Review Article
Costs of Malnutrition in Institutionalized and Community-Dwelling Older Adults: A Systematic Review

https://doi.org/10.1016/j.jamda.2015.07.005Get rights and content

Abstract

Objectives

The aim of this study was to assess health economics evidence published to date on malnutrition costs in institutionalized or community-dwelling older adults.

Design

A systematic search of the literature published until December 2013 was performed using standard literature, international and national electronic databases, including MedLine/PubMed, Cochrane Library, ISI WOK, SCOPUS, MEDES, IBECS, and Google Scholar. Publications identified referred to the economic burden and use of medical resources associated with malnutrition (or risk of malnutrition) in institutionalized or community-dwelling older adults, written in either English or Spanish. Costs were updated to 2014 (€).

Results

A total of 9 studies of 46 initially retrieved met the preestablished criteria and were submitted to thorough scrutiny. All publications reviewed involved studies conducted in Europe, and the results regarding the contents of all the studies showed that total costs associated with malnutrition in institutionalized and community-dwelling older adults were considerably higher than those of well-nourished ones, mainly due to a higher use of health care resources (GP consultations, hospitalizations, health care monitoring, and treatments). Interventions to reduce the prevalence of malnutrition, such as the use of oral nutritional supplements, showed an important decrease in-hospital admissions and medical visits.

Conclusion

Malnutrition is associated with higher health care costs in institutionalized or community-dwelling older adults. The adoption of nutritional interventions, such as oral nutritional supplements, may have an important impact in reducing annual health care costs per patient.

Section snippets

Methods

A systematic literature search regarding malnutrition costs or the resources use in institutionalized or community-dwelling older adults was performed. All publications until December 2013 were included. International (MedLine/PubMed, Cochrane Library, ISI Web of Knowledge [ISI WOK], SCOPUS) and national electronic databases (Medicina en Español [MEDES], Índice Bibliográfico Español en Ciencias de la Salud [IBECS]) were used, including Google Scholar. The English search terms used are

Results

A total of 1105 titles of publications were identified, of which 1059 were excluded, as they were duplicates or did not contain any relevant information. After full-text reading and application of the inclusion/exclusion criteria, 9 of the 46 retrieved publications were included in the present review (Figure 1).

All the studies reviewed included European populations (3 of 9 were conducted in the Netherlands, 3 in United Kingdom, 1 in Ireland, 1 in Sweden, and 1 in France).

Despite the

Discussion

According to this systematic review of the literature, only a select number of studies have addressed the direct medical costs of malnutrition and/or DRM in institutionalized and community-dwelling older adults, as well as the economic impact of specific preventive or therapeutic interventions on malnutrition costs in this population. Although there are important methodological differences between the selected publications, which might hamper robust comparisons among studies, the information

Conclusion

Our systematic review suggests that malnutrition and DRM are important burdens of illness, mainly because of their high prevalence associated with the aging population in Western societies, leading to increased morbidity and mortality, decreasing patients' quality of life, and resulting in increased health care and societal costs. For these reasons, even a small reduction in their prevalence or severity might have the potential to cause substantial savings for the health care system, as DRM is

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All authors, except Núria Barcons, declare no conflict of interest.

Funded by a grant from Nestlé Health Science. Red Temática de Investigación Cooperativa Fragilidad y Envejecimiento-RETICEF-Instituto de Salud Carlos III, Ministerio de Economía y Competitividad, España RD12/43 provided support to develop this project.

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