**1. Introduction**

Due to the global increase in aging, the elderly population is constantly growing [1]. During the period 2015–2030, the elderly population is expected to grow from 901 million to 1.4 billion people (by 56%), and the 2015 population is expected to double by 2050 [2].

This increase in the elderly population is already placing substantial extra strain on healthcare and support services [3], increasing the costs due to health-related complications [4].

Among the main concerns linked to age, malnutrition is a common health problem in people older than 65 [5]; in fact, nutritional fragility is a frequent condition in vulnerable elderly people and is related to an increased incidence of mortality in this population [6]. Moreover, it is often associated with a reduced adaptive response to physiological and pathological conditions [7]; for instance, the elderly population experiences a physiological loss of taste, which impacts the frailty condition. Assessment of nutritional status through

**Citation:** Liquori, G.; De Leo, A.; De Nuzzo, D.; D'Inzeo, V.; Arancio, R.M.; Di Simone, E.; Dionisi, S.; Giannetta, N.; Ricciardi, F.; Fabbian, F.; et al. Management Strategies and Nursing Activities for Nutritional Care in Hospitalized Patients with Cognitive Decline: A Scoping Review. *Nutrients* **2022**, *14*, 4036. https://doi.org/ 10.3390/nu14194036

Academic Editors: Alessandra Durazzo and Massimo Lucarini

Received: 9 August 2022 Accepted: 26 September 2022 Published: 28 September 2022

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anthropometric measurements in these patients is essential to ensure healthy aging and adequate food intake [8].

Malnutrition has a negative impact on both people living independently and, overall, on those admitted to healthcare facilities, affecting up to 60% of hospitalized older adults [9]. In fact, according to estimates, up to 50% of patients are undernourished when they are admitted, increasing their malnutrition while being treated in a hospital [10]. This issue is linked to lengthier hospital stays, increased morbidity (pressure ulcers, infections, and falls), and mortality, especially in patients affected by chronic diseases [11,12].

In elderly people with cognitive impairment, the phenomenon is also more serious, since malnutrition irreversibly worsens other health conditions [13]. At the same time, mental status significantly affects nutritional status; people with lower cognitive levels tend to face a higher risk of malnutrition, especially during hospitalization [14,15]. The relationships between nutritional status, cognitive decline, and performance are complex and reciprocal: the presence or the risk of malnutrition may influence cognitive performance, and the presence of cognitive decline may affect the activities of daily living (ADL), also affecting food intake [16].

Unfortunately, malnutrition is also a frequently underdiagnosed entity, capable of subtly impacting patient outcomes, length of stay, hospital costs, and readmissions [9]. Recent studies suggest the crucial role of nurses in preventing, assessing, and treating malnutrition in this fragile population [2,7]. One of the possible key points could be implementing all known strategies to avoid worsening nutritional status, improving health status, and reducing mortality risk [17].

Therefore, this scoping review was targeted at evaluating the relationship between nursing activities and the identification, prevention, and management of malnutrition among hospitalized elderly individuals with cognitive impairment. In particular, our aims were collecting best practice and scientific evidence with regard to: (i) risk factors for developing low food intake in hospitalized older patients with cognitive impairment; (ii) prevalence of malnutrition in older patients with cognitive impairment; (iii) identify the nursing strategies to enhance clinical outcomes and care of patients with cognitive impairment in the hospital environments.
