Abstract
In order to tackle the increasing problem of malnutrition (i.e. protein‐energy malnutrition) in the older population, the Joint Action Malnutrition in the Elderly (MaNuEL) Knowledge Hub has been recently launched as part of the Strategic Research Agenda of the Joint Programming Initiative (JPI) A Healthy Diet for a Healthy Life (HDHL). This paper introduces this new European initiative and describes its objectives and design. The MaNuEL consortium consists of 22 research groups from seven countries (Austria, France, Germany, Ireland, Spain, The Netherlands and New Zealand). The Consortium aims to extend scientific knowledge; strengthen evidence‐based practice in the management of malnutrition in older persons; build a sustainable, transnational, competent network of malnutrition experts; and harmonise research and clinical practice. MaNuEL is built on five interconnected work packages that focus on (i) defining treatable malnutrition; (ii) screening of malnutrition in different settings; (iii) determinants of malnutrition; (iv) prevention and treatment of malnutrition; and (v) policies and education regarding malnutrition screening and treatment in older persons across Europe. Systematic literature reviews will be performed to assess current research on malnutrition and identify potential knowledge gaps. Secondary data analyses of nutritional intervention trials and observational studies will also be conducted. Using Web‐based questionnaires, MaNuEL will provide insight into current clinical practice, policies and health professionals’ education on malnutrition and will make recommendations for improvement. MaNuEL is being advised by a stakeholder board of five experts in geriatric nutrition who represent relevant European professional societies.
Introduction
Protein‐energy malnutrition in older Europeans is an increasing health problem, mainly due to changes in demographics. In 2015, 18.9% of the European population was aged 65 years and older. This percentage is expected to increase to 28.1% in 2050 (Eurostat 2017). The prevalence of malnutrition varies widely across different population subgroups of older persons but is generally acknowledged to be higher in older persons with deteriorating health and functional status, and increasing dependency and disability. In the community, malnutrition affects less than 10% of independently living older persons; however, the prevalence of malnutrition has been reported to be 50% and higher in nursing home residents, geriatric patients in acute care hospitals and patients in geriatric rehabilitation (Kaiser et al. 2010; Cereda 2012; Kruizenga et al. 2016; Rojer et al. 2016; Van Zwienen‐Pot et al. 2016). Apart from prevalent malnutrition, in all settings a large proportion of older people are at risk of developing malnutrition (Kaiser et al. 2010; Cereda 2012).
Unequivocally, malnutrition is associated with serious health problems, which impact negatively on the wellbeing and quality of life of the individual and also healthcare systems (Abizanda et al. 2016). Earlier studies have focused on malnutrition in older persons in terms of clinical outcomes and consistently reported an increased risk of morbidity (e.g. the development of pressure ulcers and poor wound‐healing, infectious complications and hospital readmissions) and mortality (Sullivan & Walls 1998; McMinn et al. 2011) but, in recent years, the relationship between nutritional deficits and functional impairment has become more apparent (Kiesswetter et al. 2014). Energy intake below bodily requirements and the accompanying weight loss aggravate age‐related loss of muscle mass and physical function (Newman et al. 2005; Ritchie et al. 2008). Thus, malnutrition has emerged as an important aetiological factor in the development of sarcopenia and frailty, two major geriatric health threats, which, in turn, provoke nutritional problems and may further aggravate malnutrition (Cruz‐Jentoft et al. 2010; Mezuk et al. 2016).
Despite increasing scientific interest in malnutrition in older persons over the last decades, many uncertainties remain. There is, for example, still debate about a unified definition of malnutrition in older persons and, consequently, about the optimal screening tool to identify malnourished persons. The effectiveness of nutritional interventions remains unclear (Health Council of The Netherlands 2011), especially in community‐dwelling older adults (De van der Schueren et al. 2016). In addition, it is unclear who will benefit most from which intervention and in what setting.
Although malnutrition is currently higher on the agenda of policymakers in several European countries, there is still low awareness of malnutrition in many healthcare settings among healthcare professionals, older persons themselves and their caring relatives (Monteagudo et al. 2015; Ziylan et al. 2015; Craven et al. 2016). Furthermore, research, educational programmes and health policies that contribute to tackling malnutrition in old age mainly take place at a local or national level and employ different methods and strategies. Thus, there is a clear need for more attention to the problem of malnutrition in older adults (Volkert 2013) and for increased communication and co‐operation between key stakeholders in government, health care and academia in order to harmonise efforts and strengthen malnutrition research, education and policymaking. A European joint effort could contribute to achieving these aims.
In 2010, the Joint Programming Initiative (JPI) A Healthy Diet for a Healthy Life (HDHL) was launched to achieve the vision that by 2030 all citizens will have the motivation, ability and opportunity to consume a healthy diet from a variety of foods and have healthy levels of physical activity, and that the incidence of diet‐related diseases will have decreased significantly (JPI 2015). Within this initiative, in 2015 a call for a Joint Action ‘Malnutrition in the Elderly Knowledge Hub’ was launched to support networking activities in this field. On 1 March 2016, the Malnutrition in the Elderly (MaNuEL) Knowledge Hub was established. It includes a consortium of 22 research groups from seven countries [Austria, France, Germany, Ireland, Spain, The Netherlands and New Zealand (Table 1)] supported by a stakeholder advisory board of geriatric nutrition experts who represent relevant European expert societies (Table 2). This paper introduces this new European initiative and describes its objectives and design.
