Background

Ageing is associated with progressive physiological, functional, and nutritional changes that predispose older adults to malnutrition, sarcopenia, and dysphagia. These conditions frequently coexist and interact synergistically, creating a vicious cycle that accelerates functional decline, morbidity, and poor quality of life. However, they are often assessed and managed in isolation in routine clinical practice.

Objective

To highlight the interrelationship between malnutrition, sarcopenia, and dysphagia in older adults and to emphasise the need for an integrated, multidisciplinary, nutrition-focused approach to assessment and management.

Methods

This narrative review synthesises current evidence on the prevalence, shared risk factors, pathophysiology, and clinical consequences of malnutrition, sarcopenia, and dysphagia in the elderly. Literature from nutrition, geriatrics, rehabilitation medicine, and swallowing sciences was reviewed to conceptualise this triad and its bidirectional mechanisms.

Results

Malnutrition contributes to reduced skeletal muscle mass and strength, thereby worsening sarcopenia. Sarcopenia of the oropharyngeal muscles impairs swallowing function, leading to dysphagia. Dysphagia, in turn, compromises oral intake, diet quality, and protein adequacy, further aggravating malnutrition. This triad is associated with increased risks of aspiration, infections, frailty, prolonged hospitalisation, and mortality. Early identification using validated screening tools, combined with timely nutrition intervention, texture-modified diets, adequate protein and energy provision, and targeted swallowing rehabilitation, can help interrupt this cycle.

Conclusion

The malnutrition–sarcopenia–dysphagia triad represents a critical yet under-recognised clinical entity in geriatric care. Addressing these interrelated conditions through an integrated, multidisciplinary, nutrition-centred strategy is essential to improve functional outcomes and quality of life in ageing populations.

Sreemathy Venkatraman is a clinical dietitian working in the area of Gut Health and nutrition. She has a background as a clinical dietitian and nutritionist and is a Senior Consultant and the Head of the Clinical Nutrition Unit at Trustwell Hospitals, Bangalore, India. She leads the Dysphagia Special Interest Group for the Indian Association of Parenteral & Enteral Nutrition, PEN society in India. She is the author of several textbooks on Nutrition for Reed Elsevier. She has been a speaker at several national and international congresses and scientific meetings. Sreemathy is the founder of Mitha Aahara- Eat to Live which is an online consultancy that deals with Nutritional management for several IBS and IBD patients.