Nutritional care of the older patient with fragility fracture is complex. Diagnostic difficulties, multi-morbidities and interdependencies and social complexities all contribute to the wicked problem of malnutrition. Whilst many settings have attempted to address malnutrition through highly specialised care, increasing evidence supports the role of systematised, interdisciplinary approaches across acute care, rehabilitation and secondary prevention settings. Consequently, this chapter is devoted to highlighting why a SIMPLE approach to malnutrition should underpin the nutritional care of the older patient with fragility fracture, regardless of setting or healthcare provider.S Screen for nutrition riskI Interdisciplinary assessmentM Make the diagnosis (es)P Plan with the patientL impLement interventionsE Evaluate ongoing care requirements

Sarcopenia is age-related loss of muscle mass and strength with resulting decrease in function that affects balance, gait, and overall ability to perform tasks of daily living. Decline in skeletal muscle mass begins around age 30 with a significant acceleration after age 65, accompanied by a concomitant reduction in muscle strength (Curcio, et al., 2016). Muscle strength is a critical component of walking and its decrease in the older adult contributes to a high prevalence of falls (Dhillon & Hasni, 2017). Early recognition and intervention can modify some of these detrimental outcomes. Some major risk factors for sarcopenia include; lack of exercise, age-related decreases in hormone concentrations and a decrease in the body's ability to synthesize protein, combined with inadequate caloric and/or protein intake (Dhillon & Hasni, 2017). Acute and chronic illnesses raise the risk level. Screening for sarcopenia may not be routine in many clinical practices. However, screening for impairment in physical function and activities of daily living (ADL's) should be routine for all older adults. Individuals with impaired ADLs and those who describe a noticeable decline in function, strength, or overall health status should have more specific testing for sarcopenia (Brown & McCarthy, 2015). The European Working Group on Sarcopenia in Older people (EWGSOP), in their consensus document, outlined an algorithm to aid the screening and diagnosis of sarcopenia (Cruz-Jentoft, et al., 2010).

Introduction We aim to investigate the longitudinal associations between changes in body weight (BW) and declines in cognitive function and risk of mild cognitive impairment (MCI)/dementia among cognitively normal individuals 65 years or older. Methods Data from the Age Gene/Environment Susceptibility‐Reykjavik Study (AGES‐Reykjavik Study) including 2620 participants, were examined using multiple logistic regression models. Cognitive function included speed of processing (SP), executive function (EF), and memory function (MF). Changes in BW were classified as; weight loss (WL), weight gain (WG), and stable weight (SW). Results Mean follow‐up time was 5.2 years and 61.3% were stable weight. Participants who experienced WL (13.4%) were significantly more likely to have declines in MF and SP compared to the SW group. Weight changes were not associated with EF. WL was associated with a higher risk of MCI, while WG (25.3%) was associated with a higher dementia risk, when compared to SW. Discussion Significant BW changes in older adulthood may indicate impending changes in cognitive function.

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