Associations between nutritional and physical outcomes of community-dwelling older adults eating alone, versus with others: A systematic review.

Abstract

Age-related changes in physiological function and an older person's physical, social and economic environment can impact their nutritional intake and overall health. While it is well-established that social isolation and loneliness can contribute to decreased food intake, the evidence quantifying the association between nutritional and physical outcomes of older adults eating alone, versus with others, has yet to be synthesised. Therefore, this systematic review aimed to answer the question, "What is the association between nutritional and physical outcomes of community-dwelling older adults (aged ≥65 years) who eat alone, versus with others?" This systematic review followed the PRISMA guidelines. Four databases (MEDLINE, CINAHL, Scopus, PsycINFO) were searched to February 2025 to identify relevant publications. From 3759 articles identified, 24 fulfilled the inclusion criteria. These cross-sectional (n=19), cohort (n=4) or case-control (n=1) studies were mostly of neutral methodological quality and reported on nutritional status, dietary intake, appetite, body mass index, weight loss, muscle mass and/or frailty. Five studies reported no negative associations between eating alone and these outcomes. The remaining studies reported significant negative outcomes for those who ate alone: (1) poorer diet quality and food diversity; (2) lower fruit, vegetable and meat intake; and (3) an increased risk of weight loss and frailty. Strategies targeting shared mealtimes for community-dwelling older people should be investigated to reduce the experience of eating alone and associated negative outcomes. Implications for dietetic practice, primary and preventative healthcare include screening of mealtime habits to determine nutritional risk, and monitoring of outcomes identified in this review.