BACKGROUND: Malnutrition and dehydration are widespread in older people, and obesity is an increasing problem. In clinical practice, it is often unclear which strategies are suitable and effective in counteracting these key health threats. AIM: To provide evidence-based recommendations for clinical nutrition and hydration in older persons in order to prevent and/or treat malnutrition and dehydration. Further, to address whether weight-reducing interventions are appropriate for overweight or obese older persons. METHODS: This guideline was developed according to the standard operating procedure for ESPEN guidelines and consensus papers. A systematic literature search for systematic reviews and primary studies was performed based on 33 clinical questions in PICO format. Existing evidence was graded according to the SIGN grading system. Recommendations were developed and agreed in a multistage consensus process. RESULTS: We provide eighty-two evidence-based recommendations for nutritional care in older persons, covering four main topics: Basic questions and general principles, recommendations for older persons with malnutrition or at risk of malnutrition, recommendations for older patients with specific diseases, and recommendations to prevent, identify and treat dehydration. Overall, we recommend that all older persons shall routinely be screened for malnutrition in order to identify an existing risk early. Oral nutrition can be supported by nursing interventions, education, nutritional counselling, food modification and oral nutritional supplements. Enteral nutrition should be initiated if oral, and parenteral if enteral nutrition is insufficient or impossible and the general prognosis is altogether favorable. Dietary restrictions should generally be avoided, and weight-reducing diets shall only be considered in obese older persons with weight-related health problems and combined with physical exercise. All older persons should be considered to be at risk of low-intake dehydration and encouraged to consume adequate amounts of drinks. Generally, interventions shall be individualized, comprehensive and part of a multimodal and multidisciplinary team approach. CONCLUSION: A range of effective interventions is available to support adequate nutrition and hydration in older persons in order to maintain or improve nutritional status and improve clinical course and quality of life. These interventions should be implemented in clinical practice and routinely used.

3rd Department of Medicine Medical Faculty and Faculty Hospital Hradec Kralove Charles University Czech Republic

APHP Department of Geriatrics Bichat Hospital University of Paris Paris France

Department for Clinical Nutrition University of Hohenheim Stuttgart Germany

Department of Geriatric Medicine of the Radboud University Medical Center Nijmegen the Netherlands

Department of Medicine and Surgery University of Parma Geriatric Rehabilitation Department Parma University Hospital Parma Italy

Department of Public Health and Caring Sciences Division of Clinical Nutrition and Metabolism Uppsala University Uppsala Sweden; Theme Inflammation and Aging Karolinska University Hospital Stockholm Sweden

Dietetic and Nutritional Research Unit Herlev and Gentofte University Hospital University College Copenhagen Faculty of Health Institute of Nutrition and Nursing Copenhagen Denmark

Institute for Biomedicine of Aging Friedrich Alexander Universität Erlangen Nürnberg Nuremberg Germany

Institute for Biomedicine of Aging Friedrich Alexander Universität Erlangen Nürnberg Nuremberg Germany; Department of Medicine Kantonsspital Winterthur Winterthur Switzerland

Marien Hospital Herne Ruhr Universität Bochum Herne Germany

Norwich Medical School University of East Anglia Norwich UK

Servicio de Geriatría Hospital Universitario Ramón y Cajal Madrid Spain

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