Malnutrition Prevalence and Nutrient Intakes of Indonesian Older Adults in Institutionalized Care Setting: A Systematic Review of Observational Studies.

Introduction: Data on the prevalence of malnutrition and nutrient intakes among Indonesian older adults in institutionalized care setting are scattered and scarce. Thus, we conducted a systematic review of published and gray literature to estimate (1) the prevalence of malnutrition, (2) the level and distribution of habitual energy and nutrient intakes, and (3) the prevalence of inadequacy of energy and nutrient intakes among hospitalized and institutionalized older adults in Indonesia. Methods: This systematic review was written following the PRISMA 2020 checklist. The population of this review was Indonesian older adults in institutionalized care settings, including hospital wards, orphanages, nursing homes, residential facilities, and rehabilitation centers. Malnutrition was assessed using body mass index, the Mini Nutritional Assessment (MNA) score, or the subjective global assessment (SGA) score. The dietary intakes (from food recalls, food records, or food frequency questionnaire) were compared with the Indonesian Recommended Dietary Allowances for people aged 65–80. The prevalence of inadequacy was calculated using two-thirds of the Recommended Dietary Allowance as a proxy for the estimated average requirement. Results: The search yielded 330 studies from electronic databases, resulting in fifteen eligible studies. One report was obtained from an unpublished study. Based on the JBI criteria, most studies had low risk of bias and represented the target population. The prevalence of malnutrition in hospital, nursing home, and other institutionalized care ranged from 6.5% to 48.3% in hospitals and 3.2% to 61.0% in other institutionalized care units. In the hospital setting, there was a high prevalence of inadequacies for all nutrients, particularly protein (20%), calcium (more than 90%), and vitamin D intakes (more than 50%). In nursing homes, these proportions were exceptionally high for protein (66%) and calcium and vitamin D intakes (almost 100%). Conclusion: The high risk of malnutrition in Indonesian older adults in institutionalized care setting is pronounced, along with poor intakes of macronutrients and micronutrients in both settings. Plain Language Summary: This systematic review aimed to understand how many Indonesian elderly receiving care in institutional care units such as hospitals, nursing home, rehabilitation unit, and other type of units had malnutrition. Additionally, this systematic review also assessed the intake of several nutrients in the same population, namely, protein, carbohydrate, fat, calcium, and vitamins. This study included references that are not formally published in a research journal as its reference since data on the topic were quite prevalent in the unpublished literature, including theses and governmental reports. This is something that is not usually done in a systematic review, thus serving as a selling point of this study. This review found varying percentages of elderly with impaired nutritional status, which differs across several types of care units. [ABSTRACT FROM AUTHOR]