Undernutrition in community-dwelling older adults: prevalence, causes and consequences

The aim of this paper is to review several key aspects of undernutrition in later life, with a major focus on undernutrition in community-dwelling older adults. The prevalence of undernutrition in community-dwelling older adults is about 8.5%, but higher in vulnerable subgroups such as the oldest old (19.3%), those reporting poor appetite (22.4%), and those receiving home care (15.8%). Frequently reported risk factors for undernutrition in the community include poor appetite, functional limitations and previous hospitalisation. The Determinants of Malnutrition in Aged Persons (DoMAP) model provides a clear framework to structure the different direct and indirect potential determinants of undernutrition in old age. Low BMI as well as involuntary weight loss, both important phenotypic criteria of undernutrition, are associated with early mortality in older adults. Furthermore, undernutrition in community-dwelling older adults is associated with a subsequent increased risk of frailty, falls, functional decline and rehospitalisation. Qualitative studies indicate a poor undernutrition awareness among healthcare professionals working in community care as well as among older adults themselves. The Malnutrition Awareness Scale can be used to objectively measure an older persons' undernutrition awareness. In conclusion, the prevalence of undernutrition among older adults living in the community is substantial and has several negative consequences for health and functioning. Strategies towards greater undernutrition awareness by primary care professionals as well as older adults themselves is therefore necessary.