Malnutrition in older adults: screening and determinants

Abstract

Older adults are at risk of protein-energy malnutrition (PEM). PEM detrimentally impacts on health, cognitive and physical functioning and quality of life. Given these negative health outcomes in the context of an ageing global population, the Healthy Diet for a Healthy Life Joint Programming Initiative Malnutrition in the Elderly (MaNuEL) sought to create a knowledge hub on malnutrition in older adults. This review summarises the findings related to the screening and determinants of malnutrition. Based on a scoring system that incorporated validity, parameters used and practicability, recommendations on setting-specific screening tools for use with older adults were made. These are: DETERMINE your health checklist for the community, Nutritional Form for the Elderly for rehabilitation, Short Nutritional Assessment Questionnaire-Residential Care for residential care and Malnutrition Screening Tool or Mini Nutritional Assessment-Short Form for hospitals. A meta-analysis was conducted on six longitudinal studies from MaNuEL partner countries to identify the determinants of malnutrition. Increasing age, unmarried/separated/divorced status (vs.married but not widowed), difficulties walking 100 m or climbing stairs and hospitalisation in the year prior to baseline or during follow-up predicted malnutrition. The sex-specific predictors of malnutrition were explored within The Irish Longitudinal Study of Ageing dataset. For females, cognitive impairment or receiving social support predicted malnutrition. The predictors for males were falling in the previous 2 years, hospitalisation in the past year and self-reported difficulties in climbing stairs. Incorporation of these findings into public health policy and clinical practice would support the early identification and management of malnutrition.

Social and Economic Factors and Malnutrition or the Risk of Malnutrition in the Elderly: A Systematic Review and Meta-Analysis of Observational Studies

“…Aging can be associated with malnutrition, which is a public health problem characterized by a multifactorial physiological state [3,4]. Malnutrition is defined as an insufficient nutritional intake or absorption, which leads to a decrease in fat and muscle mass [5,6]. From the European Society for Clinical Nutrition and Metabolism (ESPEN) definition, malnutrition is diagnosed by a body mass index (BMI) of <18.5 kg/m 2 or by meeting two of these three criteria: unintentional weight loss (>10% in an indefinite time period or >5% over the last three months) combined with either a low BMI (BMI of <20 kg/m 2 if <70 years of age, or <22 kg/m 2 if ≥70 years of age) or a low fat-free mass index (FFMI) score (FFMI of <15 and <17 kg/m 2 in women and men, respectively) [7].…”

The prevalence of malnutrition and impact on patient outcomes among older adults presenting at an Irish emergency department: a secondary analysis of the OPTI-MEND trial

“…Protein-energy malnutrition, often referred to simply as malnutrition, is a condition resulting from inadequate intake or an inability to absorb and/or digest adequate energy and/or protein [ 7 ]. A strong association between malnutrition and adverse health outcomes among older adults is well documented including increased morbidity and mortality [ 8 – 10 ].…”

Hospital Nutrition Care Betters Patient Clinical Outcomes and Reduces Costs: The Malnutrition Quality Improvement Initiative Story

“…14,15 Older adults are particularly vulnerable because of their higher likelihood of having multiple chronic conditions or diseases along with acute illness or need for surgery, impaired functional or cognitive status, or limited food access. [16][17][18][19][20] Notably, conditions such as gastrointestinal and other cancers, [21][22][23] chronic obstructive pulmonary disease, 24 and heart disease 25 may impair appetite and lower nutrient intake and increase metabolic needs due to inflammatory processes; the overall result of these factors is malnutrition.…”