Cater with Care
Tasty and effective nutrition for elderly

A serious problem

Undernutrition, the lack of adequate calories, protein, or other nutrients needed for tissue maintenance or repair, is a serious health issue among Dutch older adults, especially when they lose weight and muscle mass. Recent study results show that 1 in 6 older adults receiving home care are undernourished. In residential care homes and hospitals, 1 in 5 older adults are undernourished and 1 in 3 are at risk of developing undernutrition.

Undernutrition develops when intake does not meet the requirements. Requirements usually decline with ageing, however protein requirements seem to increase and intake may not be sufficient due to appetite loss, shifts in taste and smell perception and dependence on others with regard to grocery shopping and cooking. During disease, energy and protein requirements may be increased due to inflammation, wound healing, and losses from wounds or the gastrointestinal tract.


In general, undernutrition reduces both the physical and mental well-being of the elderly. One of the physical consequences is muscle loss, especially in combination with disease and inactivity, which increases the risk of falling and dependence on caregivers. Moreover, undernutrition delays wound healing, prolongs hospital stay, and is associated with poorer quality of life and increased mortality. Furthermore undernutrition puts a large burden on health costs in the Netherlands.


The Dutch guideline "Dieetrichtlijn Ondervoeding 2012” advises to restore or stabilize nutritional status with normal foods and with nutritional supplements if no improvement is seen. The recommended daily protein intake for healthy adults is 0.8 gram per kilogram of body weight. For hospital patients and people with increased risk of developing undernutrition, the recommended daily intake is 1.2 to 1.5 gram per kilogram of body weight. A protein intake of 25 to 30 grams per main meal seems optimal for the maintenance of muscle mass. Many elderly, however, fail to meet this recommendation.

Our approach

When recommended protein intake is not achieved through regular foods, often oral nutritional supplements (ONS) are prescribed. Their effect on intake in practice is limited by poor compliance due to a low palatability, negative effects on satiety and gastrointestinal side effects. Moreover, protein intake may also be inadequate in (institutionalized) elderly who are not considered undernourished.

This Cater with Care ® project aimed to increase protein intake with a novel strategy of protein-enriched familiar foods and drinks, to offer an effective long term solution, both in health care and at home. More in-depth insights in undernutrition, working definitions and other considerations are summarized by the Nutrition Team in this Cater with Care® factsheet.

Read more: Results Cater with Care concerning undernutrition in the publication in Gastvrije Zorg (In Dutch).