Malnutrition in Older Adults

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Malnutrition in Older Adults

Welcome to the Malnutrition in Older Adults Project

Malnutrition is multifactorial; thus, many tools and resources are needed to support care in different populations and settings. Malnutrition is characterized by inadequate protein and energy intake that can result in loss of fat and muscle stores. Malnutrition can result in decreased quality of life, and increased morbidity and mortality. The target audience for this guideline and supporting systematic review is older adults (mean age of >/= 65 years) living in long-term care and community settings.

Evidence-Based Nutrition Practice Guideline

The objective of this evidence-based nutrition practice guideline (EBNPG) is to provide evidence-based recommendations to identify, prevent or treat protein-energy malnutrition (further referred to as malnutrition) in older adults living in long-term care and community settings. Improved nutrition status may improve quality of life, prevent decline in physical function, and may decrease risk of hospitalization and mortality. 

The EBNPG includes recommendations on the following topics:

  • Malnutrition Assessment 
  • Oral Nutrition Supplements
  • Food Fortification
  • Home Delivered Meals and Congregate Meals
  • Dietitian Effectiveness 

The expert panel developed the following resources to assist with the implementation of this guideline:

  • Prevention and Treatment of Malnutrition in Older Adults: Nutrition Care Process Flow Chart (PDF)
  • Practitioner Guide Prevention and Treatment of Malnutrition in Older Adults: Community (PDF)
  • Practitioner Guide Prevention and Treatment of Malnutrition in Older Adults: Long-Term Care (PDF)

For additional implementation and dissemination tools, click on the Dissemination and Implementation tab in the left navigation bar.

Systematic Review

The systematic review focused on two subtopics – Assessment and Intervention. In the Assessment subtopic, the expert panel reviewed the validity and reliability for malnutrition diagnosis, and the predictive validity for mortality, hospitalization, and decline of physical function of identified nutrition assessment tools used in long-term care and the community. The Intervention subtopic addresses oral nutrition supplements, food fortification, RDN effectiveness, and home-delivered and congregate meals.  

Key Findings include: 

  • Oral nutrition supplement interventions likely increase calorie and protein intake in older adults living in long-term care, those discharged from acute care to the community, and those living in community settings. Oral nutrition supplements may also improve the nutrition status of older adults living in long-term care. 
  • Registered dietitian nutritionists’ interventions likely increase calorie and protein intake and help maintain or increase body weight in older adults discharged from acute care to the community, and those living in the community. RDN interventions may also improve the nutrition status in older adults discharged from acute care to the community. 
  • Three tools have available data meeting study criteria:  Mini-Nutrition Assessment (MNA); Subjective Global Assessment (SGA); and Patient Generated Subjective Global Assessment (PG-SGA). 
  • Home-delivered and congregate meal sites may help increase calorie and protein intake and reduce the incidence of malnutrition. 
  • MNA has moderate validity and reliability for use in the community, and low validity for use in long-term care.
  • MNA has predictive ability for mortality, hospitalization, and declining physical function in the community, and predictive ability for mortality and hospitalization in long term care. 
  • SGA has moderate validity for use in the community, and low validity for use in long-term care.

Use the links on the left navigation bar to access the guideline and results of the systematic review. The complete guideline in PDF format can be downloaded from here. 

Expand the section below titled Project Team and Disclosures for a listing of individuals who contributed to the development of the project, disclosures, and project funding information. Expand the section titled Articles and Resources for resources from this project. 

1/17/2024

  • Scoping Review Project Team and Disclosures (2020)

    The following individuals contributed their valuable time and expertise to the scoping review:

    Project Team

    • Lisa Moloney, MS, RD, Project Manager
      Nutrition Researcher, Academy of Nutrition and Dietetics, Chicago, IL, USA
    • Brittany Y. Jarret, PhD, RD, Lead Analyst
      Associate Medical Writer, Complete HealthVizion, Chicago, IL, USA
    • Deepa Handu, PhD, RD, Methodologist
      Senior Scientist, Academy of Nutrition and Dietetics, Chicago, IL, USA


    Content Advisors

    • Judi Porter, PhD
      Associate Professor, Monash University, Melbourne, Victoria, Australia
    • Jingyi Wang, MPH, RD, LD
      Clinical Dietitian, Providence Seward Medical and Care Center, Seward, AK, USA


    Financial Contributors

    • Commission on Dietetic Registration
    • Dietetics in Health Care Communities Dietetic Practice Group
    • Academy of Nutrition and Dietetics

    The views or interests of the funding bodies did not influence the development of this scoping review.
     

    Disclosures of Potential Conflicts of Interest: In the interest of full disclosure, the Academy has adopted the policy of revealing relationships workgroup members and content advisors have with companies that sell products or services that are relevant to this topic. Workgroup members and content advisors are required to disclose potential conflicts of interest by completing the Academy Conflict of Interest Form. It should not be assumed that these financial interests will have adverse impact on the content, but they are noted here to fully inform readers:

    • None of the content advisors listed above disclosed potential conflicts of interest.
  • Articles and Resources
    • Nutrition Assessment and Interventions for the Prevention and Treatment of Malnutrition in Older Adults: An Evidence Analysis Center Scoping Review. Moloney L, Jarrett B. J Acad Nutr Diet 2020  
       
    • Malnutrition in Older Adults (2023) Guideline Presentation: this 39-slide MS PowerPoint presentation includes the recommendations and ratings of the guideline along with implementation tips and resources. Ideal for meetings, in-service presentations, and classroom lectures (this product is not designed for the consumer). Download for free.
       
    • Prevention and Treatment of Malnutrition in Older Adults: Nutrition Care Process Flow Chart (PDF)
       
    • Practitioner Guide Prevention and Treatment of Malnutrition in Older Adults: Community (PDF)
       
    • Practitioner Guide Prevention and Treatment of Malnutrition in Older Adults: Long-Term Care (PDF) 
       
    • The Recommendation Prioritization Tool was created to help dietitians and other healthcare practitioners prioritize recommendations from comprehensive evidence-based guidelines for incorporation of new practices or innovations into their daily practice. Learn more
  • Malnutrition in Older Adults Guideline and Systematic Review Project Team and Disclosures (2022-23)

    The following individuals contributed their valuable time and expertise to this project:

    Expert Panel Workgroup Members

    • Nancy Munoz, DCN, MHA, RDN, FAND, Chair
      Chief, Nutrition and Food Services, VA Southern Nevada Healthcare System, Las Vegas, NV, USA
    • Anne E. Coltman, MSHA, MS, RDN, FAND, FACHE,, Co-Chair
      Senior General Manager, Trinity Health, Maywood, IL, USA (through April 2023); Senior Director, Quality Standards and Interoperability, Commission on Dietetic Registration, Academy of Nutrition and Dietetics, Chicago, IL, USA (effective April 2023)
    • Krista M. Clark, MBA, RD, LD, CSG, FAND
      Director of Education and Training, CJL Consulting LLC, Cincinnati, OH, USA
    • Nancy Collins, PhD, RDN, LD, NWCC, FAND
      President, Light Bulb Health Inc., Las Vegas, NV, USA
    • Shina Nishioka, PhD, RD
      Deputy Director, Department of Training and Education / Chief, Department of Clinical Nutrition Food Service, Nagasaki Rehabilitation Hospital, Ngasaki City, Nagasaki, Japan
    • Emily Riddle, PhD, RD
      Assistant Professor, SUNY Oneonta, Ithaca, NY, USA
    • Terese M. Scollard, MBA, RDN, LD, FAND, FASPEN
      Owner/Consultant, MySurgeryPlate LLC, Beaverton, OR,USA
    • Judy R. Simon, MS, RD, LD
      National Nutritionist, Administration for Community Living, U.S. Department of Health and Human Services, Washington, DC, USA

    Patient Advocates

    • Lamia C. Nasrallah, MPH, RDN, LDN
      Manager, Clinical Nutrition, UNC Hospitals, Chapel Hill, NC, USA
    • Beth A. Smith, MS, RD-AP, LDN
      Clinical Dietitian, Memorial Hermann Hospital, Houston, TX, USA

    Project Leaders

    • Lisa Moloney, PhD, RD, Project Manager
      Nutrition Researcher, Academy of Nutrition and Dietetics, Chicago, IL, USA
    • Mary Katherine Hoy, MEd, RDN, Lead Analyst
      Nutritionist, ARS-USDA, Beltsville, MD, USA
    • Deepa Handu, PhD, RDN, Methodologist
      Senior Scientist, Academy of Nutrition and Dietetics, Chicago, IL, USA
    • Amanda Wanner, MLIS, AHIP, Medical Librarian
      Information Specialist Consultant, British Columbia,  Canada

    Evidence Analysts

    • Lisa A. Davis, MS, RD
      Madison, WI, USA
    • Sharon Foley, PhD, RDN
      Chicago, IL, USA
    • Kay Howarter, MS, RD
      West Lafayette, IN, USA
    • Telma Moreira, MS, RDN, LD, CNSC
      Houston, TX, USA
    • Keiy Murofushi, MS, RDN
      Los Angeles, CA, USA
    • Megan Piotrowski, MS, BSN, RN, CHES
      Grosse Point Farms, MI, USA
    • Jessica Schueler, MS, RDN
      Bend, OR, USA

    Guideline Reviewers

    External

    • Christina Badaracco, MPH, RDN
      Research Scientist II, Avalere Health, Washington, DC, USA
    • Michelle Brown, MS, RD, LDN, CNSC 
      Clinical Dietitian, UF Health, Gainesville, FL, USA 
    • Nissa Fuller, PhD, RDN, LD 
      Clinical Dietitian, Sodexo, Highland Ranch, CO, USA 
    • Madeline Hric, MS, RD, LDN 
      Clinical Dietitian, Cleveland Clinic, Cleveland, OH, USA 
    • Amna Kashif, MSc, Registered Nutritionist
      Freelance, Karachi, Pakistan 
    • Owen J. Kelly, PhD 
      Assistant Professor Nutrition, Sam Houston State University, Conroe, TX, USA
    • Morgan Kuiper, MS, RD, LD 
      Dietitian II, Sodexo at PeaceHealth Sacred Heart Medical Center at RiverBend, Eugene, OR, USA 
    • Beshir E. Kulleche, MSc 
      Lecturer, Addis Ababa Science and Technology University, Addis Ababa, Ethiopia 
    • Mallory R. Lacey, MS, RD, LDN, CNSC 
      Inpatient Clinical Dietitian, Penn Medicine Lancaster, General Hospital, Lancaster, PA, USA 
    • Tabbetha D. Lopez, PhD, RD, LD 
      Assistant Professor/Director of Dietetic Internship, Sam Houston State University, Houston, TX, USA 
    • Ainsley M. Malone, MS, RDN, CNSC, FAND, FASPEN 
      Clinical Practice Specialist, American Society for Parenteral and Enteral Nutrition; Nutrition Support Dietitian, Mt. Carmel East Hospital, Columbus, OH, USA 
    • Kelly A. Martin, DCN, RDN, CDN 
      Assistant Professor/Assistant Director, MS Nutrition Program, SUNY Oneonta, Oneonta, NY, USA 
    • Rayna M. McCann, MS, RDN, CSO, CDN 
      Territory Manager for Kate Farms and Adjunct Assistant Professor at Long Island University - Post, NY, USA 
    • Danielle McDevitt, MS, RD, LDN 
      Clinical Nutritionist, New Jersey Veterans Memorial Home, Vineland, NJ, USA 
    • Jordan D. Mize, MS, RDN,LD 
      Associate Professor, Cox College, Springfield, MO, USA 
    • Christie A. Roberts, MS, RD, LDN 
      Clinical Informatics Specialist, Metz Culinary Management, Clearwater, FL, USA 
    • Lema Safadi, MS, RD 
      TriHealth, Mason, OH, USA  
    • Chelsi A. Snell, MS, RD, LD 
      Clinical Dietitian, Wellstar Health System, Atlanta, GA, USA 
    • Angela Wolfenberger, MS, RDN, LD
      Dietitian, Sodexo, Kamuela, HI, USA

    Internal

    • Jennifer Herendeen
      Senior Director, Clinical Content Strategy, Academy of Nutrition and Dietetics, Chicago, IL, USA
    • Beth Mordarski, RDN, LD 
      Manager, Nutrition Focused Physical Exam Program, Academy of Nutrition and Dietetics, Chicago, IL, USA

    Financial Contributors

    • Dietetics in Health Care Communities Dietetic Practice Group
    • Academy of Nutrition and Dietetics Foundation
    • Academy of Nutrition and Dietetics

    The views or interests of the funding bodies did not influence the development of the guideline or systematic review.


    Disclosures of Potential Conflicts of Interest: In the interest of full disclosure, the Academy has adopted the policy of revealing relationships workgroup members have with companies that sell products or services that are relevant to this topic. Workgroup members are required to disclose potential conflicts of interest by completing the Academy Conflict of Interest Form. It should not be assumed that these financial interests will have an adverse impact on the content, but they are noted here to fully inform readers.

    • Collins N: received compensation for consultant services, lectures, and development of education materials from Abbott Nutrition, Medtrition
    • Scollard T: site coordinator for Malnutrition Clinical Characteristics Validation Study; MNT for Malnutrition, NCPTC Classification subcommittee.

    1/18/2024