Current Nutrition Reports

, Volume 4, Issue 2, pp 176–184 | Cite as

Nutritional Vulnerability in Older Adults: A Continuum of Concerns

  • Kathryn N. Porter StarrEmail author
  • Shelley R. McDonald
  • Connie W. Bales
Nutrition and Aging (KM Beavers, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Nutrition and Aging


A nutritionally vulnerable older adult has a reduced physical reserve that limits the ability to mount a vigorous recovery in the face of an acute health threat or stressor. Often, this vulnerability contributes to more medical complications, longer hospital stays, and increased likelihood of nursing home admission. We have characterized in this review the etiology of nutritional vulnerability across the continuum of the community, hospital, and long-term care settings. Frail older adults may become less vulnerable with strong, consistent, and individualized nutritional care. Interventions for the vulnerable older adult must take their nutritional needs into account to optimize resiliency in the face of the acute and/or chronic health challenges they will surely face in their life course.


Older adults Nutritionally vulnerable Malnutrition Community dwelling Hospital malnutrition Long-term care 



The authors acknowledge the support of the National Institutes of Health via training grant support for KPS (AG0000029) and the Duke Claude D. Pepper Older Americans Independence Center (1P30-AG028716). The authors also acknowledge having participated in the following studies:

•National Pork Board: A High-Protein Weight Loss Treatment for Sarcopenic Obesity, November 1, 2013 to October 30, 2015; Connie W. Bales, PhD, RD, Principal Investigator; Shelley R. McDonald DO, PhD, Coinvestigator.

•AMDA Foundation/Pfizer Quality Improvement Award: Development of an Educational Program to Improve the Skills of CNAs to Recognize, Report and Respond to BPSD; Shelley R. McDonald DO, PhD, Principal Investigator, March 1, 2013 to June 1, 2015.

•National Cattlemen’s Beef Association: Does Enhanced Protein Intake Preserve Function and Lean Muscle Mass during Weight Reduction in Frail, Obese Older Adults? (MEASUR-UP); Connie W. Bales, PhD, RD, Principal Investigator; Shelley R. McDonald, DO, PhD, Coinvestigator, February 1, 2012 to September 30, 2014.

Compliance with Ethics Guidelines

Conflict of Interest

Kathryn N. Porter Starr, Shelley R. McDonald, and Connie W. Bales declare that they have no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.••
    Bernstein M, Munoz N. Position of the Academy of Nutrition and Dietetics: food and nutrition for older adults: promoting health and wellness. J Acad Nutr Diet. 2012;112(8):1255–77. This position paper outlines distinct nutritional needs of community-dwelling older adults and how to address them.PubMedCrossRefGoogle Scholar
  2. 2.
    Agarwal E, Miller M, Yaxley A, Isenring E. Malnutrition in the elderly: a narrative review. Maturitas. 2013;76(4):296–302.PubMedCrossRefGoogle Scholar
  3. 3.
    Soenen S, Chapman IM. Body weight, anorexia, and undernutrition in older people. J Am Med Dir Assoc. 2013;14(9):642–8.PubMedCrossRefGoogle Scholar
  4. 4.
    Gielen E, Verschueren S, O'Neill TW, Pye SR, O'Connell MD, Lee DM, et al. Musculoskeletal frailty: a geriatric syndrome at the core of fracture occurrence in older age. Calcif Tissue Int. 2012;91(3):161–77.PubMedCrossRefGoogle Scholar
  5. 5.
    Fried LP, Ferrucci L, Darer J, Williamson JD, Anderson G. Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care. J Gerontol A Biol Sci Med Sci. 2004;59(3):255–63.PubMedCrossRefGoogle Scholar
  6. 6.
    Shamliyan T, Talley KM, Ramakrishnan R, Kane RL. Association of frailty with survival: a systematic literature review. Ageing Res Rev. 2013;12(2):719–36.PubMedCrossRefGoogle Scholar
  7. 7.
    Brewer DP, Catlett CS, Porter KN, Lee JS, Hausman DB, Reddy S, et al. Physical limitations contribute to food insecurity and the food insecurity-obesity paradox in older adults at senior centers in Georgia. J Nutr Elder. 2010;29(2):150–69.PubMedCrossRefGoogle Scholar
  8. 8.
    Penn DM, Fischer JG, Sun Lee J, Hausman DB, Johnson MA. High BMI and waist circumference are associated with a high prevalence of comorbidities in older Americans Act programs in Georgia senior centers. J Nutr Health Aging. 2009;13(9):827–32.PubMedCrossRefGoogle Scholar
  9. 9.
    Porter KN, Johnson MA. Obesity is more strongly associated with inappropriate eating behaviors than with mental health in older adults receiving congregate meals. J Nutr Gerontol Geriatr. 2011;30(4):403–15.PubMedCrossRefGoogle Scholar
  10. 10.
    Johnson MA, Fischer JG, Park S. Vitamin D deficiency and insufficiency in the Georgia Older Americans Nutrition Program. J Nutr Elder. 2008;27(1–2):29–46.PubMedCrossRefGoogle Scholar
  11. 11.
    Quigley KK, Hermann JR, Warde WD. Factors associated with Oklahoma Older Americans Act Nutrition Program participants’ ability to shop, cook, and feed themselves. J Nutr Elder. 2005;25(2):69–82.PubMedCrossRefGoogle Scholar
  12. 12.
    Porter Starr K, Fischer JG, Johnson MA. Eating behaviors, mental health, and food intake are associated with obesity in older congregate meal participants. J Nutr Gerontol Geriatr. 2014;33(4):340–56.PubMedCentralPubMedCrossRefGoogle Scholar
  13. 13.
    Lee JS, Fischer JG, Johnson MA. Food insecurity, food and nutrition programs, and aging: experiences from Georgia. J Nutr Elder. 2010;29(2):116–49.PubMedCrossRefGoogle Scholar
  14. 14.
    Mathus-Vliegen EM. Obesity and the elderly. J Clin Gastroenterol. 2012;46(7):533–44.PubMedCrossRefGoogle Scholar
  15. 15.•
    Porter Starr KN, McDonald SR, Bales CW. Obesity and physical frailty in older adults: a scoping review of lifestyle intervention trials. J Am Med Dir Assoc. 2014. A recent scoping review of lifestyle interventions targeted towards obese, frail older adults.Google Scholar
  16. 16.
    Walker AE. Multiple chronic diseases and quality of life: patterns emerging from a large national sample. Aust Chron Illn. 2007;3(3):202–18.CrossRefGoogle Scholar
  17. 17.
    Seals DR, Melov S. Translational geroscience: emphasizing function to achieve optimal longevity. Aging (Albany NY). 2014;6(9):718–30.Google Scholar
  18. 18.
    Kennedy BK, Berger SL, Brunet A, Campisi J, Cuervo AM, Epel ES, et al. Geroscience: linking aging to chronic disease. Cell. 2014;159(4):709–13.PubMedCrossRefGoogle Scholar
  19. 19.
    Ward BW, Schiller JS. Prevalence of multiple chronic conditions among US adults: estimates from the National Health Interview Survey, 2010. Prev Chron Dis. 2013;10:E65.Google Scholar
  20. 20.
    Parekh AK, Goodman RA, Gordon C, Koh HK. Managing multiple chronic conditions: a strategic framework for improving health outcomes and quality of life. Public Health Rep. 2011;126(4):460–71.PubMedCentralPubMedGoogle Scholar
  21. 21.
    Luppa M, Sikorski C, Luck T, Ehreke L, Konnopka A, Wiese B, et al. Age- and gender-specific prevalence of depression in latest-life—systematic review and meta-analysis. J Affect Disord. 2012;136(3):212–21.PubMedCrossRefGoogle Scholar
  22. 22.
    Djernes JK. Prevalence and predictors of depression in populations of elderly: a review. Acta Psychiatr Scand. 2006;113(5):372–87.PubMedCrossRefGoogle Scholar
  23. 23.
    Cabrera MAS, Mesas AE, Garcia ARL, de Andrade SM. Malnutrition and depression among community-dwelling elderly people. J Am Med Direct Assoc. 2007;8(9):582–4.CrossRefGoogle Scholar
  24. 24.
    Williams JA, Sink KM, Tooze JA, Atkinson HH, Cauley JA, Yaffe K, et al. Low 25-hydroxyvitamin D concentrations predict incident depression in well-functioning older adults: the health, aging, and body composition study. J Gerontol A Biol Sci Med Sci. 2014.Google Scholar
  25. 25.
    Gougeon L. Nutritional predictors of depression in a cohort of community-dwelling elderly Canadians: NuAge cohort. Appl Physiol Nutr Metab. 2014;39(12):1412.PubMedCrossRefGoogle Scholar
  26. 26.
    Skarupski KA, Tangney C, Li H, Ouyang B, Evans DA, Morris MC. Longitudinal association of vitamin B-6, folate, and vitamin B-12 with depressive symptoms among older adults over time. Am J Clin Nutr. 2010;92(2):330–5.PubMedCentralPubMedCrossRefGoogle Scholar
  27. 27.
    Swardfager W, Herrmann N, Mazereeuw G, Goldberger K, Harimoto T, Lanctôt KL. Zinc in depression: a meta-analysis. Biol Psychiatry. 2013;74(12):872–8.PubMedCrossRefGoogle Scholar
  28. 28.
    Taylor WD. Depression in the elderly. N Engl J Med. 2014;371(13):1228–36.PubMedCrossRefGoogle Scholar
  29. 29.
    Coyle CE, Dugan E. Social isolation, loneliness and health among older adults. J Aging Health. 2012;24(8):1346–63.PubMedCrossRefGoogle Scholar
  30. 30.
    Dickens AP, Richards SH, Greaves CJ, Campbell JL. Interventions targeting social isolation in older people: a systematic review. BMC Public Health. 2011;11:647.PubMedCentralPubMedCrossRefGoogle Scholar
  31. 31.
    Steptoe A, Shankar A, Demakakos P, Wardle J. Social isolation, loneliness, and all-cause mortality in older men and women. Proc Natl Acad Sci U S A. 2013;110(15):5797–801.PubMedCentralPubMedCrossRefGoogle Scholar
  32. 32.
    Romero-Ortuno R, Casey AM, Cunningham CU, Squires S, Prendergast D, Kenny RA, et al. Psychosocial and functional correlates of nutrition among community-dwelling older adults in Ireland. J Nutr Health Aging. 2011;15(7):527–31.PubMedCrossRefGoogle Scholar
  33. 33.
    Hughes G, Bennett KM, Hetherington MM. Old and alone: barriers to healthy eating in older men living on their own. Appetite. 2004;43(3):269–76.PubMedCrossRefGoogle Scholar
  34. 34.
    Holwerda TJ, Beekman AT, Deeg DJ, Stek ML, van Tilburg TG, Visser PJ, et al. Increased risk of mortality associated with social isolation in older men: only when feeling lonely? Results from the Amsterdam Study of the Elderly (AMSTEL). Psychol Med. 2012;42(4):843–53.PubMedCrossRefGoogle Scholar
  35. 35.
    Bickel G, Nord M, Prince C, Hamilton W, Cook J. Guide to measuring household food security revised. In: U.S. Department of Agriculture FaNS, ed. Alexandria, VA; 2000.Google Scholar
  36. 36.
    Coleman-Jensen A, Nord M, Singh A. Household food security in the United States in 2012, ERR-155. U.S. Department of Agriculture, Food and Nutrition Service, Economic Research Service 2013.Google Scholar
  37. 37.
    Ziliak J, Gundersen C. The state of senior hunger in America 2012: an annual report. National Foundation to End Senior Hunger; 2014.Google Scholar
  38. 38.
    Cook JT, Frank DA. Food security, poverty, and human development in the United States. Ann N Y Acad Sci. 2008;1136:193–209.PubMedCrossRefGoogle Scholar
  39. 39.•
    Buys DR, Locher JL. Food insecurity and hunger among older adults. In: Bales C, Locher J, Saltzman E, editors. Handbook of clinical nutrition and aging. 3rd ed. New York: Springer Science + Business Media; 2014. p. 147–59. This chapter provides a succint discussion of food inscruity and hunger in the aging population and how to address it.Google Scholar
  40. 40.
    Alley DE, Soldo BJ, Pagán JA, McCabe J, de Blois M, Field SH, et al. Material resources and population health: disadvantages in health care, housing, and food among adults over 50 years of age. Am J Public Health. 2009;99 Suppl 3:S693–701.PubMedCentralPubMedCrossRefGoogle Scholar
  41. 41.
    Seligman HK, Laraia BA, Kushel MB. Food insecurity is associated with chronic disease among low-income NHANES participants. J Nutr. 2010;140(2):304–10.PubMedCentralPubMedCrossRefGoogle Scholar
  42. 42.
    Lee JS, Gundersen C, Cook J, Laraia B, Johnson MA. Food insecurity and health across the lifespan. Adv Nutr Int Rev J. 2012;3(5):744–5.CrossRefGoogle Scholar
  43. 43.
    Holben DH, Pheley AM. Diabetes risk and obesity in food-insecure households in rural Appalachian Ohio. Prev Chron Dis. 2006;3(3):A82.Google Scholar
  44. 44.
    Klesges LM, Pahor M, Shorr RI, Wan JY, Williamson JD, Guralnik JM. Financial difficulty in acquiring food among elderly disabled women: results from the Women’s Health and Aging Study. Am J Public Health. 2001;91(1):68–75.PubMedCentralPubMedCrossRefGoogle Scholar
  45. 45.
    Dinour LM, Bergen D, Yeh MC. The food insecurity-obesity paradox: a review of the literature and the role food stamps may play. J Am Diet Assoc. 2007;107(11):1952–61.PubMedCrossRefGoogle Scholar
  46. 46.
    Kim K, Frongillo EA. Participation in food assistance programs modifies the relation of food insecurity with weight and depression in elders. J Nutr. 2007;137(4):1005–10.PubMedGoogle Scholar
  47. 47.
    Stuff JE, Casey PH, Szeto KL, Gossett JM, Robbins JM, Simpson PM, et al. Household food insecurity is associated with adult health status. J Nutr. 2004;134(9):2330–5.PubMedGoogle Scholar
  48. 48.
    Gao X, Scott T, Falcon LM, Wilde PE, Tucker KL. Food insecurity and cognitive function in Puerto Rican adults. Am J Clin Nutr. 2009;89(4):1197–203.PubMedCentralPubMedCrossRefGoogle Scholar
  49. 49.
    Lee MR, Berthelot ER. Community covariates of malnutrition-based mortality among older adults. Ann Epidemiol. 2010;20(5):371–9.PubMedCrossRefGoogle Scholar
  50. 50.
    Jensen GL. Inflammation as the key interface of the medical and nutrition universes: a provocative examination of the future of clinical nutrition and medicine. JPEN J Parenter Enteral Nutr. 2006;30(5):453–63.PubMedCrossRefGoogle Scholar
  51. 51.••
    Tappenden KA, Quatrara B, Parkhurst ML, Malone AM, Fanjiang G, Ziegler TR. Critical role of nutrition in improving quality of care: an interdisciplinary call to action to address adult hospital malnutrition. J Acad Nutr Diet. 2013;113(9):1219–37. This article highlights the immediate need for identifying and addressing malnutrition in the hospital setting.PubMedCrossRefGoogle Scholar
  52. 52.
    White JV, Guenter P, Jensen G, Malone A, Schofield M. Consensus statement of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition: characteristics recommended for the identification and documentation of adult malnutrition (undernutrition). J Acad Nutr Diet. 2012;112(5):730–8.PubMedCrossRefGoogle Scholar
  53. 53.
    Corkins MR, Guenter P, DiMaria-Ghalili RA, Jensen GL, Malone A, Miller S, et al. Malnutrition diagnoses in hospitalized patients: United States, 2010. JPEN J Parenter Enteral Nutr. 2014;38(2):186–95.PubMedCrossRefGoogle Scholar
  54. 54.
    US Bureau. U.S. Census Bureau: State and County QuickFacts. 2014; Accessed 12 Dec 2014.
  55. 55.
    Weiss AJ, Elixhauser A. Overview of hospital stays in the United States, 2012. HCUP Statistical Brief #180. Rockville, MD: Agency for Healthcare Research and Quality; 2014.Google Scholar
  56. 56.
    Col N, Fanale JE, Kronholm P. The role of medication noncompliance and adverse drug reactions in hospitalizations of the elderly. Arch Intern Med. 1990;150(4):841–5.PubMedCrossRefGoogle Scholar
  57. 57.
    Creditor MC. Hazards of hospitalization of the elderly. Ann Intern Med. 1993;118(3):219–23.PubMedCrossRefGoogle Scholar
  58. 58.
    Fernandez HM, Callahan KE, Likourezos A, Leipzig RM. House staff member awareness of older inpatients’ risks for hazards of hospitalization. Arch Intern Med. 2008;168(4):390–6.PubMedCrossRefGoogle Scholar
  59. 59.
    Kaiser MJ, Bauer JM, Ramsch C, Uter W, Guigoz Y, Cederholm T, et al. Frequency of malnutrition in older adults: a multinational perspective using the mini nutritional assessment. J Am Geriatr Soc. 2010;58(9):1734–8.PubMedCrossRefGoogle Scholar
  60. 60.
    Mowe M, Bøhmer T, Kindt E. Reduced nutritional status in an elderly population (>70 y) is probable before disease and possibly contributes to the development of disease. Am J Clin Nutr. 1994;59(2):317–24.PubMedGoogle Scholar
  61. 61.
    Cerri AP, Bellelli G, Mazzone A, Pittella F, Landi F, Zambon A, et al. Sarcopenia and malnutrition in acutely ill hospitalized elderly: Prevalence and outcomes. Clin Nutr. 2014.Google Scholar
  62. 62.
    Heersink JT, Brown CJ, Dimaria-Ghalili RA, Locher JL. Undernutrition in hospitalized older adults: patterns and correlates, outcomes, and opportunities for intervention with a focus on processes of care. J Nutr Elder. 2010;29(1):4–41.PubMedCrossRefGoogle Scholar
  63. 63.
    Buie VC, Owings MF, DeFrances CJ, Golosinskiy A. National hospital discharge survey: 2006 annual summary. Vital Health Stat. 2010;13(168):1–79.Google Scholar
  64. 64.
    Inoue M, Kinoshita K, Sano F, Kobayashi M, Yasuda S, Sowa T, et al. Perioperative nutritional support with immune-enhancing diet for surgical closure of open thoracic window. Kyobu Geka. 2012;65(7):559–62.PubMedGoogle Scholar
  65. 65.•
    Martindale RG, McClave SA, Taylor B, Lawson CM. Perioperative nutrition: what is the current landscape? J Parenter Enter Nutr. 2013;37(5 suppl):5S–20S. This article provides a detailed and compendious description of preoperative nutritional strategies to improve recovery and reduce adverse outcomes.CrossRefGoogle Scholar
  66. 66.
    Greene KA, Wilde AH, Stulberg BN. Preoperative nutritional status of total joint patients: relationship to postoperative wound complications. J Arthroplasty. 1991;6(4):321–5.PubMedCrossRefGoogle Scholar
  67. 67.
    Guo JJ, Yang H, Qian H, Huang L, Guo Z, Tang T. The effects of different nutritional measurements on delayed wound healing after hip fracture in the elderly. J Surg Res. 2010;159(1):503–8.PubMedCrossRefGoogle Scholar
  68. 68.
    Foster MR, Heppenstall RB, Friedenberg ZB, Hozack WJ. A prospective assessment of nutritional status and complications in patients with fractures of the hip. J Orthop Trauma. 1990;4(1):49–57.PubMedCrossRefGoogle Scholar
  69. 69.
    Cerri AP, Bellelli G, Mazzone A, Pittella F, Landi F, Zambon A, et al. Sarcopenia and malnutrition in acutely ill hospitalized elderly: prevalence and outcomes. Clin Nutr. 2014.Google Scholar
  70. 70.
    Patel V, Romano M, Corkins MR, DiMaria-Ghalili RA, Earthman C, Malone A, et al. Nutrition screening and assessment in hospitalized patients a survey of current practice in the United States. Nutr Clin Pract. 2014;29(4):483–90.PubMedCrossRefGoogle Scholar
  71. 71.
    Graham CL, Ivey SL, Neuhauser L. From hospital to home: assessing the transitional care needs of vulnerable seniors. Gerontologist. 2009;49(1):23–33.PubMedCrossRefGoogle Scholar
  72. 72.
    Boling PA. Managing posthospital care transitions for older adults: challenges and opportunities. JAMA. 2014;312(13):1303–4.PubMedCrossRefGoogle Scholar
  73. 73.
    Krumholz HM. Post-hospital syndrome–an acquired, transient condition of generalized risk. N Engl J Med. 2013;368(2):100–2.PubMedCentralPubMedCrossRefGoogle Scholar
  74. 74.
    Locher JL, Wellman NS. “Never the twain shall meet:” dual systems exacerbate malnutrition in older adults recently discharged from hospitals. J Nutr Gerontol Geriatr. 2011;30(1):24–8.PubMedCentralPubMedCrossRefGoogle Scholar
  75. 75.
    Sahyoun NR, Akobundu U, Coray K, Netterville L. Challenges in the delivery of nutrition services to hospital discharged older adults: the community connections demonstration project. J Nutr Elder. 2009;28(2):127–42.PubMedCrossRefGoogle Scholar
  76. 76.
    Sahyoun NR, Anyanwu UO, Sharkey JR, Netterville L. Recently hospital-discharged older adults are vulnerable and may be underserved by the Older Americans Act Nutrition Program. J Nutr Elder. 2010;29(2):227–40.PubMedCrossRefGoogle Scholar
  77. 77.
    Kayser-Jones J. Malnutrition, dehydration, and starvation in the midst of plenty: the political impact of qualitative inquiry. Qual Health Res. 2002;12(10):1391–405.PubMedCrossRefGoogle Scholar
  78. 78.
    Bell CL, Tamura BK, Masaki KH, Amella EJ. Prevalence and measures of nutritional compromise among nursing home patients: weight loss, low body mass index, malnutrition, and feeding dependency, a systematic review of the literature. J Am Med Dir Assoc. 2013;14(2):94–100.PubMedCrossRefGoogle Scholar
  79. 79.
    Pauly L, Stehle P, Volkert D. Nutritional situation of elderly nursing home residents. Z Gerontol Geriatr. 2007;40(1):3–12.PubMedCrossRefGoogle Scholar
  80. 80.
    Serrano-Urrea R, Garcia-Meseguer MJ. Malnutrition in an elderly population without cognitive impairment living in nursing homes in Spain: study of prevalence using the Mini Nutritional Assessment test. Gerontology. 2013;59(6):490–8.PubMedCrossRefGoogle Scholar
  81. 81.
    Sloane PD, Ivey J, Helton M, Barrick AL, Cerna A. Nutritional issues in long-term care. J Am Med Dir Assoc. 2008;9(7):476–85.PubMedCrossRefGoogle Scholar
  82. 82.
    Bell CL, Lee AS, Tamura BK. Malnutrition in the nursing home. Curr Opin Clin Nutr Metab Care. 2015;18(1):17–23.PubMedCrossRefGoogle Scholar
  83. 83.
    Cowan DT, Roberts JD, Fitzpatrick JM, While AE, Baldwin J. Nutritional status of older people in long term care settings: current status and future directions. Int J Nurs Stud. 2004;41(3):225–37.PubMedCrossRefGoogle Scholar
  84. 84.•
    Tamura BK, Bell CL, Masaki KH, Amella EJ. Factors associated with weight loss, low BMI, and malnutrition among nursing home patients: a systematic review of the literature. J Am Med Dir Assoc. 2013;14(9):649–55. A thorough and recent systematic review of studies of malnutrition and weight loss in nursing homes.PubMedCrossRefGoogle Scholar
  85. 85.
    Messinger-Rapport BJ, Gammack JK, Little MO, Morley JE. Clinical update on nursing home medicine: 2014. J Am Med Dir Assoc. 2014;15(11):786–801.PubMedCrossRefGoogle Scholar
  86. 86.
    Powell LS, Felix HC, Bradway C, Miller E, Heivly A, Fleshner I. Additional research on the cost of caring for obese nursing home residents is critical to maintaining adequate resources in the long-term care industry. J Am Med Dir Assoc. 2010;11(3):222.PubMedCrossRefGoogle Scholar
  87. 87.
    Felix HC. Personal care assistance needs of obese elders entering nursing homes. J Am Med Dir Assoc. 2008;9(5):319–26.PubMedCrossRefGoogle Scholar
  88. 88.
    Buys DR, Roth DL, Ritchie CS, Sawyer P, Allman RM, Funkhouser EM, et al. Nutritional risk and body mass index predict hospitalization, nursing home admissions, and mortality in community-dwelling older adults: results from the UAB Study of Aging with 8.5 years of follow-up. J Gerontol A Biol Sci Med Sci. 2014;69(9):1146–53.PubMedCrossRefGoogle Scholar
  89. 89.••
    Aselage M, Amella EJ, Rose SB, Bales CW. Dementia-related mealtime difficulties: assessment and management in the long-term care setting. In: Bales CW, Locher JL, Saltzman ES, editors. Handbook of Clinical Nutrition and Aging. 3rd ed. Springer 2014. This chapter provides a detailed and comprehensive discussion of dementia-related feeding difficultites and their management, including different approaches to careful hand feeding. Google Scholar
  90. 90.
    Heuberger RA. Artificial nutrition and hydration at the end of life. J Nutr Elder. 2010;29(4):347–85.PubMedCrossRefGoogle Scholar
  91. 91.
    Galanos AN, Neff EC, Heuberger RA. What is “optimal nourishment” for older adults at the end of life? A conversation. Interview by Connie W. Bales. J Nutr Elder. 2010;29(4):386–92.PubMedCrossRefGoogle Scholar
  92. 92.
    Fischberg D, Bull J, Casarett D, Hanson LC, Klein SM, Rotella J, et al. Five things physicians and patients should question in hospice and palliative medicine. J Pain Symptom Manage. 2013;45(3):595–605.PubMedCrossRefGoogle Scholar
  93. 93.
    Hanson LC, Carey TS, Caprio AJ, Lee TJ, Ersek M, Garrett J, et al. Improving decision-making for feeding options in advanced dementia: a randomized, controlled trial. J Am Geriatr Soc. 2011;59(11):2009–16.PubMedCentralPubMedCrossRefGoogle Scholar
  94. 94.
    Candy B, Sampson EL, Jones L. Enteral tube feeding in older people with advanced dementia: findings from a Cochrane systematic review. Int J Palliat Nurs. 2009;15(8):396–404.PubMedCrossRefGoogle Scholar
  95. 95.
    Teno JM, Mitchell SL, Kuo SK, Gozalo PL, Rhodes RL, Lima JC, et al. Decision-making and outcomes of feeding tube insertion: a five-state study. J Am Geriatr Soc. 2011;59(5):881–6.PubMedCentralPubMedCrossRefGoogle Scholar
  96. 96.
    Committee AGSECaCPaMoC. American Geriatrics Society feeding tubes in advanced dementia position statement. J Am Geriatr Soc. 2014;62(8):1590–3.CrossRefGoogle Scholar
  97. 97.
    Yukawa M, Seel RC. Nutrition at the end of life. In: Bales CW, Locher JL, Saltzman E, editors. Handbook of clinical nutrition and aging. 3rd ed. New York: Springer Science + Business Media; 2014. p. 303–12.Google Scholar
  98. 98.
    Del Rio MI, Shand B, Bonati P, Palma A, Maldonado A, Taboada P, et al. Hydration and nutrition at the end of life: a systematic review of emotional impact, perceptions, and decision-making among patients, family, and health care staff. Psychooncology. 2012;21(9):913–21.PubMedCrossRefGoogle Scholar
  99. 99.
    Yang Y, Brown CJ, Burgio KL, Kilgore ML, Ritchie CS, Roth DL, et al. Undernutrition at baseline and health services utilization and mortality over a 1-year period in older adults receiving Medicare home health services. J Am Med Dir Assoc. 2011;12(4):287–94.PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Kathryn N. Porter Starr
    • 1
    • 2
    Email author
  • Shelley R. McDonald
    • 3
  • Connie W. Bales
    • 1
    • 2
    • 3
  1. 1.Geriatric Research, Education, and Clinical CenterDurham VA Medical CenterDurhamUSA
  2. 2.Center for the Study of AgingDuke University Medical CenterDurhamUSA
  3. 3.Department of MedicineDuke University Medical CenterDurhamUSA

Personalised recommendations