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. 2026 Apr 27;51(4):590–602. doi: 10.1007/s10900-026-01567-w

A Review of Community-Based Frailty and Malnutrition Screening in Older Adults: Current Interventions and Tools

Azliyana Azizan 1,✉, Hafifi Hisham 2, Ameera Faisal 3, Farid Rahman 4
PMCID: PMC13385013  PMID: 42043469

Abstract

Frailty and malnutrition are prevalent and interrelated conditions among community-dwelling older adults, contributing to functional decline, reduced quality of life, and increased healthcare utilization. Early identification through community-based screening offers an important opportunity for prevention; however, screening practices and linked interventions remain heterogeneous across settings. This structured narrative review synthesized peer-reviewed studies published between January 2021 and February 2026 identified through the Scopus database. Eligible studies focused on adults aged ≥ 60 years and examined either community-based frailty or malnutrition screening tools or community interventions that incorporated screenings. Data were synthesized descriptively across two analytical components: screening tools and screening-informed interventions. A total of 42 studies were included. Screening tools ranged from low-resource anthropometric measures and brief questionnaires to structured nutritional indices and multidomain frameworks. Interventions commonly integrated screening with nutrition-focused strategies, physical activity, education, or multidomain lifestyle programs delivered in community settings. Recent studies increasingly emphasized feasibility, early risk identification, and linkage between screening and preventive action. Community-based frailty and malnutrition screening is increasingly used as a gateway to preventive interventions rather than as an isolated assessment. Aligning feasible screening tools with actionable intervention pathways is critical for advancing healthy aging strategies. Future research should prioritize long-term outcomes, implementation sustainability, and system-level integration within community health services.

Graphical Abstract

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Keywords: Frailty, Malnutrition, Older adults, Interventions, Tools

Introduction

Population aging presents a major public health challenge worldwide, with increasing numbers of older adults living with complex health needs in community settings. Among these, frailty and malnutrition are particularly prevalent and often coexisting conditions that contribute to functional decline, disability, hospitalization, and mortality [1,2]. Importantly, both conditions are potentially modifiable, especially when identified early, making them priority targets for community-based prevention strategies.

Frailty is commonly conceptualized as a state of increased vulnerability resulting from age-related decline across multiple physiological systems, leading to reduced resilience to stressors [3,4]. Malnutrition, including undernutrition and inadequate protein or energy intake, is both a contributor to and consequence of frailty, particularly among community-dwelling older adults [5,6]. Despite their clinical significance, frailty and malnutrition frequently remain under-recognized in community and primary care settings, where time, resources, and specialist expertise may be limited.

In response, a wide range of community-based screening tools have been developed to facilitate early identification of frailty and nutritional risk. These tools vary considerably in scope, complexity, and feasibility, ranging from brief questionnaires and anthropometric measures to structured indices and multidomain frameworks [7]. Parallel to these developments, community-based interventions increasingly incorporate screening results to guide nutrition support, physical activity, education, and integrated care pathways [1,8]. However, evidence remains fragmented, and there is limited synthesis that focused on how screening tools are applied in community contexts and how they inform subsequent interventions.

Therefore, the objective of this review was to synthesize recent evidence on community-based frailty and malnutrition screening in older adults, with a dual focus on (i) screening tools used in community settings and (ii) community-based interventions that incorporate screening as part of prevention or service delivery. By examining both screening feasibility and actionability, this review aims to inform community health practice and support the development of integrated, prevention-oriented aging strategies.

Methods

Given the growing emphasis on early identification and prevention of frailty and malnutrition in community settings, a structured synthesis of recent evidence was undertaken to capture both screening practices and linked interventions among older adults. The methodological approach was designed to reflect real-world community health contexts, where feasibility, scalability, and actionability are central to screening and prevention strategies.

Study Design

This review employed a two-part structured narrative review design to synthesize heterogeneous evidence across community health domains [9]. Narrative and structured reviews are particularly suited to public health topics where study designs, settings, and outcome measures vary substantially and where implementation context is central to interpretation. The review focused on community-based frailty and malnutrition screening in older adults and was organized into two analytic components:

  • (i)

    identification and description of frailty and malnutrition screening tools used in community settings, and.

  • (ii)

    synthesis of current community-based interventions that incorporated frailty or malnutrition screening as part of service delivery or prevention strategies.

Data Source and Search Strategy

The literature search was conducted using Scopus, selected for its broad coverage of public health, gerontology, primary care, and community health research and its suitability for multidisciplinary reviews [10]. The dataset comprised 351 peer-reviewed records published between January 2021 and February 2026. Searches were restricted to English-language publications.

Search terms combined four conceptual domains:

(1) population (older adults),

(2) condition (frailty and/or malnutrition),

(3) screening or assessment, and.

(4) community setting.

Searches were applied to article titles, abstracts, and author keywords to maximize sensitivity. Records were exported in CSV format for systematic screening and data extraction.

Eligibility Criteria

Studies were included if they met all of the following criteria:

  • Focused on adults aged 60 years or older;

  • Conducted in community-based, non-institutional settings, including primary care, home care, senior centers, public health programs, or community outreach initiatives;

  • Addressed frailty or malnutrition screening tools (Part 1) or interventions that incorporated screening (Part 2);

  • Published as peer-reviewed journal articles.

Studies were excluded if they:

  • Were conducted exclusively in acute hospital or inpatient settings, as these differ substantially from community contexts in screening feasibility and implementation.

  • Focused solely on diagnostic biomarkers or laboratory measures without a screening or assessment component.

  • Were editorials, conference abstracts, protocols, commentaries, or other non-peer-reviewed formats.

These criteria were selected to ensure relevance to community health practice and alignment with prevention-oriented aging research.

Study Selection

All records were imported into a reference management environment, and duplicate records were removed prior to screening. Titles and abstracts were screened for relevance to community-based frailty or malnutrition screening. Full texts were reviewed when eligibility could not be determined from abstracts alone. Screening decisions were guided by the predefined inclusion and exclusion criteria.

The study selection process followed PRISMA 2020 reporting principles, with records categorized into identification, screening, eligibility, and inclusion stages to enhance transparency and reproducibility [11].

Data Extraction and Synthesis

For Part 1, data were extracted on screening tools type, assessment domains (e.g., nutritional, physical, multidomain), and applicability within community settings. For Part 2, extracted data included intervention type, delivery setting, target population, and the extent to which screening results informed subsequent actions such as referral, education, or support.

Given heterogeneity in study designs, outcomes, and implementation contexts, findings were synthesized descriptively rather than quantitatively, consistent with best practices for narrative and public health reviews [12]. Screening tools and interventions were grouped thematically to facilitate comparison across community contexts and to identify patterns relevant to practice and policy. Figure 1. PRISMA 2020 flow diagram of the study selection process. Records were identified through Scopus database searching (n = 351). Following title and abstract screening, 289 records were excluded. Full-text articles were assessed for eligibility (n = 62), of which 20 were excluded for non-community-based settings, lack of a screening component, or publication type. A total of 42 studies were included in the qualitative synthesis.

Fig. 1.

Fig. 1

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The PRISMA flow diagram detailing the screening and selection process of literature

Results

Overview of Included Studies

The included literature spanned January 2021 through February 2026 and addressed either (1) community-based frailty and/or malnutrition screening tools (Part 1) or (2) community-based interventions incorporating screening (Part 2), with some studies contributing evidence relevant to both components. Consistent with the evolving emphasis on community prevention and healthy aging, the included studies increased in frequency over time, with many published between 2023 and 2025. Studies were conducted across multiple regions, including East Asia (e.g., Korea, China, Singapore, Japan), Europe, and North America, underscoring broad international interest in scalable screening and intervention strategies for aging populations.

Part 1: Frailty and Malnutrition Screening Tools

The included studies demonstrated substantial diversity in community-feasible screening approaches, ranging from brief anthropometric measures and questionnaires to composite indices and multidomain functional screening tools (Table 1). Several studies evaluated nutritional screening measures as practical entry points for identifying frailty-related vulnerability. For example, Desiana (2025) [13] examined the combined use of Mini Nutritional Assessment (MNA) scores and body mass index, alongside a community frailty checklist, to identify frailty risk among community-dwelling older adults, supporting the feasibility of nutrition-based screening for early frailty detection. Similarly, Kim (2024) [14] evaluated mid-upper arm circumference (MUAC) within a large community cohort and demonstrated its utility as a pragmatic, low-resource anthropometric marker for identifying physical frailty in community-dwelling older adults.

Table 1.

Community-Based Frailty and Malnutrition Screening Tools Among Older Adults

Study Study type Community setting Population Screening tool / measure What the tool measures Key results relevant to community screening
(as reported)

Desiana (2025)

[13]

 Cross-sectional/community study Community (Indonesia) Community-dwelling older adults MNA score + BMI (with Kihon’s Frailty Checklist) Nutritional status + frailty status Evaluated the predictive/associative value of MNA and BMI for frailty status using a community frailty checklist; supports feasibility of nutrition screening to flag frailty risk in the community

Kim (2024)

[14]

 Cohort-based analysis (KFACS) Community-dwelling cohort Community-dwelling older adults (Korea) Mid-upper arm circumference (MUAC) Anthropometric proxy for muscle/nutritional reserves; frailty risk indicator Tested MUAC as a screening tool for identifying physical frailty in community-dwelling older adults; supports MUAC as a pragmatic, low-resource community screen

Wei (2024)

[15]

 Observational study Community (China) Chinese community-dwelling older adults ENIGMA (Elderly Nutritional Indicators for Geriatric Malnutrition Assessment) Nutritional risk index Examined nutritional risk using ENIGMA and links to adverse outcomes; supports use of structured nutritional indices for risk stratification in community settings

Ng (2022)

[16]

 Validation/construct study Community-based cohort Community-dwelling older persons ENIGMA index (external evaluation) Nutritional risk/geriatric malnutrition risk Reported concurrent, construct, and predictive validity of ENIGMA in an external community cohort; supports index-based nutritional screening in community populations

Lu (2023)

[17]

 Diagnostic performance study Community/primary care-type screening context Older adults screened for intrinsic capacity decline WHO ICOPE screening tool Intrinsic capacity decline domains (multi-domain function) Reported diagnostic performance of the ICOPE screening tool to identify decline; supports feasibility of brief multi-domain screening relevant to frailty prevention in community care

Okyar-Bas (2023)

[18]

 Validation study Community / outpatient context Older adults (Turkey) PRISMA-7 (Turkish version) Case-finding for frailty Reported validation of PRISMA-7 as a case-finding instrument for detecting older adults living with frailty; supports brief frailty case-finding in community settings

Lee (2021)

[19]

 Observational association study Community-dwelling (Korea) Korean older adults FRAIL scale Frailty risk (brief questionnaire) Reported associations between FRAIL scale and geriatric syndromes/health outcomes; supports FRAIL as a feasible community screen linked with broader vulnerability

Cheong (2023)

[20]

 Longitudinal cohort analysis Community cohort (Singapore) Older adults in a longitudinal aging study Frailty/malnutrition/metabolic/inflammatory indexes Multi-index risk profiling Compared multiple frailty and malnutrition-related indexes with multimorbidity incidence/progression and mortality impact; supports index-based stratification approaches in community aging cohorts

Edwards (2022)

[21]

 Community evaluation / brief intervention study Community outreach settings Older people at risk of undernutrition PaperWeight Armband (MUAC-based) Undernutrition risk case-finding Evaluated feasibility of using a very low-resource MUAC-based tool to identify undernutrition risk in the community, paired with brief follow-up action

De Luca (2022)

[7]

 Narrative review Community-dwelling focus Community-dwelling older adults Biopsychosocial frailty tools (multiple) Physical, psychological, and social frailty dimensions Summarized multidimensional frailty tools used in community populations, supporting broader conceptualization of frailty beyond physical phenotype in community screening
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A second cluster of studies focused on structured indices and multidomain screening tools to enhance risk stratification in community populations. Previous findings had reported on the ENIGMA nutritional risk index, providing evidence of its validity and associations with adverse health outcomes in community-dwelling older adults [15,16]. These findings highlight growing interest in index-based screening approaches that may be scalable beyond traditional nutritional tools. Beyond nutritional risk, community screening increasingly extended to broader functional vulnerability. Lu (2023) [17] evaluated the diagnostic performance of the World Health Organization Integrated Care for Older People (WHO ICOPE) screening tool for identifying intrinsic capacity decline, emphasizing the feasibility of brief multidomain screening that is relevant to frailty prevention in community care settings.

Frailty-specific case-finding tools were also well represented. Okyar-Bas (2023) [18] validated a Turkish version of PRISMA-7, supporting its use as a brief case-finding instrument for identifying older adults living with frailty in community or outpatient contexts [19]. Complementing these single-tool studies, one study had compared multiple frailty, malnutrition, metabolic, and inflammatory indices within a longitudinal community cohort, illustrating increasing use of combined risk profiling to predict multimorbidity progression and mortality among community-dwelling older adults [20]. Finally, Edwards (2022) [21]evaluated the PaperWeight Armband, a MUAC-based screening device, demonstrating the feasibility of extremely low-resource undernutrition case-finding paired with brief follow-up action in community outreach settings. Collectively, these studies indicate a shift toward a spectrum of screening tools, which ranging from simple anthropometry to multidomain frameworks, that selected primarily for feasibility and scalability in non-specialist community settings (Table 1). This trend is further supported that biopsychosocial frailty tools suitable for community populations and advocated for broader conceptualization of frailty beyond purely physical criteria [7].

Part 2: Community-Based Interventions

A substantial subset of included studies described community-based interventions that explicitly incorporated frailty and/or malnutrition screening into eligibility determination, intervention tailoring, or outcome evaluation (Table 2). Nutrition-focused interventions were among the most commonly reported and frequently used screening to identify individuals at risk prior to intervention delivery. For example, latest findings reported outcomes of a community nutrition-focused program in which frailty screening was used to assess and monitor changes in frailty-related status, illustrating a nutrition-led approach to community frailty prevention [22]. Similarly, Struszczak (2025) [23] evaluated a community intervention involving a daily high-protein, high-energy meal targeted to malnourished or at-risk older adults, with nutrition status assessment directly linked to intervention delivery and evaluation. Previously, study had assessed the impact of a nutritionally complete oral nutritional supplement in a community context, further reflecting integration of screening with targeted nutritional intervention [24].

Table 2.

Community-Based Interventions Incorporating Frailty and Malnutrition Screening in Older Adults

Study Study type Community setting Population Intervention type Screening integration (frailty/malnutrition) Key results relevant to community practice (as reported)

Cano-Gutierrez (2025)

[22]

 Intervention evaluation Community Older adults Nutrition-focused program Frailty screening used to assess/change frailty status Reported program outcomes on frailty-related status; illustrates nutrition-led community approach

Zhou (2025)

[36]

 Intervention study Community (Pre)frail community-dwelling older adults Theory-driven exercise intervention Baseline nutritional status used to evaluate differential effectiveness Examined how nutritional status modifies exercise intervention response in (pre)frail older adults

Buhl (2025)

[37]

 Randomised controlled trial Community-dwelling Adults ≥ 80 years Whole-food dairy protein supplementation Screening/eligibility includes community-dwelling ≥ 80; nutrition-related targeting Reported success/acceptability outcomes for personalised protein supplementation

Pöyhönen (2025)

[28]

 Post hoc analysis of RCT Community-based trial context Older adults Multidomain lifestyle intervention Frailty outcome used to assess short/long-term effect Examined short- and long-term frailty effects of a multidomain lifestyle intervention

Ng (2025)

[29]

 Community intervention study Community Pre-frail older adults Community nutrition education Pre-frail screening; sarcopenia markers assessed Evaluated nutrition education effects on intake and sarcopenia-related markers in pre-frail adults

Struszczak (2025)

[23]

 Intervention study Community-dwelling Malnourished/at-risk older adults Daily high-protein/high-energy meal Malnutrition status assessed; nutrition screening linked to intervention Reported effects on physical and psychological wellbeing in malnourished community-dwelling older adults

Sen (2025)

[32]

 Systematic review Community/public health Older adults Interventions targeting social isolation + food insecurity Food insecurity/malnutrition risk identification Synthesized interventions targeting social isolation and food insecurity relevant to nutrition vulnerability in older adults

Ma (2024)

[31]

 Feasibility / implementation study Community Older adults WHO ICOPE implementation feasibility ICOPE screening embedded into program Evaluated feasibility of implementing ICOPE approach in community settings

Pedrinolla (2023)

[38]

 Randomised controlled trial Community Older adults Vitamin D + other components (trial-based) Frailty/sarcopenia-related screening criteria used Reported results of RCT combining vitamin D with other strategies relevant to frailty prevention

Ward (2023)

[27]

 Trial (BMJ Open) Community Older adults Protein-enriched Mediterranean diet approach Nutrition screening/risk stratification informs intervention Examined effects of protein-enriched Mediterranean diet strategy on relevant aging outcomes

Casals (2023)

[30]

 Educational intervention study Community Older adults Educational intervention Frailty status measured pre/post Reported effects of education on frailty-related outcomes in older adults

Tufan (2023)

[39]

 Observational/clinical-community study Community-dwelling Older adults (Intervention-related comparison) Frailty stratification used Evaluated how frailty status influences relevant outcomes among community-dwelling older adults

Millan-Domingo (2022)

[40]

 Real-life program outcomes Community Older adults Multicomponent exercise intervention Frailty screening/stratification used Reported “real-life” outcomes from multicomponent exercise program

Tay (2022)

[41]

 Intervention analysis Community Older adults Intrinsic capacity-focused approach Intrinsic capacity screening considered Reported that intrinsic capacity patterns were more explanatory than “intervention exposure” in outcomes

Yeung (2022)

[24]

 Intervention study Community Older adults Nutritionally complete oral nutritional supplement Malnutrition risk assessed and linked to ONS Evaluated effect of nutritionally complete ONS in community context

Sunguya (2022)

[42]

 Intervention modeling/review Population/community Older adults Targeted + population-wide interventions Risk identification implied for targeting Discussed targeted vs. population-wide intervention strategies relevant to undernutrition

Khor (2022)

[43]

 Systematic review Community Older adults Nutrition interventions Nutrition risk/assessment central Synthesized effectiveness of nutrition interventions for community older adults

Edwards (2022)

[21]

 Community brief intervention evaluation Community outreach Older adults PaperWeight Armband + brief action MUAC-based screening triggers brief intervention Evaluated screening-triggered brief intervention to identify undernutrition risk in community

Kim (2021)

[44]

 Intervention study Community Older adults Social network intervention Frailty/functional measures tracked Reported reinforcement effects of social network intervention relevant to frailty prevention

Jyväkorpi (2021)

[45]

 Article Community/older populations Older people Sarcopenia/physical frailty-related approach Frailty/sarcopenia assessment used Addressed sarcopenia and physical frailty in older populations relevant to community strategies

Matsuo (2021)

[34]

 Intervention study Community/outpatient oral health context Older adults Oral hypofunction improvement program Oral frailty screening/assessment Reported improvements in oral hypofunction via comprehensive approach relevant to nutrition/frailty

Uemura (2021)

[35]

 Intervention study Community Older adults Active learning program Frailty-related outcomes assessed Reported effectiveness of active learning program relevant to functional aging outcomes

Chaudhuri (2025)

[33]

 Needs assessment (program participation) Community (Texas) Older adults Congregate meal participation factors Meal program participation linked to nutrition vulnerability Identified barriers/facilitators to meal program participation relevant to nutrition intervention reach
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Interventions integrating nutrition and physical activity were increasingly represented in recent literature. Zhou (2025) [25] examined a theory-driven exercise intervention among pre-frail and frail community-dwelling older adults and demonstrated that baseline nutritional status modified intervention response, highlighting nutrition as a key determinant of functional benefit. Several trials focused on targeted dietary strategies to support function and frailty prevention, including whole-food dairy protein supplementation among adults aged 80 years and older (Buhl, 2025) and protein-enriched Mediterranean dietary approaches in which nutrition screening informed intervention stratification [26,27] Broader multidomain approaches were also evident; Pöyhönen (2025) [28] evaluated short- and long-term effects of a multidomain lifestyle intervention, using frailty outcomes as assessment endpoints, supporting the relevance of comprehensive intervention strategies in community-based prevention.

Multiple studies emphasized education, behavior change, and implementation feasibility. Previous findings had evaluated community-based nutrition education among pre-frail older adults, using pre-frailty screening and sarcopenia markers for assessment, reflecting prevention-oriented targeting before advanced decline [29,30]. Their reported outcomes of an educational intervention in which frailty status was measured before and after intervention, further supporting education as a feasible component of community frailty prevention strategies. In parallel, Ma (2024) [31] evaluated the feasibility of implementing the WHO ICOPE approach in community settings, demonstrating increasing prioritization of integrated models for intrinsic capacity and frailty prevention in real-world contexts.

Other interventions extended beyond conventional lifestyle programs to address social determinants and service uptake. Current findings also synthesized interventions targeting social isolation and food insecurity, highlighting growing recognition of upstream determinants influencing nutrition vulnerability and frailty risk among community-dwelling older adults [32]. Additionally, another study also identified barriers and facilitators to congregate meal participation among older adults in Texas, directly informing the reach and effectiveness of community nutrition programs [33]. Additional studies addressed alternative domains linked to frailty and nutrition, including oral hypofunction improvement programs where oral frailty screening was central [34] and active learning programs evaluating frailty-related outcomes [35]. Across these interventions, screening was consistently used not only for participant selection but also to guide referral pathways, tailor intervention intensity, and monitor intervention impact (Table 2).

Overall, the findings indicate that community-based frailty and malnutrition screenings are increasingly operationalized as a gateway to preventive action, rather than as an isolated assessment activity. Screening tools ranged from low-resource anthropometric measures to structured indices and multidomain functional frameworks, reflecting a continuum from feasibility-driven case-finding to comprehensive risk profiling. Interventions commonly linked screening to actionable strategies such as nutritional supplementation, dietary modification, structured physical activity, and multidomain lifestyle programs, with emerging attention to implementation feasibility and social determinants. Despite these advances, substantial heterogeneity persisted across tools, intervention models, and outcome measures, and relatively few studies addressed long-term sustainability or system-level impact, highlighting important gaps for future community-based frailty and malnutrition research.

Keyword Co-Occurrence Network and Thematic Clustering

Author keyword co-occurrence analysis identified frailty and malnutrition as the most central and highly interconnected concepts within community-based aging research, closely linked with older adults and elderly (Fig. 2). Surrounding these core terms, distinct thematic clusters reflected screening domains, intervention strategies, implementation contexts, and health outcomes.

Fig. 2.

Fig. 2

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Author keyword co-occurrence network of community-based frailty and malnutrition research. Node size represents keyword frequency and link thickness indicates co-occurrence strength. Colors denote thematic clusters across screening domains, interventions, outcomes, and community health contexts

A prominent cluster centered on nutritional status and undernutrition, incorporating terms such as diet, protein intake, and GLIM criteria, highlighting nutrition as a primary focus for community-based screening and prevention. Closely related, a physical frailty and sarcopenia cluster emphasized musculoskeletal vulnerability, including physical frailty, sarcopenia, osteosarcopenia, and falls, underscoring the importance of functional decline in community-dwelling older adults.

Contextual terms formed a clear community and public health cluster, with frequent co-occurrence of community, community-dwelling, primary care, and public health, reflecting the non-institutional settings emphasized in the literature. In parallel, a multidomain aging cluster incorporating intrinsic capacity, cognition, and comprehensive geriatric assessment indicated growing attention to holistic and functional screening frameworks.

Intervention-related keywords clustered around screening, prevention, and intervention, demonstrating that screening is commonly linked to actionable pathways rather than isolated assessment. Additional clusters captured lifestyle and physical activity, psychosocial and quality of life factors, and adverse outcomes such as disability and mortality, reflecting the multidimensional scope of community frailty and malnutrition research. Smaller clusters related to emerging and context-specific topics, including COVID-19, food insecurity, and oral health, highlighted evolving research priorities.

Discussions

This review synthesizes recent evidence on community-based frailty and malnutrition screening and related interventions among older adults, highlighting evolving practices that emphasize feasibility, prevention, and actionability within real-world community health contexts. Collectively, the findings demonstrate a shift away from isolated assessment toward screening-informed intervention pathways, reflecting broader preventive aging and population health frameworks.

Across included studies, a central theme was the prioritization of screening tools that are feasible, low-burden, and suitable for non-specialist delivery in community settings. Nutritional screening instruments such as the Mini Nutritional Assessment and anthropometric measures (e.g., MUAC) were frequently used as pragmatic entry points for identifying vulnerability, consistent with earlier evidence linking malnutrition and frailty risk in community-dwelling older adults [13,14]. Importantly, these tools require minimal equipment and training, supporting scalability in primary care, outreach, and home-based services.

At the same time, several studies demonstrated increasing interest in structured indices and multidomain screening frameworks, including ENIGMA and the WHO ICOPE tool [16,17]. These approaches extend beyond single-domain screening by capturing broader aspects of intrinsic capacity and cumulative risk. Such findings align with contemporary aging models that conceptualize frailty as a multidimensional process influenced by physical, nutritional, cognitive, and social factors [7]. However, while multidomain tools may offer improved risk stratification, their implementation may require additional training and system-level support, underscoring ongoing trade-offs between comprehensiveness and feasibility in community practice.

Brief frailty case-finding tools, such as PRISMA-7 and the FRAIL scale, were commonly reported and validated across diverse community populations [18,46]. Their consistent association with adverse outcomes reinforces their value as first-line screening instruments in settings where time and resources are limited. Notably, innovative low-resource approaches such as the PaperWeight Armband further illustrate how undernutrition risk can be identified even in outreach or volunteer-led contexts [21]. Together, these findings suggest that graduated screening pathways, beginning with simple case-finding and progressing to more detailed assessment when indicated, may be particularly suitable for community-based systems.

Beyond tool selection, the findings clearly indicate that screening is increasingly operationalized as a gateway to preventive intervention, rather than as an endpoint in itself. Most intervention studies explicitly integrated frailty or malnutrition screening into participant selection, tailoring, or outcome evaluation. Nutrition-focused interventions that including oral nutritional supplementation, high-protein meals, and dietary counselling were commonly targeted to individuals identified as at risk through screening [22,23,47]. This screening-to-action linkage is consistent with recommendations that early nutritional intervention can mitigate frailty progression and functional decline.

Moreover, interventions combining nutrition and physical activity were increasingly prominent, reflecting growing recognition of their synergistic effects. Studies demonstrated that baseline nutritional status can influence responsiveness to exercise interventions, reinforcing the importance of integrated screening to optimize intervention effectiveness [26,36]. Multidomain lifestyle interventions further supported this integrated approach, with evidence suggesting both short- and longer-term benefits for frailty-related outcomes [28].

In addition to clinical and lifestyle interventions, several studies emphasized education, implementation feasibility, and social determinants of health. Community nutrition education programs targeting pre-frail older adults demonstrated improvements in dietary intake and sarcopenia-related markers, highlighting the role of education as an early preventive strategy [29]. Implementation studies of the WHO ICOPE framework further underscored the growing emphasis on integrated, system-level approaches to intrinsic capacity and frailty prevention in community settings [31].

Importantly, the review also identified interventions addressing social isolation and food insecurity, factors increasingly recognized as upstream contributors to malnutrition and frailty risk [32]. Studies examining congregate meal participation and social network–based interventions illustrated how social engagement can reinforce nutritional and functional interventions, thereby enhancing sustainability and reach [33,48]. These findings highlight the necessity of embedding screening and intervention strategies within broader community and social care infrastructures.

Taken together, the evidence suggests that effective community-based frailty and malnutrition strategies require alignment between screening tools, intervention capacity, and implementation context. Simple, low-cost screening instruments can facilitate early identification, while more comprehensive tools may support targeted intervention planning when resources permit. Importantly, screening programs are most impactful when linked to actionable pathways, including referral, education, and multidisciplinary support.

However, despite promising trends, several gaps remain. Heterogeneity in screening tools, intervention designs, and outcome measures limits direct comparison across studies. Additionally, relatively few studies reported long-term outcomes or system-level impact, such as sustained functional improvement, healthcare utilization, or cost-effectiveness. Future research should prioritize longitudinal evaluation and implementation science approaches to better understand how screening-informed interventions can be scaled and sustained within community health systems.

This review provides a focused synthesis of recent community-based evidence by restricting inclusion to peer-reviewed studies published between 2021 and 2026 and by emphasizing real-world community settings. Nevertheless, limitations should be acknowledged. The review was limited to English-language studies indexed in Scopus, which may have excluded relevant evidence from other databases or regions. Additionally, the narrative synthesis approach, while appropriate given heterogeneity, precludes quantitative comparison of effectiveness across interventions.

In conclusion, recent literature demonstrates a clear shift toward integrated, screening-informed approaches to frailty and malnutrition in community-dwelling older adults. Screening tools are increasingly selected for feasibility and scalability, while interventions emphasize nutrition, physical activity, education, and social support. Strengthening the linkage between screening and actionable community-based interventions, alongside attention to sustainability and equity, will be critical for advancing preventive aging strategies in population health contexts.

Acknowledgments

The authors acknowledge Universiti Teknologi MARA (UiTM) for its support.

Funding

Open access funding provided by The Ministry of Higher Education Malaysia and Universiti Teknologi MARA

Declarations

Competing interests

None to disclose.

Footnotes

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

References

  • 1.Dent, E., et al. (2019). Physical Frailty: ICFSR International Clinical Practice Guidelines for Identification and Management. Journal of Nutrition Health and Aging, 23(9). 10.1007/s12603-019-1273-z [DOI] [PMC free article] [PubMed]
  • 2.Rockwood, K., et al. (2005). A global clinical measure of fitness and frailty in elderly people. CMAJ Canadian Medical Association Journal, 173(5). 10.1503/cmaj.050051 [DOI] [PMC free article] [PubMed]
  • 3.Fried, L. P. (2001). Frailty in older adults: Evidence for a phenotype, Journals of Gerontology - Series A Biological Sciences and Medical Sciences, vol. 56, no. 3. 10.1093/gerona/56.3.m146 [DOI] [PubMed]
  • 4.Hoogendijk, E. O., Afilalo, J., Ensrud, K. E., Kowal, P., Onder, G., & Fried, L. P. (2019). Frailty: implications for clinical practice and public health, 10.1016/S0140-6736(19)31786-6 [DOI] [PubMed]
  • 5.Volkert, D., et al. (2019). ESPEN guideline on clinical nutrition and hydration in geriatrics. Clinical Nutrition, 38(1). 10.1016/j.clnu.2018.05.024 [DOI] [PubMed]
  • 6.Morley, J. E., Anker, S. D., & von Haehling, S. (2014). Prevalence, incidence, and clinical impact of sarcopenia: facts, numbers, and epidemiology—update 2014, 10.1007/s13539-014-0161-y [DOI] [PMC free article] [PubMed]
  • 7.De Luca, V., et al. (2022). Assessment Tools of Biopsychosocial Frailty Dimensions in Community-Dwelling Older Adults: A Narrative Review. International Journal Of Environmental Research And Public Health, 19(23). 10.3390/ijerph192316050 [DOI] [PMC free article] [PubMed]
  • 8.Fairhall, N., et al. (2011). Treating frailty-a practical guide. Bmc Medicine, 9. 10.1186/1741-7015-9-83 [DOI] [PMC free article] [PubMed]
  • 9.Ponce, R. K. M., Verma, K., Gergen-Barnett, K., Brimhall, K., & Ko, N. Y. (2025). A Review of Medical Mistrust Across the Cancer Continuum of Care and Current Interventions, 10.1007/s10900-025-01462-w [DOI] [PMC free article] [PubMed]
  • 10.Falagas, M. E., Pitsouni, E. I., Malietzis, G. A., & Pappas, G. (2008). Comparison of PubMed, Scopus, Web of Science, and Google Scholar: strengths and weaknesses. The FASEB Journal, 22(2). 10.1096/fj.07-9492lsf [DOI] [PubMed]
  • 11.Lee, G. B., Etherton-Beer, C., Hosking, S. M., Pasco, J. A., & Page, A. T. (2022). The patterns and implications of potentially suboptimal medicine regimens among older adults: a narrative review. Ther Adv Drug Saf, 13. 10.1177/20420986221100117 [DOI] [PMC free article] [PubMed]
  • 12.Popay, J., Roberts, H., Sowden, A., Petticrew, M., Britten, N., Arai, L., Roen, K., & Rodgers, M. (2005). Developing guidance on the conduct of narrative synthesis in systematic reviews. J Epidemiol Community Health., 59(Suppl 1), A7. http://jech.bmj.com/content/vol59/suppl_1/
  • 13.Desiana, I., Defi, I. R., Khairani, A. F., Indrati, A. R., Luftimas, D. E., & Haq, M. F. (2025). Predictive Power of Mini Nutritional Assessment (MNA) Score and Body Mass Index (BMI) for Frailty in the Elderly Community in Indonesia Using Kihon’s Frailty Checklist. J Nutr Gerontol Geriatr, 44(4), 229–241. 10.1080/21551197.2025.2568384 [DOI] [PubMed] [Google Scholar]
  • 14.Kim, S. Y., Kim, M., Shin, D. W., Won, C. W., Shim, H. Y., & Cho, B. L. (2024). Mid-upper arm circumference as a screening tool for identifying physical frailty in community-dwelling older adults: The Korean Frailty and Aging Cohort Study. Geriatrics & Gerontology International, 24(12), 1292–1299. 10.1111/ggi.14998 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 15.Wei, K., Wang, H., Yang, J., Lin, S., & Li, C. (2024). Nutritional risk and adverse health outcomes in Chinese community-dwelling older adults: A study based on the Elderly Nutritional Indicators for Geriatric Malnutrition Assessment (ENIGMA). Nutrition (Burbank, Los Angeles County, Calif.), 126. 10.1016/j.nut.2024.112489 [DOI] [PubMed]
  • 16.Ng, T. P., et al. (2022). The Elderly Nutritional Index for Geriatric Malnutrition Assessment (ENIGMA): Concurrent, construct and predictive validity in an external evaluation cohort of community-dwelling older persons. British Journal of Nutrition, 128(3), 509–520. 10.1017/S0007114521003433 [DOI] [PubMed] [Google Scholar]
  • 17.Lu, F., Li, J., Liu, X., Liu, S., Sun, X., & Wang, X. (2023). Diagnostic performance analysis of the Integrated Care for Older People (ICOPE) screening tool for identifying decline in intrinsic capacity. Bmc Geriatrics, 23(1). 10.1186/s12877-023-04180-x [DOI] [PMC free article] [PubMed]
  • 18.Okyar-Bas, A., et al. (2023). The Validation of the Turkish Version of the PRISMA-7 Questionnaire; A Case-finding Instrument for Detecting Older Adults Living with Frailty. European Journal of Geriatrics and Gerontology, 5(1), 52–58. 10.4274/ejgg.galenos.2022.2022-8-2 [Google Scholar]
  • 19.Lee, H., Chong, J., Jung, H. W., Baek, J. Y., Lee, E., & Jang, I. Y. (2021). Association of the frail scale with geriatric syndromes and health-related outcomes in korean older adults. Ann Geriatr Med Res, 25(2), 79–85. 10.4235/agmr.20.0095 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 20.Cheong, C. Y., Yap, P., Yap, K. B., & Ng, T. P. (2023). Associations of Inflammatory, metabolic, malnutrition, and frailty indexes with multimorbidity incidence and progression, and mortality impact: Singapore longitudinal aging study. Gerontology, 69(4), 416–427. 10.1159/000527428 [DOI] [PubMed] [Google Scholar]
  • 21.Edwards, S., Farrer, K., Rose, E., Haynes, D., & Mclaughlin, J. (2022). Brief intervention using the PaperWeight Armband to identify older people at risk of undernutrition in the community: A preliminary evaluation, J. Epidemiol. Community Health (1978), 76(1), 32–37. 10.1136/jech-2020-216277 [DOI] [PubMed] [Google Scholar]
  • 22.Cano-Gutierrez, C., et al. (2025). Improving aging-related frailty status among older adults: Results of a nutrition-focused program. Clinical Nutrition Open Science, 64, 1–12. 10.1016/j.nutos.2025.08.010 [Google Scholar]
  • 23.Struszczak, L., et al. (2025). Provision of a daily high protein and high energy meal: Effects on the physical and psychological wellbeing of community-dwelling, malnourished older adults; a randomised crossover trial. Journal of Nutrition Health and Aging, 29(2). 10.1016/j.jnha.2024.100429 [DOI] [PMC free article] [PubMed]
  • 24.Yeung, S. S. Y., Lee, J. S. W., & Kwok, T. (2022). A nutritionally complete oral nutritional supplement powder improved nutritional outcomes in free-living adults at risk of malnutrition: A randomized controlled trial. International Journal Of Environmental Research And Public Health, 19(18). 10.3390/ijerph191811354 [DOI] [PMC free article] [PubMed]
  • 25.Zhou, T., et al. (2023). Frailty knowledge level and its influencing factors among older adults in China. Geriatr Nurs (Minneap), 50, 247–254. 10.1016/j.gerinurse.2023.01.004 [DOI] [PubMed] [Google Scholar]
  • 26.Buhl, S. F., et al. (2022). Relationship between physical frailty, nutritional risk factors and protein intake in community-dwelling older adults. Clin Nutr ESPEN, 49, 449–458. 10.1016/j.clnesp.2022.03.004 [DOI] [PubMed] [Google Scholar]
  • 27.Ward, N. A., et al. (2023). Effects of PROtein enriched MEDiterranean Diet and EXercise on nutritional status and cognition in adults at risk of undernutrition and cognitive decline: The PROMED-EX Randomised Controlled Trial. British Medical Journal Open, 13(10). 10.1136/bmjopen-2022-070689 [DOI] [PMC free article] [PubMed]
  • 28.Pöyhönen, J., et al. (2025). Short- and long-term effect of multidomain lifestyle intervention on frailty: Post hoc analysis of an RCT. Journal Of The American Geriatrics Society, 73(8), 2457–2465. 10.1111/jgs.19552 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 29.Ng, W. L., Tong, C. Y., Chan, H. N., Kwek, T. H. H., & Tay, L. B. G. (2025). Empowering pre-frail older adults: assessing the effects of a community nutrition education intervention on nutritional intake and sarcopenia markers. Nutrients, 17(9). 10.3390/nu17091531 [DOI] [PMC free article] [PubMed]
  • 30.Casals, C., et al. (2023). Effects of an educational intervention on frailty status, physical function, physical activity, sleep patterns, and nutritional status of older adults with frailty or pre-frailty: the FRAGSALUD study. Front Public Health, 11. 10.3389/fpubh.2023.1267666 [DOI] [PMC free article] [PubMed]
  • 31.Ma, C. H. K., Chua, D. Q. L., Tay, L. B. G., Teo, E. W. C., Ng, W. C., & Leung, A. Y. M. (2024). The feasibility of implementing the who integrated care for older people (ICOPE) framework in Singapore. Journal of Frailty and Aging, 13(4), 514–521. 10.14283/jfa.2024.59 [DOI] [PubMed] [Google Scholar]
  • 32.Sen, K., Kruse, C. S., Mileski, M., & Ramamonjiarivelo, Z. (2025). Interventions to reduce social isolation and food insecurity in older adults: a systematic review. Front Nutr, 12. 10.3389/fnut.2025.1607057 [DOI] [PMC free article] [PubMed]
  • 33.Chaudhuri, N., Jackson, A., Sakamoto, M., Williams, A., & Netterville, L. (2025). Understanding barriers and facilitators to congregate meal program participation in Texas through a statewide needs assessment. Discover public health, 22(1). 10.1186/s12982-025-00880-4 [DOI] [PMC free article] [PubMed]
  • 34.Matsuo, K., et al. (2021). Improvement of oral hypofunction by a comprehensive oral and physical exercise programme including textured lunch gatherings. J Oral Rehabil, 48(4), 411–421. 10.1111/joor.13122 [DOI] [PubMed] [Google Scholar]
  • 35.Uemura, K., Yamada, M., & Okamoto, H. (2021). The effectiveness of an active learning program in promoting a healthy lifestyle among older adults with low health literacy: A randomized controlled trial. Gerontology, 67(1), 25–35. 10.1159/000511357 [DOI] [PubMed] [Google Scholar]
  • 36.Zhou, W., et al. (2025). Impacts of nutritional status on the effectiveness of a theory-driven exercise intervention among community-dwelling (pre)frail older adults. Geriatr Nurs (Minneap), 65. 10.1016/j.gerinurse.2025.103474 [DOI] [PubMed]
  • 37.Buhl, S. F., Piccinini, I. M., Beck, A. M., Serena, A., Vach, W., & Caserotti, P. (2025). Co-designed, personalised protein supplementation with whole-food dairy products in a randomised controlled trial: An investigation of success and acceptability in ≥ 80 years old community-dwelling adults. Clin Nutr ESPEN, 68, 774–784. 10.1016/j.clnesp.2025.06.037 [DOI] [PubMed] [Google Scholar]
  • 38.Pedrinolla, A., et al. (2023). Randomised controlled trial combining vitamin E-functionalised chocolate with physical exercise to reduce the risk of protein-energy malnutrition in predementia aged people: study protocol for Choko-Age. British Medical Journal Open, 13(12). 10.1136/bmjopen-2023-072291 [DOI] [PMC free article] [PubMed]
  • 39.Tufan, A., Yildiz, Y., Durmuş, N. Ş., Can, B., Ilgin, C., & İlhan, B. (2023). The effect of frailty in older community-dwelling outpatients with atrial fibrillation: a new score HAS-BLED-F (rail). European Review For Medical And Pharmacological Sciences, 27(7), 2919–2926. 10.26355/eurrev_202304_31923 [DOI] [PubMed] [Google Scholar]
  • 40.Millan-Domingo, F., Tarazona Santabalbina, F. J., Carretero, A., Olaso-Gonzalez, G., VINA, J., & Gómez-Cabrera, M. C. (2022). Real-life outcomes of a multicomponent exercise intervention in community-dwelling frail older adults and its association with nutritional-related factors. Nutrients, 14(23). 10.3390/nu14235147 [DOI] [PMC free article] [PubMed]
  • 41.Tay, L. B. G., Tay, E. L., Mah, S. M., Latib, A., & Ng, Y. S. (2022). Intrinsic capacity rather than intervention exposure influences reversal to robustness among prefrail community-dwelling older adults: A non-randomized controlled study of a multidomain exercise and nutrition intervention. Front Med (Lausanne), 9. 10.3389/fmed.2022.971497 [DOI] [PMC free article] [PubMed]
  • 42.Sunguya, B. F., et al. (2022). Targeted and population-wide interventions are needed to address the persistent burden of anemia among women of reproductive age in Tanzania. International Journal Of Environmental Research And Public Health, 19(14). 10.3390/ijerph19148401 [DOI] [PMC free article] [PubMed]
  • 43.Khor, P. Y., Vearing, R. M., & Charlton, K. E. (2022). The effectiveness of nutrition interventions in improving frailty and its associated constructs related to malnutrition and functional decline among community-dwelling older adults: A systematic review. Journal of Human Nutrition and Dietetics, 35(3), 566–582. 10.1111/jhn.12943 [DOI] [PubMed] [Google Scholar]
  • 44.Kim, C. O., et al. (2021). Reinforcement effects of social network intervention during nutritional supplementation in frail older adults. Gerontology, 67(5), 620–632. 10.1159/000514676 [DOI] [PubMed] [Google Scholar]
  • 45.Jyväkorpi, S. K., et al. (2021). The sarcopenia and physical frailty in older people: multi-component treatment strategies (SPRINTT) project: description and feasibility of a nutrition intervention in community-dwelling older Europeans. European Geriatric Medicine, 12(2), 303–312. 10.1007/s41999-020-00438-4 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 46.Lee, S. Y., Hung, L., & Chaudhury, H. (2021). Effect of physical environment on person-centred dementia care in a long-term care facility: Focus group interviews with staff. Alzheimers Dement, 17, e051554. 10.1002/alz.051554 [Google Scholar]
  • 47.Yeung, S. S. Y., Chan, R. S. M., Kwok, T., Lee, J. S. W., & Woo, J. (2021). Malnutrition According to GLIM criteria and adverse outcomes in community-dwelling chinese older adults: A prospective analysis. Journal Of The American Medical Directors Association, 22(9), 1953–1959. 10.1016/j.jamda.2020.09.029 [DOI] [PubMed] [Google Scholar]
  • 48.Kim, Y. M., Yang, N., & Kim, K. (2021). Effects of perceived food store environment on malnutrition and frailty among the food-insecure elderly in a metropolitan city. Nutrients, 13(7). 10.3390/nu13072392 [DOI] [PMC free article] [PubMed]

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