Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1694819200767.pdf (Australia)
Malnutrition in older Australians Older Australians in residential care and in the community represent a heterogeneous population with respect to nutrition, i.e.

some are well nourished, some are overweight or obese, some are malnourished.
Malnutrition is defined as two or more of the following characteristics: insufficient energy intake, weight loss, loss of muscle mass, loss of subcutaneous fat, localized or generalized fluid accumulation or diminished functional status.1 People with malnutrition experience greater morbidity and mortality than people who are well nourished.

There are a variety of tools available to screen and assess malnutrition in different care settings.
These have been reviewed and summarised on NEMO on the Queensland Health webpages.

While there is no single marker for malnutrition, unplanned weight loss is a key indicator of malnutrition.

It is possible to be overweight or obese and to be malnourished where there has been unintended weight loss.

Studies show also that there is an increased risk for older people with a BMI <23.0 kgm2.

Body weight should be monitored regularly and action taken in individuals where unplanned weight loss has occurred.
There may be many contributors to malnutrition and for this reason approaches to identifying, treating and preventing malnutrition need involve various stakeholders i.e.

include consumers, carers, dietitians, nurses, care workers, food service managers, food service staff etc.

Trends in weight changes for older people in care are a flag to inform organisation efforts to ensure people are adequately nourished and hydrated.

An organisation would aim to minimise prevalence of unplanned weight loss.
Public reports of prevalence can be accompanied by indicators of what steps organisations take to prevent and to manage malnutrition.

A distinction might also be made between malnutrition acquired in that organisation, as distinct to prior to entering care of the organisation or while in the care of another facility e.g.

hospital.

1.
hospital.

1.

White JV, Guenter P, Jensen G, Malone A, Schofield M. Consensus statement: Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral Nutrition: characteristics recommended for the identification and documentation of adult malnutrition (undernutrition).

JPEN 2012; 36: 275-83 Annette Byron, Senior Policy Officer, Dietitians Association of Australia.

June 2017 Thanks to Prof Karen Walton for contributing a number of references.
Effectiveness of the Aged Care Quality Assessment and accreditation framework for protecting residents from abuse andpoor practices, and ensuring proper clinical and medical care standards are maintained and practisedSubmission 10 - Attachment 1 Summary table showing prevalence of malnutrition in Australian studies While the focus in this document is residential care and community settings, the prevalence of malnutrition in Australian hospitals is also of concern.
Most hospital programs aim to screen and assess patients soon after admission, which reflects nutritional status prior to admission to hospital.

This is not to say however that a great deal more needs to be done to address malnutrition in hospital, whether it is pre-existing or not.

The table below is a summary of Australian studies in malnutrition.
Year of publication 2016 Age of subjects >75 yrs Number subjects 72 Author Hamirudin et al Hamirudin et al 2016 Walton et al 2015 Winter et al 2013 2013 Ulltang 2013 Charlton et al 2013 Manning et al 2012 Malnutrition prevalence 1.4% malnourished 27.8% at risk 61.8% at risk or malnourished 5% malnourished 38% at risk Assessment Tool MNA-SF MNA MNA 79 42 225 1 malnourished person MNA-SF Practice setting State/Territory General Practice DVA MoW customers General Practice NSW NSW NSW VIC 16% At Risk 153 774 23 17% malnourished 34% malnourished 55% at risk 35% malnourished 52% at risk SGA MNA MNA Hospital – MAPU Older Rehabilitation Inpatients Hospital QLD NSW NSW Mean: 85+5.8 yrs Mean: 81.9 (±9.4) yrs >75 yrs Mean: 81.3 + 4.3 yrs Mean age 62 Mean: 83.2+8.9 yrs Effectiveness of the Aged Care Quality Assessment and accreditation framework for protecting residents from abuse andpoor practices, and ensuring proper clinical and medical care standards are maintained and practisedSubmission 10 - Attachment 1 PG- SGA hospital Charlton et al 2012 Kellett 2013 Kellett 2013 Kellett 2012 Gout 2012 Ackerie 2012 Sheard 2012 Agarwal 2010 Rist 2009 Vivanti 2009 Gaskill 2008 Adams et al 2008 Leggo 2008 Brownie et al 2007 Mean: 80.6+27.7 yrs 59.5 +/- 19.9 yrs Mean 70 (35 -92) 64 +/- 18 yrs 82 (65– 100) yrs Median 74 yrs (65–82) Mean: 81.9 yrs 76.5 +/- 7.2 yrs 65-98 yrs 2076 51.5% malnourished or at risk MNA 57 101 189 275 352 97 3122 235 126 350 100 1145 1263 26% moderately malnourished 7% severely malnourished 20% moderately malnourished 2% severely malnourished 47% moderately malnourished 6% severely malnourished 16% % moderately malnourished 6.5% severely malnourished 19.5% moderately malnourished – Public 18.5% moderately malnourished - Private 5% severely malnourished – Public 6% severely malnourished - Private 16% moderately malnourished 0% severely malnourished 24% moderately malnourished 6% severely malnourished 8.1% malnourished 34.5% at risk of malnutrition 14.3% moderately malnourished 1% severely malnourished 43.1%
 moderately malnourished 6.4/5 severely malnourished 30% malnourished 61% at risk 5 – 11% malnourished 36% high risk 23% moderate risk SGA SGA SGA SGA PG-SGA SGA MNA SGA SGA MNA PG - SGA ANSI Older Rehabilitation Inpatients RACF RACF Hospital Hospital – public and private NSW ACT ACT ACT VIC QLD Hospital QLD Community VIC metro QLD QLD QLD Hospital – Emergency department RACF Hospital HACC eligible clients Community setting Effectiveness of the Aged Care Quality Assessment and accreditation framework for protecting residents from abuse andpoor practices, and ensuring proper clinical and medical care standards are maintained and practisedSubmission 10 - Attachment 1 2007 Thomas et al Walton et al 2007 Banks 2007 Mean: 79.9 yrs Mean: 79.2+11.9 66.5/ 65.0 yrs 64 30 774 1434 hospital 78.9 78.7 yrs 381 458 RACF 53% moderately malnourished 9.4% severely malnourished 37% malnourished 40% at risk Hospital 27.8% moderately malnourished, 7.0% severely malnourished (2002), 26.1%% moderately malnourished, 5.3% severely malnourished (2003) RACF 41.6% mod malnourished, 8.4% severely malnourished (2002), 35.0% moderately malnourished, 14.2% severely malnourished (2003) malnourished PG_SGA Hospital MNA SGA Rehabilitation Hospitals Hospital NSW QLD – metro, regional and remote RACF 34% moderately malnourished 8% severely malnourished (at baseline) 42.3% malnourished SGA SGA Community NSW Acute Hospital NSW Collins et al 2005 Lazarus et al Martineau et al Neumann et al Visvanathan et al 2005 2005 2005 2004 Visvanathan 2003 Mean: 80.1 +8.1 Mean: 66.8 yrs Mean: 72 yrs Mean: 81 yrs Mean: 76.5-79.8 yrs 67 – 99 yrs 50 324 73 133 65 16.4% moderately malnourished 2.7% severely malnourished 6% malnourished 47% at risk 35.4-43.1% 250 baseline Baseline 38.4% not well nourished 4.8% malnourished Patterson et al 2002 70-75 yrs 12,939 30% high risk 23% moderate risk PG-SGA MNA MNA MNA ANSI Acute Stroke Unit Rehabilitation Hospital Rehabilitation Hospital Domiciliary care clients Community setting SA
 SA metro Effectiveness of the Aged Care Quality Assessment and accreditation framework for protecting residents from abuse andpoor practices, and ensuring proper clinical and medical care standards are maintained and practisedSubmission 10 - Attachment 1 Middleton et al Beck et al 2001 2001 Median: 66 yrs Mean not available 819 36% malnourished 5749 7-14% malnourished in acute setting 49% malnourished in rehabilitation setting Burge & Gazibarich 1999 >65 yrs 92 Mean: 75.2 +5.8 yrs -High risk: 27% (score of 6 or more) -Moderate risk: 30% (score of 4-5) -Low risk: 43% (score of 0-3) -Most common nutrition risk factors: polypharmacy (47%), eating alone most of the time (45%) and dietary modification due to illness (35%).
SGA MNA Australian Nutrition Screening Initiative (ANSI) Acute Hospital NSW NSW NSW Regional Acute and Rehabilitation Hospitals Community living (Senior citizen’s centres) Cobiac & Syrette 1996 >70 yrs 1098 30% high risk 20.6% moderate risk ANSI Community setting Effectiveness of the Aged Care Quality Assessment and accreditation framework for protecting residents from abuse andpoor practices, and ensuring proper clinical and medical care standards are maintained and practisedSubmission 10 - Attachment 1 References for summary table 1.
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Am J Clin Nutr 2014; doi:10.3945/ajcn.113.068122 Effectiveness of the Aged Care Quality Assessment and accreditation framework for protecting residents from abuse andpoor practices, and ensuring proper clinical and medical care standards are maintained and practisedSubmission 10 - Attachment 1