Malnutrition in the elderly

A close relationship exists between nutritional status and health; malnutrition (both over- and undernutrition) is associated with a decline in functional status, impaired muscle function, decreased bone mass, immune dysfunction, reduced cognitive function, poor wound-healing, delayed recovery from surgery, higher hospitalization and readmission rate, and mortality. Elderly subjects can be considered as nutritionally frail: their nutritional status is at increased vulnerability to stressors. Social, psychological, functional, and clinical difficulties may lead to malnutrition (over- and undernutrition) status, more readily than in younger subjects. In the elderly, the consequences of malnutrition may be more insidious and potentially harmful, while the recovery from malnutrition is more difficult. The assessment of nutritional status is important in clinical practice to provide a prognostic evaluation of the nutritional risk, an early diagnosis of malnutrition (either over- or undernutrition), the identification of nutritional requirements, the detection of patients needing total or partial nutritional support (diet, supplementation, artificial nutrition), the evaluation of efficacy of nutritional intervention, and, in epidemiologic and clinical studies, the comparison of groups of patients. Nutritional status evaluation is a two-step procedure considering screening tools and in-depth evaluation (energy balance [nutritional habits and physical activity], body composition, and body function). Prevention of malnutrition may be achieved through the fight against food insecurity, effective screening, education, and intervention programs on the determinants of malnutrition. Nutritional intervention must be tailored on elderly needs combining dietary intervention, oral nutritional supplements, and artificial nutrition. Programs that provide nutrition education (nutrition therapy and care management for older adults), the provision of routine nutrition screening tools, the provision of nutritional assistance (food security, meal preparation, dietary and fluid intake), the routine assessment of functional status, cognitive status, depression, oral health, and polypharmacy, the evaluation of nutritional and functional outcomes, together with QoL assessment, are essential in recovering from malnutrition status.