Highlights
- •Malnutrition remains unacceptably high in residential aged care.
- •Timely malnutrition management improves health- and cost-related outcomes.
- •Food insecurity in this setting requires further investigation.
- •The role of family members and the effect of mealtime ambience warrant further research.
Abstract
In developed countries the prevalence of protein-energy malnutrition increases with
age and multi-morbidities increase nutritional risk in aged care residents in particular.
This paper presents a narrative review of the current literature on the identification,
prevalence, associated risk factors, consequences, and management of malnutrition
in the residential aged care (RAC) setting. We performed searches of English-language
publications on Medline, PubMed, Ovid and the Cochrane Library from January 1, 1990
to November 25, 2015. We found that, on average, half of all residents in aged care
are malnourished as a result of factors affecting appetite, dietary intake and nutrient
absorption. Malnutrition is associated with a multitude of adverse outcomes, including
increased risk of infections, falls, pressure ulcers and hospital admissions, all
of which can lead to increased health care costs and poorer quality of life. A number
of food and nutrition strategies have demonstrated positive nutritional and clinical
outcomes in the RAC setting. These strategies extend beyond simply enhancing the nutritional
value of foods and hence necessitate the involvement of a range of committed stakeholders.
Implementing a nutritional protocol in RAC facilities that comprises routine nutrition
screening, assessment, appropriate nutrition intervention, including attention to
food service systems, and monitoring by a multidisciplinary team can help prevent
decline in residents’ nutritional status. Food and nutritional issues should be identified
early and managed on admission and regularly in the RAC setting.
Keywords
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References
- World Population Ageing 2013.2013 (Available from: http://www.un.org/en/development/desa/population/publications/pdf/ageing/WorldPopulationAgeing2013.pdf. (accessed 10.07.15))
- Interesting facts about ageing.2012 (Available from: www.who.int_ageing_about_facts_en_index.html.pdf. (accessed 13.06.13))
- Global and regional burden of disease and risk factors: 2001: systematic analysis of population health data.Lancet. 2006; 367: 1747-1757
Department of Health and Ageing Residential Care Services, (2008). Available from: http://www.health.gov.au/internet/main/publishing.nsf/Content/ageing-rescare-index.htm. (accessed 30.8.13).
- Australia's Health 2014.Australian Institute of Health and Welfare, Canberra2014 (Report No.: Australia's health series no. 14. Cat. no. AUS 178. Available from: http://www.aihw.gov.au/publication-detail/?id=60129547205. (accessed 17.11.15))
- A concept analysis of malnutrition in the elderly.J. Adv. Nurs. 2001; 36: 131-142
- How much do residential aged care staff members know about the nutritional needs of residents?.Int. J. Older People Nurs. 2013; 9: 54-64
- How well do nurses recognize malnutrition in elderly patients?.Eur. J. Clin. Nutr. 2007; 63: 292-296
- Malnutrition prevalence and nutrition issues in residential aged care facilities.Aust. J. Ageing. 2008; 27: 189-194
- Prevalence of ‘being at risk of malnutrition’ and associated factors in adult patients receiving nursing care at home in Belgium.Int. J. Nurs. Pract. 2015; 21: 635-644
- Knowledge and attitudes of nursing staff towards malnutrition care in nursing homes: a multicentre cross-sectional study.J. Nutr. Health Aging. 2015; 19: 734-740
- Nutritional issues in long-Term care.J. Am. Med. Dir. Assoc. 2008; 9: 476-485
- International survey of nursing home research priorities.J. Am. Med. Dir. Assoc. 2014; 15: 309-312
- Measures of nutritional compromise among nursing home patients: weight loss, low body mass index, malnutrition, and feeding dependency, a systematic review of the literature.J. Am. Med. Dir. Assoc. 2013; 14: 94-100
- Risk factors for malnutrition in older adults: a systematic review of the literature based on longitudinal data.Adv. Nutr. 2016; 7: 507-522
- Effectiveness of mealtime interventions on nutritional outcomes for the elderly living in residential care: a systematic review and meta-analysis.Ageing Res. Rev. 2013; 12: 967-981
- A review of the effect of oral nutritional interventions on both weight change and functional outcomes in older nursing home residents.E Spen. Eur. E J. Clin. Nutr. Metab. 2011; 6: e101-e105
- A systematic review of the cost and cost effectiveness of using standard oral nutritional supplements in community and care home settings.Clin. Nutr. 2016; 35: 125-137
National Centre for Classification in Health. The international statistical classification of diseases and related health problems, 10th revision, Australian modification (ICD-10-AM): New South Wales, Australia : National Centre for Classification in Health, Faculty of Health Sciences, The University of Sydney; 2010.
- BMI and all-cause mortality in older adults: a meta-analysis.Am. J. Clin. Nutr. 2014; 99: 875-890
- A systematic review of the literature concerning the relationship between obesity and mortality in the elderly.J. Nutr. Health Aging. 2012; 16: 89-98
- Inverse relationship between body mass index and mortality in older nursing home residents: a meta-analysis of 19,538 elderly subjects.Obes. Rev. 2015; 16: 1001-1015
- Malnutrition in older adults – urgent need for action: a plea for improving the nutritional situation of older adults.Gerontology. 2013; 59: 328-333
- Nutritional screening and assessment tools for older adults: literature review.J. Adv. Nurs. 2006; 54: 477-490
- Screening for undernutrition in geriatric practice: developing the short-form mini nutritional assessment (MNA-SF).J. Gerontol. 2001; 56A: M366-M372
- Nutrition Screening Initiative: development and implementation of the public awareness checklist and screening tools.J. Am. Diet. Assoc. 1992; 92: 163-167
- Geriatric Nutritional Risk Index: a new index for evaluating at-risk elderly medical patients.Am. J. Clin. Nutr. 2005; 82: 777-783
- Progress in the development of a nutritional risk index.J. Nutr. 1990; 120: 1549-1553
- The'MUST'report. Nutritional Screening for Adults: a Multidisciplinary Responsibility. Development and Use of The'Malnutrition Universal Screening Tool' (MUST) for Adults.British Association for Parenteral and Enteral Nutrition (BAPEN), 2003
- Developing and testing the nutritional form for the elderly.Int. J. Nurs. Pract. 2001; 7: 336-341
- Simple nutrition screening tools for healthcare facilities: development and validity assessment.Can. J. Diet. Pract. Res. 2001; 62: 26
- Validity of the minimum data set for assessing nutritional status in nursing home residents.Am. J. Clin. Nutr. 1997; 66: 787-794
- Development of the Chinese Nutrition Screen (CNS) for use in institutional settings.J. Nutr. Health Aging. 2005; 9: 203-210
- Appetite assessment: simple appetite questionnaire predicts weight loss in community-dwelling adults and nursing home residents.Am. J. Clin. Nutr. 2005; 82: 1074-1081
- The SNAQRC, an easy traffic light system as a first step in the recognition of undernutrition in residential care.J. Nutr. Health Aging. 2010; 14: 83-89
- Nutritional screening tools as predictors of mortality, functional decline, and move to higher level care in older people: a systematic review.J. Nutr. Gerontol. Geriatr. 2012; 31: 97-145
- A systematic review of malnutrition screening tools for the nursing home setting.J. Am. Med. Dir. Assoc. 2014; 15: 171-184
- Consensus statement: academy of nutrition and dietetics and american society for parenteral and enteral nutrition.JPEN. J. Parenter. Enteral Nutr. 2012; 36: 275-283
- What is subjective global assessment of nutritional status?.JPEN. J. Parenter. Enteral Nutr. 1987; 11: 8-13
- Encouraging Best Practice Nutrition and Hydration in Residential Aged Care. Final Report.Australian Government Department of Health & Ageing, 2009 (Available from: https://www.newcastle.edu.au/__data/assets/pdf_file/0017/34037/EBPRAC-report.pdf. (accessed 10.11.15))
- Assessing the nutritional status of the elderly: the mini nutritional assessment as part of the geriatric evaluation.Nutr. Rev. 1996; 54: S59-S65
- Evaluation of mini-nutritional assessment for Japanese frail elderly.Nutrition. 2005; 21: 498-503
- Use of subjective global assessment to identify nutrition-associated complications and death in geriatric long-term care facility residents.J. Am. Coll. Nutr. 2000; 19: 570-577
- Epidemiological study of malnutrition in elderly patients in acute, sub-acute and long-term care using the MNA [R].J. Nutr. Health Aging. 1999; 3: 146-151
- Nutritional status according to mini nutritional assessment in an institutionalized elderly population in Sweden.Gerontology. 2000; 46: 139-145
- Nutritional care needs in elderly residents of long-term care institutions: potential implications for policies.J. Nutr. Health Aging. 2015; 19: 947-954
- Malnutrition, prevalence and relation to some risk factors among elderly residents of nursing homes in tehran, Iran.Iran. J. Public Health. 2015; 44: 218-227
- A cross-sectional survey to investigate the quality of care in Tuscan (Italy) nursing homes: the structural, process and outcome indicators of nutritional care.BMC Health Serv. Res. 2015; 15: 1-10
- Malnutrition and associated factors among aged residents in all nursing homes in Helsinki.Eur. J. Clin. Nutr. 2005; 59: 578-583
- Structural and process indicators of nutritional care: a comparison between austrian hospitals and nursing homes.Nutrition. 2012; 28: 868-873
- Malnutrition and mealtime ambiance in nursing homes.J. Am. Med. Dir. Assoc. 2009; 10: 226-229
- Anorexia of aging: physiologic and pathologic.Am. J. Clin. Nutr. 1997; 66: 760-773
- Evaluation of weight loss in the elderly.Geriatrics. 1989; 44: 31-37
- New Zealand society for geriatric medicine (Position statement No. 6). under-nutrition and the older person.Aust. J. Ageing. 2009; 28: 99-105
- Age as a determinant of nutritional status: a cross sectional study.Nutrition. 2005; 4: 28
- Relationship between nutritional status and tooth loss in an older population from Sri Lanka.Gerodontology. 2012; 29: e566-e570
- Basics in clinical nutrition: nutrition in the elderly.E Spen. Eur. E J. Clin. Nutr. Metab. 2009; 4: e289-e299
- Position paper of the American Dietetic Association: nutrition across the spectrum of aging.J. Am. Diet. Assoc. 2005; 105: 616-633
- Dysphagia in long-term care: a systematic review.J. Nutr. Gerontol. Geriatr. 2015; 34: 1-21
- Factors associated with weight loss, low BMI, and malnutrition among nursing home patients: a systematic review of the literature.J. Am. Med. Dir. Assoc. 2013; 14: 649-655
- Weight loss, mortality and associated potentially modifiable nutritional risk factors among nursing home residents- a Danish follow-up study.J. Nutr. Health Aging. 2015; 19: 96-101
- Nursing home food services linked with risk of malnutrition.Can. J. Diet. Pract. Res. 2007; 68: 14-20
- Individual and household food insecurity in Canada: position of dietitians of Canada.Can. J. Diet. Pract. Res. 2005; 66: 43
- Food security: who is being excluded? A case of older people with dementia in long-term care homes.J. Nutr. Health Aging. 2014; 18: 685-691
- Knowledge and attitudes of nursing staff towards malnutrition care in nursing homes: a multicentre cross-sectional study.J. Nutr. Health Aging. 2015; 19: 734-740
- Alterations in nutritional status.in: Porth C. Pathophysiology, Concepts of Altered Health States. 7th ed. Lippincott Williams & Wilkins, Philadelphia2005
- Skeletal muscle apoptosis, sarcopenia and frailty at old age.Exp. Gerontol. 2006; 41: 1234-1238
- Medical nutrition therapy for pulmonary disease.in: Mahan L.K. Escott-Stump S. Krouse's Food & Nutrition Therapy. Saunders Elsevier, Missouri2008: 899-920
- Sarcopenia as a risk factor for falls in elderly individuals: results from the ilSIRENTE study.Clin. Nutr. 2012; 31: 652-658
- Malnutrition and ageing.Postgrad. Med. J. 2006; 82: 2-8
- Screening for malnutrition among nursing home residents – a comparative analysis of the Mini Nutritional Assessment, the Nutritional Risk Screening, and the Malnutrition Universal Screening Tool.J. Nutr. Health Aging. 2013; 17: 326-331
- The Mini Nutritional Assessment-Short Form and mortality in nursing home residents – Results from the INCUR study.J. Nutr. Health Aging. 2015; 19: 383-388
- Nutritional assessment in an Asian nursing home and its association with mortality.J. Nutr. Health Aging. 2010; 14: 23-28
- Outcomes of feeding problems in advanced dementia in a nursing home population.J. Am. Geriatr. Soc. 2013; 61: 1692-1697
- Prevalence and risk indicators of depression in elderly nursing home patients: the AGED study.J. Affect. Disord. 2004; 83: 135-142
- Depression in older patients admitted for postacute nursing home rehabilitation.J. Am. Geriatr. Soc. 2005; 53: 1017-1022
- Factors associated with low body mass index and weight loss in nursing home residents.J. Gerontol. A. Biol. Sci. Med. Sci. 1995; 50: M162-M168
- Malnutrition and depression in the institutionalised elderly.Br. J. Nutr. 2009; 102: 1663-1667
- Malnutrition and depression among community-dwelling elderly people.J. Am. Med. Dir. Assoc. 2007; 8: 582-584
- Depressive symptoms and risk for malnutrition among hospitalized elderly people.J. Nutr. Health Aging. 2008; 12: 313-318
- Causes of weight loss in a community nursing home.J. Am. Geriatr. Soc. 1994; 42: 583-585
- An investigation into the association between nutritional status and quality of life in older people admitted to hospital.J. Hum. Nutr. Diet. 2014; 27: 142-151
- The economic costs of disease related malnutrition.Clin. Nutr. 2013; 32: 136-141
- The Cost of Disease-Related Malnutrition in the UK and Economic Considerations for the Use of Oral Nutritional Supplements (ONS) in Adults.British Association for Parenteral and Enteral Nutrition, Redditch, UK2006 (Available from: http://www.bapen.org.uk/pdfs/health_econ_exec_sum.pdf. (accessed on 10.09.12))
- Evidence based practice guidelines for the nutritional management of malnutrition in patients across the continuum of care.Nutr. Diet. 2009; 66: S1-S34
- Are informal carers and community care workers effective in managing malnutrition in the older adult community? A systematic review of current evidence.J. Nutr. Health Aging. 2013; 17: 645-651
- Nutrition Support for Adults: Oral Nutrition Support, Enteral Tube Feeding and Parenteral Nutrition.National Collaborating Centre for Acute Care (UK), London2006 (NICE Clinical Guidelines, No. 32.). Available from: http://www.ncbi.nlm.nih.gov/books/NBK49269/. (accessed on 14.07.11)
- Menu planning in residential aged care—the level of choice and quality of planning of meals available to residents.Nutrients. 2015; 7: 7580-7592
- Malnutrition in institutionalized seniors: the iatrogenic component.J. Am. Geriatr. Soc. 2003; 51: 85-90
- Quality of life in assisted living facilities: viewpoints of residents.J. Appl. Gerontol. 2000; 19: 304-325
- Determinants of foodservice satisfaction for patients in geriatrics/rehabilitation and residents in residential aged care.Health Expect. 2013; 16: 251-265
- Menu planning in long-term care: toward resident-centred menus.Can. J. Diet. Pract. Res. 2011; 72: e126-e133
- Assessment of the nutritional status among residents in a Danish nursing home – health effects of a formulated food and meal policy.J. Clin. Nurs. 2008; 17: 2288-2293
- Development and psychometric evaluation of the knowledge of malnutrition – geriatric (KoM-G) questionnaire to measure malnutrition knowledge among nursing staff in Austrian nursing homes.Scand. J. Caring Sci. 2015; 29: 193-202
- Malnutrition in the nursing home.Curr. Opin. Clin. Nutr. Metab. Care. 2015; 18: 17-23
- Maintaining nutrition in aged care residents with a train-the-trainer intervention and nutrition coordinator.J. Nutr. Health Aging. 2009; 13: 913-917
- Smaller but energy and protein enriched meals improve energy and nutrient intakes in elderly patients.J. Nutr. Health Aging. 2005; 9: 243-247
- High consumption foods and their influence on energy and protein intake in institutionalized older adults.J. Nutr. Health Aging. 2012; 16: 115-122
- Micronutrient food fortification for residential care: a scoping review of current interventions.J. Am. Med. Dir. Assoc. 2016; 17: 588-595
- Energy-dense meals improve energy intake in elderly residents in a nursing home.Clin. Nutr. 2003; 22: 125-131
- Improving the dietary intake of under nourished older people in residential care homes using an energy-enriching food approach: a cluster randomised controlled study.J. Hum. Nutr. Diet. 2013; 26: 387-394
- Effects of food fortification on nutritional and functional status in frail elderly nursing home residents at risk of malnutrition.Nutrition. 2008; 24: 1139-1144
- Consuming two additional serves of dairy food a day significantly improves energy and nutrient intakes in ambulatory aged care residents: a feasibility study.J. Nutr. Health Aging. 2013; 17: 509-513
- Energy-dense meals improve energy intake in elderly residents in a nursing home.Clin. Nutr. 2003; 22: 125-131
- Lack of compliance of staff in an intervention study with focus on nutrition, exercise and oral care among old (65+ yrs) Danish nursing home residents.Aging Clin. Exp. Res. 2009; 21: 143-149
- Meeting the nutritional needs of elderly residents in aged-care: are we doing enough?.J. Nutr. Health Aging. 2013; 17: 503-508
- Restrictive diets in the elderly: never say never again?.Clin. Nutr. 2010; 29: 170-174
- A novel dysphagia diet improves the nutrient intake of institutionalized elders.J. Am. Diet. Assoc. 2006; 106: 1614-1623
- Dietary and fluid intakes of older adults in care homes requiring a texture modified diet: the role of snacks.J. Am. Med. Dir. Assoc. 2011; 12: 234-239
- Analysis of the food consumption of 87 elderly nursing home residents, depending on food texture.J. Nutr. Health Aging. 2011; 15: 192-195
- Issues associated with the use of modified texture foods.J. Nutr. Health Aging. 2012; 16: 195-200
- Effect of family-style meals on energy intake and risk of malnutrition in dutch nursing home residents: a randomized controlled trial.J. Gerontol. A. Biol. Sci. Med. Sci. 2006; 61: 935-942
- The effect of interventions to prevent and treat malnutrition in patients admitted for rehabilitation: a systematic review with meta-analysis.J. Hum. Nutr. Diet. 2015; 28: 1-15
- Home-made oral supplement as nutritional support of old nursing home residents, who are undernourished or at risk of undernutrition based on the MNA. A pilot trial. Mini nutritional assessment.Aging Clin. Exp. Res. 2002; 14: 212-215
- Effect of a nutrient-enriched drink on dietary intake and nutritional status in institutionalised elderly.Eur. J. Clin. Nutr. 2009; 63: 1241-1250
- Effects of a low-volume, nutrient- and energy-dense oral nutritional supplement on nutritional and functional status: a randomized, controlled trial in nursing home residents.J. Am. Med. Dir. Assoc. 2013; 14 (628): e1-e8
- An innovative solid oral nutritional supplement to fight weight loss and anorexia: open, randomised controlled trial of efficacy in institutionalised, malnourished older adults.Age Ageing. 2015; 44: 245-251
- Compliance of nursing home residents with a nutrient- and energy-dense oral nutritional supplement determines effects on nutritional status.J. Nutr. Health Aging. 2015; 19: 356-364
- Effect of essential amino acid supplementation on quality of life: amino acid profile and strength in institutionalized elderly patients.Clin. Nutr. 2011; 30: 571-577
- Need-based nutritional intervention is effective in improving handgrip strength and Barthel Index scores of older people living in a nursing home: a randomized controlled trial.Int. J. Nurs. Stud. 2015; 52: 904-912
- Exercise training and nutritional supplementation for physical frailty in very elderly people.N. Engl. J. Med. 1994; 330: 1769-1775
- Physical and social functional abilities seem to be maintained by a multifaceted randomized controlled nutritional intervention among old (>65 years) Danish nursing home residents.Arch. Gerontol. Geriatr. 2010; 50: 351-355
- Need-based intervention is an effective strategy for improving the nutritional status of older people living in a nursing home: a randomized controlled trial.Int. J. Nurs. Stud. 2013; 50: 1580-1588
- Oral liquid nutritional supplements for people with dementia in residential aged care facilities: a systematic review.JBI Database Syst. Rev. Implement. Rep. 2010; 8: 1-52
- Clinical and organizational factors associated with feeding tube use among nursing home residents with advanced cognitive impairment.JAMA. 2003; 290: 73-80
- Percutaneous endoscopic gastrostomy (PEG) tube feeding of nursing home residents is not associated with improved body composition parameters.J. Nutr. Health Aging. 2013; 17: 162-165
- Long-term enteral feeding of aged demented nursing home patients.J. Am. Geriatr. Soc. 1990; 38: 1195-1198
- The costs arising from pressure ulcers attributable to malnutrition.Clin. Nutr. 2010; 29: 180-186
- Diet liberalisation in older Australians decreases risk of frailty without increasing the risk of developing chronic disease.JFA. 2012; 1: 174-182
- Estimating the costs associated with malnutrition in Dutch nursing homes.Clin. Nutr. 2012; 31: 65-68
- Consensus statement of the academy of nutrition and dietetics/American society for parenteral and enteral nutrition: characteristics recommended for the identification and documentation of adult malnutrition (Undernutrition).J Acad Nutr Diet. 2012; 112: 730-738
- The relationship between body mass index and quality of life in community-living older adults living in the United States.J. Nutr. Health Aging. 2013; 17: 495-501
- The influence of protein-calorie malnutrition on quality of life in nursing homes.J. Gerontol. A. Biol. Sci. Med. Sci. 2003; 58: M159-M164
- Depression in older patients admitted for postacute nursing home rehabilitation.J. Am. Geriatr. Soc. 2005; 53: 1017-1022
Article info
Publication history
Published online: June 22, 2016
Accepted:
June 22,
2016
Received in revised form:
June 13,
2016
Received:
April 15,
2016
Identification
Copyright
© 2016 Published by Elsevier Ireland Ltd.
