Prevention and Treatment of Malnutrition in Older Adults Living in Long-Term Care or the Community: An Evidence-Based Nutrition Practice Guideline.

Malnutrition in older adults can decrease quality of life and increase risk of morbidities and mortality. Accurate and timely identification of malnutrition, as well as subsequent implementation of effective interventions, are essential to decrease poor outcomes associated with malnutrition in older adults. The Academy of Nutrition and Dietetics Evidence Analysis Center conducted a systematic review of the literature to develop an evidence-based nutrition practice guideline for the prevention and treatment of malnutrition in older adults. The objective of this guideline was to provide evidence-based recommendations to identify, prevent, or treat protein-energy malnutrition in older adults (mean age ≥65 years) living in long-term care and community settings. This guideline provides 11 nutrition recommendations to inform shared decision making among dietitians, members of the health care team, family members or caregivers, and older adults living in long-term care or the community to prevent or treat malnutrition. Topics include dietitian effectiveness, nutrition assessment tools, oral nutrition supplements, food fortification, and home-delivered and congregate meals. Guideline implementation should include consideration of the importance of comprehensive individualized nutrition care for older adults. Future research is needed to address gaps that were identified related to the validity, reliability, and feasibility of nutrition assessment tools, as well as the effectiveness of dietitian interventions on outcomes of interest in older adults living in long-term care and the community.

A Brief Intervention for Malnutrition among Older Adults: Stepping Up Your Nutrition.

Despite a multitude of nutritional risk factors among older adults, there is a lack of community-based programs and activities that screen for malnutrition and address modifiable risk among this vulnerable population. Given the known association of protein and fluid consumption with fall-related risk among older adults and the high prevalence of falls among Americans age 65 years and older each year, a brief intervention was created. Stepping Up Your Nutrition (SUYN) is a 2.5 h workshop developed through a public/private partnership to motivate older adults to reduce their malnutrition risk. The purposes of this naturalistic workshop dissemination were to: (1) describe the SUYN brief intervention; (2) identify participant characteristics associated with malnutrition risk; and (3) identify participant characteristics associated with subsequent participation in Stepping On (SO), an evidence-based fall prevention program. Data were analyzed from 429 SUYN participants, of which 38% (n = 163) subsequently attended SO. As measured by the SCREEN II®, high and moderate malnutrition risk scores were reported among approximately 71% and 20% of SUYN participants, respectively. Of the SUYN participants with high malnutrition risk, a significantly larger proportion attended a subsequent SO workshop (79.1%) compared to SUYN participants who did not proceed to SO (65.8%) (χ2 = 8.73, p = 0.013). Findings suggest SUYN may help to identify malnutrition risk among community-dwelling older adults and link them to needed services like evidence-based programs. Efforts are needed to expand the delivery infrastructure of SUYN to reach more at-risk older adults.

Food preferences of older adults in senior nutrition programs.

The Elderly Nutrition Program (ENP) is being challenged to improve the quality of meal programs. The purpose of this study was to explore how food preferences varied depending on gender and ethnic groups. A total of 2,024 participants in the ENP aged 60 years or older were interviewed. A majority of the participants were female (74.7%), served by congregate meal programs (71.7%), with the mean ± SD age of 76.9 ± 9.2 years. A general impression of the meals and preferences for 13 food groups (fresh fruit, chicken, soup, salad, vegetables, potatoes, meat, sandwiches, pasta, canned fruit, legumes, deli meats, and ethnic foods) were assessed. After adjusting other variables, older males were significantly more likely to prefer deli meats, meat, legumes, canned fruit, and ethnic foods compared to females. In addition, compared with African Americans, Caucasians demonstrated higher percentages of preference for 9 of 13 food groups including pasta, meat, and fresh fruit. To improve the quality of the ENP, and to increase dietary compliance of the older adults to the programs, the nutritional services require a strategic meal plan that solicits and incorporates older adults' food preferences.