Malnutrition: A common but unrecognized health problem in the elderly
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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.
Physical 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
Social factors 
- 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.
- Loneliness
Medical factors
- 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.
Identifying malnutrition
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
| PROBLEM | SOLUTION |
| 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. |
References
1. Furman EF. Undernutrition in Older Adults across the Continuum of Care. J Gerontol Nurs. 2006;(32)1:22-27.
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10 Comments
This is some great information that I think too many people just don’t think about. After my great uncle lost his wife, this was something that was a danger to him. He couldn’t see and was in poor health. He was left on his own at their house. Luckily his granddaughter was around and fought to get him in an assisted living place. Before he was taken there, he was left at home with a single TV dinner in the fridge. But since he couldn’t see, he couldn’t even eat it! It scares me to think of how many are out there struggling through this. Thank you for helping to educate the public!
Oh wow! Thank you for sharing your story. It is good to hear that your great uncle is now in an assisted living facility. Unfortunately, there are not many who are lucky like him. I personally have had experienced this when I was taking care of my parents. At times, I felt like a mom chasing after her kids, making them eat their vegetables! 🙂
I am glad that you liked this article. If you know of anyone who would benefit from this article or this website, please feel free to share it.
HI there,
Good nutrition is important in all citizens and not just senior citizens. As a society, we must learn to identify when some on is suffering from malnutrition, be it kids, teenagers or our seniors. BY identifying malnutrition it would not only save someone life (potentially) but improve it also and reduce medical care costs (that some governments pay for).
Not just for care givers, but for society in general more public awareness is required, as, sadly often goes unnoticed!
Hi Derek.You hit the nail right on the head. Couldn’t have said it better, myself. 🙂
A very informative article for the care of the elderly.
I wonder how many of the elderly are fortunate enough to enjoy their old age with their children or grand children with adequate love and care.
Today most of the youngsters don’t have time to care for their parents or grandparents in their old-age and only alternative is assisted living centers.
But how many of them can afford the expenses..
Thank you Shafeek for your comments. Yes, having the fortune of children taking care of their parents is indeed a blessing nowadays. The fact is living in a nursing home or an assisted living center is more a future reality for the majority of us. You brought out a very good point about affordability of such places. No one has really taken this into account, have they? Scary thought, indeed.
Very helpful information for some of us also having to look after our elderly. Because of the lack of such information and knowledge we often loose our loved ones to soon.
I also find your website very simple but with loads of useful information.
Thanks for sharing.
Thank you, Oliver 🙂
Thanks for bringing this to my attention. My mom is a diabetic in her late 60’s and she’s loosing some weight. We have been quite strict with her diet and I thought that is the main reason.
However, going through this list, I realized that she also has arthritis, severe dental problem, high cholesterol and doesn’t do a lot of social activity. I think I need to investigate further into her so-called weight loss problem.
Hi Cathy,
I am glad my article helped out. Yes, further tests and medical investigation should be done on your mum. Diabetic does cause a certain amount of weight loss but do send her for a full body check-up for other underlying diseases. Sometimes, lack of nutrition can be fixed by supplementation.
As far as social activity is concerned, try to encourage her to meet up some people in the community center or church, even if it is a trip to the park with the grand kids would do, to brighten the mood which equates to a great appetite and a happy mind 🙂