What are the systems issues that affect the nutrition intake of older adults

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In Australia, the group-based equations published by the NHMRC Nutrient Reference Values (NRVs) are used to estimate the food energy needs of adults (6). However, they come with some limitations. These include (i) the equations for older adults are defined as a single group who are aged 60+ and older adults are not defined (ii) they were not derived from gold standard measures, rather they apply the 1985 Schofield Equations (7) which were extrapolated from data provided by younger individuals. The Nutrient Reference Values themselves categorise all older adults as 60+ years with no nuanced appreciation of body composition and activity changes that occur with aging. Our primary and underpinning discovery research has shown that the energy needs of octogenarians, nonagenarians and centenarians are considerably different to those of a 60-year-old. We have published new equations specifically for older adults, which include contemporary Australian data that we collected in a study in Melbourne (8).
This underpinning work has led to the publication of new improved equations for estimating the energy requirements specifically for aged groups of older adults, including a unique set for those over 80 years of age (9,10,11). These three papers were all published in the top nutrition journal The American Journal of Clinical Nutrition and have received over 48 citations (google scholar June 2026). These new equations, provide a high level of evidence, quality and strength to warrant implementation.
The adoption of new evidence-based innovations into routine practice can take many years. On average, there is an estimated 16-year gap between the generation of new knowledge and its consistent use to improve health outcomes for beneficiaries (12). For this reason, it is important to understand the perceived barriers to adopting these updated energy equations, as well as the factors that may enable more rapid uptake of practice change.
This study will examine barriers and enablers to change from the perspectives of multiple stakeholders. It will also explore how beneficiaries of this new knowledge—including older adults, carers, service providers and health professionals—may respond when an older persons’ nutritional requirements are more accurately estimated and met through nutrition care. These insights will help determine whether implementing the updated equations could improve food provision in hospitals, aged care settings and other services that support older adults who rely on others for meals, and whether this may contribute to better nutrition status and health outcomes over the longer term.
Implementation has grown into a branch of science of its own in part due to the need to have an in depth understanding of the theory of practice change and develop a theoretical understanding of system change which can be used to influence the direction or adoption of change. We will apply the Consolidated Framework for Implementation Research (CFIR) and benefit from the extensive library of resources available to researchers that accompanies this model (14). The CFIR therefore provides the theoretical model for this project.