PURPOSE:The primary objective of this systematic review is to explore the role of AI-driven interventions in preventing and managing malnutrition in older adults. METHODS:Using PRISMA guidelines, the authors searched electronic databases for relevant studies from the past five years. The authors appraised selected studies on AI-driven nutritional interventions for older adults using Critical Appraisal Skills Programme tools, assessing for potential bias before synthesizing the findings. RESULTS:The review found that AI-driven intervention, such as personalized meal plans and self-monitoring apps, hold promise for improving dietary habits. AI models also showed high accuracy in predicting malnutrition risks and screening for early signs, like swallowing difficulties. Preventative tools were identified as valuable for proactive care, and the importance of user-centred design and the role of healthcare professionals in improving technology adoption was highlighted. KEY CONCLUSIONS:AI-driven interventions have significant potential for improving nutrition care for older adults through personalized strategies. However, challenges like usability, data privacy, and the need for validation in diverse settings must be addressed. Future research should focus on refining these technologies and including underrepresented populations to improve the health and quality of life of older adults.
BACKGROUND:Malnutrition is a critical but often under-recognized associated with adverse health outcomes in older adults with diabetes. This study aimed to examine the relationship between nutritional status and geriatric syndromes in a low-resource context. METHODS:We conducted a cross-sectional study among 100 older adults with diabetes in urban slums of Casablanca, Morocco. Standardized tools were used to assess nutritional status, cognitive function, depressive symptoms, functional status, quality of life, and comorbidity burden. Descriptive, bivariate, and multivariable linear regression analyses were performed using Jamovi version 2.3. RESULTS:In adjusted models, better nutritional status was independently associated with improved cognitive function (β = 1.31, P < 0.001), reduced depressive symptoms (β = -0.508, P < 0.001), higher quality of life (β = 2.80, P < 0.001), greater functional independence (Katz: β = 0.330, P < 0.001; Lawton: β = 0.497, P < 0.001), and lower comorbidity burden (β = -0.115, P = 0.002). These associations remained significant after adjusting for HbA1c and physical activity. CONCLUSIONS:Nutritional status is a central independent predictor of geriatric syndromes in older adults with diabetes. Routine nutritional screening may help identify individuals at increased risk of functional impairment, cognitive decline, and reduced quality of life.
BACKGROUND:Cognitive impairment in older adults has been linked to low serum Vitamin B12 (B12) and elevated homocysteine (HCY) levels, but evidence remains inconclusive. This study examined their relationship with cognitive impairment among older adults in India. METHODS:This retrospective case note-based study included 96 subjects: cognitively normal (n = 21), Alzheimer's disease (AD; n = 42), and other cognitive disorders (n = 33). The mean age was 70.1 (± 8.9) years, with 58% males. Cognitive function was assessed using the Hindi Mental Status Examination (HMSE). Serum B12 (pg/ml) and HCY (micromol/L) levels were measured. Pearson's correlation, multiple linear regression, and bootstrapped mediation analyses were performed. RESULTS:Elevated HCY (>15 micromol/L) was seen in 72%, and low B12 (<200 pg/mL) in 33%. The mean HMSE score was 16.9 (± 8.5). No significant correlation was found between HMSE scores and HCY (r = -0.006, p = 0.95) or B12 (r = 0.12, p = 0.23). HCY levels were higher in cognitively impaired groups than controls, but not significantly. Regression analysis showed gender as a significant predictor, while B12, HCY, and age were not. CONCLUSION:B12 and HCY levels were not independently associated with cognitive performance. No significant moderation effect between B12 and HCY on HMSE scores was observed.
This study investigated whether sufficient energy intake is associated with clinical trajectories in patients with end-stage aspiration pneumonia. A retrospective cohort study was conducted in patients with end-stage aspiration pneumonia in a long-term care ward (LTCW). Patients were classified into sufficient and poor energy intake groups, with sufficient intake defined as exceeding estimated energy needs. The primary outcome was swallowing recovery, defined as an improvement of ≥1 point on the Food Intake Level Scale (FILS). Secondary outcomes included survival discharge and 60-day survival in the LTCW. Multivariate logistic regression analyses were performed to assess associations between energy intake and outcomes, adjusting for confounders. Among 240 patients (mean age 84.6 ± 8.3 years, 51.3% male), 33 received sufficient energy intake. After adjustment for confounders, sufficient energy intake was significantly associated with swallowing recovery (OR: 5.29, p = 0.006) and survival discharge (OR: 8.33, p < 0.001). However, no significant association was observed between sufficient energy intake and 60-day survival (OR: 1.32, p = 0.530). Overall, sufficient energy intake may promote swallowing recovery and facilitate survival discharge in patients with end-stage aspiration pneumonia. These findings highlight the potential role of nutrition management in optimizing care strategies for this vulnerable population.
People with dementia can develop resistive behavior that adversely affects the intake of food and fluids. This behavior, including (non-)verbal refusal, such as pushing away cutlery or an assisting person, can lead to malnutrition, dehydration, and increases mortality risk. However, it is unclear how common this behavior is in residents with young-onset dementia (YOD; symptoms under age 65) and how it compares to late-onset dementia (LOD). This study investigated the incidence and characteristics of these behaviors. We conducted a prospective cohort study with a twelve-month follow-up period, including thirty-six care units comprising 424 beds in twelve nursing homes across the Netherlands. Monthly registration of the total number of residents at risk informed the denominator, and the numerator was determined by the number of incident cases. Of forty reported cases, sixteen were incident, resulting in an incidence rate of 32/1000 person-years. The incidence rate was higher in residents with YOD (45/1000 person-years) than in LOD (26/1000 person-years). In all cases, at least two symptoms were observed. In fourteen of sixteen cases there was a prioritized global care goal aimed at providing comfort care and accept persisting resistive behavior. The findings might imply that young residents are at greater risk of developing these behaviors, and professional and informal caregivers should be prepared for the occurrence of specific resistive behaviors in younger residents.
One in four US adults age ≥ 65 have two or more chronic conditions, many of which can be prevented or managed through nutritional interventions. Despite known benefits, nutrition is not prioritized in undergraduate or graduate medical education. We reviewed agendas of three major geriatrics-related continuing medical education (CME) conferences from 2018 to 2025 to understand the extent to which deficits in nutrition training could be addressed via CME. We searched 19 conference agendas for the terms: "nutrition," "diet," "lifestyle," "food," "fat," "carbohydrates," "protein," "vitamin," "mineral," "weight," and "nutrients." Our results showed that nutrition topics were inconsistently offered at geriatrics-related CME conferences, with some conferences offering no nutrition-related talks, and some offering as little as 8 minutes of nutrition-related talks. Few sessions addressed malnutrition or food security. This is the first known review of nutrition education at geriatrics-focused CME conferences. We found insufficient practical nutrition education for providers at CME events to overcome training gaps in medical education. Improved interdisciplinary participation at CME events could increase availability of nutrition education for physicians.
OBJECTIVE:Characterize and compare the food consumption of independent community-dwelling older adults with and without sarcopenia. METHODS:A descriptive cross-sectional study was conducted with data from 50 community-dwelling older adults receiving care at the secondary level of health in a city in southeastern Brazil in 2017. Three criteria were used to diagnose sarcopenia: dual X-ray absorptiometry, hand grip strength and walk speed. Diet intake data was obtained by three 24-h Multiple Pass Recalls. The consumption of energy, macro and micronutrients was compared between the participants without sarcopenia and those with sarcopenia. The t-Student test was performed to compare dietary consumption. The adopted significance level was p < 0.05. RESULTS:Men with sarcopenia had lower intake of animal protein (g) compared with those without sarcopenia (p < 0.05). In women, those with sarcopenia had higher intake of carbohydrate (%) and lower intake of protein (g), animal protein (g) and saturated fatty acids (SFAs) (%) (p < 0.05). The mean consumption of vitamin D, vitamin E and calcium was lower than the Estimated Average Requirement in all groups. CONCLUSION:The lower intake of important nutrients for muscle health by both groups of participants can be a risk factor for developing and aggravating sarcopenia.
This study aimed to evaluate the nutritional profile of very old individuals according to frailty, since dietary changes may be associated with this syndrome. Octogenarians were evaluated for phenotypic classification of frailty, including frail and non-frail individuals. Body Mass Index (BMI), upper arm circumference (AC), and calf circumference (CC) were obtained. The Food Frequency Questionnaire was used to assess eating habits in the last 6 months and the Mini Nutritional Assessment to assess nutritional status. Individuals aged 80 years or older had a median age of 84.5 years. Most ate 4 meals a day and had a normal nutritional status, despite the altered diet composition, with excess carbohydrates, a lower percentage of lipids, and lower protein intake than the current recommendation. Overall, there was a low intake of total fiber, vitamin D, calcium, iron, and potassium. Comparing frail and non-frail individuals, the former were older, had more comorbidities, worse nutritional status, and lower fiber and potassium intake. BMI, AC, and CC were not different between groups. Frailty was associated with worse nutritional status. This study emphasizes the importance of continuous nutritional assessment of very old individuals and identification of frailty syndrome so that appropriate interventions can be initiated.
This study evaluated the perspectives of clinicians and dyads (adults with early-stage ADRD and caregivers) on virtually-delivered care and how it relates to the development of a health promotion intervention to slow cognitive decline. Ten clinicians and 10 dyads were recruited via various recruitment platforms. All participated in one semi-structured interview via Zoom focusing on cognitive challenges, barriers, their current virtual-based experiences, and the ideas to improve a proposed virtual-based exercise and nutrition-based intervention. Interviews were transcribed and analyzed using thematic analysis. Dyads' perspective identified four major themes for persons with cognitive challenges: (1) Barriers to receiving care for older adults with dementia; (2) Receptivity to receiving virtual-based care if this was balanced with in-person visits; and (3) Enthusiasm if an exercise and nutrition-based intervention delivered virtually can improve access to care but lead to increased anxiety about using technology. Clinicians believed that limited access to receiving care and limited time in clinic were barriers for persons with dementia but having a virtual-based intervention could potentially overcome these challenges and engage individuals. These perspectives aligned with those of the dyads. Participants overall supported virtual-based care and that with careful design, showed promise in developing an exercise and nutrition-based intervention as a possible means to slow cognitive decline.
The aim of this study was to investigate the effect of individually tailored dietary counseling on frailty status among older family caregivers (FC). This study is part of the LifEstyle, NutriTion, and Oral health in caregivers (LENTO) intervention study. There were a total of 113 participants, with a mean age of 74 years (SD 8.0). This randomized intervention included individually tailored nutritional guidance given by the clinical nutritionist at the baseline and at the 2-month visit and the intervention period was 6 months. At the baseline frailty prevalence was 68% (n = 43 out of 63) in the intervention group and 78% (n = 39 out of 50) in the control group. At the end of the 6-month intervention the prevalence in the intervention group had decreased to 41% (n = 24 out of 59) but remained stable in the control group with 79% (n = 37 out of 47). There was a significant difference in the change of the prevalence of frailty between the groups (P < 0.001). The intervention resulted in increased protein intake in the intervention group from 0.95 g/kg/d (SD 0.34) to 1.05 g/kg/d (SD 0.37) (P = 0.003). The results suggest that frailty among older caregivers can be decreased with personalized nutritional guidance.
BACKGROUND:Frailty screening and nutritional assessment are essential for identifying and managing frailty in older adults. This study investigates the predictive power of the Mini Nutritional Assessment (MNA) score and Body Mass Index (BMI) in assessing frailty among the elderly in the community of Bandung, Indonesia, using Kihon's Frailty Checklist (KCL). METHODS:A cross-sectional study was conducted among 71 elderly individuals attending community health centers routinely in Bandung. The mean age of participants was 67.1 ± 5.13 years with 81.6% female. Frailty status was assessed using the KCL, while nutritional status was evaluated using the short-form MNA and BMI. Predictive accuracy was analyzed through Receiver Operating Characteristic (ROC) curves and Area Under the Curve (AUC) values. DeLong's test was used to compare the predictive capacities of MNA and BMI. RESULTS:Of the participants, 30.99% were frail, 39.44% prefrail, and 29.58% robust. Nutritional status categorized by MNA revealed 59.15% with normal nutrition, 33.80% at risk of malnutrition, and 7.04% malnourished. BMI indicated 47.89% healthy weight, 32.39% overweight, 11.27% obese, and 8.45% underweight. The AUC for MNA (0.73; 95% CI: 0.67-0.79) demonstrated good discriminatory power, significantly outperforming BMI (AUC: 0.52; 95% CI: 0.46-0.58) in predicting frailty (p < 0.05). CONCLUSION:The MNA score showed superior predictive power compared to BMI for identifying frailty in this elderly community population. MNA's multidimensional approach, capturing factors such as nutrition, cognitive function, and mobility, provides a more comprehensive assessment of frailty. This study underscores the importance of adopting comprehensive tools like MNA for frailty screening and highlights its potential for early intervention and improving elderly care in community settings. Further research is recommended to explore long-term outcomes and integration into routine health practices.
Body Mass Index (BMI) use in older adults has been questioned as it does not account for the loss of height with age, overestimating weight status. We explored age-height loss adjusted BMI (BMI-A) correlation with health variables, the significance of these associations for each BMI category, and concordance between BMI and BMI-A. This is a secondary analysis of three different population studies of older adults: SABE Ecuador 2009, SABE Colombia 2015, and MHAS 2015 (total n = 30,904). BMI-A was based on expected physiological loss, adding centimeters based on patient's age range. A descriptive analysis was performed, and concordance and correlation between models was tested. The correlation of each model divided by anthropometrical categories was tested with outcomes. Mean age was 69.8 (SD 7.59) years, 54.24% were females. BMI-A value was lower. For BMI-A the most common category was normal weight, compared to BMI where overweight was the most common. Correlation and agreement between models were good. For the general sample, all correlations were statistically significant, except for albumin. However, for the different categories, significance was reduced, and specifically in people with low weight any relationship was significant. Relying exclusively on BMI for clinical decisions in older adults may not be optimal.
The present study aimed at investigating the nutritional state of functionally dependent older adults belonging to the indigenous communities (i.e., tribal communities) in West Bengal, India, and its association with other covariates. The nutritional state of older adults was measured using the MNA tool. Results indicated that those individuals with poor functional capacity had 6.52 times [AOR:6.52; CI:1.55,27.41] and 8.53 times [AOR:8.53; CI:2.53,28.84] higher chances of being malnourished or at risk of being malnourished, respectively. Older adults with multiple chronic illnesses, poor self-perceived health status, experiencing depression, and consuming alcohol were significantly more likely to suffer from malnutrition. Respondents who were aged 80 years and older, female and widowed, or having poor family income were more likely to have malnutrition than their counterparts. The study concluded that functionally dependent older adults in indigenous communities are vulnerable to being malnourished and suggested a policy intervention in the form of appropriate nutritional programmes for improving the worsening condition of such older people in India.
Despite the significant risk of nutritional problems among older adults in nursing homes, the impact of environmental and situational factors is understudied. This study explores the interaction between residents, food, and the nursing home environment, and asks "Why do residents eat what they do?." Using an ethnographic approach, the study investigates food environments in six rural nursing homes through approximately 2,000 hours of participant observations, nine interviews with residents, and four group interviews with care staff. Data analysis was conducted concurrently using the inductive methods of grounded theory. Using a "foodscape" to illustrate the nursing home environment provides valuable insights into where residents eat, how they eat, what and when they eat, and with whom they eat. Four primary concepts emerged: (1) the physical environment, (2) food patterns dictated by dietary concepts and care staff resources, (3) residents' passive involvement due to care staff's task-focused view of mealtimes, and (4) social perspectives on eating, whether in isolation or in a family-style setup. The foodscape contributes to understanding the residents' food intake and can be used to develop strategies to improve nutrition and life quality for this vulnerable group of people.
BACKGROUND:Isolation mitigated the risks of COVID-19 infection. For older adults, isolation itself can be harmful. Isolation and loneliness impact nutritional status which leads to other health consequences. This study identified the changes of 167 individuals 80+ years old pre and post COVID-19 isolation and the association of habitation and location. METHODS:We collected demographic (age, gender, cohabitation, and isolation) and clinical (BMI and nutritional) information from patients 80+ years old prior to and 6 months after COVID-19 began in the region. We collected nutritional data using the mini-nutritional assessment short form (MNA-SF). RESULTS:Averages for the studied cohort (n = 167) were age = 85.1, BMI = 26.5, and MNA-SF = 11.8. Females (-0.51; P = 0.015) and those living alone (-0.66; P < 0.001) had greater decreases in BMI after 6 months. Nutritional status worsened significantly for females (-0.74; P < 0.001), those living alone (-0.82; P = 0.015), and those in rural (-0.70; P < 0.001) and isolated (-0.61; P = 0.031) locations. CONCLUSION:Females, those living alone, and those in rural and isolated locations had a greater decline in nutritional status during the COVID-19 isolation period. This identifies a disparity in an already vulnerable population of older adults that should be addressed with further research targeted toward prevention and treatment.
BACKGROUND & AIMS:Age-related macular degeneration (AMD) stands as the leading cause of visual impairment and blindness in developed nations. The Age-Related Eye Disease Study 2 (AREDS 2) conclusively demonstrated the advantages of vitamin and mineral supplementation in either preventing or slowing down the progression of AMD. This survey was crafted to evaluate the utilization of nutritional supplements and to gauge the knowledge, attitudes, and practices of patients with AMD. The aim was to identify factors predicting adherence and explore the public health implications. METHODS:A cross-sectorial study was conducted involving 148 patients through a survey carried out at a tertiary-level hospital. The survey focused on patients with AMD who were candidates for nutritional supplements. RESULTS:The primary outcome was the rate of adherence to AREDS recommendations, which was found to be 83%. Female gender (P = 0.038), effective medication regimen management (P < 0.01), and higher levels of education (P < 0.01) emerged as independent factors significantly associated with adherence. CONCLUSIONS:While ophthalmologists play a crucial role in addressing neovascular complications of AMD, they also bear the responsibility of promoting patient adherence to AREDS supplements. Achieving optimal compliance requires addressing the multifaceted factors identified in this study, with specific attention to patients' educational backgrounds and informational requirements.
PURPOSE:Polypharmacy (PP) and malnutrition are two conditions that frequently occur in older patient groups. In this retrospective cross-sectional study, we aimed to investigate the relationship between nutrition and PP in a cohort of older outpatients from Northern Sardinia, Italy. METHODS:A database of 619 outpatients undergoing a specific drug therapy during the examination was analyzed. A multivariable analysis was performed using a logistic regression model, in which a dichotomized MNA score was the dependent variable, according to several covariates. RESULTS:Exposure to ≥ five drugs was associated with a higher risk of malnutrition among males and females, as well as a higher risk of overt malnutrition among males and females compared to those exposed to four or fewer drugs. In addition, depression significantly increased the risk of malnutrition in both sexes, whereas cognitive status and comorbidity did not. Moreover, the effect of PP on nutritional status was statistically significant only for the global component of the MNA score. CONCLUSIONS:The present study detected a significant association between PP and an increased risk of malnutrition. Depressed mood was an additional independent predictor, whereas cognitive status and comorbidity did not reveal a significant association.
The Mediterranean diet has been linked to preserving physical function, but studies on its impact on physical function decline in older adults have shown mixed results. This longitudinal study used a large sample of community-dwelling older women from the Women's Health Initiative Long Life Study to examine this relationship. We assessed 4516 older women (mean age at baseline = 78.97), including a subsample of 849 women who reported currently having diabetes. Data on physical function, measured by the SF-36 Physical Function subscale, were collected annually from 2012-2019. Adherence to the Mediterranean diet was measured using alternative Mediterranean diet (aMED) scores between 2012 and 2013. Results indicated that higher aMED scores were associated with better physical function at baseline in the general sample (4.89 to 8.23 points) and in the diabetes subsample (5.37 to 8.97 points) over eight years. However, adherence to the Mediterranean diet did not affect the rate of physical function decline. Future research should include longitudinal dietary assessments, a broader age range, and detailed information on diabetes duration.
Malnutrition is observed in approximately 20-50% of hospitals and long-term care facilities. We examined the effects of malted rice amazake beverage on the nutritional status and gut microbiome of older patients and residents in an integrated long-term care facility; 13 older patients and residents (84.6 ± 9.3 years) were prescribed 35 g of malted rice amazake daily for six weeks. Gut microbiome analysis, body composition and blood biochemistry test results, defecation surveys, dietary intake, and medications were recorded before and after the intervention. After the intervention, the Geriatric Nutritional Risk Index (GNRI) increased from 83.6 ± 9.1 points to 86.0 ± 9.8 points, and serum albumin increased from 3.3 ± 0.5 g/dL to 3.4 ± 0.5 g/dL. The α-diversity of gut bacteria increased from 390.1 ± 89.4 before to 447.2 ± 108.1, and the abundance of Desulfovibrio decreased from 0.76 ± 0.47% to 0.56 ± 0.60%. ΔGNRI showed a positive correlation with ΔBifidobacterium and ΔBarnesiella, but a negative correlation with ΔKlebsiella. Consumption of malted rice amazake for six weeks improved the GNRI and altered the gut microbiome of older patients and residents at moderate risk of nutritional disorders. Malted rice amazake may be a new way to improve nutrition because it has a high nutritional value, mainly in terms of carbohydrates, and improves the gut microbiome.
BACKGROUND:Metabolic syndrome poses a significant public health challenge globally, particularly among older adults. Dietary patterns play a crucial role in the development and management of metabolic syndrome. However, to our knowledge, no evidence exists regarding the association between dietary patterns and metabolic syndrome among the Mexican older adult population. Thus, the objective of the present study is to assess the association between dietary patterns and metabolic syndrome in Mexican older adults. METHODS:This cross-sectional study utilized data from the Mexican National Health and Nutrition Survey 2016 to investigate the relationship between dietary patterns and metabolic syndrome in 804 OA (aged ≥60 years). Dietary patterns were derived using factor analysis, and metabolic syndrome was defined based on established criteria. Logistic regression models were employed to assess associations, adjusting for potential confounders. RESULTS:Three dietary patterns were identified: a "Westernized" pattern characterized by high consumption of processed meat, red meat, and saturated fats; a "Transitional" pattern high in fresh vegetables and fruits; and a "Prudent" pattern high in fish and low-fat dairy products. The "Westernized" pattern exhibited a positive association with metabolic syndrome, while the "Prudent" pattern showed a negative association. The associations remained significant after adjusting for confounders. Biological mechanisms linking the "Westernized" pattern to metabolic syndrome include chronic inflammation, endothelial dysfunction, and dyslipidemia induced by components such as processed meats and soft drinks. CONCLUSION:Our study highlights the importance of dietary patterns in influencing metabolic syndrome risk among Mexican older adults. Promoting dietary patterns rich in fish, vegetables, and legumes while reducing consumption of processed meats and sugary beverages may offer significant health benefits in this population. Further prospective studies are needed to confirm these findings and inform targeted interventions for metabolic syndrome prevention and management in older adults.
