Table 4 Description of elderly´s health outcomes (morbidity, mortality, functional capacity, and quality of life), and main conclusions of the eligible studies

Ahmed et al. [18]

The risk of death for those with diabetes increased 69% in malnourished versus normal nutrients (P < 0.0001). Malnutrition increased the risk of death within reach of the common comorbid conditions, including ischaemic heart disease, chronic obstructive pulmonary disorder, stroke or transient ischemic attack, heart failure, chronic kidney disease, and acute myocardial infarction. In addition, the total annual expenditure for the malnourished beneficiaries were significantly higher than then for the normal-nutrient beneficiaries ($36 079 vs 20 787) (P < 0.0001)

Malnutrition is significant comorbidity affecting the survival and health care costs of the person with diabetes. There is a need to develop and implement evidence-based clinical decision pathways for appropriate screening, assessment, diagnosis, and treatment of malnourished patients, and to prevent malnutrition in normal-nutritious patients with diabetes

Alhamadan et al. [19]

There was a significant association between nutritional status and ADL. Only 15.2% were at risk of malnutrition or malnourishment among those assessed as fully functional. Among those rated as moderately functional or severely unfunctional, 55.3% and 73.9% were classified as at risk of malnutrition or malnourished, respectively

Assessing the nutritional status of the elderly identified a high prevalence of undernutrition and obesity. Such assessments should be routine practise in PHC

Galiot et al. [20]

The risk of malnutrition was positively related to social risk and chronic diseases. 3.6% of participants who had social problems, were at risk of malnutrition and malnutrition (1.8%). People suffering from more than six pathologies, also had a higher nutritional risk

The risk of undernutrition seems to be associated with a more disadvantaged social condition and comorbidities. The development of training programs in nutrition education and the use of simple tools to identify nutritional risk in primary health care could effectively reduce the prevalence of malnutrition, avoid negative health consequences and improve the quality of care. If a situation of nutritional risk is not detected and treated early, it can lead to malnutrition, a serious pathological situation with very negative consequences for the elderly´s health, not to mention the social and health costs that this situation entails

Geurden et al., [21]

Patients at risk of malnutrition were significantly sicker (P < 0.001), and revealed more eating problems such as difficulties with chewing or swallowing and loss of appetite (P < 0.001)

Belgian nurses providing care at home do not yet fully comply with international nutritional recommendations. Our survey of nurses revealed low awareness, low knowledge capacity, and poor communication between stakeholders. Systematic screening should be further developed and evaluated in this population at risk. Additional training in nutritional nursing care and screening methods for malnutrition is needed

Hegendörfer et al. [22]

Survival is statistically significantly lower for those with a risk of malnutrition based on either MNA (P < 0.001) or pre-albumin (P = 0.001). No significantly higher hospitalization is observed for those at risk of malnutrition based on MNA (P = 0.068) or pre-albumin (P = 0.058)

There is the need for further research on the assessment of nutritional status in community-dwelling, independent very old adults who would benefit from a combination of both anthropometric and/or dietary assessment and biomarkers such as pre-albumin. This is important in light of the growing global population of adults 80 years and older, the impact of malnutrition on their quality of life and risk of adverse outcomes, and the availability of potentially beneficial interventions

Klemenc-Ketis et al. [23]

There is a significant association of increased risk of malnutrition with age and BMI (P = 0.022); several chronic diseases (P = 0.001); a misperception of their current health status (P = 0.001); feeling lonely (P < 0.001); and increased pain intensity (P = 0.003)

A screening program in primary health care can help identify people at risk of malnutrition. In addition, appropriate nutritional support is suggested as it can help reverse or stop the trajectory of malnutrition and the negative outcomes associated with poor nutritional status. It should be noted that by limiting screening for malnutrition only to hospitalized and elderly patients, we are missing a large percentage of the population living at home, especially those who do not attend PHC

Krishnamoorthy et al. [24]

Not Reported

Nutritional dysfunctions are important health issues to be considered among the elderly population. Opportunistic screening may be useful at the PHC level. Strengthening primary health care to address and prevent this health issue through balanced dietary practices can improve their nutritional status, thereby improving their quality of life

Mastronuzzi et al. [25]

A significantly higher number of major events, including death, were observed in the undernourished group. In 20.4% of patients were identified as having a high risk of developing major complications in the future. The sensitivity of the MNA test in identifying these patients was 84%. Several major events were registered both in patients at risk of malnutrition and in malnourished ones (bone fractures – 20.5%; hospitalization – 30%; death – 2.8–16%)

The prevalence of malnutrition is high among the elderly in the family practice. The MNA allows for better identification of malnourished subjects than the BMI and effectively. The application of a simple, quick, and easy-to-fill screening tool such as the MNA makes it possible to identify better than BMI those older adults who are malnourished or at risk, which is also useful for quantifying the risk of future major events. Malnutrition is often underestimated as nutritional status is not routinely checked and reported in the patient's electronic file. The classification obtained by the MNA makes it possible to stratify patients and obtain information on the risk of complications, at least in older and frail subjects, and indirectly to estimate the burden of care

Pedersen et al. [26]

Early and integrated nutritional monitoring (Hosp-PHC) of the elderly by health teams in a home setting, prevents and improves the deterioration of activities of daily living and the independence of the individual when associated with malnutrition (in 96% of cases and statically significant p < 0.001). There is also a reduction in the length of hospital stay

The early identification of the risk of malnutrition can prevent a negative spiral of results for the elderly (functional deterioration, hospital readmissions, death)

Preston et al. [27]

50% of participants at nutritional risk were at risk of isolation. A large proportion of participants (79.9%) had multiple illnesses with almost 50% more than six prescribed medications. 80% of the nutritional risk group are considered frail. Frailty (P < 0.004) and prescribed medications (P < 0.042) reveal a statistically significant relationship with nutritional status

Screening practices with valid and reliable screening tools are imperative to ensure identification and management of older people at risk

Rodriguez-Tadeo et al. [28]

Functional impairment, cognitive impairment, and depression were 3.0, 1.5, and 2.9 times more likely in the presence of malnutrition or risk of malnutrition. Malnutrition correlates positively with depression, functional impairment to move, and living alone (P < 0.001)

PHC plays an important role in early detection, improved quality of life, and better prognosis for malnourished individuals

Schilp et al. [29]

No statistically significant differences were found between introduction of dietary treatment VS usual care in body weight change (mean difference 0.78 kg, 95% CI-0.26e1.82), QALYs (mean difference 0.001, 95% CI—0.04e0.04) and total costs (mean difference V1645, 95% CI -525e3547). The incremental cost-utility ratio (ICUR) for QALYs was not interpretable. The incremental cost-effectiveness ratio (ICER) for body weight gain was 2111. The probability of dietary treatment being cost-effective was 0.78 for a cost-effectiveness ratio of V5000 for body weight and 0.06 for a threshold ratio

Dietary treatment in older, undernourished, community-dwelling individuals was not cost-effective

Shakersain et al. [30]

The mean age at death of participants with malnutrition and risk of malnutrition was ~ 3 and 1.5 years shorter (CI—95%, P < 0.001) than that of participants with normal nutritional status, respectively, while malnutrition or risk of malnutrition together with abnormal biomarker levels (hemoglobin and albumin) was related to one year shorter survival

Malnutrition and the risk of malnutrition are significantly associated with shorter survival. Poor nutritional status in combination with abnormalities in biomarkers is associated with even shorter survival

Spirgienė et al. [31]

The risk of/malnutrition was associated with chronic (P < 0.004) and intermittent pain (P < 0.001), chewing difficulties (P < 0.001), swallowing disorders (P < 0.001), dental problems (P < 0.001), and medication use (P < 0.001). The risk of malnutrition and undernutrition was related to depression (P = 0.001) and Alzheimer's disease or other dementia (P < 0.001), but had no statistically significant relationship with cancer (P = 0.120) or diabetes mellitus (P = 0.065)

Educating community elders about healthy nutrition and providing them with specific updated guidelines to follow over the long term contributed to favorable changes. The findings infer that community nurses' efforts to ensure better health outcomes for the elderly, using minimal financial and human resources, appeared to be effective in improving elderly people's nutrition knowledge and practices on nutrition

Vandewoude et al. [32]

Of all undernourished individuals, 49% were diagnosed by PHC and 13% of the undernourished recognized themselves as such. Mobility (climbing stairs and walking) and ADL dependence (Belgian KATZ score) were impaired in older people with (risk of) malnutrition compared to individuals with normal nutritional status (P < 0.001)

Under-diagnosis of malnutrition is problematic, because the associated loss of mobility and independence may accelerate the transformation of frailty into disability in older people

Yang et al. [33]

Participants who were malnourished or at risk of malnutrition were more likely to experience sequential under-hospitalization (P = 0.040), emergency room visits (P = 0.047), use of home health aides (P = 0.027), and mortality (P = 0.031)

Malnourished people or at risk of malnutrition, are more likely to use greater amounts of health care resources subsequently and experience mortality. Nutritional interventions aimed at addressing undernutrition in this vulnerable population can improve health outcomes and decrease health service utilization