Original study
The Effect of Megestrol Acetate on Oral Food and Fluid Intake in Nursing Home Residents: A Pilot Study

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Objectives

The objective of this study was to evaluate the effect of megestrol acetate (Megace ®OS; Bristol-Myers Squibb, Princeton, NJ) on the oral food and fluid intake of nursing home (NH) residents under two conditions: usual NH care and optimal mealtime feeding assistance.

Design and setting

We conducted a prospective, preliminary trial in four NHs.

Participants

Participants (n = 17) were recruited from a larger study designed to assess nutritional care quality. Eligibility for the Megace ®OS trial required participants to consistently eat less than 75% of most meals under both usual NH care and optimal feeding assistance conditions at baseline.

Intervention

Megace ®OS, an oral liquid suspension of megestrol acetate, was given daily in a 400-mg dose for 63 days.

Measurements

Each participant’s oral food and fluid intake was monitored weekly for 1 day (three meals) during which research staff conducted direct observations of usual NH care (weeks 1, 3, and 5 and day 63) or provided optimal feeding assistance (weeks 2, 4, and 6). Average total percent intake was compared from baseline across the assessment weeks of the trial under the two mealtime care conditions.

Results

Megace ®OS had a significant effect on oral food and fluid intake only under the optimal mealtime feeding assistance condition, in which average total percent eaten increased from 50% (±15%) at baseline to 63% (±14%) post-63 days of the trial. There was no change in participants’ oral food and fluid intake under the usual NH care condition (average total percent intake at baseline 43% ± 12% vs. 43% ± 20% post-63 days).

Conclusion

The results of this preliminary study suggest that Megace ®OS is not an effective nutritional intervention to increase oral intake under usual NH care conditions, which is often characterized by inadequate feeding assistance. However, Megace ®OS in combination with optimal mealtime feeding assistance does significantly increase oral intake in a frail NH sample at high risk for weight loss.

Section snippets

Subjects and Setting

Participants were recruited from a larger study designed to assess the quality of nutritional care practices. The larger study was conducted in four NHs, two of which were for-profit. The mean bed size of the four NHs was 156 (±42). Nurse-aide level staff-to-resident ratios across the four NHs, as reported by the Directors of Nursing, ranged from seven to 10 residents per nurse aide on the 7 am to 3 pm shift (eg, breakfast and lunch) and seven to 14 residents per nurse aide on the 3 pm to 11 pm

Participant Characteristics

Table 2 shows the demographic, medical, and nutritional characteristics of the 17 participants who completed the Megace trial. The participants were predominantly female (88%) and white (88%). They had mild to moderate cognitive impairment, as indicated by the prevalence of physician-recorded chart diagnoses of dementia (41%) and an average MMSE total score of 16.2 (±5.0). The prevalence of physician-recorded chart diagnoses of depression was 35%. The body mass index (BMI) of participants

Discussion

The results of this preliminary study showed that Megace did not increase the oral food and fluid intake or weight status of NH residents under usual care conditions, which consisted of inadequate feeding assistance (an average of less than 5 minutes of assistance from staff per meal). In contrast, oral intake did improve when optimal feeding assistance (an average of 30 minutes of assistance per meal) was provided to participants. Specifically, Megace given in combination with optimal feeding

Conclusion

The results of this preliminary study showed that Megace was not an effective nutritional intervention to increase the oral food intake of NH residents given inadequate feeding assistance during meals. Megace was only effective in improving oral intake when given in combination with optimal mealtime feeding assistance.

Acknowledgments

This research was supported by Bristol-Myers Squibb (Princeton, NJ), the National Institute on Aging, UCLA Claude D. Pepper Older Americans Independence Center grant (#AG 10415), and the John A. Hartford Foundation/ AFAR Medical Student Geriatric Scholars Program. The views expressed in this article are those of the authors and may not reflect those of the funding agencies.

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