There is evidence that malnutrition is common in the elderly and may influence the prognosis associated with several pathological processes, loss of independence, decrease of quality of life, and increase of morbidity-mortality and hospital admissions [1–3].
Malnutrition prevalence has been reported as 3–5% in free-living older adults and 11.6% to 60% in institutionalized individuals [4, 5] but a recent study showed 21.3% in home care patients .
Educational programs for the elderly, including nutritional advice, have observed improvement in health status . In Barcelona, a controlled trial was conducted in chronically ill 65-year-old patients and healthy controls. The intervention consisted of a self-care program as well as education on physical activity, nutrition, and social support; a statistically significant difference was observed in nutritional status .
Aging is related to a loss of functional capacity, and the role of caregiver becomes crucial to quality of life and for both prevention and treatment of malnutrition in dependent patients. A caregiver support program for hospitalized dependent patients observed that the support obtained positive results for the dependent patients . In Finland, a nutrition education program based on constructive learning theory was developed to educate professional caregivers of patients with dementia. After one year, the study concluded that education had positive effects on the nutrition of patients .
However, educational interventions for caregivers of Alzheimer patients in France  and Parkinson patients in Europe  have not proven effective.
The Mini Nutritional Assessment Test (MNA), commonly used to assess nutritional status because it can be done quickly, has been validated for screening and assessment of malnutrition in older people, including the use of a reduced version [12–14]. Harris et al. noted that the MNA test has a sensitivity of 80% and a specificity of 90% . Different programs have affirmed the ability of the geriatric nutritional risk index to assess the nutritional status of patients at home [16, 17]. A study using the MNA found that 67.6% of subjects treated in a Home Care Program and 93.1% of the institutionalized subjects were malnourished or at risk of malnutrition; with adjusted data, this risk was 4.4 times higher among Home Care Program patients than institutionalized ones .
While the use of MNA as a screening tool is well established, the assessment of nutritional status and in particular of the changes produced by an intervention should have more specific estimator instruments. A recent study observes that age, sex, and body mass index (BMI) are responsible for 11.3% of the variability of the MNA test, whereas MNA items related to diet are responsible for 62.5% of this variability, indicating the importance of diet on the change in nutritional status. On one hand, this observation indicates that the most important items affecting improvement of nutritional status are the adequacy of the patient’s diet and, on the other, that more accurate methods of assessing food consumption are needed to determine the change in the diet .
Furthermore, the most important risk factors for malnutrition in elderly patients have been identified as number of teeth , depression , and dementia . This indicates the importance of assessing these health problems in addition to the MNA test, and of this entire assessment being done by nurses in patient care programs at the household level .
A Home Care Program for dependent patients has been developed by Primary Health Care (PHC) services in our environment to guarantee continuity of care, access to services, and equality in care of these patients who for various reasons cannot go to a Primary Care Center (PCC).
The aim of the study is to assess the effect of a nutritional education intervention aimed at caregivers on the nutritional status of dependent patients at risk of malnutrition.