Practical Approaches to Nutritional Interventions for Malnutrition, Sarcopenia, and Frailty in Community-Dwelling Older Adults and Care Home Populations: A Narrative Review

Background: Average life expectancy has increased substantially on a global scale; this demographic shift presents considerable public health challenges, as increased longevity is accompanied by higher prevalence of chronic diseases, functional decline, and dependency. Malnutrition, sarcopenia, and frailty frequently coexist in older adults, particularly among care home residents. These interrelated conditions contribute to adverse clinical outcomes including falls, hospitalisation, and reduced quality of life. Despite their growing recognition, gaps remain in understanding optimal nutritional intervention strategies and their implementation in care home settings. Purpose and scope: This literature review examines the interplay between malnutrition, sarcopenia, and frailty in older adults, with particular focus on care home populations. The review evaluates evidence-based nutritional interventions, including the Food First approach, food fortification, and oral nutritional supplements (ONSs), and explores factors influencing intervention adherence and effectiveness. Main findings and conclusions: Evidence demonstrates that malnutrition, sarcopenia, and frailty share common pathophysiological mechanisms and overlapping clinical features such as unintended weight loss and age-related loss of muscle mass and strength yet represent distinct conditions requiring targeted assessment and intervention. While food fortification effectively increases energy and protein intake, when insufficient, ONS have been shown to significantly increase energy intake, BMI, as well as improve functional outcomes, reduce hospitalisation rates, and demonstrate cost effectiveness. However, adherence remains challenging and can be affected by barriers related to personal, contextual or product-related factors. Such nutritional strategies, particularly when combined with others such as physical activity/exercise as part of a multimodal approach, and focusing on providing an individualised, patient-centred care may help to achieve optimal outcomes in older adults. Further research is needed to establish standardised protocols for implementing combined nutritional and multimodal strategies in diverse care environments to optimise health outcomes for older adults.