References

Ahmed T, Haboubi N Assessment and management of nutrition in older people and its importance to health. Clin Interv Aging. 2010; 5:207-216 https://doi.org/10.2147/cia.s9664

Bartali B, Frongillo EA, Bandinelli S Low nutrient intake is an essential component of frailty in older persons. J Gerontol A Biol Sci Med Sci.. 2006; 61:(6)589-593 https://doi.org/10.1093/gerona/61.6.589

Baxter CT, Offord NJ Frailty on the acute medical take. Clin Med (Lond). 2022; 22:(4)298-301 https://doi.org/10.7861/clinmed.2022-0312

Boyd PJ, Nevard M, Ford JA, Khondoker M, Cross JL, Fox C The electronic frailty index as an indicator of community healthcare service utilisation in the older population. Age Ageing. 2019; 48:(2)273-277 https://doi.org/10.1093/ageing/afy181

British Association for Parenteral and Enteral Nutrition. must screening tool. 2003. https//www.bapen.org.uk/pdfs/must/must_full.pdf (accessed 19 February 2024)

British Association for Parenteral and Enteral Nutrition. Malnutrition and Nutritional Care Survey in Adults: UK Malnutrition Awareness Week, October 2022. 2023. https//www.bapen.org.uk/pdfs/reports/mag/national-survey-of-malnutrition-and-nutritional-care-2022.pdf (accessed 19 February 2024)

British Geriatrics Society. Fit for frailty part 1. Consensus best practice guidance for the care of older people living in community and outpatient settings. 2014. http//www.bgs.org.uk/sites/default/files/content/resources/files/2018-05-23/fff_full.pdf (accessed 19 February 2024)

Cangiano A The impact of migration on UK population growth.University of Oxford: Migration Observatory Briefing; 2023

Cederholm T, Barazzoni R, Austin P ESPEN guidelines on definitions and terminology of clinical nutrition. Clin Nutr.. 2017; 36:(1)49-64 https://doi.org/10.1016/j.clnu.2016.09.004

Centre for Ageing Better. State of ageing 2023-24. 2023. https//ageing-better.org.uk/sites/default/files/2023-12/The-State-of-Ageing-interactive-summary-2023-4.pdf (accessed 19 February 2024)

Clegg A, Rogers L, Young J Diagnostic test accuracy of simple instruments for identifying frailty in community-dwelling older people: a systematic review. Age Ageing. 2015; 44:(1)148-152 https://doi.org/10.1093/ageing/afu157

Clegg A, Bates C, Young J, Ryan R, Nichols L, Ann Teale E, Mohammed MA, Parry J, Marshall T Development and validation of an electronic frailty index using routine primary care electronic health record data. Age Ageing. 2016; 45:(3)353-360 https://doi.org/10.1093/ageing/afw039

Corcoran C, Murphy C, Culligan EP, Walton J, Sleator RD Malnutrition in the elderly. Sci Prog.. 2019; 102:(2)171-180 https://doi.org/10.1177/0036850419854290

Cox NJ, Morrison L, Ibrahim K, Robinson SM, Sayer AA, Roberts HC New horizons in appetite and the anorexia of ageing. Age Ageing. 2020; 49:(4)526-534 https://doi.org/10.1093/ageing/afaa014

Crocker TF, Brown L, Clegg A Quality of life is substantially worse for community-dwelling older people living with frailty: systematic review and meta-analysis. Qual Life Res.. 2019; 28:(8)2041-2056 https://doi.org/10.1007/s11136-019-02149-1

Dent E, Kowal P, Hoogendijk EO Frailty measurement in research and clinical practice: A review. Eur J Intern Med. 2016; 31:3-10 https://doi.org/10.1016/j.ejim.2016.03.007

Dent E, Wright ORL, Woo J, Hoogendijk EO Malnutrition in older adults. Lancet. 2023; 401:(10380)951-966 https://doi.org/10.1016/s0140-6736(22)02612-5

Dera M, Woodham D Treating malnutrition in the community. Br J Community Nurs. 2016; 21:(11)558-562 https://doi.org/10.12968/bjcn.2016.21.11.558

Department for Economic and Social Affairs, United Nations. World population prospects 2019: Highlights. 2019. https//www.un.org/development/desa/pd/news/world-population-prospects-2019-0 (accessed 19 February 2024)

Downer S, Berkowitz SA, Harlan TS, Olstad DL, Mozaffarian D Food is medicine: actions to integrate food and nutrition into healthcare. BMJ. 2020; 369 https://doi.org/10.1136/bmj.m2482

Fried LP, Tangen CM, Walston J Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci.. 2001; 56:(3)M146-156 https://doi.org/10.1093/gerona/56.3.m146

Hengeveld LM, Wijnhoven HAH, Olthof MR Prospective associations of diet quality with incident frailty in older adults: the health, aging, and body composition study. J Am Geriatr Soc.. 2019; 67:(9)1835-1842 https://doi.org/10.1111/jgs.16011

Kim N, Kim GS, Won CW, Lee JJ, Park MK, Shin J, Kim M Two-year longitudinal associations between nutritional status and frailty in community-dwelling older adults: Korean Frailty and Aging Cohort Study. BMC Geriatr. 2023; 23:(1) https://doi.org/10.1186/s12877-023-03903-4

Kojima G Frailty defined by FRAIL scale as a predictor of mortality: a systematic review and meta-analysis. J Am Med Dir Assoc. 2018a; 19:(6)480-483 https://doi.org/10.1016/j.jamda.2018.04.006

Kojima G, Iliffe S, Walters K Frailty index as a predictor of mortality: a systematic review and meta-analysis. Age Ageing. 2018b; 47:(2)193-200 https://doi.org/10.1093/ageing/afx162

Liang H, Li X, Lin X, Ju Y, Leng J The correlation between nutrition and frailty and the receiver operating characteristic curve of different nutritional indexes for frailty. BMC Geriatr. 2021; 21:(1) https://doi.org/10.1186/s12877-021-02580-5

Lochlainn M, Cox NJ, Wilson T Nutrition and frailty: opportunities for prevention and treatment. Nutrients. 2021; 13:(7) https://doi.org/10.3390/nu13072349

Malnutrition Task Force. State of the nation 2021: older people and malnutrition in the UK today. 2021. https//www.malnutritiontaskforce.org.uk/sites/default/files/2021-10/State%20of%20the%20Nation%202020%20F%20revise.pdf (accessed 19 February 2024)

Miles D Macroeconomic impacts of changes in life expectancy and fertility. J Economics Ageing. 2023; 24 https://doi.org/10.1016/j.jeoa.2022.100425

Murphy J, Mayor A, Forde E Identifying and treating older patients with malnutrition in primary care: the MUST screening tool. Br J Gen Pract. 2018; 68:(672)344-345 https://doi.org/10.3399/bjgp18x697853

Murphy J Do oral nutritional supplements effectively reduce malnutrition or its adverse outcomes in older people with frailty?. Lancet Healthy Longev.. 2022; 3:(10)e637-e638 https://doi.org/10.1016/s2666-7568(22)00193-3

National Institute for Health and Clinical Excellence. Multimorbidity: clinical assessment and management. [NG56]. 2016. https//www.nice.org.uk/guidance/ng56 (accessed 19 February 2024)

National Institute for Health and Clinical Excellence. Nutrition support in adults-oral nutrition support, enteral tube feedig and parentral nutrition. [CG32]. 2006. https//www.nice.org.uk/Guidance/CG32 (accessed 19 February 2024)

Ng TP, Feng L, Nyunt MS Nutritional, physical, cognitive, and combination interventions and frailty reversal among older adults: a randomized controlled trial. Am J Med. 2015; 128:(11)1225-1236.e1 https://doi.org/10.1016/j.amjmed.2015.06.017

NHS England. Identifying Frailty. 2024. https//www.england.nhs.uk/ourwork/clinical-policy/older-people/frailty/frailty-risk-identification/ (accessed 19 February 2024)

Norman K, Haß U, Pirlich M Malnutrition in older adults-recent advances and remaining challenges. Nutrients. 2021; 13:(8) https://doi.org/10.3390/nu13082764

O'Caoimh R, Costello M, Small C Comparison of frailty screening instruments in the emergency department. Int J Environ Res Public Health. 2019; 16:(19) https://doi.org/10.3390/ijerph16193626

O'Connor D, Molloy AM, Laird E, Kenny RA, O'Halloran AM Sustaining an ageing population: the role of micronutrients in frailty and cognitive impairment. Proc Nutr Soc.. 2023; 82:(3)315-328 https://doi.org/10.1017/s0029665123002707

Office for National Statistics. 2020-based interim national population projections: year ending June 2022 estimated international migration variant. 2023. http//tinyurl.com/52ks4hzr (accessed 19 February 2024)

O'Halloran AM, Laird EJ, Feeney J Circulating Micronutrient biomarkers are associated with 3 measures of frailty: evidence from the Irish Longitudinal Study on Ageing. J Am Med Dir Assoc.. 2020; 21:(2)240-247.e5 https://doi.org/10.1016/j.jamda.2019.06.011

Pan E, Bloomfield K, Boyd M Resilience, not frailty: A qualitative study of the perceptions of older adults towards frailty. Int J Older People Nurs. 2019; 14:(4) https://doi.org/10.1111/opn.12261

Poulia KA, Yannakoulia M, Karageorgou D Evaluation of the efficacy of six nutritional screening tools to predict malnutrition in the elderly. Clin Nutr. 2012; 31:(3)378-385 https://doi.org/10.4162/nrp.2015.9.6.637

Pouyssegur V, Brocker P, Schneider SM 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:(2)245-251 https://doi.org/10.1093/ageing/afu150

Rechel B, Jagger C, McKee M Living longer, but in better or worse health? [Internet]. In: Cylus J, Normand C, Figueras J, North J, White C (eds). Copenhagen (Denmark): European Observatory on Health Systems and Policies; 2020

Roy M, Gaudreau P, Payette H A scoping review of anorexia of aging correlates and their relevance to population health interventions. Appetite. 2016; 105:688-699 https://doi.org/10.1016/j.appet.2016.06.037

Nutrition screening surveys in hospitals in the UK, 2007–2011. 2014. https//www.bapen.org.uk/pdfs/nsw/bapen-nsw-uk.pdf (accessed 19 February 2024)

Scott AJ The longevity economy. Lancet Healthy Longev.. 2021; 2:(12)e828-e835 https://doi.org/10.1016/S2666-7568(21)00250-6

Sossen L, Bonham M, Porter J Can fortified, nutrient-dense and enriched foods and drink-based nutrition interventions increase energy and protein intake in residential aged care residents? A systematic review with meta-analyses. Int J Nurs Stud. 2021; 124 https://doi.org/10.1016/j.ijnurstu.2021.104088

Stow D, Matthews FE, Barclay S Evaluating frailty scores to predict mortality in older adults using data from population based electronic health records: case control study. Age Ageing. 2018; 47:(4)564-569 https://doi.org/10.1093/ageing/afy022

Stratton R, Longmore HA Malnutrition in hospital out-patients: prevalence, concurrent validity and ease of use of the ‘malnutrition universal screening tool’ (‘MUST’) for adults. Br J Nutr.. 2004; 95:(5)799-808 https://doi.org/10.1079/bjn20041258

Struijk EA, Hagan KA, Fung TT, Hu FB, Rodríguez-Artalejo F, Lopez-Garcia E Diet quality and risk of frailty among older women in the Nurses' Health Study. Am J Clin Nutr.. 2020; 111:(4)877-883 https://doi.org/10.1093/ajcn/nqaa028

Taylor N Overview of oral nutrition supplements and their use. Br J Community Nurs. 2020; 25:S12-S15 https://doi.org/10.12968/bjcn.2020.25.sup8.s12

Thomson KH, Rice S, Arisa O Effectiveness and cost-effectiveness of oral nutritional supplements in frail older people who are malnourished or at risk of malnutrition: a systematic review and meta-analysis. Lancet Healthy Longev.. 2022; 3:(10)e654-e666 https://doi.org/10.1016/s2666-7568(22)00171-4

Watanabe D, Yoshida T, Yamada Y Combined use of two frailty tools in predicting mortality in older adults. Sci Rep.. 2022; 12:(1) https://doi.org/10.1038/s41598-022-19148-x

Watanabe D, Yoshida T, Yamada Y Combined use of two frailty tools in predicting mortality in older adults. Sci Rep. 2022; 12:(1) https://doi.org/10.1038/s41598-022-19148-x

Won CW Diagnosis and management of frailty in primary health care. Korean J Fam Med. 2020; 41:(4)207-213 https://doi.org/10.4082%2Fkjfm.20.0122

Wysokiński A, Sobów T, Kłoszewska I, Kostka T Mechanisms of the anorexia of aging-a review. Age (Dordr). 2015; 37:(4) https://doi.org/10.1007/s11357-015-9821-x

Frailty and nutrition

02 March 2024
Volume 29 · Issue 3

Abstract

As the ageing population grows and forms a significant category of over 65s in many societies, along with it comes the risk of developing physical and psychological degenerative changes. This presents many challenges for health and social care services in not only identifying those at risk but also managing that risk to try to preserve health and independence for as long as possible. Screening for frailty has supported services to identify those that may be at risk of hospitalisation, requiring long term care or support services at home in older age. Frailty can be exacerbated by the risk of nutritional deficiencies and more severe malnutrition. Therefore, screening for frailty should also include a nutritional assessment, which can be supported by a recognition of the need for nutritional support along with other holistic frailty management.

Over the past decade there has been a demographic shift in the UK's population, which has seen the proportion of older people rising. The United Nations estimate that, by 2050, older people over the age of 65 years will form one of the largest age groups in societies, exceeding those under 5 years and adolescents (Department for Economics and Social Affairs and United Nations, 2019). According to the Centre for Ageing Better (2023), those aged 65 years and over currently comprise 20% of England's total population, with the number of older people predicted to increase further over the next 40 years. The ageing population can be attributed to several factors including demographic changes, political influences, and social and health care trends (Scott, 2021). Improved healthcare and chronic disease management has contributed to an increase in life expectancy, while changing attitudes towards marriage and family planning has resulted in lower fertility rates (Miles, 2023). These factors, alongside a challenging economic backdrop and a change in immigration and ending of free movement for EU nationals all contribute to an ageing population (Cangiano, 2023). The trend of an ageing population will continue to rise, with those more than 80 years old growing most rapidly (Office for National Statistics, 2023). Not only will the ageing population undoubtedly have a cultural and socioeconomic impact, it will likely have implications and challenges for future healthcare provisions (Scott, 2021). As healthcare providers we must actively ensure that services are equipped to meet the needs of our future ageing population and for services to identify those that may need health and social care support.

Register now to continue reading

Thank you for visiting Community Nursing and reading some of our peer-reviewed resources for district and community nurses. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to clinical or professional articles

  • New content and clinical newsletter updates each month