Ólöf Guðný Geirsdóttir

Objectives: The growing proportion of older adults underscores the importance of healthy aging. Maintaining good nutrition and physical activity are crucial for sustaining health. However, research on aging inequalities suggests that individuals with lower socioeconomic status (SES) may be at higher risk for inadequate nutrition. The study examined associations between SES and nutrition in older community-dwelling adults in Iceland and whether the Sustainable Development Goals (SDGs) are being met in Iceland. Methods: Data from the AGES-Reykjavik study were used, and SES was grouped into four categories (low, medium-low, medium-high, and high), derived from education and occupation. Descriptive statistics were used to examine differences between groups, and logistic regression was used to explore associations with food and drink consumption. Results: Older adults with low SES were less likely to frequently consume vegetables, fruit, cod or saithe liver oil/pills, oatmeal or muesli, and cultured milk products, and they were less likely to meet nutritional guidelines. Higher SES was associated with greater alcohol intake. Conclusions: Older adults with low socioeconomic status are less likely to consume healthy food products than those with higher SES. As these individuals live independently, the findings highlight the need for targeted nutritional prevention and support to reduce health disparities, including potential risks such as insufficient vitamin D intake. Furthermore, the results suggest that the SDGs related to nutrition are not being met in Iceland, warranting monitoring and policy action.

Background/Objectives: This systematic review aimed to investigate the relationship between birth size, a marker of prenatal undernutrition, and both physical and cognitive function in individuals aged 60 years and older. Methods: We searched the PubMed and Scopus databases up to November 2024 for prospective cohort studies that included data on birth size and physical or cognitive function in individuals aged 60 or older, excluding studies focused on preterm individuals. The Risk Of Bias In Non-randomized Studies—of Exposure (ROBINS-E) tool was used to evaluate the bias of each included study. Fixed-effects meta-analysis was performed using Review Manager. This systematic review was registered with PROSPERO, CRD42023360823. Results: Twenty-four articles met the eligibility criteria, with participant numbers ranging from 52 to 4000 (about 50% women) and an average age range of 60.9 to 78.4 years. Eight articles had a high risk of bias, while the remaining 16 presented some concerns. Three meta-analyses were conducted: two for grip strength and one for word fluency. Grip strength was positively associated with birth weight, both in an unadjusted analysis, which showed an increase of 1.88 kg (95% CI 1.19, 2.56), and in an analysis adjusted for age, sex, and height/body mass index, which showed an increase of 1.15 kg (95% CI 0.71, 1.59). Word fluency also displayed a positive association with birth weight, with an increase of 0.62 words per minute (95% CI 0.15, 1.10). Conclusions: Smaller birth size, indicative of prenatal undernutrition, is associated with diminished physical and cognitive function in later life. These results highlight the importance of identifying individuals born small as a vulnerable group and implementing lifelong strategies to promote healthy aging.

Background/Objectives: Malnutrition is a key contributor to poor outcomes in older adults with fragility fractures, increasing the risk of complications, functional decline, prolonged hospital stays, mortality, and healthcare costs. Substantial evidence limited to hip fracture supports early, interdisciplinary nutrition care. However, global audits reveal that most hip fracture patients do not receive recommended interventions. This quality improvement (QI) project aimed to co-create and test a pathway and toolkit to help apply evidence-based nutrition care in different fragility fracture settings globally. Methods: The SIMPLER Pathway and toolkit (SIMPLER) were developed through a multiphase, co-creation QI initiative (2018–2025), guided by the Knowledge-to-Action framework. Global experts and clinical teams synthesized evidence, identified the “know-do” gap, and adapted SIMPLER to context through iterative action–reflection cycles. The Model for Improvement guided team building, goal setting, testing changes, and measuring outcomes at pilot sites. Results: Over 100 co-creation activities between 2018 and 2025 engaged staff and patients to shape and refine SIMPLER. A global clinician survey (n = 308, 46 countries), two bi-national audits (n = 965, 63 hospitals), and qualitative interviews (n = 15) confirmed a widespread evidence-practice gap. The pathway and toolkit were pilot-tested in five hospitals across four countries, with action–reflection cycles enabling continuous refinement of prioritized nutrition improvements tailored to the local context. Following endorsement in late 2024, 46 healthcare services in 23 countries have formally committed to implementing SIMPLER. Conclusions: The SIMPLER Nutrition Pathway provides a scalable, adaptable framework to support the delivery of evidence-based nutrition care in fragility fracture settings. A global evaluation is underway.

Background/Objectives: Malnutrition is a key contributor to poor outcomes in older adults with fragility fractures, increasing risk of complications, functional decline, prolonged hospital stays, mortality, and healthcare costs. Substantial evidence limited to hip fracture supports early, interdisciplinary nutrition care. However, global audits reveal that most hip fracture patients do not receive recommended interventions. This quality improvement (QI) project aimed to co-create and test a pathway and toolkit to help apply evidence-based nutrition care in different fragility fracture settings globally. Methods: The SIMPLER Pathway and toolkit (SIMPLER) were developed through a multiphase, co-creation QI initiative (2018–2025), guided by the Knowledge-to-Action framework. Global experts and clinical teams synthesized evidence, identified the “know-do” gap, and adapted SIMPLER to context through iterative action-reflection cycles. The Model for Improvement guided team building, goal setting, testing changes, and measuring outcomes at pilot sites. Results: Over 100 co-creation activities between 2018 and 2025 engaged staff and patients to shape and refine SIMPLER. A global clinician survey (n=308, 46 countries), two bi-national audits (n=965, 63 hospitals), and qualitative interviews (n=15) confirmed a widespread evidence-practice gap. The pathway and toolkit were pilot-tested in five hospitals across four countries, with action-reflection cycles enabling continuous refinement of prioritized nutrition improvements tailored to local context. Following endorsement in late 2024, 46 healthcare services in 23 countries have formally committed to implementing SIMPLER. Conclusion: The SIMPLER Nutrition Pathway provides a scalable, adaptable framework to support delivery of evidence-based nutrition care in fragility fracture settings. A global evaluation is underway.

This study examined whether participants with poor activities of daily living (ADLs) at hospital discharge had increased weight loss after 6 months of follow-up and whether nutrition therapy can prevent this weight loss. This dietary randomized controlled trial (N = 104) examined community-dwelling older adults (66–95 years) discharged from hospital and at risk for malnutrition, receiving either 6 months of nutrition therapy (intervention) or only standard care (control). ADL was assessed using seven questions on self-care based on the Katz et al.’s method. At discharge, 45 (43%), 36 (35%), and 23 (22%) had high, medium, and poor ADL, respectively, with no differences between the control and intervention groups according to chi-square test. Participants in the control group with poor ADL had significantly higher weight loss than participants with high ADL (age- and sex-adjusted analysis of covariance: 3.6 kg; 95% confidence interval [1.0, 6.1] kg, p = .007). No such difference was observed in the intervention group. Participants with poor ADL at hospital discharge develop lower body weight by around 3.5 kg 6 months later when compared with participants with high ADL. Receiving nutrition therapy could help older adults with poor ADL to maintain body weight after hospital discharge.

Background: Malnutrition predicts poor outcomes following hip fracture, affecting patient recovery, healthcare performance, and costs. Evidence-based guidelines recommend multicomponent, interdisciplinary nutrition care to improve intake, reduce complications, and enhance outcomes. This study examines global variation in oral nutrition support for older (65+ years) hip fracture inpatients. Methods: A global survey was conducted as part of a broader program to improve interdisciplinary nutrition care. The protocol was based on evidence-based guidelines, reviewed by experts, and piloted for validity. Recruitment used snowball sampling to achieve diversity across income levels, countries, and healthcare roles. Results: The survey (July–September 2023) recruited 308 participants from 46 countries across five global regions. Respondents primarily worked in acute teaching (57.5%) and non-teaching (17.5%) hospitals, representing medical (48.4%), nursing (28.2%), and allied health (17.9%) roles. Findings revealed a global knowledge-to-practice gap in multicomponent nutrition care, across providing high-protein/energy food and fluids (median: “half the time”), post-operative provision of oral nutritional supplements (median: “half the time”) and continuation for one month with assessment (median: “not very often”), and nutritional education (median: “not very often”). Only 17.9% of respondents reported routine provision (“often” and “nearly always or always”) of high-protein/energy food, supplements, and education. Substantial regional variation showed Western Pacific respondents perceiving the lowest provision across multicomponent processes. Interdisciplinary, multicomponent interventions were seen as a potential opportunity requiring further exploration. Conclusions: Major gaps persist in implementing evidence-based, interdisciplinary, multicomponent nutrition care for older adults with hip fractures. A targeted implementation approach is the next step to addressing the knowledge-to-practice gap.

Food is one of the main drivers of global greenhouse gas (GHG) emissions. Therefore, it is crucial to investigate the environmental impact of food choices. A National Dietary Survey (NDS) is executed every ten years in Iceland. However, the dietary carbon footprint (DCF) based on the results from the NDS has not been estimated for Iceland before. Thus, the objective was to assess the DCF of dietary habits of adults living in Iceland. A carbon footprint modelling tool was implemented using data from three independent LCA databases from Denmark, the US, and France. The DCF was calculated using results from the latest NDS, including data from 2019 to 2021. This was a random study sample of 18–80 year old inhabitants living in Iceland with 822 participants, including 428 (52%) females and 394 (48%) males. The participation rate in the NDS was 51%. The average total DCF from the three databases was 5.7 kg CO₂-eq/day. The highest emissions originated from the consumption of meat and meat products (49%) (median intake 850 g/week) and dairy products (15%) (median intake 250 g/day), while emissions from the consumption of seafood (median intake 130 g/week) had a broader range (3–10%). Beverages also contributed to a significant proportion (12%), plant sources contributed 3%, and other food groups combined contributed 13% of the DCF in all three databases. The DCF for the participants following the Planetary Health Diet, the Nordic Nutrition Recommendations, and the Danish food-based dietary guidelines for intake levels of meat and dairy products was an average of 2.6 kg CO₂-eq/day. The main driver of GHG emissions from food consumption, identified by the three databases, was meat and dairy products, contributing to an average of 64% of the total DCF. When estimating the DCF for participants following recommendations for meat and dairy consumption, a similar pattern emerged, where the DCF decreased from 5.9–2.6 kg CO₂-eq. These consistent results suggest that uncertainties in estimating the DCF from different food groups using the three databases are not critical in identifying key drivers of GHG emissions.

Proteins are needed for providing essential amino acids, nitrogen, and fuel for the body’s needs in all age groups. Proteins are especially required during active growth in pregnancy, lactation, childhood, and tissue growth in general. An adequate protein intake is needed in old adults to avoid premature muscle loss. According to the current dietary surveys, protein intake in the Nordic and Baltic countries varies from 15 to 19% of the total energy intake in adults. Comprehensive data regarding children and older adults are lacking. No good measure for protein status exists, and the estimation of physiological requirements is based on N-balance studies having some weaknesses. Protein quality is assessed by considering the protein digestibility of individual indispensable amino acids and their utilization (bioavailability), which is affected by food antinutrients and processing. The evidence regarding the association of protein intake per se with health outcomes is limited or suggestive. It is difficult to separate from the effect of other nutrients or ingredients in protein-rich foods. Proteins are widespread in foods, deriving from both animal and plant sources. Animal-sourced protein production puts more strain on the environment than plant-sourced proteins and contributes significantly to greenhouse gas emissions, thereby enhancing climate change. In Nordic and Baltic countries, consumption of animal-sourced proteins is relatively high. A shift toward more plant-based protein diets would be advisable for promoting a healthy and sustainable diet.

Nutrition and hydration are fundamental aspects of healthcare, especially in the care of older people, particularly those in hospitals or in long-term care facilities. Worldwide, nurses are ‘best-placed’ coordinators of interdisciplinary nutritional management and care processes. Even so, it is essential that nurses collaborate with other healthcare specialists as an interdisciplinary team to provide high-quality care that reflects patients’ needs for assessment, intervention, and health promotion. When an interdisciplinary team work collaboratively, care is more successful, improves patient outcomes, and reduces the risk of in-hospital and long-term mortality.The care process begins with screening and monitoring of the nutritional status and fluid intake of all older people within 24 h of admission. In the case of positive screening, comprehensive assessment and involvement of other team members should undertake to understand the underlying problem. Appropriate food and appealing meals, snacks, and drinks should be available and offered with recommended amounts of energy, protein, vitamins, minerals (particularly calcium), and water. This should be complemented with supplementary drinks if intake is not adequate. The prescription of vitamin D and calcium should be discussed.Patient-centred and evidence-based information should provide and interventions in the case of end-of-life care should be appropriate discussed. Educating, informing, and involving patients and families increases their level of health literacy. Malnutrition and/or dehydration management should be included in the discharge plan.The aim of this chapter is to increase awareness of nurses’ responsibility, within a multidisciplinary team, for assessment and intervention of nutrition and hydration, examine the issues pertaining to nutrition and fluid balance in older people and outline the nature, assessment and interventions relating to malnutrition and dehydration.