Malnutrition, also known as undernutrition, is a state of energy or nutrient deficiency caused by inadequate intake or impaired utilization. Aging is closely associated with malnutrition, and older adults are at increased risk of malnutrition due to reduced digestive system function, increased oral problems, and medication use. Non-pharmacological interventions are important measures to improve nutritional status, dietary guidance, oral nutritional supplementation, exercise interventions and combined interventions included are the most common non-pharmacological interventions, and relevant norms need to be developed to guide their application and implementation in malnourished elderly. Currently, some foreign institutions have issued guidelines and consensus on malnutrition in the general population, and considering the differences in population, culture, and medical environment, the applicability of these guidelines to the population in China is worthy of further discussion, and there are no guidelines for non-pharmacological interventions for malnutrition in the elderly in China. Therefore, the China Geriatric Care Alliance (CGCA) led the initiative to organize domestic experts to develop the Clinical Practice Guidelines for Non-pharmacological Interventions for Malnourished Elderly according to the methods and steps of clinical evidence-based practice guidelines, based on research evidence and combined with the clinical reality in China, focusing on malnourished elderly who can eat orally, and to develop the Clinical Practice Guidelines for Non-pharmacological Interventions for Malnourished Elderly to provide a reference for implementing dietary guidance, oral nutritional supplementation, exercise interventions and combined interventions in malnourished elderly, so as to improve their malnutrition status, enhance their quality of life and reduce the burden on families and society.
Dietary guidance
Dietary guidance is a nutritional intervention based on the theory of "Understanding - Believe - Implement". Dietary guidance is a priority nutritional intervention for older adults who are at nutritional risk or malnourished. (1B)
Dietary guidance consists of dietary guidance led by medical personnel specialized in nutrition and self-managed dietary guidance interventions. The content of each method is basically the same and can be selected according to local conditions. (2B)
In elderly people at nutritional risk or malnourished, oral nutritional supplementation (ONS) is the preferred method when people need nutritional support. (1A)
It is recommended that older adults at nutritional risk or malnourished should be supplemented with ONS, a standard whole protein formula, protein or essential amino acids should be supplemented orally when the standard whole protein formula is supplemented with ONS for energy. When the intake is insufficient, oral supplementation with protein or essential amino acids is recommended, usually in the form of small mouth slurping. (1A)
Additional supplementation should be made when there is some specific nutritional risk or malnutrition condition in the elderly; it is recommended that such elderly people choose micronutrient classes containing different components (or types) as supplementation according to their nutritional needs to meet the body's needs for different nutrients; in addition, regular monitoring should be done to prevent oversupplementation. (1B) Frequency: 1 to 2 times /d. (1B)
Recommendations: Exercise interventions include many types, which can be carried out in combination with traditional exercises in China, and the type and frequency of exercise should be determined according to the nutritional status and somatic function of the elderly. (1C)
Joint interventions
Combined interventions are richer than single nutritional interventions and should take into account the mutual reinforcing effect between various intervention components to maximize the intervention effect. (1B)