Development of a Model on Determinants of Malnutrition in Aged Persons: A MaNuEL Project

Abstract

In older persons, the origin of malnutrition is often multifactorial with a multitude of factors involved. Presently, a common understanding about potential causes and their mode of action is lacking, and a consensus on the theoretical framework on the etiology of malnutrition does not exist. Within the European Knowledge Hub "Malnutrition in the Elderly (MaNuEL)," a model of "Determinants of Malnutrition in Aged Persons" (DoMAP) was developed in a multistage consensus process with live meetings and written feedback (modified Delphi process) by a multiprofessional group of 33 experts in geriatric nutrition. DoMAP consists of three triangle-shaped levels with malnutrition in the center, surrounded by the three principal conditions through which malnutrition develops in the innermost level: low intake, high requirements, and impaired nutrient bioavailability. The middle level consists of factors directly causing one of these conditions, and the outermost level contains factors indirectly causing one of the three conditions through the direct factors. The DoMAP model may contribute to a common understanding about the multitude of factors involved in the etiology of malnutrition, and about potential causative mechanisms. It may serve as basis for future research and may also be helpful in clinical routine to identify persons at increased risk of malnutrition.

Keywords: determinants; etiology; malnutrition; model; older persons.

Figure 1.

Development process of the DoMAP model on Determinants of Malnutrition in Aged Persons. Note. MaNuEL = Malnutrition in the Elderly Knowledge Hub (Visser et al., 2017).

Figure 2.

DoMAP model. All factors—independent of the level—are regarded as (potential) “determinants” of MN meaning that they may contribute to the development of MN in a causative manner. The levels illustrate different modes of action: Level 1 (dark green): Central etiologic mechanisms; Level 2 (light green): Factors in this level directly lead to one of the three mechanisms in Level 1 (e.g., swallowing problems may directly cause low intake); Level 3 (yellow): Factors in this level may indirectly lead to one (or more) of the three central mechanisms through one (or more) of the direct factors in the light green triangle (e.g., stroke may cause low intake via dysphagia or difficulties with eating); surrounding factors in red are age-related changes and general aspects which also contribute to the development of MN, but act even more indirectly or subtle. DoMAP = Determinants of Malnutrition in Aged Persons; MN = malnutrition.