The REFRESH trial

nutRition intervEntions For malnouRished oldEr adultS in care Homes: a parallel, superiority, three-arm cluster randomised controlled trial.
Female cook serving food to a group of seniors in a nursing home

Trial status: due to start 1 January 2025

People who live in care homes are more at risk of malnutrition. Malnutrition harms their health, reduces their quality of life, and increases the risk of falls and infections. They need more GP and hospital appointments, and experience slow recovery from illness. Treating malnutrition cost a huge amount; estimated at over £11 billion a year in health and social care. Some of this money is spent on prescribing oral nutritional supplements (drinks containing a balance of energy, protein, vitamins and minerals). 
REFRESH aims to test how best to treat malnutrition in older care home residents. We will recruit 90 care homes and 1,530 residents at risk of malnutrition. Each care home will be randomly put into one group and their residents will receive this approach to treating any malnutrition: 
  • Prescribed oral nutritional supplements
  • Fortified food and drink
  • Routine practice (treatment as usual)
We will collect information from residents at the start of the trial, and then at six and 12 months after the start, including quality of life, food intake, appetite, muscle strength, weight, activities of daily living, and costs of the use of prescribed oral nutritional supplements and NHS services. 
Those who often do not have the opportunity to take part in research – for example, those from ethnic minority groups and people who depend on others to make their decisions – will be included.