What is Malnutrition In the Elderly?

We hear about malnutrition in the world news, but it’s not just a problem in other countries. Malnutrition is a hidden epidemic in the world, that is under-recognized and under-treated. Malnutrition occurs when the body doesn’t get the right balance of nutrients and calories that it needs to stay healthy. This doesn’t just happen to people who suffer from hunger, or who don’t have access to healthy food. Malnutrition can happen to anyone.

So, who is at risk from malnutrition?

Older adults are at an increased risk because as we age our dietary needs can change, our sense of taste and smell may weaken, digestive systems may slow, chewing or swallowing problems may develop, and the ability of our bodies to absorb nutrients can decline. People with chronic disease are also at risk. These diseases can reduce appetite, make it physically difficult to shop, cook, and eat, make it hard to remember to eat, and change metabolism and digestion. And their treatment and management can require dietary restrictions, as well as medications that cause appetite-reducing side effects. Malnutrition can lead to hospitalization, and hospitalization itself puts people at risk. Surgeries and other procedures may require that patients follow restricted diets, or not eat. Illnesses and procedures can decrease appetite. And people may eat less because they don’t like their food choices, or are worried or depressed. This can all happen at a time when people may need more nutrients than usual to promote healing and recovery. Living in a nursing home or other long-term-care facility also raises risk.

Residents are more likely to have multiple chronic diseases and conditions that complicate nutrient needs and the ability to eat. They may also be socially isolated or depressed, or lack interest in food, and depend on staff for help with eating. The consequences of malnutrition are serious. Without proper nutrition, our bodies can’t stay healthy, fight off disease, or deal with illnesses that we already have. It weakens our immune systems and leaves us vulnerable to infections, and slower recovery and wound healing. It also causes weight loss and muscle loss that can lead to frailty, falls, and broken bones, disability, loss of independence, and complication of other diseases. Disease-related malnutrition is often associated with protein deficiencies which can result in loss of muscle mass and strength. This can be very serious and cause or worsen sarcopenia, the progressive loss of skeletal muscle as we age. And the consequences are far-reaching.

Malnourishment while hospitalized often leads to longer stays, higher infection rates, higher hospital readmission rates, worse outcomes, and death. And the increased economic burden in the U.S. for disease-associated malnutrition in older adults is more than 51 billion dollars each year. Thankfully, malnutrition can be treated. Involving the whole health care team in treatment is vital and may include treating the underlying cause of malnutrition if possible, changing the diet to work around restrictions or provide foods with more calories and protein, offering social services like in-home support, meal delivery, community-based nutrition programs, and access to food. People with disease-associated malnutrition, or in hospitals or institutions, may take oral nutrition supplement drinks, for easy access to needed nutrition. In some cases, tube feeding or IV nutrition is necessary. With malnutrition, it’s important to remember that people of any body size or type–even those who are overweight or obese–can become malnourished. So it’s not the weight alone that counts. Healthcare professionals may not always recognize the signs of malnutrition. The symptoms may be subtle and may be dismissed as a normal part of ageing. So start the conversation if you or a loved one experiences sudden unintended weight loss and/or loss of appetite and decreased food intake. Those are the two main symptoms but people who are malnourished may also experience other symptoms. Request a consultation with a dietitian to be sure that you are getting enough nutrients. If you have a chronic disease that impacts your nutrition, have regular discussions with your health care team about your nutritional status. And be sure to ask for a nutrition plan before a hospitalization so you can make sure you don’t lose weight during your stay. Discuss a nutrition plan for home before you are discharged so you don’t lose weight during your recovery. The hospital dietitian can help you connect with community nutrition programs, such as home-delivered meals and nutrition counselling.