Abstract
Many older people with frailty are at risk of malnutrition and poor health, yet there is evidence that improving nutrition and weight loss can reduce frailty. This will become more important as the number of older people with frailty increases worldwide in future. Identifying those at risk is challenging due to the difficulty of reaching and screening those older people most at risk, the large number of nutritional assessment tools used, and the lack of consensus on the criteria to make a diagnosis of malnutrition. The management of older people with or at risk of malnutrition should be multi-modal and multi-disciplinary, and all care staff have an important role in delivering appropriate nutritional advice and support. This paper will highlight a number of practical approaches that clinicians can take to manage malnutrition in older people with frailty in community and acute settings, including environmental changes to enhance mealtime experience, food fortification and supplementation.
Highlights
Under nutrition is common among older people and often poorly recognised and under diagnosed
Systematic reviews have reported that energy- and protein-based fortification and supplementation could be employed as an effective, well-tolerated and cost-effective intervention to improve the dietary intake of older people [120,121] especially those with frailty and cognitive impairment
Enteral nutrition is recommended for patients who have a functional gastrointestinal system but are unable to consume their daily required calories over several days [144]
Summary
Under nutrition ( referred to as malnutrition) is common among older people and often poorly recognised and under diagnosed It is associated with frailty, sarcopenia and poor health outcomes. A recent meta-analysis of 5447 community dwelling older adults including out-patients (mean age 77 years) from 10 studies in Belgium, Germany, Spain, Turkey, Mexico, Russia and Japan identified 2.3% as malnourished using the Mini-Nutritional Assessment and 19.1% as physically frail using the Fried Frailty Phenotype [20]. Malnutrition is associated with increased use of primary care services [27] and a study of community dwelling older Canadians reported 20% higher odds of hospital admission and 60% higher odds of death over 3 years among those at risk of poor nutrition [28]. There are a number of practical approaches to the management of malnutrition in frail older people that can be undertaken, starting with early identification of those at risk
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