The DOI matches its Crossref record; 289 of the 289 references it cites were found in a registry or an index; 166 of the 427 sources its claims cite were checked for support.
ESPEN practical guideline: Clinical nutrition and hydration in geriatrics
Open accessAbstract
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.
Overview
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Written from the paper’s full text.
TL;DR
This ESPEN practical guideline presents 82 recommendations for clinical nutrition and hydration in older persons, covering malnutrition, dehydration, and obesity management. It condenses the 2019 ESPEN geriatrics guideline into a practical/graphical format without changing the original recommendations.
Key findings
- A general energy guiding value is 30 kcal/kg body weight/day, individually adjusted; protein intake should be at least 1 g/kg BW/day, with 1.0–1.2 g/kg suggested for healthy older persons, 1.2–1.5 g/kg in acute or chronic illness, and up to 2.0 g/kg in severe illness, injury, or malnutrition.
- Older women should be offered at least 1.6 L of drinks/day and older men at least 2.0 L/day unless a clinical condition requires a different approach; this is based on EFSA adequate intake of 2.0 L/day for women and 2.5 L/day for men, assuming 80% comes from drinks.
- ONS should provide at least 400 kcal/day including 30 g or more protein/day, be continued for at least one month, and have efficacy/expected benefit assessed monthly; in 46 trials, overall ONS compliance was 78%, better in the community (81%) than in hospital (67%).
- Low-intake dehydration should be identified using directly measured serum/plasma osmolality >300 mOsm/kg, or calculated osmolarity >295 mmol/L if direct measurement is unavailable; simple signs/tests and bioelectrical impedance should not be used to assess hydration status in older adults.
Methods
- This practical guideline consists of 82 recommendations based on the 2019 ESPEN guideline on clinical nutrition and hydration in geriatrics; the original was shortened, commentaries focused on the underlying evidence/literature, recommendations were not changed, and content was transformed into a graphical presentation.
- The original guideline was developed according to the ESPEN standard operating procedure; a comprehensive systematic literature search was performed on 4 July 2016 based on 33 clinical questions in PICO format, with evidence graded by SIGN and recommendations graded A/B/0/GPP.
- Recommendations were agreed through a multistage consensus process with percentage agreement reported; funding was exclusively from ESPEN, with guideline shortage and dissemination funded in part by UEG and ESPEN.
Limitations
- The paper states that evidence is often poor, heterogeneous, or limited: for example, multimodal/multidisciplinary evidence grade was reduced from A to B, home-delivered meals was downgraded to B, nutritional counseling was downgraded to B, and pressure ulcer recommendation was downgraded to B because only one RCT documented benefit.
- The paper states that the original guideline was shortened and recommendations were not changed; for further methodology details it refers readers to the full ESPEN guideline and ESPEN SOP.
- Evident from the text: the systematic search date was 2016, so later evidence is not incorporated; many recommendations are GPP/consensus-based rather than high-grade evidence, and some guidance relies on clinical experience or common sense (e.g., counseling duration, the four-week EN time frame described as “somehow arbitrary”).
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Claims the paper makes
96 No full text of the sources · 48 Partly supported · 35 No basis given · 34 Supported · 20 Supported so far · 15 Not checked yet · 15 Own interpretation · 5 Sources not found · 5 Own method · 2 Couldn’t confirm · 1 Mixed support · 1 Not supported · 1 Own result · accuracy not yet measured
Some cited sources support this claim and some don’t — read each source’s verdict below.
In the paper
“as meta-analyses indicate that the mortality risk of healthy older people is lowest in the overweight range (279-281).”
§ Clinical nutrition and hydration in geriatrics > J o u r n a l P r e -p r o o f
What the sources say
- Disputedcites [279] Di Angelantonio, 2016, Body-mass index and all-cause mortality: individual-participant-data meta-analysis of 239 prospective studies in four continents, Lancet sourceExperimental — accuracy not yet measured
The Results report that mortality was lowest at BMI 20–<25 kg/m², below the overweight range. For participants aged 70–89, the reported nadir was BMI 24 kg/m², also below the overweight threshold of 25 kg/m². The Discussion explicitly challenges earlier claims that overweight is associated with lower mortality. (LLM, conf=0.94)
Checked by a reasoning model — may be wrong.
- Partly supportedcites [280] Winter, 2014, BMI and all-cause mortality in older adults: a meta-analysis, Am J Clin Nutr sourceExperimental — accuracy not yet measured
Table 2 and the Discussion (page not supplied) place the lowest estimated mortality risk in the overweight BMI range for adults aged 65 or older. The meta-analysis studied community-dwelling older adults, not a population restricted to healthy people, so the claim's health qualifier is not established by this source. (LLM, conf=0.84)
- Partly supportedcites [281] Flegal, 2013, Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis, JAMA sourceExperimental — accuracy not yet measured
Table 2 reports lower all-cause mortality for the overweight category among adults aged 65 or older (HR 0.90, 95% CI 0.86–0.95, relative to normal weight). But the review does not establish that risk is lowest specifically among healthy older people: its age subgroup is not restricted to healthy participants, and it does not establish a definitive lowest-risk BMI range. (LLM, conf=0.86)
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
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- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Disputed
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“and is regarded as one important contributing factor in the complex etiology of sarcopenia and frailty (1,3,4).”
§ Clinical nutrition and hydration in geriatrics > Introduction
What the sources say
- Supportedcites [1] Morley, 2017, Anorexia of ageing: a key component in the pathogenesis of both sarcopenia and cachexia, J Cachexia Sarcopenia Muscle source
The paper’s main text (indexed under Abstract; page not specified) says age-related anorexia decreases muscle mass and that sarcopenia has multiple causes. It also identifies weight loss together with sarcopenia as major causes of physical frailty and recommends treating nutritional abnormalities in older people. This supports the claim that poor nutrition is a contributing factor, rather than the sole cause, of sarcopenia and frailty. (LLM, conf=0.88)
- Partly supportedcites [3] Cruz-Jentoft, 2010, European working group on sarcopenia in older people: sarcopenia: European consensus on definition and diagnosis. Report of the European workign group on sarcopenia in older people, Age Ageing sourceExperimental — accuracy not yet measured
In “Sarcopenia as a geriatric syndrome” (page not provided), the paper lists less-than-optimal diet among several contributing factors to sarcopenia. Its “Frailty” section (page not provided) describes overlap with sarcopenia and includes unintended weight loss in a frailty definition, but does not identify malnutrition as a contributing cause of frailty. (LLM, conf=0.84)
- Supportedcites [4] Clegg, 2013, Frailty in elderly people, Lancet source
In “Frail skeletal muscle—sarcopenia,” the paper says nutritional factors influence muscle homeostasis and identifies sarcopenia as a key component of frailty. In “The pathway to frailty,” it also says nutritional status can mediate frailty. Together, these passages support the claim that poor nutrition is a contributing factor in their complex development. (LLM, conf=0.88)
plainconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“In healthy and sick elderly persons, measurements of REE resulted in about 20 kcal/kg body weight (BW) and day (14)(15)(16).”
§ Clinical nutrition and hydration in geriatrics > Commentary
What the sources say
- Not checked — no full text of the sourcecites [14] Alix, 2007, Energy requirements in hospitalized elderly people, J Am Geriatr Soc source
- Partly supportedcites [15] Gaillard, 2008, A practical approach to estimate resting energy expenditure in frail elderly people, J Nutr Health Aging sourceExperimental — accuracy not yet measured
The Results (Predicted resting energy expenditure; page unavailable) report measured weight-adjusted REE close to 20 kcal/kg/day in the study’s sick elderly patients: 19.1 in normal-weight patients and 22.4 in underweight patients. The paper does not establish that figure for healthy elderly people, so the claim extends beyond the population studied. (LLM, conf=0.88)
- Not checked — no full text of the sourcecites [16] Gaillard, 2007, Energy requirements in frail elderly people: a review of the literature, Clin Nutr source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“One study in malnourished community-dwelling older adults failed to show any effect of individual nutritional advice and physical training (83).”
§ Clinical nutrition and hydration in geriatrics > Commentary
What the sources say
- Partly supportedcites [83] Lammes, 2012, Effects of nutritional intervention and physical training on energy intake, resting metabolic rate and body composition in frail elderly. a randomised, controlled pilot study, J Nutr Health Aging sourceExperimental — accuracy not yet measured
The Abstract conclusion reports no effect of individual nutrition counselling and physical exercise on energy intake, resting metabolic rate or fat-free mass in community-dwelling frail adults aged 75 and older. But the Results say only three of 93 participants were classified as malnourished, so the claim mischaracterizes the study population. The Discussion also reports a small, statistically significant increase in resting metabolic rate in the training group, making “any effect” too broad. (LLM, conf=0.90)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Partly supported
The sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
In the paper
“Five RCTs were identified comparing combined exercise and nutrition interventions to singular exercise interventions in older people with malnutrition or at risk of J o u r n a l P r e -p r o o f malnutrition (83,87,(94)(95)(96).”
§ Clinical nutrition and hydration in geriatrics > Commentary
What the sources say
- Supportedcites [83] Lammes, 2012, Effects of nutritional intervention and physical training on energy intake, resting metabolic rate and body composition in frail elderly. a randomised, controlled pilot study, J Nutr Health Aging source
The Randomisation section describes a pilot RCT with separate nutrition-and-training and training-only arms. The Inclusion criteria section specifies participants aged 75 or older with unintentional weight loss and/or low BMI, consistent with nutritional risk. This paper supports its identification as one of the cited RCTs; it does not itself establish the citing document’s total of five. (LLM, conf=0.89)
- Not checked — no full text of the sourcecites [87] Miller, 2006, Nutritional supplementation and resistance training in nutritionally at risk older adults following lower limb fracture: a randomized controlled trial, Clin Rehabil source
- Supportedcites [94] Sugawara, 2012, Effect of anti-inflammatory supplementation with whey peptide and exercise therapy in patients with COPD, Respir Med source
The Introduction (page not available) says 36 elderly COPD patients with %ideal body weight below 110% were randomly allocated to supplementation or control groups; both received exercise therapy. The Method (page not available) confirms the comparison of supplementation plus exercise with exercise without the supplement. This citation identifies one of the trials in the citing authors’ five-trial count, rather than attributing that count to this paper. (LLM, conf=0.89)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
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- Supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“Adequate amounts of protein are at least as important to avoid muscle atrophy and to stimulate muscle protein synthesis (93) (see recommendation 2).”
§ Clinical nutrition and hydration in geriatrics > Commentary
What the sources say
- Supportedcites [93] Argilés, 2016, Skeletal muscle regulates metabolism via interorgan crosstalk: roles in health and disease, J Am Med Dir Assoc source
In “Nutritional Strategies for Maintaining and Rebuilding Muscle,” the paper says adequate energy is a first step, high protein intake is vital to treating or delaying muscle atrophy, and sufficient protein is the most direct way to prevent muscle loss. The same section says branched-chain amino acids promote muscle protein synthesis. (LLM, conf=0.90)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Supported
The sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
In the paper
“Four of them -one in COPD patients (94), two in rehabilitation patients (95,96), one in malnourished patients with lower limb fracture (87) -reported positive effects of oral nutritional supplementation in combination with exercise training on various outcome parameters, e.g.BW (87,94,95), MNA score (95), muscle mass (95,96).”
§ Clinical nutrition and hydration in geriatrics > Commentary
What the sources say
- Not checked — no full text of the sourcecites [87] Miller, 2006, Nutritional supplementation and resistance training in nutritionally at risk older adults following lower limb fracture: a randomized controlled trial, Clin Rehabil source
- Supportedcites [94] Sugawara, 2012, Effect of anti-inflammatory supplementation with whey peptide and exercise therapy in patients with COPD, Respir Med source
The Introduction describes random allocation of COPD patients to nutritional supplementation or a control condition alongside exercise therapy. The Results report a significant increase in body weight after 12 weeks in the supplementation-and-exercise group. In the citing sentence, this paper is cited for the COPD trial and body-weight outcome; the MNA and muscle-mass outcomes are assigned to other citations. (LLM, conf=0.94)
- Not checked — no full text of the sourcecites [95] Rondanelli, 2016, Whey protein, amino acids, and vitamin D supplementation with physical activity increases fat-free mass and strength, functionality, and quality of life and decreases inflammation in sarcopenic elderly, Am J Clin Nutr source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
In the paper
“as the older muscle is still able to react on anabolic stimuli of exercise training (89)(90)(91).”
§ Clinical nutrition and hydration in geriatrics > Commentary
What the sources say
- Supportedcites [89] Liu, 2009 source
The Background (‘How the intervention might work’; page not provided) says that muscles of people aged 60 and older remain adaptable, even in extreme old age, and that training can produce large strength gains. This supports the citing sentence’s general point that older muscle can respond to exercise training. (LLM, conf=0.86)
- Not checked — no full text of the sourcecites [90] Steib, 2010, Dose-response relationship of resistance training in older adults: a meta-analysis, Med Sci Sports Exerc source
- Not checked — no full text of the sourcecites [91] Giné-Garriga, 2014, Physical exercise interventions for improving performance-based measures of physical function in community-dwelling, frail older adults: a systematic review and meta-analysis, Arch Phys Med Rehabil source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Supported
The sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
In the paper
“Seven RCTs (low/acceptable quality) were found using a four factorial design with an exercise group and a control group in addition to the two aforementioned intervention groups (81)(82)(83)(84)(85)(86)(87)(88).”
§ Clinical nutrition and hydration in geriatrics > Commentary
What the sources say
- Not checked — no full text of the sourcecites [81] Rydwik, 2008, Effects of a physical and nutritional intervention program for frail elderly people over age 75. A randomized controlled pilot treatment trial, Aging Clin Exp Res source
- Not checked — no full text of the sourcecites [82] Rydwik, 2010, Effects of a physical training and nutritional intervention program in frail elderly people regarding habitual physical activity level and activities of daily living—a randomized controlled pilot study, Arch Gerontol Geriatr source
- Supportedcites [83] Lammes, 2012, Effects of nutritional intervention and physical training on energy intake, resting metabolic rate and body composition in frail elderly. a randomised, controlled pilot study, J Nutr Health Aging source
Split into 2 atoms — 2 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Texturemodification can also make the swallowing process slower and thereby safer (105, 106).”
§ Clinical nutrition and hydration in geriatrics > Commentary
What the sources say
- Supportedcites [105] Wirth, 2016, Oropharyngeal dysphagia in older persons–from pathophysiology to adequate intervention: a review and summary of an international expert meeting, Clin Interv Aging source
The “Texture modification of diet” section states that texture-modified food and thickened fluid are intended to make swallowing slower and thereby safer. This directly supports the claim’s qualified wording, “can.” (LLM, conf=0.94)
- Partly supportedcites [106] Baijens, 2016, European society for swallowing disorders–European union geriatric medicine society white paper: oropharyngeal dysphagia as a geriatric syndrome, Clin Interv Aging sourceExperimental — accuracy not yet measured
The Treatment > Bolus modifications section says that modifying food or liquid consistency can improve swallowing safety and that thickeners reduce penetration and aspiration. It does not say that texture modification makes swallowing slower or that slowing is why it is safer; searches for slower bolus flow and transit time did not establish that mechanism. No page number is available in our copy. (LLM, conf=0.84)
plaindirect- Asserted: passes — The authors put it forward as true.
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- Supported
- It may state two separate claims as one. 90
- Probably not a substantial claim. 49
- The quote only partly states this claim. 1
At least one cited source doesn’t support this claim or points to a different paper, and none confirmed it — see the verdicts below.
In the paper
“Prevalence rates are also low in independent, community-dwelling older persons but increase to more than one third in more frail and vulnerable older adults and those in need of care (9).”
§ Clinical nutrition and hydration in geriatrics > Introduction
What the sources say
- Disputedcites [9] Hooper, 2015, Which frail older people are dehydrated? The UK DRIE study, J Gerontol- Series A Biol Sci Med Sci sourceExperimental — accuracy not yet measured
The Abstract reports that 20% of the 188 UK long-term-care residents were dehydrated, contrary to the claim that prevalence in older adults needing care exceeds one third. Figure 2 in the Discussion separately reports 28% with impending dehydration; it does not classify them as currently dehydrated. The study does not establish a prevalence rate for independent, community-dwelling older people. (LLM, conf=0.88)
Checked by a reasoning model — may be wrong.
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Disputed
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Particularly in advanced age and in the case of acute and chronic illness, nutritional problems are widespread, and a reduced dietary intake in combination with the effects of catabolic disease rapidly leads to malnutrition (1,2).”
§ Clinical nutrition and hydration in geriatrics > Introduction
What the sources say
- Partly supportedcites [1] Morley, 2017, Anorexia of ageing: a key component in the pathogenesis of both sarcopenia and cachexia, J Cachexia Sarcopenia Muscle sourceExperimental — accuracy not yet measured
The paper’s Abstract (page unavailable) says that food intake decreases with ageing and that illness-associated inflammation can worsen anorexia and weight loss in older people. It does not establish that nutritional problems are widespread across acute and chronic illness, or that reduced intake combined with catabolic disease rapidly causes malnutrition. (LLM, conf=0.84)
- Not checked — no full text of the sourcecites [2] Agarwal, 2013, Malnutrition in the elderly: a narrative review, Maturitas source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
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It may state two separate claims as one.
- Partly supported
The sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
In the paper
“Besides malnutrition, older persons are at increased risk of dehydration for various reasons, which is also related to serious health consequences (7,8).”
§ Clinical nutrition and hydration in geriatrics > Introduction
What the sources say
- Supportedcites [7] Hooper, 2014, Water-loss dehydration and aging, Mech Ageing Dev source
Section 6 explains several reasons older people are more susceptible to water-loss dehydration, including reduced fluid reserves, a less effective thirst response, and declining kidney function. Section 9 associates dehydration in older people with serious outcomes, including falls, delirium, renal failure, stroke, and death among those hospitalized with dehydration. (LLM, conf=0.94)
- Not checked — no full text of the sourcecites [8] Hodgkinson, 2003, Maintaining oral hydration in older adults: a systematic review, Int J Nurs Pract source
plaincorrelational- Asserted: passes — The authors put it forward as true.
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- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“obesity with its well-known negative health consequences is an increasing problem also in older people, currently affecting between 18 and 30% of the worldwide population aged 65 years and older (10,11).”
§ Clinical nutrition and hydration in geriatrics > Introduction
What the sources say
- Not checked — no full text of the sourcecites [10] Gallus, 2015, Overweight and obesity in 16 European countries, Eur J Nutr source
- Partly supportedcites [11] Porter Starr, 2016, Challenges in the management of geriatric obesity in high risk populations, Nutrients sourceExperimental — accuracy not yet measured
Section 1, “Overview of the Obesity Challenge in High-Risk Populations,” describes obesity as an increasing global challenge among older adults. It does not give an 18–30% prevalence for the worldwide population aged 65 and older; its figures concern U.S. adults aged 60 and older, other age groups, or a worldwide change in prevalence rather than current prevalence. (LLM, conf=0.90)
plaindirect- Asserted: passes — The authors put it forward as true.
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- Load-bearing: fails — The paper’s conclusions may not depend on it.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Daily amounts of 1.2 -1.5 g/kg have been suggested for older persons with acute or chronic illness (17,18) and up to 2.0 g/kg BW and day in case of severe illness, injury or malnutrition (17).”
§ Clinical nutrition and hydration in geriatrics > Commentary
What the sources say
- Partly supportedcites [17] Bauer, 2013, Evidence-based recommendations for optimal dietary protein intake in older people: a position paper from the PROT-AGE Study Group, J Am Med Dir Assoc sourceExperimental — accuracy not yet measured
The Key PROT-AGE recommendations state that most older adults with acute or chronic disease need 1.2–1.5 g/kg body weight per day, and that those with severe illness or injury or with marked malnutrition may need as much as 2.0 g/kg. The citing sentence omits the qualification that malnutrition is marked, making that part broader than the source’s recommendation. (LLM, conf=0.86)
- Partly supportedcites [18] Deutz, 2014, Protein intake and exercise for optimal muscle function with aging: recommendations from the ESPEN Expert Group, Clin Nutr sourceExperimental — accuracy not yet measured
The Abstract recommends 1.2–1.5 g protein/kg body weight/day for older people who are malnourished or at risk of malnutrition because of acute or chronic illness. It also recommends higher intake for severe illness or injury, but the passages in our copy do not specify an upper amount of 2.0 g/kg/day. (LLM, conf=0.87)
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
The sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
In the paper
“Daily amounts of 1.0 -1.2 g/kg BW have been suggested for healthy older persons by several expert groups (17)(18)(19).”
§ Clinical nutrition and hydration in geriatrics > Commentary
What the sources say
- Supportedcites [17] Bauer, 2013, Evidence-based recommendations for optimal dietary protein intake in older people: a position paper from the PROT-AGE Study Group, J Am Med Dir Assoc source
The “PROT-AGE recommendations for dietary protein intake in healthy older adults” section recommends an average daily intake of 1.0–1.2 g/kg body weight for older people. This position paper supports the cited recommendation as one of the expert-group sources; the supplied passage has no page number. (LLM, conf=0.94)
- Supportedcites [18] Deutz, 2014, Protein intake and exercise for optimal muscle function with aging: recommendations from the ESPEN Expert Group, Clin Nutr source
The Dietary protein needs section supports increasing intake to 1.0–1.2 g/kg body weight/day for adults over 65. The Amount of protein section also describes recommendations from other expert groups, supporting the claim that several groups have suggested higher daily amounts. Page numbers were not available in our copy. (LLM, conf=0.93)
- Not checked — no full text of the sourcecites [19] Rizzoli, 2014, The role of dietary protein and vitamin D in maintaining musculoskeletal health in postmenopausal women: a consensus statement from the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO), Maturitas source
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
- Supported
The sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
In the paper
“Three relevant systematic literature reviews (SLRs) of high (63,64) or average quality (65) were identified, which examined the effectiveness of training for staff in residential care (64), people with dementia and/or their formal or informal care-givers (63) and informal carers and community care workers (65).”
§ Clinical nutrition and hydration in geriatrics > Commentary
What the sources say
- Supportedcites [63] Bunn, 2016, Effectiveness of interventions to indirectly support food and drink intake in people with dementia: eating and Drinking Well IN dementiA (EDWINA) systematic review, BMC Geriatr source
Split into 2 atoms — 2 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
- Not checked — no full text of the sourcecites [64] Abbott, 2013, Effectiveness of mealtime interventions on nutritional outcomes for the elderly living in residential care: a systematic review and meta-analysis, Ageing Res Rev source
- Supportedcites [65] Marshall, 2013, Are informal carers and community care workers effective in managing malnutrition in the older adult community? A systematic review of current evidence, J Nutr Health Aging source
The Methods section identifies this paper as a systematic literature review. Its search strategy specifies interventions delivered to informal carers and non-clinical community care workers, matching the part of the citing sentence attributed to reference 65. The 'average quality' label is the citing authors' assessment of the review, not a finding attributed to it. (LLM, conf=0.92)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“The SLR by Bunn et al. (63) included interventions with an educational and/or awareness component for persons J o u r n a l P r e -p r o o f with dementia and/or their formal or informal care-givers.The overall effect on nutritional status in the three RCTs included was very limited.”
§ Clinical nutrition and hydration in geriatrics > Commentary
What the sources say
- Supportedcites [63] Bunn, 2016, Effectiveness of interventions to indirectly support food and drink intake in people with dementia: eating and Drinking Well IN dementiA (EDWINA) systematic review, BMC Geriatr source
Split into 2 atoms — 2 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“However, in this study independent of the interventions, participants who needed to increase their energy intake by ≥ 20% to reach their energy requirements but failed this goal lost weight and fat-free mass during the intervention period whereas no changes were observed in those reaching this goal (83).”
§ Clinical nutrition and hydration in geriatrics > Commentary
What the sources say
- Supportedcites [83] Lammes, 2012, Effects of nutritional intervention and physical training on energy intake, resting metabolic rate and body composition in frail elderly. a randomised, controlled pilot study, J Nutr Health Aging source
The Results of intervention section compares participants who needed to increase energy intake by 20% or more across all four treatment groups. It reports no change in outcome variables among those who reached the target, but decreases in body weight and fat-free mass among those who did not. (LLM, conf=0.93)
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
The sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
In the paper
“In older people weight loss occurs at the expense of muscle mass (78) and is associated with impaired physical function (79).”
§ Clinical nutrition and hydration in geriatrics > Commentary
What the sources say
- Not checked — no full text of the sourcecites [78] Newman, 2005, Weight change and the conservation of lean mass in old age: the Health, Aging and Body Composition Study, Am J Clin Nutr source
- Supportedcites [79] Ritchie, 2008, Unintentional weight loss predicts decline in activities of daily living function and life-space mobility over 4 years among community-dwelling older adults, J Gerontol Series A: Biol Sci Med Sci source
Citation (79) is attached to the physical-function clause, not the muscle-mass clause, which cites (78). The Abstract (page unavailable) reports that unintentional weight loss was associated with a faster rate of functional decline in older adults, regardless of baseline BMI; it does not establish causation. (LLM, conf=0.93)
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
Every source the paper cites for this claim was checked and supports it.
In the paper
“Due to the heterogeneity of the studies, small numbers of participants and poor quality of some studies, the authors concluded that further high-quality studies are required to provide reliable evidence (101).”
§ Clinical nutrition and hydration in geriatrics > Commentary
What the sources say
- Supportedcites [101] Morilla-Herrera, 2016, Effectiveness of food-based fortification in older people. A systematic review and meta-analysis, J Nutr Health Aging source
The Abstract (Results) explicitly calls for further high-quality studies because of the small number of participants and poor quality of some studies. The Discussion also identifies study heterogeneity as a reason for caution about the evidence on food-based fortification. (LLM, conf=0.94)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
- Supported
The sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
In the paper
“Complication rates of EN are reported to be generally low (160), but in individual patients, both nasogastric tube feeding and PEG feeding may be harmful (136, 161).”
§ Clinical nutrition and hydration in geriatrics > Commentary
What the sources say
- Not checked — no full text of the sourcecites [136] Wirth, 2012, Complications and mortality after percutaneous endoscopic gastrostomy in geriatrics: a prospective multicenter observational trial, J Am Med Dir Assoc source
- Supportedcites [161] Sparks, 2011, Pulmonary complications of 9931 narrow-bore nasoenteric tubes during blind placement, J Parenter Enteral Nutr source
The Discussion (page not specified in our copy) says enteral nutrition delivered through nasoenteric tubes carries risks, including pneumothorax, aspiration pneumonia and death from tube malpositioning. This supports the potential harm from nasogastric tube feeding for which this source is cited; the sentence pairs the PEG-feeding point with a separate citation. (LLM, conf=0.90)
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
Every source the paper cites for this claim was checked and supports it.
In the paper
“Within this review, a meta-analysis was not possible for mortality and nutritional outcomes, but three studies suggested improved mortality outcomes with PEG feeding while two out of three studies reported PEG feeding to be better from a nutritional perspective.”
§ Clinical nutrition and hydration in geriatrics > Commentary
What the sources say
- Supportedcites [166] Jaafar, 2015, Percutaneous endoscopic gastrostomy versus nasogastric feeding in older individuals with non-stroke dysphagia: a systematic review, J Nutr Health Aging source
The Abstract’s Results state this claim directly. The Results sections on mortality and nutritional status also describe three studies favoring PEG for mortality and two of three studies reporting nutritional improvements, while explaining why neither outcome could be pooled. (LLM, conf=0.95)
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“A RCT observed an increase of 17% mean volume of fluid and tube feed given in the nasal loop group, without any differences in outcome after three months (169).”
§ Clinical nutrition and hydration in geriatrics > Commentary
What the sources say
- Partly supportedcites [169] Beavan, 2010, Does looped nasogastric tube feeding improve nutritional delivery for patients with dysphagia after acute stroke? A randomised controlled trial, Age Ageing sourceExperimental — accuracy not yet measured
The Results (page not available in our copy) report that the nasal-loop group received a 17-percentage-point higher proportion of prescribed feed and fluids, not a 17% increase in mean volume; mean volumes were 17.0 L versus 11.4 L. The Results describe three-month outcomes as similarly poor, and Table 2 shows no statistically significant differences in the three-month outcomes reported. (LLM, conf=0.88)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“In patients with severe dementia, the risk-benefit ratio of EN is generally unfavorable and EN thus not recommended.”
§ Clinical nutrition and hydration in geriatrics > Commentary
What the sources say
- Supportedcites [163] Volkert, 2015, ESPEN guidelines on nutrition in dementia, Clin Nutr source
Recommendation 17 in §3.4, “Artificial nutrition and hydration” (page not supplied), recommends against initiating tube feeding in patients with severe dementia. Its commentary reports no demonstrated survival benefit and says careful hand-feeding is the best alternative in the vast majority of cases, supporting the claim’s general risk-benefit characterization. (LLM, conf=0.93)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Two studies on nasal loops in tube-fed stroke patients demonstrated that nasal loops are safe, well-tolerated and effective in delivering full EN (167-169).”
§ Clinical nutrition and hydration in geriatrics > Commentary
What the sources say
- Not checked — no full text of the sourcecites [167] Anderson, 2004, The nasal loop provides an alternative to percutaneous endoscopic gastrostomy in high-risk dysphagic stroke patients, Clin Nutr source
- Partly supportedcites [168] Beavan, 2007, Is looped nasogastric tube feeding more effective than conventional nasogastric tube feeding for dysphagia in acute stroke?, Trials sourceExperimental — accuracy not yet measured
The Background (page not provided) says early reports suggest nasal loops secure tubes and may allow more reliable feeding without compromising patient acceptability. But this paper is a trial protocol: its Abstract Methods lists feed delivery, adverse events and tolerability as outcomes to be measured, not findings. It does not demonstrate safety, good tolerability or delivery of full enteral nutrition. (LLM, conf=0.86)
- Partly supportedcites [169] Beavan, 2010, Does looped nasogastric tube feeding improve nutritional delivery for patients with dysphagia after acute stroke? A randomised controlled trial, Age Ageing sourceExperimental — accuracy not yet measured
The Discussion reports that nasal loops increased delivery of prescribed feed and fluids from 57% to 75%, not that they delivered full enteral nutrition. The Results report no significant difference in measured tolerability, but minor nasal problems were more common with loops (37% versus 15%); none required medical intervention. These findings support improved delivery and some reassurance about tolerability, but not the unqualified claims of full delivery and safety. (LLM, conf=0.88)
boosteddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Unfortunately, most trials assessed fluid intake hydration status and health outcomes poorly, so success in increasing fluid intake is unclear.”
§ Clinical nutrition and hydration in geriatrics > 58) All older persons should be screened for low-intake dehydration when they contact the healthcare system if the clinical condition changes unexpectedly, and periodically when malnourished or at risk of malnutrition. (R64, Grade GPP, strong consensus 100%) Commentary
What the sources say
- Partly supportedcites [219] Abdelhamid, 2016, Effectiveness of interventions to directly improve, maintain or facilitate food and drink intake in people with dementia: eating and Drinking Well IN dementiA (EDWINA) systematic review and meta-analysis, BMC Geriatr sourceExperimental — accuracy not yet measured
The Discussion reports insufficient high-quality evidence to establish whether the interventions were effective and calls for more robust hydration and health outcomes. The Strengths and limitations section also notes a lack of clear hydration-status data. These findings support the concern about poor assessment and uncertain effectiveness, but the review concerns people with dementia, not older adults generally, and does not establish that most trials poorly assessed all three named outcomes. (LLM, conf=0.85)
- Partly supportedcites [220] Bunn, 2015, Increasing fluid intake and reducing dehydration risk in older people living in long-term care: a systematic review, J Am Med Dir Assoc sourceExperimental — accuracy not yet measured
The Discussion (page unavailable) says most studies had considerable risk of bias and that, without 24-hour measurement, a change in overall fluid intake cannot be determined. The Risk of Bias section (page unavailable) finds fluid-intake or hydration assessment at high risk of bias in 16 of 23 studies. The copy supports uncertainty about increasing fluid intake, but does not specifically establish that most trials assessed health outcomes poorly. (LLM, conf=0.84)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“Combined analysis of eleven trials using standard ONS indicated a reduced risk of postoperative complications, whereas for high-protein ONS (two RCTs) no such effect was found (182).”
§ Clinical nutrition and hydration in geriatrics > 2.3.6.2 Implementation
What the sources say
- Supportedcites [182] Avenell, 2016, Nutritional supplementation for hip fracture aftercare in older people, Cochrane Database Syst Rev source
The Main results report fewer participants with complications across 11 trials of oral multinutrient feeds (RR 0.71). The Increasing protein intake section finds no clear effect on complications from higher protein intake; complication data were unavailable from two of the four trials. The evidence is low quality, so “no such effect was found” should not be read as proof of no effect. Page numbers were not available in our copy. (LLM, conf=0.88)
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“A range of positive effects are reported after six to twelve months, e.g.reduced length of hospital stay (55,56), improved independence in activities of daily living (56,192,193), improved mobility (56), reduced in-hospital falls and fall-related injuries (57), decreased emergency department visits (192) significantly fewer days of delirium (55), fewer pressure ulcers (55), reduced nursing home ad”
§ Clinical nutrition and hydration in geriatrics > J o u r n a l P r e -p r o o f
What the sources say
- Not checked — no full text of the sourcecites [55] Olofsson, 2007, Malnutrition in hip fracture patients: an intervention study, J Clin Nurs source
- Partly supportedcites [56] Stenvall, 2007, A multidisciplinary, multifactorial intervention program reduces postoperative falls and injuries after femoral neck fracture, Osteoporos Int sourceExperimental — accuracy not yet measured
Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
- Not checked — no full text of the sourcecites [192] Shyu, 2016, Enhanced interdisciplinary care improves self-care ability and decreases emergency department visits for older Taiwanese patients over 2 years after hip-fracture surgery: a randomised controlled trial, Int J Nurs Stud source
- Not checked — no full text of the sourcecites [193] Singh, 2012, Effects of high-intensity progressive resistance training and targeted multidisciplinary treatment of frailty on mortality and nursing home admissions after hip fracture: a randomized controlled trial, J Am Med Dir Assoc source
- Not checked — no full text of the sourcecites [57] Stenvall, 2007, Improved performance in activities of daily living and mobility after a multidisciplinary postoperative rehabilitation in older people with femoral neck fracture: a randomized controlled trial with 1-year follow-up, J Rehabil Med source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
Every source the paper cites for this claim was checked and supports it.
In the paper
“Hypophosphatemia was also associated with an increased length of hospital stay and mortality rate, which was however no longer significant in a multivariate analysis (176).”
§ Clinical nutrition and hydration in geriatrics > J o u r n a l P r e -p r o o f
What the sources say
- Supportedcites [176] Kagansky, 2005, Hypophosphataemia in old patients is associated with the refeeding syndrome and reduced survival, J Intern Med source
The Clinical course and outcome section reports a significantly longer hospital stay in the hypophosphataemia group. The In-hospital mortality section reports higher unadjusted mortality, but says the association was no longer significant after adjustment for all specified variables in a multivariate logistic regression. (LLM, conf=0.93)
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Memory problems may cause older adults to forget to drink and forget that they haven't drunk (7)(8)(9)252).”
§ Clinical nutrition and hydration in geriatrics > 65) All older persons should be considered to be at risk of low-intake dehydration and encouraged to consume adequate amounts of drinks. (R63, Grade GPP, strong consensus 100%) Commentary
What the sources say
- Supportedcites [7] Hooper, 2014, Water-loss dehydration and aging, Mech Ageing Dev source
The Problems section says that older people with dementia may forget drinks or believe they have recently had one. This supports the claim that memory problems may lead them to forget to drink or forget that they have not drunk. (LLM, conf=0.91)
- Not checked — no full text of the sourcecites [8] Hodgkinson, 2003, Maintaining oral hydration in older adults: a systematic review, Int J Nurs Pract source
- Partly supportedcites [9] Hooper, 2015, Which frail older people are dehydrated? The UK DRIE study, J Gerontol- Series A Biol Sci Med Sci sourceExperimental — accuracy not yet measured
The paper’s introductory passage says people with dementia may forget to drink when daily routines are lost, and the Discussion says dementia can disrupt drinking habits. It does not say they forget that they have not drunk; the study also cautions that its cross-sectional findings cannot establish causation. No page numbers are available in our copy. (LLM, conf=0.86)
- Partly supportedcites [252] Marra, 2016, Elevated serum osmolality and total water deficit indicate impaired hydration status in residents of long-term care facilities regardless of low or high body mass index, J Acad Nutr Diet sourceExperimental — accuracy not yet measured
The Introduction (page not provided) says residents with cognitive impairment may be unaware of their needs and forget to drink or request beverages. It does not say they forget whether they have already drunk, so that part of the claim is not supported. (LLM, conf=0.85)
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Among age-related physiological changes, reduced thirst and reduced urine concentration by the kidney increase dehydration risk (9,(243)(244)(245)(246).”
§ Clinical nutrition and hydration in geriatrics > 65) All older persons should be considered to be at risk of low-intake dehydration and encouraged to consume adequate amounts of drinks. (R63, Grade GPP, strong consensus 100%) Commentary
What the sources say
- Partly supportedcites [9] Hooper, 2015, Which frail older people are dehydrated? The UK DRIE study, J Gerontol- Series A Biol Sci Med Sci sourceExperimental — accuracy not yet measured
The paper’s introductory passage says older people are thought to face greater dehydration risk because thirst sensation and urinary concentrating ability frequently decline with age. The Discussion cautions that DRIE was cross-sectional and could not establish whether poor renal function causes dehydration or the reverse. The citing sentence presents the risk increase as established rather than qualified. (LLM, conf=0.83)
- Not checked — no full text of the sourcecites [243] Davies, 1995, Age-associated alterations in thirst and arginine vasopressin in response to a water or sodium load, Age Ageing source
- Not checked — no full text of the sourcecites [244] de Castro, 1992, Age-related changes in natural spontaneous fluid ingestion and thirst in humans, J Gerontol: Psychol Sci source
- Not checked — no full text of the sourcecites [245] Lindeman, 1985, Longitudinal studies on the rate of decline in renal function with age, J Am Geriatr Soc source
- Not checked — no full text of the sourcecites [246] Rowe, 1976, The influence of age on the renal response to water deprivation in man, Nephron source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“A small short term RCT in older adults with severe cognitive impairment J o u r n a l P r e -p r o o f suggested that cervical spine manipulation may increase dysphagia limit for those with swallowing problems, but effects on hydration were not assessed (265).”
§ Clinical nutrition and hydration in geriatrics > Commentary
What the sources say
- Supportedcites [265] Bautmans, 2008, Dysphagia in elderly nursing home residents with severe cognitive impairment can be attenuated by cervical spine mobilization, J Rehabil Med source
The Methods (p. 1) describe a small, short-term randomized crossover trial in older nursing-home residents with severe dementia and dysphagia. The Dysphagia limit discussion (p. 4) reports an increased dysphagia limit after gentle cervical spine mobilization. The Measurements section (p. 2) lists swallowing capacity, not hydration, as an outcome; the conclusion (p. 6) calls for future research on effects on drinking. (LLM, conf=0.90)
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
- Supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“Therefore, and to avoid a progression to obesity, maintaining stable BW is considered desirable for overweight older adults (11).”
§ Clinical nutrition and hydration in geriatrics > Commentary
What the sources say
- Supportedcites [11] Porter Starr, 2016, Challenges in the management of geriatric obesity in high risk populations, Nutrients source
In §1, “The Controversial Nature of Weight Management in Older Adults” (page unavailable), the review emphasizes the benefits of weight stability in later life and says there is no need to change body weight for older adults in the overweight BMI range. It distinguishes that range from obesity, supporting the cited recommendation to maintain a stable weight. (LLM, conf=0.92)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“A recent systematic review and guidelines report RCTs showing that in people following stroke, thickened fluids alongside access to free water (no other drinks) compared to thickened liquids alone was effective at protecting against aspiration and increasing fluid intake.”
§ Clinical nutrition and hydration in geriatrics > Commentary
What the sources say
- Partly supportedcites [110] Burgos, 2017, ESPEN guideline on clinical nutrition in Neurology, Clin Nutr sourceExperimental — accuracy not yet measured
In the Recommendation 61 commentary (page unavailable), the guideline describes stroke trials comparing thickened liquids plus free water with thickened liquids alone, and reports no pneumonia in either group. But the reported RCT found identical mean total beverage intake in both groups; the guideline does not establish that free water increased intake or protected against aspiration compared with thickened liquids alone. (LLM, conf=0.87)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Obesity, especially severe obesity (BMI ≥35 kg/m²), increases metabolic and cardiovascular risk as well as the risk of mobility limitations and frailty in older persons (277,278,285), particularly when marked muscle loss has already occurred (283).”
§ Clinical nutrition and hydration in geriatrics > Commentary
What the sources say
- Not checked — no full text of the sourcecites [277] Visvanathan, 2012, Australian and New Zealand Society for Geriatric Medicine: position statement-obesity and the older person, Australas J Ageing source
- Not checked — no full text of the sourcecites [278] Villareal, 2005, Obesity in older adults: technical review and position statement of the American Society for Nutrition and NAASO, the Obesity Society, Obesity source
- Partly supportedcites [285] Batsis, 2018, Addressing obesity in aging patients, Med Clin sourceExperimental — accuracy not yet measured
The sections “Impact of Obesity on Physical Function/Disability” and “Sarcopenic Obesity – a subset of high-risk individuals” link obesity to disability and reduced function in older adults, with greater risk when low muscle mass or strength coexists. “Defining Obesity in Older Adults” discusses cardiometabolic risk, but does not establish that BMI ≥35 specifically increases that risk; it also does not establish that obesity increases frailty risk. Page numbers are unavailable in our copy. (LLM, conf=0.84)
- Not checked — no full text of the sourcecites [283] Parr, 2013, ‘Sarcobesity’: a metabolic conundrum, Maturitas source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“In these cases, positive effects of intended weight loss on orthopedic problems, cardiovascular and metabolic risk, insulin sensitivity, chronic inflammation, and functional limitations have been reported, partly in combination with physical exercise (11,274,276,278,285,286).”
§ Clinical nutrition and hydration in geriatrics > 4.1.2 Treatment of volume depletion
What the sources say
- Partly supportedcites [11] Porter Starr, 2016, Challenges in the management of geriatric obesity in high risk populations, Nutrients sourceExperimental — accuracy not yet measured
The Overview section (page unavailable) reports that planned, supervised weight reduction in obese older adults can improve type 2 diabetes, coronary heart disease, osteoarthritis symptoms, and physical function. It also describes weight reduction combined with exercise. The copy does not report improved insulin sensitivity or reduced chronic inflammation from weight loss; its discussion of inflammation concerns obesity’s contribution to a chronic inflammatory state. (LLM, conf=0.86)
- Not checked — no full text of the sourcecites [274] Garvey, 2016, American Association of Clinical Endocrinologists and American College of Endocrinology comprehensive clinical practice guidelines for medical care of patients with obesity, Endocr Pract source
- Supportedcites [276] Mathus-Vliegen, 2012, Prevalence, pathophysiology, health consequences and treatment options of obesity in the elderly: a guideline, Obes Facts source
The guideline recommends weight loss for older people with obesity and weight-related comorbidities or functional limitations (Who Should Lose Weight and What Are the Concerns?; page not specified). It reports improvements in knee osteoarthritis pain and physical function with diet, especially with exercise, and describes benefits for cardiovascular and metabolic measures, insulin sensitivity, and inflammation (Life-Style Intervention: Is It Feasible in the Frail Elderly?; Why Add Exercise to a Diet?; pages not specified). (LLM, conf=0.92)
- Not checked — no full text of the sourcecites [278] Villareal, 2005, Obesity in older adults: technical review and position statement of the American Society for Nutrition and NAASO, the Obesity Society, Obesity source
- Partly supportedcites [285] Batsis, 2018, Addressing obesity in aging patients, Med Clin sourceExperimental — accuracy not yet measured
The “Evidence for Weight Loss in Older Adults?” section reports improved physical performance when intentional weight loss was combined with exercise, and “Cautions of Losing Weight in Older Adults” describes improvements in cardiometabolic risk and physical function. The copy does not report benefits for orthopedic problems, insulin sensitivity, or chronic inflammation; its evidence also concerns older adults rather than all people with obesity and comorbidities. No page numbers are available in our copy. (LLM, conf=0.86)
- Not checked — no full text of the sourcecites [286] Gill, 2015, Weight management in older adults, Curr Obes Rep source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“but a key suggestion from assessments of nutrition more generally was that studies with a strong social element, where socializing around food and drink was supported, tended to improve quality of life, nutritional status and fluid intake (219).”
§ Clinical nutrition and hydration in geriatrics > Commentary
What the sources say
- Partly supportedcites [219] Abdelhamid, 2016, Effectiveness of interventions to directly improve, maintain or facilitate food and drink intake in people with dementia: eating and Drinking Well IN dementiA (EDWINA) systematic review and meta-analysis, BMC Geriatr sourceExperimental — accuracy not yet measured
The Results section reports that small studies of social activities around meals found improvements in interaction and enjoyment, and one family-style-meal study found increased weight. The Discussion says social interventions consistently suggested possible improvements in aspects of quality of life. It does not report improved fluid intake from those interventions, and the nutritional finding is limited to one study; no page numbers were provided in our copy. (LLM, conf=0.88)
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
The sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
In the paper
“The combination with J o u r n a l P r e -p r o o f exercise training had comparable if not greater effects than the singular weight-reducing diets regarding the reduction of BW and fat mass, while often preserving lean mass better than diet alone (289-291, 295-297, 299).”
§ Clinical nutrition and hydration in geriatrics > Commentary
What the sources say
- Supportedcites [289] Villareal, 2011, Weight loss, exercise, or both and physical function in obese older adults, N Engl J Med source
The Results (Body Weight and Composition; page not provided) report comparable reductions in body weight and fat mass with diet plus exercise and diet alone. Lean body mass decreased less with diet plus exercise (1.8 kg versus 3.2 kg). These findings are from obese adults aged 65 or older. (LLM, conf=0.91)
- Not checked — no full text of the sourcecites [290] Avila, 2010, Effect of moderate intensity resistance training during weight loss on body composition and physical performance in overweight older adults, Eur J Appl Physiol source
- Supportedcites [291] Frimel, 2008, Exercise attenuates the weight-loss-induced reduction in muscle mass in frail obese older adults, Med Sci Sports Exerc source
The Results section reports similar six-month losses of body weight and fat mass with diet plus exercise and diet alone. It also reports significantly smaller losses of fat-free mass with diet plus exercise (1.8 versus 3.5 kg), supporting the claim about better lean-mass preservation in this study of frail obese older adults. (LLM, conf=0.94)
- Supportedcites [295] Chomentowski, 2009, Moderate exercise attenuates the loss of skeletal muscle mass that occurs with intentional caloric restriction-induced weight loss in older, overweight to obese adults, J Gerontol A Biol Sci Med Sci source
The Results report similar reductions in body weight and whole-body fat mass for diet alone and diet plus exercise, while fat-free mass declined significantly only with diet alone. The Discussion likewise says the groups lost similar amounts of weight and body fat, but the diet-only group lost four times as much fat-free mass. The study concerns older adults with overweight or obesity. (LLM, conf=0.94)
- Supportedcites [296] Campbell, 2009, Resistance training preserves fat-free mass without impacting changes in protein metabolism after weight loss in older women, Obesity (Silver Spring) source
The Results (Body composition) report that body-mass and fat-mass changes did not differ between the diet-only and diet-plus-resistance-training groups, while fat-free mass was preserved in the training group and decreased in the diet-only group. The finding applies to the older women studied; this paper shows comparable, not greater, weight and fat loss with exercise. (LLM, conf=0.91)
- Supportedcites [297] Dunstan, 2002, High-intensity resistance training improves glycemic control in older patients with type 2 diabetes, Diabetes Care source
The Results (p. 1) report similar six-month reductions in body weight and fat mass with resistance training plus moderate weight loss versus weight loss alone. Lean body mass increased in the combined group but decreased in the weight-loss-only group. The finding is for older patients with type 2 diabetes. (LLM, conf=0.90)
- Supportedcites [299] Amati, 2008, Separate and combined effects of exercise training and weight loss on exercise efficiency and substrate oxidation, J Appl Physiol (1985) source
The Results (‘Changes in Physical Characteristics’; page not provided) report comparable weight and fat-mass reductions with combined exercise and diet versus diet-induced weight loss alone. The combined group lost less lean body mass (1.5% versus 4.3%), supporting the claim that it better preserved lean mass. (LLM, conf=0.94)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Treatment for low-intake dehydration involves the administration of hypotonic fluids (222-224), which will help correct the fluid deficit while diluting down the raised osmolality.”
§ Clinical nutrition and hydration in geriatrics > J o u r n a l P r e -p r o o f
What the sources say
- Partly supportedcites [222] Cheuvront, 2013, Physiologic basis for understanding quantitative dehydration assessment, Am J Clin Nutr sourceExperimental — accuracy not yet measured
The Introduction (page unavailable) says that fluid acquisition is necessary to restore body-water balance, and the section on AVP and thirst responses says water loading lowers plasma osmolality. The paper does not recommend administering hypotonic fluids as treatment for low-intake dehydration, so it supports the underlying physiology but not the cited treatment claim. (LLM, conf=0.78)
- Partly supportedcites [223] Nadal, 1941, A comparison between dehydration from salt loss and from water deprivation, J Clin Invest sourceExperimental — accuracy not yet measured
The Procedure and Results (pages unavailable) show that subjects dehydrated by water deprivation recovered after receiving distilled water, supporting replacement of a water deficit with salt-free fluid. The paper does not recommend hypotonic-fluid administration as a clinical treatment or show that it lowers raised osmolality; the Results report no significant change in serum sodium in Experiment IIA. (LLM, conf=0.84)
- Not checked — no full text of the sourcecites [224] Thomas, 2008, Understanding clinical dehydration and its treatment, JAMDA source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“but suggested that overall the studies were at high risk of bias.”
§ Clinical nutrition and hydration in geriatrics > J o u r n a l P r e -p r o o f
What the sources say
- Supportedcites [220] Bunn, 2015, Increasing fluid intake and reducing dehydration risk in older people living in long-term care: a systematic review, J Am Med Dir Assoc source
The Discussion states that risk of bias was considerable in most studies. The Conclusion likewise says that high risk of bias prevented the review from demonstrating the effectiveness of many strategies. This supports the citing sentence’s overall characterization. (LLM, conf=0.94)
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“It was also suggested that the introduction of the US Resident Assessment Instrument (which requires mandatory monitoring and reporting of hydration risks) reduced dehydration in older adults(220, 261).”
§ Clinical nutrition and hydration in geriatrics > J o u r n a l P r e -p r o o f
What the sources say
- Partly supportedcites [220] Bunn, 2015, Increasing fluid intake and reducing dehydration risk in older people living in long-term care: a systematic review, J Am Med Dir Assoc sourceExperimental — accuracy not yet measured
The RAI-MDS section (page unavailable) reports that dehydration prevalence in US nursing-home residents fell from 3% to 1% after compulsory implementation, supporting the suggested reduction. It does not say that the instrument requires mandatory monitoring and reporting of hydration risks, and the finding is specific to long-term-care residents rather than older adults generally. (LLM, conf=0.86)
- Partly supportedcites [261] Fries, 1997, Effect of the national resident assessment instrument on selected health conditions and problems, J Am Geriatr Soc sourceExperimental — accuracy not yet measured
The Results and Discussion report that dehydration prevalence fell after RAI implementation among US nursing-home residents, and the authors suggest the RAI contributed while acknowledging other possible causes. The paper describes required resident assessments and guidelines for identifying dehydration risks, but does not establish a requirement to report those risks; its findings also concern nursing-home residents, not older adults generally. (LLM, conf=0.84)
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“A recent systematic review (see recommendations 67, 68) suggested that multiple strategies including involvement and input from older adults, staff, management, and policymakers will be needed to address problems with drinking in residential care (220).”
§ Clinical nutrition and hydration in geriatrics > J o u r n a l P r e -p r o o f
What the sources say
- Partly supportedcites [220] Bunn, 2015, Increasing fluid intake and reducing dehydration risk in older people living in long-term care: a systematic review, J Am Med Dir Assoc sourceExperimental — accuracy not yet measured
The Abstract says reducing dehydration in long-term care is likely to require multiple strategies involving policymakers, management, and care staff. The Conclusion calls for work at resident, institutional, and policy levels and for person-centered approaches to drinking barriers, but it does not specifically call for older adults’ involvement and input. (LLM, conf=0.83)
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
- Partly supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“Sample sizes were small (between 18 and 140 participants), the interventions were always started within five days from surgery and usually continued until discharge or until oral intake was sufficient.”
§ Clinical nutrition and hydration in geriatrics > J o u r n a l P r e -p r o o f
What the sources say
- Supportedcites [182] Avenell, 2016, Nutritional supplementation for hip fracture aftercare in older people, Cochrane Database Syst Rev source
The ‘Nasogastric tube feeding’ section reports four studies in which supplementation started within five days of surgery and usually continued until oral intake was sufficient or the patient was discharged. The review identifies study sizes of 18 participants (Sullivan 1998) and 140 participants (Hartgrink 1998). These details support the claim for the nasogastric-feeding studies, not for every intervention covered by the review; page numbers are unavailable in our copy. (LLM, conf=0.91)
plainn = 140- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“Regarding mortality and complication risk, the meta-analysis of EN only studies as well as the RCT using EN followed by ONS showed no evidence of an effect.”
§ Clinical nutrition and hydration in geriatrics > J o u r n a l P r e -p r o o f
What the sources say
- Supportedcites [182] Avenell, 2016, Nutritional supplementation for hip fracture aftercare in older people, Cochrane Database Syst Rev source
The Main results report that pooled data from three nasogastric-feeding trials showed no evidence of an effect on mortality, while one trial found no difference in complications. The same section reports no evidence of an effect on mortality or complications in a trial of tube feeding followed by oral supplementation. Complications in the EN-only group were assessed in one trial, not pooled. (LLM, conf=0.91)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“The Cochrane analysis from Avenell et al. (182) found three RCTs and one quasirandomized trial that tested the effects of supplementary overnight EN alone and oneadditional RCT that tested overnight EN followed by ONS.”
§ Clinical nutrition and hydration in geriatrics > J o u r n a l P r e -p r o o f
What the sources say
- Partly supportedcites [182] Avenell, 2016, Nutritional supplementation for hip fracture aftercare in older people, Cochrane Database Syst Rev sourceExperimental — accuracy not yet measured
The Nasogastric tube feeding section identifies four studies of tube feeding, and the Nasogastric tube feeding and oral supplements section identifies one additional study (Sullivan 2004) using nightly tube feeding followed by oral supplements. The retrieved passages do not establish that the first four comprised exactly three RCTs and one quasi-randomized trial, or that all four used overnight feeding. (LLM, conf=0.78)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“and consequently increases the risk of sarcopenia, frailty, functional decline, fractures, and malnutrition (276, 282, 283).”
§ Clinical nutrition and hydration in geriatrics > J o u r n a l P r e -p r o o f
What the sources say
- Partly supportedcites [276] Mathus-Vliegen, 2012, Prevalence, pathophysiology, health consequences and treatment options of obesity in the elderly: a guideline, Obes Facts sourceExperimental — accuracy not yet measured
In “Nutrition and Diet” (page not specified), the guideline says diet-induced weight loss could worsen age-related muscle loss and impair physical function. In “Who Should Lose Weight and What Are the Concerns?” (page not specified), it identifies sarcopenic obesity and hip fractures as potential adverse effects, but limits the fracture association to non-overweight elderly people. It does not say weight loss increases malnutrition risk, and it links frailty to sarcopenic obesity rather than directly to weight loss; the claim also states as certain what the guideline presents as a risk. (LLM, conf=0.88)
- Partly supportedcites [282] Cetin, 2014, Obesity in the elderly: more complicated than you think, Cleve Clin J Med sourceExperimental — accuracy not yet measured
The “CETIN AND NASR” section says intentional weight loss also reduces skeletal muscle, and “SARCOPENIA: LOSS OF MUSCLE WITH AGE” links muscle loss to frailty and loss of physical function. But Table 2 lists improved physical function with intentional weight loss, while the treatment discussion names protection from fractures as a potential benefit. The paper does not establish that weight loss increases fracture or malnutrition risk. (LLM, conf=0.88)
- Not checked — no full text of the sourcecites [283] Parr, 2013, ‘Sarcobesity’: a metabolic conundrum, Maturitas source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“and following medical conditions resulting in excessive losses of fluid and electrolytes, such as excessive blood loss, vomiting, and diarrhea (221-224).”
§ Clinical nutrition and hydration in geriatrics > J o u r n a l P r e -p r o o f
What the sources say
- Not checked — no full text of the sourcecites [221] Cheuvront, 2010, Biological variation and diagnostic accuracy of dehydration assessment markers, Am J Clin Nutr source
- Partly supportedcites [222] Cheuvront, 2013, Physiologic basis for understanding quantitative dehydration assessment, Am J Clin Nutr sourceExperimental — accuracy not yet measured
In “Two Critical Caveats to Understanding Osmotic Responses to Dehydration” (pp. 1–4), the paper identifies vomiting and secretory diarrhea as causes of isotonic hypovolemia, also called volume depletion because solute is lost along with water. It discusses blood-volume loss when assessing volume depletion, but does not explicitly identify excessive blood loss as a cause in the same way. (LLM, conf=0.79)
- Partly supportedcites [223] Nadal, 1941, A comparison between dehydration from salt loss and from water deprivation, J Clin Invest sourceExperimental — accuracy not yet measured
The Results (page not specified) state that loss of extracellular electrolyte reduces extracellular and plasma volume. The “Mixed type of dehydration” section (page not specified) identifies vomiting and diarrhea as causes of dehydration, but the paper does not identify excessive blood loss as a cause in this discussion. (LLM, conf=0.85)
- Not checked — no full text of the sourcecites [224] Thomas, 2008, Understanding clinical dehydration and its treatment, JAMDA source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“The study reported increased energy intake and decreased mortality in the trauma unit and within four months after discharge in the intervention group compared to the group with standard care.”
§ Clinical nutrition and hydration in geriatrics > Commentary
What the sources say
- Not checked — no full text of the sourcecites [46] Duncan, 2005, Using dietetic assistants to improve the outcome of hip fracture: a randomised controlled trial of nutritional support in an acute trauma ward, Age Ageing source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“however, no intervention effects on energy or protein intake, BW, and functional measures.”
§ Clinical nutrition and hydration in geriatrics > Commentary
What the sources say
- Not checked — no full text of the sourcecites [47] Feldblum, 2011, Individualized nutritional intervention during and after hospitalization: the nutrition intervention study clinical trial, J Am Geriatr Soc source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Feldblum et al. (47) extended an individualized nutritional intervention in older internal medical patients to six months after hospitalization and reported an improved Mini Nutritional Assessment (MNA) score and reduced mortality in the intervention compared to the control group”
§ Clinical nutrition and hydration in geriatrics > Commentary
What the sources say
- Not checked — no full text of the sourcecites [47] Feldblum, 2011, Individualized nutritional intervention during and after hospitalization: the nutrition intervention study clinical trial, J Am Geriatr Soc source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Bodyweight, grip strength, complications, and length of hospital stay were however unaffected.”
§ Clinical nutrition and hydration in geriatrics > Commentary
What the sources say
- Not checked — no full text of the sourcecites [46] Duncan, 2005, Using dietetic assistants to improve the outcome of hip fracture: a randomised controlled trial of nutritional support in an acute trauma ward, Age Ageing source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Multidisciplinary nutritional care concepts including regular team meetings increased dietary intake and improved quality of life in hip fracture patients (41)”
§ Clinical nutrition and hydration in geriatrics > J o u r n a l P r e -p r o o f
What the sources say
- Not checked — no full text of the sourcecites [41] Hoekstra, 2011, Effectiveness of multidisciplinary nutritional care on nutritional intake, nutritional status and quality of life in patients with hip fractures: a controlled prospective cohort study, Clin Nutr source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“Positive effects on various outcome parameter were reported (e.g.dietary intake (49,50,53), nutritional status, the incidence of falls (53,56), fall-related injuries (56), health status (55), physical performance (48)(49)(50)(51)57), social activity (49,50), costeffectiveness (52) and quality of life (48,51)), results were however not always consistent.”
§ Clinical nutrition and hydration in geriatrics > Commentary
What the sources say
- Not checked — no full text of the sourcecites [48] Beck, 2016, Multidisciplinary nutritional support for undernutrition in nursing home and home-care: a cluster randomized controlled trial, Nutrition source
- Not checked — no full text of the sourcecites [49] Beck, 2008, Multifaceted nutritional intervention among nursing-home residents has a positive influence on nutrition and function, Nutrition source
- Not checked — no full text of the sourcecites [50] Beck, 2010, Physical and social functional abilities seem to be maintained by a multifaceted randomized controlled nutritional intervention among old (>65 years) Danish nursing home residents, Arch Gerontol Geriatr source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“Three RCTs of low to acceptable quality investigated the effects of comprehensive individualized nutritional interventions in older hospitalized patients at nutritional risk with various diagnoses (43,44) or after acute stroke (45), and reported positive effects on energy and protein intake (43,44), BW (44,45), complications, antibiotic use, readmissions (44) and functional measures (44,45).”
§ Clinical nutrition and hydration in geriatrics > Commentary
What the sources say
- Not checked — no full text of the sourcecites [43] Rufenacht, 2010, Nutritional counseling improves quality of life and nutrient intake in hospitalized undernourished patients, Nutrition source
- Not checked — no full text of the sourcecites [44] Starke, 2011, Short-term individual nutritional care as part of routine clinical setting improves outcome and quality of life in malnourished medical patients, Clin Nutr source
- Not checked — no full text of the sourcecites [45] Ha, 2010, Individual, nutritional support prevents undernutrition, increases muscle strength and improves QoL among elderly at nutritional risk hospitalized for acute stroke: a randomized, controlled trial, Clin Nutr source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“The narrative summation and meta-analysis did not find any significant effects, but trends in favor of individualized dietary counseling were reported for most outcomes considered (99).”
§ Clinical nutrition and hydration in geriatrics > J o u r n a l P r e -p r o o f
What the sources say
- Not checked yetcites [99] 2016, National Clinical Guideline for exercise and nutrition to old people with geriatric problems, DHMA
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Meta-analysis results were in favor of the intervention regarding BW (all three RCTs) and energy intake (two RCTs) but not J o u r n a l P r e -p r o o f significant.”
§ Clinical nutrition and hydration in geriatrics > Commentary
What the sources say
- Not checked — no full text of the sourcecites [64] Abbott, 2013, Effectiveness of mealtime interventions on nutritional outcomes for the elderly living in residential care: a systematic review and meta-analysis, Ageing Res Rev source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Abbott et al. (64) included six feeding assistance studies.Two RCTs and three pre-post comparisons described positive effects on dietary intake.”
§ Clinical nutrition and hydration in geriatrics > Commentary
What the sources say
- Not checked — no full text of the sourcecites [64] Abbott, 2013, Effectiveness of mealtime interventions on nutritional outcomes for the elderly living in residential care: a systematic review and meta-analysis, Ageing Res Rev source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Quality of life was examined in two studies which both found beneficial effects.”
§ Clinical nutrition and hydration in geriatrics > Commentary
What the sources say
- Not checked — no full text of the sourcecites [64] Abbott, 2013, Effectiveness of mealtime interventions on nutritional outcomes for the elderly living in residential care: a systematic review and meta-analysis, Ageing Res Rev source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one. The quote only partly states this claim.
In the paper
“Young et al. (77) reviewed the evidence regarding the effectiveness of nutritional education or advice in people over 65 years of age living at home.Five studies (of 23) had nutritional education as the sole constituent of the program, whilst the rest included it as part of a more complex intervention.”
§ Clinical nutrition and hydration in geriatrics > Commentary
What the sources say
- Not checked — no full text of the sourcecites [77] Young, 2011, Nutritional education for community dwelling older people: a systematic review of randomised controlled trials, Int J Nurs Stud source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Study designs and results of included studies were heterogeneous with partly positive effects on dietary intake and nutritional status.”
§ Clinical nutrition and hydration in geriatrics > Commentary
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“No intervention studies have been performed among old people in home-care where malnutrition and risk of malnutrition are also prevalent.”
§ Clinical nutrition and hydration in geriatrics > Commentary
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
In the paper
“Meta-analysis found positive effects on BW, energy, and protein intake but no effect on handgrip strength or mortality compared to brief dietary advice or no intervention (100).”
§ Clinical nutrition and hydration in geriatrics > J o u r n a l P r e -p r o o f
What the sources say
- Not checked — no full text of the sourcecites [100] Munk, 2016, Individualised dietary counselling for nutritionally at-risk older patients following discharge from acute hospital to home: a systematic review and meta-analysis, J Hum Nutr Diet source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Malnutrition is related to poor outcome, e.g.increased rates of infections, length of hospital stay, duration of convalescence after acute illness as well as mortality risk (2)”
§ Clinical nutrition and hydration in geriatrics > Introduction
What the sources say
- Not checked — no full text of the sourcecites [2] Agarwal, 2013, Malnutrition in the elderly: a narrative review, Maturitas source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“Reported prevalence rates are generally below 10% in independently living older persons and increase up to two thirds in hospitalized older patients (5,6).”
§ Clinical nutrition and hydration in geriatrics > Introduction
What the sources say
- Not checked — no full text of the sourcecites [5] Kaiser, 2010, Frequency of malnutrition in older adults: a multinational perspective using the mini nutritional assessment, J Am Geriatr Soc source
- Not checked — no full text of the sourcecites [6] Cereda, 2016, Nutritional status in older persons according to healthcare setting: a systematic review and meta-analysis of prevalence data using MNA®, Clin Nutr source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Given this variation, the use of the EFSA fluid recommendation seems appropriately cautious in older adults.”
§ Clinical nutrition and hydration in geriatrics > 5) Older women should be offered at least 1.6 L of drinks each day, while older men
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence.
In the paper
“Daily amounts of 25 g are considered adequate for normal laxation in adults of ages (23) and can be regarded as guiding value also for older patients.”
§ Clinical nutrition and hydration in geriatrics > Commentary
What the sources say
- Not checked yetcites [23] European Food Safety Authority (EFSA), 2010, Scientific opinion on dietary reference values for carbohydrates and dietary fibre, EFSA J
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Due to their strong relation to fat-free mass, basal energy requirements are also influenced by gender and by nutritional status; in fact, REE/kg BW is higher for men than for women and increases with decreasing body mass index (BMI).”
§ Clinical nutrition and hydration in geriatrics > Commentary
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Existing evidence was graded according to the SIGN (Scottish Intercollegiate Guidelines Network) grading system.”
§ Clinical nutrition and hydration in geriatrics > Methodology
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“All recommendations were agreed in a multistage consensus process, which resulted in a percentage of agreement (%).”
§ Clinical nutrition and hydration in geriatrics > Methodology
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“As recently reviewed by Darmon et al. (59), restrictive diets furthermore seem to be less effective with increasing age, albeit data about their effects in older persons are rare.”
§ Clinical nutrition and hydration in geriatrics > 10) Dietary restrictions that may limit dietary intake are potentially harmful and should be avoided. (R11, Grade GPP, strong consensus 91%)
What the sources say
- Not checked — no full text of the sourcecites [59] Darmon, 2010, Restrictive diets in the elderly: never say never again?, Clin Nutr source
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“A comprehensive, systematic literature search was performed on 4th July 2016 based on 33 clinical questions in PICO (population of interest, interventions, comparisons, outcomes) format.”
§ Clinical nutrition and hydration in geriatrics > Methodology
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Assuming 80% of these fluid needs to come from drinks then women would require 1.6 L/d of drinks, and men 2.0 L/d.”
§ Clinical nutrition and hydration in geriatrics > 5) Older women should be offered at least 1.6 L of drinks each day, while older men
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Because of partly inconsistent results, the evidence grade was reduced from A to B.”
§ Clinical nutrition and hydration in geriatrics > Commentary
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
None of the sources cited for this claim have been checked yet.
In the paper
“Nutritional counseling by a health care professional is regarded as the first line of nutrition therapy.”
§ Clinical nutrition and hydration in geriatrics > Commentary
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“Eating is a social act, and eating in company is known to stimulate dietary intake, also in older persons (70,71).”
§ Clinical nutrition and hydration in geriatrics > Commentary
What the sources say
- Not checked — no full text of the sourcecites [70] Stroebele, 2004, Effect of ambience on food intake and food choice, Nutrition source
- Not checked — no full text of the sourcecites [71] De Castro, 1992, The amount eaten in meals by humans is a power function of the number of people present, Physiol Behav source
boosteddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“In a position statement, the American Dietetic Association concludes that the liberalization of diet prescriptions for older adults in longterm care may enhance the nutritional status and quality of life (61).”
§ Clinical nutrition and hydration in geriatrics > 10) Dietary restrictions that may limit dietary intake are potentially harmful and should be avoided. (R11, Grade GPP, strong consensus 91%)
What the sources say
- Not checked — no full text of the sourcecites [61] Niedert, 2005, Position of the American Dietetic Association: liberalization of the diet prescription improves quality of life for older adults in long-term care, J Am Diet Assoc source
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Altogether, scientific evidence is presently poor, but education and support for formal and informal caregivers are rated as one promising strategy among others to support the adequate dietary intake of older persons with malnutrition or at risk of malnutrition.”
§ Clinical nutrition and hydration in geriatrics > Commentary
plainconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“EN is frequently commenced late after substantial weight loss has already developed, which is in the stage of severe malnutrition (128, 129) and which hampers effective nutritional therapy (130).”
§ Clinical nutrition and hydration in geriatrics > Commentary
What the sources say
- Not checked — no full text of the sourcecites [128] Loser, 1998, Enteral long-term nutrition via percutaneous endoscopic gastrostomy (PEG) in 210 patients a four-year prospective study, Dig Dis Sci source
- Not checked — no full text of the sourcecites [129] Klose, 2003, Nutritional status and quality of life in patients with percutaneous endoscopic gastrostomy (PEG) in practice: prospective one-year follow-up, Dig Dis Sci source
- Not checked — no full text of the sourcecites [130] Donini, 2009, Predicting the outcome of artificial nutrition by clinical and functional indices, Nutrition source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Rigorous prospective RCTs comparing EN with no feeding are not feasible for ethical reasons.”
§ Clinical nutrition and hydration in geriatrics > Commentary
plain- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence. The paper may give no reason why it holds.
In the paper
“One SLR focusing on the time following hospital discharge (116) included six trials and found evidence for increased dietary intake and BW with ONS, but not concerning mortality or readmission risk.”
§ Clinical nutrition and hydration in geriatrics > 28) After discharge from the hospital, older persons with malnutrition or at risk of malnutrition shall be offered ONS in order to improve dietary intake and BW and to lower the risk of functional decline. (R25, Grade A, strong consensus 100%)
What the sources say
- Not checked — no full text of the sourcecites [116] Beck, 2013, Oral nutritional support of older (65 years+) medical and surgical patients after discharge from hospital: systematic review and meta-analysis of randomized controlled trials, Clin Rehabil source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Furthermore, older malnourished patients need a higher energy supply than younger adults to gain weight, and the increase in BW and fat-free mass in response to equal energy supply is slower in older patients (126).”
§ Clinical nutrition and hydration in geriatrics > Commentary
What the sources say
- Not checked — no full text of the sourcecites [126] Hébuterne, 1997, Effects of refeeding by cyclic enteral nutrition on body composition: comparative study of elderly and younger patients, Clin Nutr source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Due to the limited quality of the original studies, restriction to hospital discharge in some of the studies and only rare involvement of caregivers, the recommendation was downgraded to B.”
§ Clinical nutrition and hydration in geriatrics > J o u r n a l P r e -p r o o f
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
In the paper
“In 46 clinical trials in mostly older participants across healthcare settings (mean age 74 years), overall compliance was 78%, better in the community (81%) than in the hospital (67%) (127).”
§ Clinical nutrition and hydration in geriatrics > Commentary
What the sources say
- Not checked — no full text of the sourcecites [127] Hubbard, 2012, A systematic review of compliance to oral nutritional supplements, Clin Nutr source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Rests on an assumption: Compliance is crucial to achieve beneficial effects of ONS.
In the paper
“Energy intake increased in seven out of nine studies using energy enrichment and protein intake increased in three out of five J o u r n a l P r e -p r o o f studies using protein enrichment.”
§ Clinical nutrition and hydration in geriatrics > Commentary
What the sources say
- Not checked — no full text of the sourcecites [102] Trabal, 2015, Effects of dietary enrichment with conventional foods on energy and protein intake in older adults: a systematic review, Nutr Rev source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“Two other RCTs (not included in this systematic review) studied the effects of a combined dietary counseling and ONS intervention after hospital discharge and reported prevention of weight loss and improved activities of daily living functions (124) and decreased functional limitations (52,125).”
§ Clinical nutrition and hydration in geriatrics > 28) After discharge from the hospital, older persons with malnutrition or at risk of malnutrition shall be offered ONS in order to improve dietary intake and BW and to lower the risk of functional decline. (R25, Grade A, strong consensus 100%)
What the sources say
- Not checked — no full text of the sourcecites [124] Persson, 2007, Nutritional supplementation and dietary advice in geriatric patients at risk of malnutrition, Clin Nutr source
- Not checked — no full text of the sourcecites [52] Neelemaat, 2012, Oral nutritional support in malnourished elderly decreases functional limitations with no extra costs, Clin Nutr source
- Not checked — no full text of the sourcecites [125] Neelemaat, 2011, Post-discharge nutritional support in malnourished elderly individuals improves functional limitations, J Am Med Dir Assoc source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“There was also a significant positive correlation between compliance and total energy intake (energy intake from food plus ONS energy intake), showing that ONS consumption has little effect on the usual food intake.”
§ Clinical nutrition and hydration in geriatrics > Commentary
What the sources say
- Not checked — no full text of the sourcecites [127] Hubbard, 2012, A systematic review of compliance to oral nutritional supplements, Clin Nutr source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“EN is in principle a life-prolonging procedure.”
§ Clinical nutrition and hydration in geriatrics > Commentary
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Oral intake of the safe texture should be encouraged as far as safely possible because oral intake is associated with sensory input and training of swallowing, increased quality of life and enhances the cleaning of the oropharynx.”
§ Clinical nutrition and hydration in geriatrics > Commentary
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
- Rests on an assumption: Oral intake is associated with sensory input and training of swallowing, increased quality of life and enhances cleaning of the oropharynx.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“EN and PN are medical treatments because they require the insertion of a feeding tube or intravenous cannulation and a physician's prescription.”
§ Clinical nutrition and hydration in geriatrics > Commentary
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“Especially in patients where death is imminent, e.g.within the next four weeks, or in patients with an incurable disease which cannot be improved by any treatment including nutritional support (e.g.advanced dementia, terminal phase of malignant cancer disease), the patient´s comfort is the highest priority (162).”
§ Clinical nutrition and hydration in geriatrics > Commentary
What the sources say
- Not checked — no full text of the sourcecites [162] Druml, 2016, ESPEN guideline on ethical aspects of artificial nutrition and hydration, Clin Nutr source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Clinical improvement, as well as prevention of further clinical deterioration, can both be relevant goals for an individual patient.”
§ Clinical nutrition and hydration in geriatrics > Commentary
plain- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence. It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“It has to be kept in mind that even patients with dysphagia and nil-by-mouth have to swallow more than 500 ml of saliva per day which alone is a risk factor for aspiration pneumonia.”
§ Clinical nutrition and hydration in geriatrics > Commentary
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: unclear — It is unclear why the paper says it holds.
It may state two separate claims as one.
- Rests on an assumption: Even patients with dysphagia and nil-by-mouth have to swallow more than 500 ml of saliva per day which alone is a risk factor for aspiration pneumonia.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“In geriatric patients, nasogastric tubes are frequently not well tolerated but are also often not fixed adequately.”
§ Clinical nutrition and hydration in geriatrics > Commentary
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper may give no reason why it holds. It may state two separate claims as one.
In the paper
“In this situation, covering a patient's nutritional requirements is entirely irrelevant (162).”
§ Clinical nutrition and hydration in geriatrics > Commentary
What the sources say
- Not checked — no full text of the sourcecites [162] Druml, 2016, ESPEN guideline on ethical aspects of artificial nutrition and hydration, Clin Nutr source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“Known risk factors for the RFS are a reduced BMI, significant unintended weight loss, no nutritional intake for several days, low plasma concentrations of magnesium, potassium or phosphate before feeding and a medical history of drug or alcohol abuse (172)”
§ Clinical nutrition and hydration in geriatrics > J o u r n a l P r e -p r o o f
What the sources say
- Not matchedcites [172] 2006
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Not matched
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Refeeding syndrome (RFS) is a condition of potential risk in malnourished patients with electrolyte disturbances leading to clinical deterioration.”
§ Clinical nutrition and hydration in geriatrics > Commentary
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
In the paper
“A second meta-analysis (183) included a subset of ten of these RCTs with a total of 986 patients and came to the same conclusions regarding mortality and complications.”
§ Clinical nutrition and hydration in geriatrics > 2.3.6.2 Implementation
What the sources say
- Not checked yetcites [183] Liu, 2015, The role of perioperative oral nutritional supplementation in elderly patients after hip surgery, Clin Interv Aging
plainn = 986- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Several studies have documented that PN is a feasible and successful method of nutritional support also in older people (130,(178)(179)(180), not only in the hospital but also at home (181).”
§ Clinical nutrition and hydration in geriatrics > 2.3.6
What the sources say
- Not checked — no full text of the sourcecites [130] Donini, 2009, Predicting the outcome of artificial nutrition by clinical and functional indices, Nutrition source
- Not checked — no full text of the sourcecites [178] Hearnshaw, 2007, Use of parenteral nutrition in hospitals in the North of England, J Hum Nutr Diet source
- Not checked — no full text of the sourcecites [179] Howard, 1997, Clinical outcome of geriatric patients in the United States receiving home parenteral and enteral nutrition, Am J Clin Nutr source
- Not checked yetcites [180] Thomas, 2005, A prospective, randomized clinical study of adjunctive peripheral parenteral nutrition in adult subacute care patients, J Nutr Health Aging
- Not checked — no full text of the sourcecites [181] Violante, 2006, Adult home parenteral nutrition: a clinical evaluation after a 3-year experience in a Southern European centre, Eur J Clin Nutr source
boosteddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Consequences include volume overload, redistribution of phosphate, potassium, and magnesium, hypophosphatemia, muscle weakness, anemia and finally organ failure.”
§ Clinical nutrition and hydration in geriatrics > Commentary
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“As a consequence, rapid deterioration of nutritional status and impairment of recovery and rehabilitation are common.”
§ Clinical nutrition and hydration in geriatrics > 2.3.6.2 Implementation
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Voluntary oral intake in the postoperative phase is often markedly below requirements.”
§ Clinical nutrition and hydration in geriatrics > 2.3.6.2 Implementation
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper may give no reason why it holds.
In the paper
“The risk of complications within four months was significantly reduced (RR 0.21 (99% CI 0.08-0.59),while mortality risk, length of hospital stay and the proportion of participants who were discharged to their own homes were unaffected (185).”
§ Clinical nutrition and hydration in geriatrics > 2.3.6.2 Implementation
What the sources say
- Not checked — no full text of the sourcecites [185] Eneroth, 2006, Nutritional supplementation decreases hip fracture-related complications, Clin Orthop Relat Res source
plaindirectn = 80- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Possible cardiac sudden death is described in up to 20%.”
§ Clinical nutrition and hydration in geriatrics > Commentary
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“It has to be mentioned, however, that in rare exceptions, such as hyperactive delirium, it may be advantageous for the patient to use drugs with sedative effects or even physical restraints for a very limited period of time to prevent the patient from self-injury.”
§ Clinical nutrition and hydration in geriatrics > J o u r n a l P r e -p r o o f
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“Lubart et al. (177) evaluated 40 frail older patients with prolonged feeding problems before the insertion of a nasogastric tube.A high mortality rate was observed which was mainly related to infectious complications, but in the light of a considerable number of patients with hypophosphatemia, the authors suggested the RFS as a contributing factor to mortality (177).”
§ Clinical nutrition and hydration in geriatrics > J o u r n a l P r e -p r o o f
What the sources say
- Not checked — no full text of the sourcecites [177] Lubart, 2009, Mortality after nasogastric tube feeding initiation in long-term care elderly with oropharyngeal dysphagia–the contribution of refeeding syndrome, Gerontology source
hedgedconditionaln = 40- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Indication criteria for PN are the same as in middle-aged subject: older patients facing a period of starvation of more than three days when oral nutrition or EN is impossible, and when oral or EN has been or is likely to be insufficient for more than 7-10 days.”
§ Clinical nutrition and hydration in geriatrics > 2.3.6
plain- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Cultural background, economical resources, social facilities as well as ethical and religious motivations may play a substantial role in determining the nutritional treatment and its outcome in very old, frail and chronically ill patients.”
§ Clinical nutrition and hydration in geriatrics > Commentary
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
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Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
In the paper
“It is however only rarely indicated as oral and enteral interventions are generally the first choice for nutritional support (180).”
§ Clinical nutrition and hydration in geriatrics > 2.3.6
What the sources say
- Not checked yetcites [180] Thomas, 2005, A prospective, randomized clinical study of adjunctive peripheral parenteral nutrition in adult subacute care patients, J Nutr Health Aging
plain- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The loss of physical activity is a logical consequence of pharmacological sedation or physical restraints; consequently, it usually leads to muscle mass loss.”
§ Clinical nutrition and hydration in geriatrics > J o u r n a l P r e -p r o o f
plaindirect- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
In the paper
“Furthermore, social contact is a key trigger for drinking -but as social isolation becomes more common, drinking routines are lost and drink intake is reduced (254).”
§ Clinical nutrition and hydration in geriatrics > 65) All older persons should be considered to be at risk of low-intake dehydration and encouraged to consume adequate amounts of drinks. (R63, Grade GPP, strong consensus 100%) Commentary
What the sources say
- Not checked — no full text of the sourcecites [254] Philpin, 2011, Sociocultural context of nutrition in care homes, Nurs Older People source
plaindirect- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
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It may state two separate claims as one.
In the paper
“This equation has also been found to be useful in younger adults (230).”
§ Clinical nutrition and hydration in geriatrics > Commentary
What the sources say
- Not checked — no full text of the sourcecites [230] Heavens, 2014, Validation of equations used to predict plasma osmolality in a healthy adult cohort, Am J Clin Nutr source
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“In low-intake dehydration, it is common that despite raised serum osmolality none of the major components (sodium, potassium, urea or glucose) is raised out of the normal range -but general fluid concentration leads to small rises within the normal range in all these components (Hooper unpublished).”
§ Clinical nutrition and hydration in geriatrics > Commentary
What the sources say
- Not matchedcites Hooper unpublished
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plaindirect- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
- Not matched
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“Physical access to drinks can also be an issue (8,255,256), as can swallowing problems and dysphagia.”
§ Clinical nutrition and hydration in geriatrics > 65) All older persons should be considered to be at risk of low-intake dehydration and encouraged to consume adequate amounts of drinks. (R63, Grade GPP, strong consensus 100%) Commentary
What the sources say
- Not checked — no full text of the sourcecites [8] Hodgkinson, 2003, Maintaining oral hydration in older adults: a systematic review, Int J Nurs Pract source
- Not checked — no full text of the sourcecites [255] Gaspar, 1988, What determines how much patients drink?, Geriatr Nurs source
- Not checked — no full text of the sourcecites [256] Leiper, 2005, A comparison of water turnover in older people in community and institutional settings, J Nutr Health Aging
plaindirect- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
In the paper
“The clearest signs following excessive blood loss are a large postural pulse change (≥30 beats per minute) or severe postural dizziness leading to lack of ability to stand (273), which are 97% sensitive and 98% specific when blood loss is at least 630 mL, but much less sensitive at lower levels of blood loss.”
§ Clinical nutrition and hydration in geriatrics > Commentary
What the sources say
- Not checked — no full text of the sourcecites [273] McGee, 1999, The rational clinical examination. Is this patient hypovolemic?, JAMA source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“The authors report that postural hypotension has little additional predictive value.”
§ Clinical nutrition and hydration in geriatrics > Commentary
What the sources say
- Not checked — no full text of the sourcecites [273] McGee, 1999, The rational clinical examination. Is this patient hypovolemic?, JAMA source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“Another systematic review suggests that financial costs of subcutaneous rehydration are probably lower than intravenous, but the systematic review is methodologically poor and the evidence base it collates is of low quality -better-designed studies are needed (266).”
§ Clinical nutrition and hydration in geriatrics > Commentary
What the sources say
- Not checked — no full text of the sourcecites [266] Pershad, 2010, A systematic data review of the cost of rehydration therapy, Appl Health Econ Health Pol source
hedged- Asserted: fails — The authors may not put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The authors may not put it forward as true. The paper’s conclusions may not depend on it.
In the paper
“However, these results were found in younger adults not taking beta-blockers, so sensitivity and specificity may vary in older persons.”
§ Clinical nutrition and hydration in geriatrics > Commentary
What the sources say
- Not checked — no full text of the sourcecites [273] McGee, 1999, The rational clinical examination. Is this patient hypovolemic?, JAMA source
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Patients with dysphagia are at specific high risk of dehydration and fluid intake has been reported to be low, especially when thickened fluids are used to make swallowing safer (360).”
§ Clinical nutrition and hydration in geriatrics > Commentary
What the sources say
- Not matchedcites [360]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
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It may state two separate claims as one.
- Not matched
In the paper
“A combination of a balanced, nutrient-rich diet providing adequate amounts of energy and protein, and physical activity, if possible even exercise, is a sound strategy to keep weight stable and to prevent obesity (284).”
§ Clinical nutrition and hydration in geriatrics > Commentary
What the sources say
- Not checked — no full text of the sourcecites [284] Volpe, 2016, Obesity prevention in older adults, Curr Obes Rep source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
In the paper
“A highquality systematic review, though not specific to older adults, has suggested that the use of chin down swallowing and thin fluids should be the first choice of therapy in chronic dysphagia (108).”
§ Clinical nutrition and hydration in geriatrics > Commentary
What the sources say
- Not checked — no full text of the sourcecites [108] Andersen, 2013, Systematic review and evidence based recommendations on texture modified foods and thickened fluids for adults (18 years) with oropharyngeal dysphagia, e-SPEN source
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“Only Rydwik et al. (81) reported improved muscle strength in the combined intervention group compared to the nutrition group, while other functional and nutritional measures did not differ.”
§ Clinical nutrition and hydration in geriatrics > J o u r n a l P r e -p r o o f
What the sources say
- Not checked — no full text of the sourcecites [81] Rydwik, 2008, Effects of a physical and nutritional intervention program for frail elderly people over age 75. A randomized controlled pilot treatment trial, Aging Clin Exp Res source
plain- Asserted: passes — The authors put it forward as true.
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- Load-bearing: passes — The paper’s conclusions depend on it.
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It may state two separate claims as one.
In the paper
“As weight loss and poor nutritional state are risk factors for mortality in general and particularly J o u r n a l P r e -p r o o f poor survival after PEG insertion (157), weight loss before initiation of EN should be avoided as far as possible.”
§ Clinical nutrition and hydration in geriatrics > J o u r n a l P r e -p r o o f
What the sources say
- Not checked — no full text of the sourcecites [157] Chong, 2006, Percutaneous endoscopic gastrostomy outcomes: can patient profiles predict mortality and weaning?, Singap Med J
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“Altogether, positive effects of ONS on dietary intake (115, 116, 119, 121) and BW (115, 116, 119, 121), and reduced risk of complications (121) and readmissions (115, 120, 121) were reported, whereas the length of hospital stay (114, 115, 121) and mortality risk (114-116, 119, 121) were not significantly reduced.”
§ Clinical nutrition and hydration in geriatrics > J o u r n a l P r e -p r o o f
What the sources say
- Not checked — no full text of the sourcecites [115] Bally, 2016, Nutritional support and outcomes in malnourished medical inpatients: a systematic review and meta-analysis, JAMA Intern Med source
- Not checked — no full text of the sourcecites [116] Beck, 2013, Oral nutritional support of older (65 years+) medical and surgical patients after discharge from hospital: systematic review and meta-analysis of randomized controlled trials, Clin Rehabil source
- Not checked — no full text of the sourcecites [119] Milne, 2009, Protein and energy supplementation in elderly people at risk from malnutrition, Cochrane Database Syst Rev source
- Not checked — no full text of the sourcecites [121] Cawood, 2012, Systematic review and meta-analysis of the effects of high protein oral nutritional supplements, Ageing Res Rev source
- Not checked — no full text of the sourcecites [120] Stratton, 2013, A systematic review and meta-analysis of the impact of oral nutritional supplements on hospital readmissions, Ageing Res Rev source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Criteria to identify RFS vary from reduced phosphate or any electrolyte serum concentration, the coexistence of electrolyte disturbances and clinical symptoms (e.g.peripheral edema, acute circulatory fluid overload, disturbance to organ function) (175).”
§ Clinical nutrition and hydration in geriatrics > J o u r n a l P r e -p r o o f
What the sources say
- Not checked — no full text of the sourcecites [175] Friedli, 2017, Revisiting the refeeding syndrome: results of a systematic review, Nutrition source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“All these trials used GDS (a validated depression screening instrument that measures depressive symptoms) as the main outcome measure, but the minimum clinically significant difference has not been defined for GDS.”
§ Clinical nutrition and hydration in geriatrics > J o u r n a l P r e -p r o o f
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“They assessed the range of plasma osmolality in hydrated younger adults, then in the same persons who had been dehydrated, identifying the cut-off that best separated the two states.”
§ Clinical nutrition and hydration in geriatrics > J o u r n a l P r e -p r o o f
What the sources say
- Not checked — no full text of the sourcecites [221] Cheuvront, 2010, Biological variation and diagnostic accuracy of dehydration assessment markers, Am J Clin Nutr source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“A second RCT explored an individualized nutritional intervention in 259 hospitalized older patients and found no changes in GDS scores at six months (47), the number of those with depression is not stated.”
§ Clinical nutrition and hydration in geriatrics > J o u r n a l P r e -p r o o f
What the sources say
- Not checked — no full text of the sourcecites [47] Feldblum, 2011, Individualized nutritional intervention during and after hospitalization: the nutrition intervention study clinical trial, J Am Geriatr Soc source
plainn = 259- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“GDS was significantly better in the intervention compared to the control group at six months, but not at six weeks.”
§ Clinical nutrition and hydration in geriatrics > J o u r n a l P r e -p r o o f
What the sources say
- Not checked — no full text of the sourcecites [204] Gariballa, 2007, Effects of dietary supplements on depressive symptoms in older patients: a randomised double-blind placebo-controlled trial, Clin Nutr source
plaindirectn = 225- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In summary, nutrition and hydration interventions have only shown efficacy in the prevention of delirium when they are part of multidisciplinary interventions (10 of 19 trials on multidisciplinary interventions included at least one nutrition/hydration intervention).”
§ Clinical nutrition and hydration in geriatrics > J o u r n a l P r e -p r o o f
plainconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“A standardized definition is unfortunately lacking, and current knowledge about the syndrome is altogether limited.”
§ Clinical nutrition and hydration in geriatrics > J o u r n a l P r e -p r o o f
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“Their suggested threshold is that serum or plasma osmolality >300 mOsm/kg is classified as dehydrated.”
§ Clinical nutrition and hydration in geriatrics > J o u r n a l P r e -p r o o f
What the sources say
- Not checked — no full text of the sourcecites [221] Cheuvront, 2010, Biological variation and diagnostic accuracy of dehydration assessment markers, Am J Clin Nutr source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
None of the sources cited for this claim have been checked yet.
In the paper
“Treatment for volume depletion aims to replace lost water and electrolytes and involves the administration of isotonic fluids (224, 271).”
§ Clinical nutrition and hydration in geriatrics > J o u r n a l P r e -p r o o f
What the sources say
- Not checked — no full text of the sourcecites [224] Thomas, 2008, Understanding clinical dehydration and its treatment, JAMDA source
- Not matchedcites [271] 2013
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“However, the authors suggested that this form of diagnosis needs further assessment (273).”
§ Clinical nutrition and hydration in geriatrics > Additional information
What the sources say
- Not checked — no full text of the sourcecites [273] McGee, 1999, The rational clinical examination. Is this patient hypovolemic?, JAMA source
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“Isotonic or slightly hypotonic fluids are ideal (224).”
§ Clinical nutrition and hydration in geriatrics > J o u r n a l P r e -p r o o f
What the sources say
- Not checked — no full text of the sourcecites [224] Thomas, 2008, Understanding clinical dehydration and its treatment, JAMDA source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
The authors state this as an assumption.
For older persons with underweight (BMI ≤21 kg/m²), energy requirements are between 32 and 38 kcal/kg.
“For older persons with underweight (BMI ≤21 kg/m²) energy requirements between 32 and 38 kcal/kg are assumed (16).”
The authors state this as an assumption.
One of the barriers to proper nutritional support in hospitals is a lack of sufficient education concerning nutrition among all staff groups.
“One of the barriers to proper nutritional support in hospitals is assumed to be a lack of sufficient education concerning nutrition among all staff groups (62).”
The authors state this as an assumption.
Eating-dependent older persons living in private households may also benefit from mealtime assistance.
“Nevertheless, it is reasonable to assume that eating-dependent older persons living in private households may also benefit from mealtime assistance.”
The authors state this as an assumption.
Persons who are otherwise unable to obtain regular meals may benefit from home-delivered meals.
“but it seems reasonable to assume that persons who are otherwise unable to obtain regular meals may benefit from this support.”
The paper relies on this without support.
Insufficient intake of energy increases protein requirements.
“It is important to bear in mind that an insufficient intake of energy increases protein requirements.”
The paper relies on this without support.
Exercise increases energy expenditure.
“Exercise increases energy expenditure.”
The paper relies on this without support.
To avoid weight loss and maintain muscle mass, a positive or at least zero energy balance is of particular importance during periods of exercise interventions.
“To avoid (further) weight loss and to maintain muscle mass a positive or at least zero energy balance is of particular importance during periods of exercise interventions.”
The paper relies on this without support.
Many older persons are restricted in their ability to eat and drink independently due to functional and cognitive limitations.
“Many older persons are restricted in their ability to eat and drink independently due to functional and cognitive limitations.”
The paper relies on this without support.
Dietary fiber may contribute to the normalization of bowel functions, and intake is usually low in geriatric patients.
“Since dietary fiber may contribute to the normalization of bowel functions, and intake is usually low in geriatric patients, the importance of an adequate intake of dietary fiber is emphasized.”
The paper relies on this without support.
Dietary recommendations for micronutrients for older persons do not differ from those for younger adults.
“Dietary recommendations for micronutrients for older persons do not differ from those for younger adults, however, our knowledge about requirements in very old, frail or ill persons is poor.”
The paper relies on this without support.
Older persons are at increased risk of micronutrient deficiencies due to an increasing prevalence of gastrointestinal diseases accompanied by reduced nutrient bioavailability.
“Due to an increasing prevalence of gastrointestinal diseases, which are accompanied by reduced nutrient bioavailability (e.g.atrophic gastritis and impaired vitamin B12, calcium and iron absorption), older persons are at increased risk of micronutrient deficiencies, which should be corrected by supplementation.”
The paper relies on this without support.
Individual fluid needs are related to energy consumption, water losses and kidney function.
“Individual fluid needs are related to energy consumption, water losses and kidney function, so larger people may require more fluid.”
The paper relies on this without support.
Fluid needs may be higher in extreme temperatures or at times of greater physical activity.
“Needs may also be higher in extreme temperatures (e.g.summer heat) or at times of greater physical activity.”
The paper relies on this without support.
Excessive losses due to fever, diarrhea, vomiting or severe hemorrhage must be balanced by additional intake.
“Excessive losses due to, fever, diarrhea, vomiting or severe hemorrhage must also be balanced by additional intake.”
The paper relies on this without support.
Specific clinical situations, namely heart and renal failure, may need a restriction of fluid intake.
“On the other hand, specific clinical situations, namely heart, and renal failure may need a restriction of fluid intake.”
The authors state this as an assumption.
Enrichment of texture-modified diets can have similar effects as enrichment of regular texture diets for patients with chewing and/or swallowing problems.
“At present, also no studies about the effects of enrichment of texture-modified diets are available, but based on the positive effects of enrichment of regular texture diets (see recommendation 24) it is assumed that enrichment can have similar effects in texturemodified diets for patients with chewing and/or swallowing problems.”
The authors state this as an assumption.
Enteral nutrition sometimes may be continued for longer than necessary once a PEG tube has been inserted.
“It is also assumed that EN sometimes may be continued for longer than necessary once a PEG tube has been inserted.”
The paper relies on this without support.
Additional snacks and/or finger food have little expense and no risk of harm.
“Due to little expense and no risk of harm we recommend additional snacks and/or finger food despite presently very limited scientific evidence.”
The paper relies on this without support.
Dietary counseling and food modifications may be better accepted for longer durations and are cheaper than ONS.
“However, dietary counseling and food modifications J o u r n a l P r e -p r o o f may be better accepted for longer durations and are cheaper, so we suggest that in chronic clinical situations such as observed in the community or nursing homes, they may be proposed first and that ONS be offered when dietary counseling and food fortification are not sufficient to reach nutritional goals.”
The paper relies on this without support.
Compliance is crucial to achieve beneficial effects of ONS.
“To achieve beneficial effects, compliance is crucial.”
The paper relies on this without support.
Oral intake is associated with sensory input and training of swallowing, increased quality of life and enhances cleaning of the oropharynx.
“Oral intake of the safe texture should be encouraged as far as safely possible because oral intake is associated with sensory input and training of swallowing, increased quality of life and enhances the cleaning of the oropharynx.”
The paper relies on this without support.
Even patients with dysphagia and nil-by-mouth have to swallow more than 500 ml of saliva per day which alone is a risk factor for aspiration pneumonia.
“It has to be kept in mind that even patients with dysphagia and nil-by-mouth have to swallow more than 500 ml of saliva per day which alone is a risk factor for aspiration pneumonia.”
The paper relies on this without support.
Sedation and physical restraints may lead to cognitive deterioration.
“In addition, sedation and physical restraints may also lead to cognitive deterioration and should, therefore, be avoided.”
The paper relies on this without support.
Short-term starvation in the acutely ill older person leads to loss of lean body mass which can be critical especially in older patients.
“When indicated, PN should be initiated immediately due to the risk of loss of independence in older patients and because even short-term starvation in the acutely ill older person leads to loss of lean body mass which can be critical especially in older patients.”
The paper relies on this without support.
Use of ONS or EN can result in a rise in glucose levels.
“The use of ONS or EN can result in a rise in glucose levels.”
The paper relies on this without support.
Prevention and treatment of malnutrition with its probable negative short-term outcomes are more important than possible long-term complications of hyperglycemia.
“However, prevention and treatment of malnutrition with its probable negative short-term outcomes are regarded as more important than possible long-term complications of hyperglycemia.”
The paper relies on this without support.
Raised osmolality is the key physiological trigger of protection mechanisms such as thirst and increased concentration of urine by the kidney.
“The raised osmolality is the key physiological trigger of protection mechanisms (such as thirst and increased concentration of urine by the kidney).”
The paper relies on this without support.
Extracellular water loss (volume depletion) due to diarrhea, vomiting or renal sodium loss is connected with normal or low plasma osmolality.
“In contrast, extracellular water loss (volume depletion) due to diarrhea, vomiting or renal sodium loss is connected with normal or low plasma osmolality.”
The paper relies on this without support.
Very old and frail persons are more vulnerable to any kind of stress.
“As very old and frail persons are more vulnerable to any kind of stress, decisions for or against weight loss require particular care in this population subgroup (see commentary to Recommendation 55).”
The paper relies on this without support.
PN is a safe and effective therapeutic procedure, which is used for the delivery of all macronutrients and micronutrients into the organism via a central or peripheral vein.
“PN is a safe and effective therapeutic procedure, which is used for the delivery of all macronutrients and micronutrients into the organism via a central or peripheral vein.”
The paper relies on this without support.
Older persons suffering from a hip fracture and undergoing orthopedic surgery are generally at risk of malnutrition due to the acute trauma and surgery-associated anorexia.
“Older persons suffering from a hip fracture and undergoing orthopedic surgery are generally at risk of malnutrition due to the acute trauma and surgery-associated anorexia”
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ Clinical nutrition and hydration in geriatrics > Commentary
“If care-givers are involved in nutritional matters, e.g. in case of cognitive impairment, they should also be addressed ( see recommendation 12).”
§ Clinical nutrition and hydration in geriatrics > J o u r n a l P r e -p r o o f
“Figure: 11 11 ) Health care professionals, as well as informal caregivers, should be offered nutritional education”
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ Clinical nutrition and hydration in geriatrics > 2.3.6.2 Implementation
“The recommendations 40-43 in chapter 2.3.5.2 also apply to parenteral nutrition.”
§ Clinical nutrition and hydration in geriatrics > 2.3.6
“## 2.3.6 Parenteral nutrition (Fig. 7) 2. 3.6.1 Indication 43”
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ Clinical nutrition and hydration in geriatrics > Commentary
“based on the positive effects of enrichment of regular texture diets (see recommendation 24)”
§ Clinical nutrition and hydration in geriatrics > 24) Older persons with malnutrition or at risk of malnutrition should be offered additional snacks, and/or finger food, in order to facilitate dietary intake. (R21, Grade GPP, strong consensus 100%)
“## 24) Older persons with malnutrition or at risk of malnutrition should be offered additional snacks, and/or finger food, in order to facilitate dietary intake.”
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InfluentialDysphagia in hospitalized older patients: the Report-AGE project
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InfluentialLouie, J. C. Y. (2026) · Clinical Nutrition · doi:10.1016/j.clnu.2026.106769 · Cited by 2
Meal Service and Nutritional Management for Dysphagia: A Nationwide Hospital Survey
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Need for a consensus definition of chronic dehydration: A scoping review
Hasegawa, Y., Kato, K., Ogai, K., Konya, C., & Minematsu, T. (2024) · Drug Discoveries & Therapeutics · doi:10.5582/ddt.2024.01014 · Cited by 2
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“47,48 Furthermore, considering the rapid advancement of technology, the integration of more sophisticated digital tools could also be beneficial.”
The risks and benefits of managing obesity in older adults
Carroll, D. G. (2024) · American Journal of Health-System Pharmacy · doi:10.1093/ajhp/zxae288 · Cited by 2
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“First, there is no evidence of the (cost) effectiveness of homecare in supporting older people with food and drink-related needs, even if EPSEN guidelines on nutrition and hydration of older adults recommend home-based care assistance despite an absence of evidence (Volkert et al ., 2022, 2019).”
Factors associated with hypertonic dehydration in older Japanese outpatients
Kinoshita, A., Yonemitsu, T., Miyai, N., & Yonemitsu, A. (2025) · Journal of General and Family Medicine · doi:10.1002/jgf2.767 · Cited by 2
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Menu Assessment Tools Used in Residential Aged Care: A Scoping Review of Content and Quality
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“Two scales were used to monitor normal nutrition: a scale for people under 65 years of age [36] and the European Society for Clinical Nutrition and Metabolism (ESPEN) recommendations for people over 65 years of age [37].”
InfluentialRamadori, G. P. (2025) · Livers · doi:10.3390/livers5030035 · Cited by 1
“A recent report underlined the importance of hydration status when judging the effect of exercise on the lactate serum concentration even in young, non-obese people [254,255].”
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“Their qualifications differ from those of other healthcare professionals, and in many LTC facilities they often spend a significant amount of time with patients during the day, assisting them with eating and knowing their individual preferences and eating habits [2].”
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“In addition, dehydration is also related to serious health consequences [1].”
InfluentialSelf-citationThe impact of preoperative weight loss on recovery after cardiac surgery
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“Malnutrition is a prevalent and serious concern among these patients, particularly in the older individuals [3].”
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“Moreover, the clinical manifestations of these complications may be mistakenly attributed to ageing rather than to underlying food insecurity [48].”
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“Older adults with malnutrition or at risk of malnutrition often require a high intake of energy and nutrients to achieve improvement in nutritional status [16].”
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“These findings align with prior research despite the limited evidence available in the literature [2–6, 18, 38, 39].”
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“2,3,11,31,34,37”
InfluentialSelf-citationStrength Training and Nutrition Help Prevent Sarcopenia in Older Adults
Pereira, M. C. A., da Silva, A. C., Mapa, V., Peixoto, L. M., Lacerda, I., Ferreira‐Júnior, J. B., Rosse, I. C., de Oliveira, E. C., Becker, L. K., Venturini, G. R. D. O., et al. (2025) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph22071118 · Cited by 1
“The effectiveness of the nutritional counseling was evaluated by assessing dietary protein intake using 24 h dietary recalls (24HR), applied before and after the intervention [11,19].”
InfluentialSu, Y., Zhou, S., Liu, W., Qu, C., Zhang, W., Zhang, M., Peng, Y.-M., & Luo, W. (2025) · Journal of Clinical Nursing · doi:10.1111/jocn.17844 · Cited by 1
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“Actual intakes of energy and protein were compared against the requirements calculated by the Dietitian using appropriate guidelines [e.g., references (5, 17, 41)], with percentage achievements calculated.”
InfluentialPeperkamp, M., Olthof, M. R., Visser, M., & Wijnhoven, H. A. H. (2025) · European Journal of Nutrition · doi:10.1007/s00394-025-03810-x · Cited by 3
“This aligns with the recommended intake of at least 0.83 g/ kg/d [70 , 71], or 1.0 g/kg/d[72 ] for older adults.”
InfluentialGurunathan, U., Smith, S., Dillon, S., et al. (2025) · International Journal of Surgery · doi:10.1097/js9.0000000000003876 · Cited by 1
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“Daily caloric intake from PN was calculated and divided into two categories: high-calorie (>1000 kcal/day) and low-calorie ( ≤ 1000 kcal/day) [13–16].”
Elfadil, O. M., Johnson, D. A., Pattinson, A. K., Hurt, R. T., & Mundi, M. S. (2025) · Clinical Nutrition ESPEN · doi:10.1016/j.clnesp.2025.11.155 · Cited by 1
AI-assisted PEG aftercare education for older adults: clinician-informed chatbot design (PEGAssist)
Ozata, D., Alpay, K. C., Avlagi, G. K., Bilgin, S., DURAK, Ü., Özata, İ. H., Deveci, S. C., Avcı, S., Döventaş, A., & Erdinçler, U. D. (2025) · European Geriatric Medicine · doi:10.1007/s41999-025-01369-8 · Cited by 1
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“International guidelines emphasise routine nutritional screening for older adults across all healthcare settings [40].”
Ceolin, C., Liberati, V., Acunto, V., Vergadoro, M., Simonato, C., Cazzavillan, S., Papa, M. V., Trapella, G. S., Zanforlini, B. M., Curreri, C., et al. (2025) · Immunity & Ageing · doi:10.1186/s12979-025-00548-2 · Cited by 1
“Such pathways may include rapid nutritional assessment [40], prehabili-tation [41], optimization of polypharmacy [42], counselling on vaccination and adherence [43], and intensified follow-up within the first 90 days—when vulnerability is highest.”
Krajewska, A., Tłustochowicz, K., Kowalik, A., et al. (2026) · Biomedicines · doi:10.3390/biomedicines14010139 · Cited by 1
“Early enteral feeding has been associated with fewer infections, a reduced need for surgical interventions, shorter hospital stays, and a lower mortality rate compared to parenteral nutrition [36,38,39].”
Sciacqua, A., Armentaro, G., Leosco, D., Desideri, G., Ungar, A., Locatelli, E., Volpato, S., Zucchini, I., Salvi, M., Maggio, M. G., et al. (2025) · Journal of Gerontology and Geriatrics · doi:10.36150/2499-6564-n932 · Cited by 2
“Although guidelines recommend a full diagnostic multi‑ marker workup for any older people with unexplained anaemia, fatigue, or functional decline 95 , such evalua‑ tions are not always feasible in long‑term care settings due to restricted access to laboratory testing, reduced availability of…”
Self-citationPerioperative fluid management in older trauma patients
Stenmanns, C., Olotu, C., Modreker, M. K., et al. (2026) · Zeitschrift für Gerontologie und Geriatrie · doi:10.1007/s00391-025-02545-y · Cited by 1
Kuo, Y.-W., Hsu, H.-F., Hou, W.-L., Fetzer, S. J., Liu, Y.-X., Chang, L., Lin, C. C., & Lee, J.-D. (2026) · Experimental Gerontology · doi:10.1016/j.exger.2026.113065 · Cited by 1
Bahat, G., Özkök, S., Erdoğan, T., Ilhan, B., Ören, M. M., Sacar, D. E., Can, B., Çetin, B. T., Akpinar, T. S., Doğrul, R. T., et al. (2026) · Drugs & Aging · doi:10.1007/s40266-026-01282-0 · Cited by 1
“Nutritional treatment is well-recognized as having paramount importance in older adults with acute problems adversely affecting their adequate nutrient intake, directly related to morbidity, need for hospitalization, and mortality [40–42].”
ESPEN guideline on clinical nutrition and hydration in geriatrics
López-Cisneros, S., Volkert, D., Beck, A. M., Cederholm, T., Cruz-Jentoft, A., Hooper, L., Kiesswetter, E., Maggio, M. G., Raynaud-Simon, A., Sieber, C., et al. (2026) · Nutrición Hospitalaria · doi:10.20960/nh.05388 · Cited by 1
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“Consistent with external geriatric nutrition guidance (e.g., PROT-AGE position paper (Bauer et al. 2013); ESPEN guidance (Volkert et al. 2022)), protein recommendations should be individualized according to health status, appetite, and comorbidities, with KNBG considered as one possible food-based…”
Copeptin kinetics in healthy aging
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Zhang, C., Xie, Z., Zhang, Q., et al. (2026) · Frontiers in Nutrition · doi:10.3389/fnut.2026.1796378 · Cited by 1
MICRONUTRIENT DEFICIENCY AS A GLOBAL PROBLEM
Бабієнко, В. В., Hruzevskyi, О. А., Shevelenkova, A. V., Koshelnyk, O. L., Kobolyev, Y. V., & Zhyhalina, N. (2026) · Актуальні проблеми сучасної медицини Вісник Української медичної стоматологічної академії · doi:10.31718/2077-1096.26.2.313 · Cited by 1
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“Contemporary guidance for older adults uses approximately 30 kcal/kg/day only as an individualized guiding value, with adjustment for disease, activity, tolerance, and clinical phase [5].”
Quan, A. T., Nguyen, H. L., & Tran, M. T. N. (2026) · Diabetes & Metabolic Syndrome Clinical Research & Reviews · doi:10.1016/j.dsx.2026.103466 · Cited by 1
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“…patients with general malnutrition (indicated e.g. by a significant weight loss), but also malnourished long-term care residents [13], in addition to other treatment options [14] The Journal of Nutrition, Health and Aging journal homepage: www. elsevier. com/locate/jnha lack of scientific evidence.”
Self-citation
Metadata
- Authors
- Volkert, D., Beck, A. M., Cederholm, T., Cruz-Jentoft, A., Hooper, L., Kiesswetter, E., Maggio, M., Raynaud-Simon, A., Sieber, C., Sobotka, L., van Asselt, D., Wirth, R., & Bischoff, S. C.
- Affiliations
- Friedrich-Alexander-Universität Erlangen-Nürnberg (DE)
- Herlev Hospital (DK)
- Uppsala University (SE)
- Instituto Ramón y Cajal de Investigación Sanitaria (ES)
- University of East Anglia (GB)
- University of Parma (IT)
- Université Paris Cité (FR)
- Charles University (CZ)
- Universitätsklinik Marien Hospital Herne (DE)
- University of Hohenheim (DE)
- Corresponding author
- Volkert, Dorothee
- ORCID
- Venue
- Clinical Nutrition
- Publisher
- Elsevier BV
- Published
- 2022-04
- Volume
- 41
- Issue
- 4
- Pages
- 958-989
- ISSN
- 0261-5614 (ISSN-L)
- OpenAlex
- W4221040785
- Semantic Scholar
- 5ecf900bd2cd28a66bb93bef3809889ff63d01e3
- Cited by
- 516
- References
- 280
- Citations by year
- 2026: 174 · 2025: 157 · 2024: 99 · 2023: 69 · 2022: 17
- FWCI
- 43.76
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Clinical Nutrition (publishedVersion)
- PubMed (publishedVersion)
- UEA Digital Repository (University of East Anglia) (submittedVersion)
- Radboud Repository (Radboud University) (submittedVersion)
- Funders
- European Society for Clinical Nutrition and Metabolism
- United European Gastroenterology
- Topics
- Health Sciences › Medicine › Physiology (medical) › Nutrition and Health in Aging
- Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
- Health Sciences › Health Professions › Speech and Hearing › Dysphagia Assessment and Management
- Keywords
- malnutrition, dehydration, older adults, hydration, obesity, weight loss interventions, malnutrition screening, enteral nutrition, parenteral nutrition, oral nutritional supplements, nutrition counseling, dietary restriction, multidisciplinary care
- MeSH terms
- Aged, Aged, 80 and over, Geriatrics, Humans, Quality of Life, Nutritional Support, Malnutrition
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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