Undernutrition is common and associated with adverse outcomes such as prolonged hospital stays, poor wound healing, infections and falls.
Whilst under-nutrition failed to make Bernard Isaacs' 1965 shortlist of "geriatric giants", the central role of under-nutrition in immobility and instability was more apparent by the 1990s. In 1988, Morley introduced the concept of the Anorexia of Ageing, whilst in 1989 Rosenberg coined Sarcopenia as the loss of muscle mass and strength. By the early 2000s, Linda Fried identified unintentional weight loss as one of the key parameters in estimating phenotypic frailty, with undernutrition a major contributor to perpetuating the cycle of frailty. Today, undernutrition is spotlighted as part of the comprehensive care standards for hospitals. Food and nutrition are also a focus for aged care as part of Standard 6.
Screening is a means of identifying those at risk to support timely management. In Australia, the Australian Nutrition Screening Initiative was developed based on the Nutrition Screening Initiative by Peter Lipski in the mid-1990s. Such pioneering work led to our increased awareness of the hidden epidemic of undernutrition in our community and hospitals. Central to the majority of screening tools are questions relating to unintentional weight loss and reduced appetite. When instituting screening programs in settings where undernutrition is highly prevalent, it is best to treat all patients in those settings as at-risk and, if needed, screen to remove that risk.
Following screening, assessment is a must to identify amenable contributing factors. These factors might be intrinsic to the patient, but some may be environmental. So, a comprehensive approach to managing undernutrition is often warranted. Management approaches should focus on enabling healthy diets, physical activity, social connections, optimised medication, and medical (including) oral health.