New: Paramedical Guideline for Vulnerable Elderly

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Paramedical guideline for vulnerable elderly people

The overarching Paramedical Guideline for Vulnerable Elderly has been developed in a collaboration between 6 paramedical professional groups. The guideline contains 3 separate modules specifically for dietitians, with evidence-based recommendations on, among other things, sarcopenia and dietary interventions for malnutrition in combination with kidney damage, heart failure and Parkinson’s disease.

Doubling of care

The number of elderly people living at home who require intensive care will almost double in the next 25 years. This leads to an increase in hospital admissions and puts greater pressure on healthcare and informal caregivers. The Paramedical Guideline for Vulnerable Elderly offers paramedics tools to provide appropriate treatments and improve the health and independence of vulnerable elderly people.


Dieticians, physiotherapists, exercise therapists, occupational therapists, skin therapists and speech therapists all play a role in (early) identifying vulnerability in the elderly. Frail older people often show a combination of symptoms and functional limitations in different areas, such as physical functioning, cognition and psychological health. This can manifest itself in malnutrition, reduced muscle strength, fatigue, reduced mobility, an increased risk of falls, loneliness and sadness. Appropriate guidance and treatment can improve the health and independence of vulnerable elderly people.

Modules for dietitians

The recommendations in the guideline support the paramedical professional groups in identifying vulnerability and clinical decision-making, with specific modules for each professional group. There are 3 separate modules with recommendations for dietitians:

  • Factors of malnutrition and sarcopenia. This module describes the factors that must be identified for optimal diagnosis and treatment. In the case of malnutrition, these include oral problems, reduced physical activity and dependence on food. In sarcopenia, these include cognitive impairment, inactivity and comorbidities.
  • Shared decision-making about dietary interventions and quality of life. This section contains a step-by-step plan for joint decision-making about whether or not to strive for optimal nutritional status in vulnerable elderly people.
  • Dietary interventions for (risk of) malnutrition in combination with heart failure, chronic kidney damage or Parkinson’s disease. These conditions have been selected by the working group because dietitians often experience bottlenecks in dietary treatment.


The Paramedical Guideline for Vulnerable Elderly was created through the collaboration of the 6 paramedical professional groups. The implementation of the guideline is expected to start in the autumn, including training activities by the NVD Academy. The guideline can be viewed on the website of the Dutch Association of Dietitians.

Source: Dutch Association of Dietitians

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