Barriers and facilitators in the implementation of nutrition interventions to prevent or treat malnutrition in older adults: A scoping review

Malnutrition among community-dwelling older adults (OAs) is prevalent, particularly in groups using healthcare services. Malnutrition burdens health, social, and aged-care systems in terms of expenses for hospital admissions and care in nursing homes and home care settings. Effective management requires early identification and multimodal interventions; however, studies report a significant gap between recommended nutrition interventions and current healthcare practices. Therefore, this study aimed to identify, present, and map existing evidence on barriers and facilitators in the implementation of nutrition interventions among OAs living in noninstitutional municipal healthcare settings. A scoping review following the Joanna Briggs Institute guidelines and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for Scoping Reviews checklist were conducted. The study included evidence from bibliographic databases and gray-evidence sources that identify barriers and/or facilitators from stakeholder perspectives that influence the implementation of nutrition interventions for malnutrition prevention or treatment among OAs (≥65 years) in noninstitutional municipal healthcare settings. Stakeholders were OAs, informal caregivers, or healthcare professionals (HCPs). Thirty-seven articles were included and 10 categories identified. Barriers were (1) lack of knowledge and awareness among HCPs, (2) lack of resources, (3) lack of collaboration and communication, (4) missing links between healthcare settings, and (5) poor insight among OAs and caregivers. Facilitators were (1) education and training of HCPs, (2) self-care, (3) person-centered care, (4) technology in nutrition care, and (5) social and psychological factors. Findings from this review indicate an imperative need for targeted implementation strategies for developing evidence-based nutrition home care practice.