Barriers and facilitators to screening and treating malnutrition in older adults living in the community: A mixed-methods synthesis

Philine S. Harris, Liz Payne*, Leanne Morrison, Sue M. Green, Daniela Ghio, Claire Hallett, Emma L. Parsons, Paul Aveyard, Helen C. Roberts, Michelle Sutcliffe, Siân Robinson, Joanna Slodkowska-Barabasz, Paul S. Little, Michael A. Stroud, Lucy Yardley

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

4 Citations (Scopus)
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Background: Malnutrition (specifically undernutrition) in older, community-dwelling adults reduces well-being and predisposes to disease. Implementation of screen-and-treat policies could help to systematically detect and treat at-risk and malnourished patients. We aimed to identify barriers and facilitators to implementing malnutrition screen and treat policies in primary/community care, which barriers have been addressed and which facilitators have been successfully incorporated in existing interventions. Method: A data-base search was conducted using MEDLINE, Embase, PsycINFO, DARE, CINAHL, Cochrane Central and Cochrane Database of Systematic Reviews from 2012 to June 2016 to identify relevant qualitative and quantitative literature from primary/community care. Studies were included if participants were older, community-dwelling adults (65+) or healthcare professionals who would screen and treat such patients. Barriers and facilitators were extracted and mapped onto intervention features to determine whether these had addressed barriers. Results: Of a total of 2182 studies identified, 21 were included (6 qualitative, 12 quantitative and 3 mixed; 14 studies targeting patients and 7 targeting healthcare professionals). Facilitators addressing a wide range of barriers were identified, yet few interventions addressed psychosocial barriers to screen-and-treat policies for patients, such as loneliness and reluctance to be screened, or healthcare professionals' reservations about prescribing oral nutritional supplements. Conclusion: The studies reviewed identified several barriers and facilitators and addressed some of these in intervention design, although a prominent gap appeared to be psychosocial barriers. No single included study addressed all barriers or made use of all facilitators, although this appears to be possible. Interventions aiming to implement screen-and-treat approaches to malnutrition in primary care should consider barriers that both patients and healthcare professionals may face. Review registrations: PROSPERO: CRD42017071398. The review protocol was registered retrospectively.

Original languageEnglish
Article number100
Number of pages11
JournalBMC Family Practice
Issue number1
Publication statusPublished - 15 Jul 2019

Structured keywords

  • Physical and Mental Health


  • Primary Health Care
  • General practice
  • Malnutrition
  • Independent Living
  • Health Services for the Aged
  • Dietary Supplements

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