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



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


      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 (€).


      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.


      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.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of the American Medical Directors Association
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Stratton R.J.
        • Green C.J.
        • Elia M.
        Disease-related malnutrition: An evidence-based approach to treatment.
        Am J Clin Nutr. 2004; 79: 1128-1129
        • Lochs H.
        • Allison S.P.
        • Meier R.
        • et al.
        Introductory to the ESPEN Guidelines on Enteral Nutrition: Terminology, definitions and general topics.
        Clin Nutr. 2006; 25: 180-186
        • Saletti A.
        • Lindgren E.Y.
        • Johansson L.
        • Cederholm T.
        Nutritional status according to mini nutritional assessment in an institutionalized elderly population in Sweden.
        Gerontology. 2000; 46: 139-145
        • Correia M.I.
        • Waitzberg D.L.
        The impact of malnutrition on morbidity, mortality, length of hospital stay and costs evaluated through a multivariate model analysis.
        Clin Nutr. 2003; 22: 235-239
        • Elia M.
        • Russell C.
        The cost of disease-related malnutrition in the UK and economic considerations for the use of Oral Nutritional Supplements (ONS) in adults.
        BAPEN, Redditch, United Kingdom2003
        • de la Rica-Escuín M.
        • González-Vaca J.
        • Varela-Pérez R.
        • et al.
        Frailty and mortality or incident disability in institutionalized older adults: The FINAL study.
        Maturitas. 2014; 78: 329-334
        • Edington J.
        • Winter P.D.
        • Coles S.J.
        • et al.
        Outcomes of undernutrition in patients in the community with cancer or cardiovascular disease.
        Proc Nutr Soc. 1999; 58: 655-661
        • McWhirter J.P.
        • Pennington C.R.
        Incidence and recognition of malnutrition in hospital.
        BMJ. 1994; 308: 945-948
        • Rasmussen H.H.
        • Kondrup J.
        • Staun M.
        • et al.
        Prevalence of patients at nutritional risk in Danish hospitals.
        Clin Nutr. 2004; 23: 1009-1015
        • Meijers J.M.
        • Schols J.M.
        • van Bokhorst-de van der Schueren M.A.
        • et al.
        Malnutrition prevalence in The Netherlands: Results of the annual Dutch national prevalence measurement of care problems.
        Br J Nutr. 2009; 101: 417-423
        • Edington J.
        • Boorman J.
        • Durrant E.R.
        • et al.
        Prevalence of malnutrition on admission to four hospitals in England. The Malnutrition Prevalence Group.
        Clin Nutr. 2000; 19: 191-195
        • Eriksson B.G.
        • Dey D.K.
        • Hessler R.M.
        • et al.
        Relationship between MNA and SF-36 in a free-living elderly population aged 70 to 75.
        J Nutr Health Aging. 2005; 9: 212-220
        • Jiménez-Redondo S.
        • Beltrán de Miguel B.
        • Gavidia Banegas J.
        • et al.
        Influence of nutritional status on health-related quality of life of non-institutionalized older people.
        J Nutr Health Aging. 2014; 18: 359-364
        • Vellas B.J.
        • Hunt W.C.
        • Romero L.J.
        • et al.
        Changes in nutritional status and patterns of morbidity among free-living elderly persons: A 10-year longitudinal study.
        Nutrition. 1997; 13: 515-519
        • Agarwal E.
        • Miller M.
        • Yaxley A.
        • Isenring E.
        Malnutrition in the elderly: A narrative review.
        Maturitas. 2013; 76: 296-302
        • Potter J.M.
        Oral supplements in the elderly.
        Curr Opin Clin Nutr Metab Care. 2001; 4: 21-28
        • Potter J.M.
        • Roberts M.A.
        • McColl J.H.
        • Reilly J.J.
        Protein energy supplements in unwell elderly patients—a randomized controlled trial.
        JPEN J Parenter Enteral Nutr. 2001; 25: 323-329
        • Smith P.E.
        • Smith A.E.
        High-quality nutritional interventions reduce costs.
        Healthc Financ Manage. 1997; 51: 66-69
        • Lauque S.
        • Arnaud-Battandier F.
        • Mansourian R.
        • et al.
        Protein-energy oral supplementation in malnourished nursing-home residents. A controlled trial.
        Age Ageing. 2000; 29: 51-56
      1. OCEBM Levels of Evidence Working Group. “The Oxford Levels of Evidence 2.” Oxford Centre for Evidence-Based Medicine. Available at: Accessed November 21, 2013.

        • Freijer K.
        • Tan S.S.
        • Koopmanschap M.A.
        • et al.
        The economic costs of disease related malnutrition.
        Clin Nutr. 2013; 32: 136-141
        • Meijers J.M.
        • Halfens R.J.
        • Wilson L.
        • Schols J.M.
        Estimating the costs associated with malnutrition in Dutch nursing homes.
        Clin Nutr. 2012; 31: 65-68
        • Rice N.
        • Normand C.
        The cost associated with disease-related malnutrition in Ireland.
        Public Health Nutr. 2012; 15: 1966-1972
        • Guest J.F.
        • Panca M.
        • Baeyens J.P.
        • et al.
        Health economic impact of managing patients following a community-based diagnosis of malnutrition in the UK.
        Clin Nutr. 2011; 30: 422-429
        • Freijer K.
        • Nuijten M.J.
        • Schols J.M.
        The budget impact of oral nutritional supplements for disease related malnutrition in elderly in the community setting.
        Front Pharmacol. 2012; 3: 78
        • Lorefält B.
        • Andersson A.
        • Wirehn A.B.
        • Wilhelmsson S.
        Nutritional status and health care costs for the elderly living in municipal residential homes—an intervention study.
        J Nutr Health Aging. 2011; 15: 92-97
        • Kilonzo M.M.
        • Vale L.D.
        • Cook J.A.
        • et al.
        A cost-utility analysis of multivitamin and multimineral supplements in men and women aged 65 years and over.
        Clin Nutr. 2007; 26: 364-370
        • Edington J.
        • Barnes R.
        • Bryan F.
        • et al.
        A prospective randomised controlled trial of nutritional supplementation in malnourished elderly in the community: Clinical and health economic outcomes.
        Clin Nutr. 2004; 23: 195-204
        • Arnaud-Battandier F.
        • Malvy D.
        • Jeandel C.
        • et al.
        Use of oral supplements in malnourished elderly patients living in the community: A pharmaco-economic study.
        Clin Nutr. 2004; 23: 1096-1103
        • Stratton R.J.
        • Hébuterne X.
        • Elia M.
        A systematic review and meta-analysis of the impact of oral nutritional supplements on hospital readmissions.
        Ageing Res Rev. 2013; 12: 884-897
        • Neelemaat F.
        • Bosmans J.E.
        • Thijs A.
        • et al.
        Oral nutritional support in malnourished elderly decreases functional limitations with no extra costs.
        Clin Nutr. 2012; 31: 183-190
        • Norman K.
        • Pirlich M.
        • Smoliner C.
        • et al.
        Cost-effectiveness of a 3-month intervention with oral nutritional supplements in disease-related malnutrition: A randomised controlled pilot study.
        Eur J Clin Nutr. 2011; 65: 735-742
        • Stratton R.J.
        Malnutrition: Another health inequality?.
        Proc Nutr Soc. 2007; 66: 522-529
        • Gómez Candela C.
        • Cantón Blanco A.
        • Luengo Pérez L.M.
        • Fuster G.O.
        Efficacy, cost-effectiveness, and effects on quality of life of nutritional supplementation.
        Nutr Hosp. 2010; 25: 781-792