Abstract
Malnutrition, frailty and sarcopenia are becoming increasingly prevalent among community-dwelling older adults; yet are often unidentified and untreated in community settings. There is an urgent need for community-based healthcare professionals (HCPs) from all disciplines, including medicine, nursing and allied health, to be aware of, and to be able to recognise and appropriately manage these conditions. This paper provides a comprehensive overview of malnutrition, frailty and sarcopenia in the community, including their definitions, prevalence, impacts and causes/risk factors; and guidance on how these conditions may be identified and managed by HCPs in the community. A detailed description of the care process, including screening and referral, assessment and diagnosis, intervention, and monitoring and evaluation, relevant to the community context, is also provided. Further research exploring the barriers/enablers to delivering high-quality nutrition care to older community-dwelling adults who are malnourished, frail or sarcopenic is recommended, to inform the development of specific guidance for HCPs in identifying and managing these conditions in the community.
Highlights
Australia and New Zealand (ANZ) have ageing populations, with the number of people aged ≥ 80 years expected to increase by >200% by 2050, totalling > 510,000 NewZealanders and 2.8 million Australians in this age group within the 30 years [1,2].This is likely to result in an increased prevalence of age-associated conditions such as protein-energy malnutrition, frailty and sarcopenia; common and overlapping problems impacting the functional and health outcomes of older adults that are often left unidentified and untreated in community settings [3]
The Nutrition Care Process (NCP) is a standardised model used to guide healthcare professionals (HCPs) in providing consistent and high-quality nutrition care [81]. It involves four main steps: (1) nutrition assessment and re-assessment, (2) nutrition diagnosis, (3) nutrition intervention, (4) nutrition monitoring and evaluation, as well as (a) precursor and (b) follow-up steps [81]. While this process is specific to nutrition care, frailty and sarcopenia are closely related to and intertwined with malnutrition; we propose that the NCP steps can be applied to all three conditions, using tools and approaches appropriate to each
If the condition being treated is malnutrition, the HCP’s primary focus may be on improving the individual’s nutrition status through the use of nutrition-based strategies, whereas exercise-based strategies may be the focus of interventions for someone being treated for sarcopenia, considering sarcopenia is thought to occur regardless of energy balance [134]
Summary
Australia and New Zealand (ANZ) have ageing populations, with the number of people aged ≥ 80 years expected to increase by >200% by 2050, totalling > 510,000 New. Zealanders and 2.8 million Australians in this age group within the 30 years [1,2] This is likely to result in an increased prevalence of age-associated conditions such as protein-energy malnutrition, frailty and sarcopenia; common and overlapping problems impacting the functional and health outcomes of older adults that are often left unidentified and untreated in community settings [3]. These conditions lead to increased healthcare costs, with malnourished, frail and/or sarcopenic individuals requiring more health care professional (HCP) consultations, hospitalization, health care monitoring and treatments [4,5]. This review will focus on malnutrition, frailty and sarcopenia in the ANZ community, covering their prevalence, impacts and risk factors; as well as the steps for identifying and managing these conditions in this setting
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