As people get older, one of the important aspects is to continue choosing healthy foods and enjoying eating as a social activity. For people of all ages, especially the elderly, nutritional requirement is a must. Imbalance of nutrition in the elderly can occur due to either an excess or lack of nutrient consumption. This lack or excess consumption of nutrients is called malnutrition.
Malnutrition is increasingly becoming a very common health problem among the elderly population. Unfortunately, it has not received the importance it deserves.
Malnutrition can negatively impact the health of the elderly and hence, it is an important to address and resolve it as soon as it is identified. The negative impact of malnutrition include illness such as increased infection, electrolyte imbalances, altered skin integrity, anaemia, weakness, fatigue, longer stays in hospital, inability to perform regular activities, physical complications and death
Loss of appetite and unintentional weight loss are the main signs of malnutrition. Other signs may include dull and dry hair, dryness of the eye, receding gums, mental confusion, sensory loss and motor weakness. Malnutrition is prevalent in 5-10% of elderly people, majority of whom are hospitalised (about 60%) or long-term care facilities (35-85%) [Furman, 2006].
Factors that can cause malnutrition
Factors that can lead to malnutrition can be categorised into physical, social, and medical factors.
- Difficulty in chewing food due to lack of teeth and/or difficulty in swallowing
- Physical immobility or inability to feed oneself
- Early satiety and physiological appetite loss (compared to younger adults, the elderly experience a feeling of fullness more quickly)
- Decrease in taste and smell resulting in a decreased interest in food
- Financial constraints such as poverty or low-income leading to buying insufficient food
- Cultural, religious, allergic, and preferential factors that result in restricted diets which can lead to increased risk for malnutrition, especially for protein malnutrition.
- Dementia and cognitive disabilities can cause self-neglect and decreased food intake.
- Many older adults take multiple medications daily. These medications interact with food and impact absorption, metabolism, and excretion of nutrients.
The healthcare providers use many tools to identify malnutrition in the elderly. The most popular tool is the Malnutrition Universal Screening Tool developed by the British Association of Parenteral and Enteral Nutrition.
This is a simple, valid and reliable tool.
It involves assessment of weight status, change in weight and presence of acute disease (resulting in no dietary intake for more than five days). These 3 components can individually influence clinical outcomes.
This tool also categorises individuals into low, medium and high risk of nutrition and based on the outcomes of the screening and suggests appropriate care plans accordingly.
It has a very good to excellent reproducibility when the same patients are assessed by different staff in different healthcare settings (hospital, GP surgery and care home).
Optimising Oral Nutrition
|Loss of appetite||Check medications : alter where possible to minimise adverse effects|
|Encourage “little and often” – three small meals with meals with regular in-between snacks of energy-rich, high protein foods|
|Encourage people to eat every 2-3 hours|
|Maximise times of better appetite, eg. If hungry in the morning suggest a cooked breakfast – eggs, baked beans, cheese on toast|
|Serve meals & snacks that are appealing in size and appearance – large meals can be off putting, use small plates and maximise the ‘eye appeal’ of the food|
|Food has to be eaten to be of benefit-encourage the patient to select favourite foods that can be eaten at any time, eg. cereal for supper, soup for breakfast|
|Drinks can lessen appetite – suggest that drinks are taken after meals rather than before and during a meal|
|Find ways to stimulate the appetite – a short walk before meals can be helpful|
|Consider meal settings – make meal times enjoyable and avoid interruptions or rushing during meals|
|Chewing Problems||Encourage adequate dental and mouth care|
|Try soft foods that require little chewing|
|Swallowing difficulties||Consider referral for speech and language therapy assessment|
|Modify the consistency of foods as appropriate|
|Fatigue/Difficulty obtaining or preparing food||Use convenience foods : frozen meals, canned items ( soup, fruit, beans, fish), ready desserts ( custard, yogurt, rice pudding), snack bars, breakfast cereals|
|Enlist family and carer support. Consider Meals on Wheels|
|Make the most of good days : prepare snacks and meals to eat later or to store in the freezer|
|Fortify food with extra fats and sugar-add oil, butter, margarine, cream, cheese, dressings, sauces, sugar, honey and spreads to meals and snacks to boost energy intake|
|Mobility problem||Consider assessment by a physiotherapist or occupational therapist|
|Ensure shopping and food preparation assistance is available|
|Chronic pain||Find and treat cause where possible – check analgesic use|
|Social isolation, depression||Consider counselling, check medication use|
|Meals on Wheels, family, friends and social services.|