Effectiveness of Interventions to Improve Malnutrition Among Older Adults Living with Frailty Who Are Discharged from the Acute Setting: A Systematic Review.

Background & aim: Malnutrition and frailty are prevalent among older adults following discharge from acute care, including emergency departments. This transition period presents a critical window for targeted nutrition interventions. This systematic review synthesises evidence on the effectiveness of nutrition interventions for malnourished, frail older adults and incorporates analyses of stakeholders' perspectives, including those of patients, caregivers, and healthcare professionals. By integrating clinical outcomes with stakeholder experiences, the review aims to identify strategies that can optimise nutritional care and support recovery in the post-acute setting.

Methods: Searches were conducted in Scopus, CINAHL, EBSCO, EMBASE, and PubMed for randomised controlled trials (RCTs) of nutrition interventions in participants ≥65 years living with frailty and identified as malnourished on discharge from acute care. The primary outcome was assessing the effects of nutrition interventions on malnutrition, nutrition status, physical function and frailty, food intake, and quality of life. Secondary outcomes were hospital readmission and mortality. The quality of studies was assessed using the Cochrane Risk of Bias Tool (V2).

Results: Five RCTs with 551 participants were included. Nutrition interventions, including counselling, oral nutrition supplements, and multidisciplinary strategies, improved dietary intake, weight, frailty, physical function, BMI, and quality of life in older adults post-discharge. Some studies also reported reduced hospital stays, readmissions, and mortality. However, none explored stakeholder perspectives, highlighting a gap in person-centred transitional care design.

Conclusion: This systematic review highlights a critical gap in evidence for nutrition interventions targeting frail older adults at hospital discharge. While short-term benefits were observed, long-term sustainability and real-world feasibility remain uncertain. The absence of stakeholder involvement further limits person-centred design. These findings underscore the need for integrated nutrition care pathways that embed effective interventions into transitional care models.