Table 3 Quantitative outcome assessments

Handgrip strength (kg): an index of general upper extremity strength (function)

Primary researcher

Measured using a handgrip dynamometer on the non-dominant arm [39].

Limitations include the influence of debility, age and familiarity with the technique. The number of residents that refuse to participate, or for whom the measurement is not feasible, will be recorded.

Mid arm muscle circumference (MAMC) (cm): an estimate of muscle mass

Primary researcher

Calculated using mid-upper arm circumference (MUAC) (measured with a tape measure) and tricep skinfold thickness (TSF) (measured with a standardised skinfold calliper): MAMC (cm) = MUAC (cm) − 3.14 × TSF (cm)

Mean energy (kcal), protein (g) and fluid intake (ml):

Primary researcher

Calculated from analysis of three non-consecutive 24-h food record charts. Usual tableware such as bowls, plates and glasses will be measured in each care home at baseline, and the size/capacity will be recorded.

Nutrient intake will be determined using the dietary analysis software package Diet Plan 6 (Forestfield Software Ltd, West Sussex, UK), which is installed with the complete set of UK food tables.

Height (m)

Care staff measured

Taken from clinical records or measured using a stadiometer. If standing height cannot be measured, self-reported height is considered the superior secondary method, or ulna length can be measured to obtain an estimate. Information on the method used to measure height will be collected.

Weight (kg)

Care staff measured

Measured using clinical calibrated standing, chair or hoist scales. Information on the method used to measure weight will be collected.

Body mass index (BMI) (kg/m²) A measure of adiposity

Care staff measured

Calculated using: weight (kg)/height (m²).

Validity is limited by the influence of gender, ethnicity and age on body composition, which is not accounted for within the calculation [40]. Reliability is also questionable in the presence of confounding factors including oedema or ascites [41].

Healthcare resource usage

Care staff measured

The healthcare resource usage questionnaire to be piloted within this trial has been developed from consideration of existing instruments submitted for use in residential care settings on the ‘MRC Database of Instruments for Resource Use Measurement’ (DIRUM). The questionnaire will be completed by care home staff, from baseline to 3 months and from 3 to 6 months for each participating resident.

Health state using The EuroQol-5D (EQ-5D)

Participant rated

There is no malnutrition-specific measure of health state or quality of life for patients, so these well-established and validated measures will be piloted within this population to inform as to whether they are appropriate for completion by care home residents with varying cognitive function. The Euroqol group and the Dartmouth CO-OP project have granted permission to use the tools

Quality of life using the CO-OP Quality of life chart

Participant rated

Visual analogue scale (VAS) for self-perceived appetite and dietary satisfaction

Participant rated

A VAS tool has been developed to measure the following subjective sensations; ‘hunger’, ‘appetite’, ‘dietary satisfaction’, ‘pleasantness of meals’, ‘pleasantness of snacks’ and ‘pleasantness of drinks’ and will be piloted within this trial.