. The mean change in the Mini Nutritional Assessment total score was greater in the IG compared with the CG at six weeks only (p = 0.03). A habit-based dietary intervention following oral rehabilitation increased automaticity for healthy dietary behaviours, which could translate into clinically meaningful benefits in this cohort of older adults.

Functional Dentition, Chronic Periodontal Disease and Frailty in Older Adults-A Narrative Review

BACKGROUND

The likelihood of experiencing the impact of chronic disease rises with age, and cumulative functional deficits over time increase the risk of frailty in older adults. The exact causes of frailty are not clear, and research is needed to identify appropriate intervention measures to reduce risk of developing frailty in old age.

OBJECTIVE

To review the evidence on the relationship between frailty, dental status and chronic periodontitis and to determine if improvements in oral health of older adults can contribute to reversal of frailty.

RESULTS

The oral cavity is the entry point to the gastro-intestinal tract, and natural teeth facilitate efficient mastication of food prior to swallowing and subsequent digestion. The loss of natural teeth, which is gradual and cumulative over the life course, is associated with diminished nutritional intake, especially in older adults. Furthermore, chronic periodontitis has been postulated as a risk factor for frailty. The evidence supporting a strong relationship between oral health status and frailty is not clearcut. Cross sectional studies suggest an association with missing teeth and chronic periodontal inflammation. However, there are very few longitudinal studies and accordingly, it is not currently possible to claim a causal relationship. As yet, there is no evidence to suggest that improvements in oral health contribute to reversal of frailty.

CONCLUSION

Longitudinal studies with robust designs are required to better inform the relationship across functional dentition, chronic periodontitis and frailty in older adults.

Eating Advice for People Who Wear Dentures: A Scoping Review

OBJECTIVE

A scoping review of available advice to address eating problems experienced by people who wear dentures was conducted in accordance with the PRISMA statement. The objective was to identify and map type, volume, and content of the available eating advice.

METHODS

Medline, CINAHL, and grey literature databases and Google were searched. Relevant content pertaining to study type, peer-review vs. grey literature, country of origin, advice content, and methods to evaluate effectiveness was mapped.

RESULTS

Of the 4591 records identified from peer-reviewed literature, 56 full papers underwent duplicate screening, resulting in 26 papers (from Germany (n = 1), Europe (n = 1), India (n = 2), Japan (n = 7), UK (n = 6), USA (n = 6), or other (n = 3)) being included in the review. These yielded 18 different items of relevant eating advice. Of the 258 screened websites, 63 were included, yielding 30 different items of eating advice. The most-cited advice was to eat soft food and avoid hard and sticky food, cut food into bite-sized pieces, and chew on both sides of the mouth and chew slowly and thoroughly. The identified advice was not supported by reference to peer-reviewed evidence. Advice included some conflicting messages and some advice was non-compliant with authoritative nutritional advice (e.g., avoid red meat, take a vitamin supplement).

CONCLUSION

There is support for providing eating advice at the time of denture provision. A broad range of advice based on clinical experience to support people who wear dentures to overcome the functional limitations exists. However, the efficacy of this advice in improving diet and eating experience has not been tested.

Effects of Dental Implants and Nutrition on Elderly Edentulous Subjects: Protocol for a Factorial Randomized Clinical Trial

Background

Loss of masticatory function consequent to tooth loss has been associated with changes in food choices and insufficient nutritional intake. To date, interventions based on dental prostheses alone did not significantly improve nutrient intake. Pilot studies have shown positive impacts of interventions combining implant-supported fixed dental prosthesis with brief dietary advice. The relative contribution and the potential synergy of the components of such interventions need to be determined as it has major public health implications for the community-dwelling aging population that continues to disproportionately suffer from tooth loss and its consequences.

Objective

To assess the effect of rehabilitation of masticatory function with fixed implant supported dentures and nutrition education in older subjects with terminal dentition (stage IV periodontitis) or full edentulism.

Methods

A 2 × 2 factorial randomized controlled trial with 16-month follow-up of eligible adults (≥60 years) with loss of masticatory function consequent to full arch edentulism or terminal dentition (n = 120) will be conducted to test whether the rehabilitation of masticatory function with fixed implant supported dentures, nutrition education and/or their combination improves intake of fresh fruits and vegetables for aging subjects. The study has been designed to detect changes in fresh fruits and fresh vegetables intake at 4 months using the 24-h dietary recall method. Changes in protein as percentage of total energy, nutritional biomarkers, plasma metabolomics, oral and gut microbiome, quality of life and masticatory function will also be assessed.

Discussion

We hypothesize that receiving rehabilitation of masticatory function with fixed implant dentures together with nutrition education is the most effective intervention for improving nutrient intake in aging community-dwelling subjects with extensive tooth loss. The results of this study will assist in designing better treatment regimens, guide medical care for individual subjects, and inform public health and policy.

Clinical Trials Registration

NCT05334407.

Nutritional Assessment of Denture Wearers Using Matched Electronic Dental-Health Record Data

Purpose

To assess the nutritional profile of denture wearers through a retrospective cohort study using nutritional biomarkers from matched electronic dental and health record (EDR‐EHR) data.

Materials and methods

The case group (denture wearers) included matched EDR‐EHR data of patients who received removable partial, complete, and implant‐supported prosthodontic treatments between January 1, 2010 and December 31, 2018, study time. The control (nondenture wearers) group did not have recorded denture treatments and included patient records within 1 year of the denture index date (first date of case patients’ receiving complete or partial denture) of the matching cases. The qualified patients’ EDR were matched with their EHR based on the availability of laboratory reports within 2 years of receiving the dentures (index date). Nutritional biomarkers were selected from laboratory reports for complete blood count, comprehensive and basic metabolic profile, lipid, and thyroid panels. Summary statistics were performed, and general linear mixed effect models were used to evaluate the rate of change over time (slope) of nutritional biomarkers before and after the index date. Likelihood ratio tests were performed to determine the differences between dentures and controls.

Results

The final cohort included 10,481 matched EDR‐EHR data with 3,519 denture wearers and 6,962 controls that contained laboratory results within the study time. The denture wearers’ mean age was 57 ±10 years and the control group was 56 ±10 years with 55% females in both groups. Pre‐post analysis among denture wearers revealed decreased serum albumin (p = 0.002), calcium (p = 0.039), creatinine (p < 0.001) during the post‐index time. Hemoglobin (Hb) was higher pre‐index, and was decreasing during the time period but did not change post‐index (p < 0.001). Among denture wearers, completely edentulous patients had a significant decrease in serum albumin, creatinine, blood urea nitrogen (BUN), but increased estimated glomerular filtration rate (eGFR). In partially edentulous patients, total cholesterol decreased (p = 0.018) and TSH (p = 0.004), BUN (p < 0.001) increased post‐index. Patients edentulous in either upper or lower arch had decreased BUN and eGFR during post‐index. Compared to controls, denture wearers showed decreased serum albumin and protein (p = 0.008), serum calcium (p = 0.001), and controls showed increased Hb (p = 0.035) during post‐index.

Conclusions

The study results indicate nutritional biomarker variations among denture wearers suggesting a risk for undernutrition and the potential of using selected nutritional biomarkers to monitor nutritional profile.

Do implant-supported prostheses affect bioavailability of nutrients of complete and partially edentulous patients? A systematic review with meta-analysis

BACKGROUND & AIMS

Debate still exists about the impact of dental implant-supported prostheses on nutritional status of partially and complete edentulous patients. This review aims to answer the focused question: "Do complete and partial edentulous patients, using implant-supported prostheses, present better nutritional and masticatory functions when compared to those using conventional rehabilitations?". A possible cause-effect relationship between masticatory improvements and nutritional gain was also evaluated.

METHODS

Literature search included 6 databases (PubMed/Medline, Embase, LILACS, Scopus, Web of Science, and The Cochrane Library - CENTRAL), grey literature (Google Scholar, Proquest Dissertations and Thesis and Open Grey databases) and manual search (last update June 2020), without language, publication time and follow-up restrictions. We included only studies evaluating both masticatory and nutritional outcomes. The PICO question comprised complete and partial edentulous patients (Population), submitted to implant-supported prostheses (Intervention), in comparison to conventional dental prosthetic rehabilitation, evaluating masticatory function and nutrition parameters (outcomes). Risk of bias was assessed by using Cochrane Collaboration's tool (randomized clinical trials), Joanna Briggs Institute critical appraisal checklist (paired clinical trials), and Meta-Analysis of Statistics Assessment and Review Instrument" (JBI - MAStARI) critical appraisal tools (cohort studies). All meta-analyses were conducted at 5% level of significance. This report followed the PRISMA guidelines. (Review registration PROSPERO - CRD42019135744).

RESULTS

We identified 1199 articles while searching databases. Fourteen articles met eligibility criteria, including 817 prostheses installed in 660 patients (mean age = 66.8 years-old). Patients wearing implant overdentures (IOD) presented better masticatory function in comparison to conventional complete denture (CD) wearers (p < 0.05). However, bioavailability of several nutrients remained within the same range, except for serum folate that was lower in IOD patients after 6 (mean difference 3.51 nmol/L; p = 0.01) and 12 months of rehabilitation (mean difference 3.69 nmol/L; p = 0.003). When comparing the effects of CD and IOD rehabilitations along time (for the same patient), serum albumin and vitamin B12 levels also decreased for both groups after 12 months-follow-up, but still within the reference range. The additional retention of the implants did not interfere in body weight, but reduced the risk of malnutrition (using the Mini Nutritional Assessment). Implant-supported partial prostheses also improved mastication in comparison to the conventional ones, increasing short-term daily intake of carbohydrates, protein, calcium, fiber, and iron, whereas decreasing the consumption of cholesterol. However, no long-term changes on bioavailability of most nutrients were observed, expect for a slight increase in ferritin and cholinesterase, and a small reduction in folate and Vitamin A.

CONCLUSION

Current evidence indicates significant masticatory improvements for dental fixed implant-supported prostheses in comparison to conventional removable prostheses. However, bioavailability remained stable for most of the nutrients, especially for complete edentulous patients. These results indicate the importance of a multidisciplinary approach during oral rehabilitation (nutrient specialist), in order to enhance food choices and promote health benefits to the patients.

Oral Health and Nutritional Characteristics of Adults With Morbid Obesity: A Multivariate Analysis

The relationship between oral health and nutritional aspects are complex, especially in individuals with chronic diseases and comorbidities, such as morbid obesity. Thus, the aim of the present study was to identify oral health and nutritional-related patterns in 113 individuals, aged 19–68 years (92 females), seeking treatment for morbid obesity. Sociodemographic variables and medical records were examined, in addition to the consumption of fruit, vegetables, candies, and processed foods. Measures of body mass index, neck, waist and hip, caries experience (DMFT index), Community Periodontal Index (CPI index), and salivary physicochemical aspects were gathered. Aspects of oral health-related quality of life and symptoms of dry mouth were evaluated by means of Oral Health Impact Profile (OHIP-14) and Xerostomia Inventory-XI questionnaires. K-means cluster analysis and, subsequently, comparisons between clusters (one-way ANOVA) were performed (α = 5%). Three clusters were generated: Cluster 1 (labeled “Young”; n = 77) was characterized by younger participants with higher BMI, who reported the use of distractors while eating, the smallest number of meals/day, and who consumed sweetened drinks and processed food the day before. Cluster 2 (labeled “Diabetic individuals”; n = 12) was characterized by older participants with the highest proportion of diabetic participants (100% were diabetic; 73% insulin users), lower BMI, higher DMFT index and OHIP-14 and xerostomia scores, and who reported having consumed fruit and vegetables the day before. Finally, Cluster 3 (labeled “Poor periodontal health”; n = 24) was characterized by participants with the worse periodontal condition (higher CPI), and lower salivary flow, pH, and buffer capacity. Cluster 1 and 2 were the groups that showed higher demand for nutritional and dietetic counseling, because of the poor eating behavior and higher serum glucose levels, respectively. On the other hand, Cluster 2 and 3 showed the higher demand for oral rehabilitation and dental treatment because of the loss of teeth and worse periodontal condition, respectively, besides the need for dietetic counseling. This sample of individuals with morbid obesity showed very unique oral-health and nutritional characteristics and special needs patterns that should be identified to adjust or change unhealthy habits, thus improving the assistance of this condition.

Development and feasibility of a tailored habit-based dietary intervention coupled with natural tooth replacement on the nutritional status of older patients

BACKGROUND

Older adults suffering partial tooth loss may need additional intervention strategies other than natural tooth replacement alone to improve their nutritional status. This study aimed to design and develop a habit-based tailored dietary intervention and to assess the feasibility and acceptability of the intervention, in conjunction with natural tooth replacement, amongst partially dentate older adults.

METHODS

The design and development of the dietary intervention (phase 1) consisted of analysis of the target population's dietary intake and qualitative research through focus groups with community-dwelling older adults (aged 65 years and over). The dietary intervention consisted of forming three healthy dietary habits around fruits and vegetables, wholegrains and healthy proteins. Feasibility of the intervention was then tested amongst older adults who had recently completed dental treatment for natural tooth replacement in a small non-randomised single arm study (phase 2). The principal feasibility outcome was the usability and acceptability of the intervention which was measured using evaluation questionnaires and by conducting post-intervention semi-structured interviews. Supporting outcomes consisted of feasibility of screening procedures, recruitment strategies and retention/attrition rates as well as the participant's compliance to the intervention assessed through self-monitoring tracking sheets.

RESULTS

Twenty-one older adults (mean [SD] age 72.1 [10.4].) took part in one of four focus group discussions (phase 1). Twelve themes related to barriers (e.g. oral health, appetite) and facilitators (e.g. nutritional knowledge, retirement) of healthy eating guided intervention development, as did a further five themes when asked for direct intervention feedback. Nine older adult participants (mean [SD] age 72.5[9.7]) were recruited into the feasibility study (phase 2) where eight themes were identified from feedback interview discussions. The principal outcome measures identified intervention feasibility as participants considered the intervention acceptable and useable as both the evaluation questionnaire and qualitative interview results were overwhelmingly positive. As a supporting outcome measure, strong intervention compliance was also achieved. Screening procedures were accepted but additional recruitment strategies (e.g. incorporation of home study visits or recruitment via posters advertisement) may benefit future study enrolment and retention.

CONCLUSION

Phase 1 and phase 2 findings have allowed for an iterative, user-driven intervention to be developed and refined for a randomised control study to evaluate the intervention's effectiveness.

TRIAL REGISTRATION

ISRCTN66118345.