Malnutrition and ageing

Malnutrition is something most of us associate with developing countries. However, it occurs right around Australia and is more common than you think.

Could you or a family member be at risk?

What is malnutrition?

According to the World Health Organisation, “malnutrition refers to deficiencies, excesses or imbalances in a person’s intake of energy and/or nutrients”.

In short, this means that the body doesn’t receive enough nutrients for it to function properly, and under that definition both under-nutrition and over-nutrition (overweight and obesity) are classified as malnutrition.

The global obesity epidemic receives a lot of media air time. We have all heard about the health consequences of an expanding waist line.

At the other end of the nutrition spectrum there is another concern that receives much less media coverage.

Malnutrition or under-nutrition often brings images of drought and famine stricken countries to mind. But the problem of malnutrition is a lot closer to home.

In fact a recent Australian study found just over 40% of community-living older adults who were receiving home nursing services were either at risk of malnutrition or already malnourished.

Malnutrition can have a large impact on quality of life and in Australia, one group of people who are most at risk of being malnourished are the elderly.

People who are malnourished are more likely to become unwell, and when unwell, they take longer to recover, and are more likely to suffer complications.

Nutritional deficiencies can cause a host of problems, including:

• impaired immune function
• muscle atrophy (loss of muscle mass, strength and function)
• poor wound healing
• increased risk of osteoporosis, recurrent falls and fractures
• frailty

It is also known that people who are malnourished:

• will need to see their GP more often
• will need to be admitted to hospital more often
• are more likely to need to move into an aged care facility at an earlier stage than someone who is well nourished

What do the statistics say?

It’s estimated that anywhere between 10 to 44 per cent of older Australians are at risk of malnutrition, while a third of Australians aged over 65 who are admitted to hospital are malnourished. Of those living in residential care, between 20 to 65 per cent are malnourished and almost 75 per cent are at risk. Up to 10 per cent of older adults living at home are likely to be malnourished and a further 35 per cent are also at risk.

 

What causes malnutrition in the elderly?

Malnutrition in the elderly can be caused by a number of things, including medical, physical and social, and physiological reasons

As we age we become more vulnerable to malnutrition for a number of reasons:

• our requirement for a number of nutrients increases, such as; protein, calcium and vitamin D
• we experience changes in our ability to taste and smell food as we get older, this can mean we no longer get the same enjoyment out of eating as we once did
• physical changes can also make it more difficult to buy, prepare, cook, and eat food without help

• Medical illnesses such as depression, poor dentition (condition of teeth), difficulty swallowing, side effects of medication, dementia, and chronic illness become more commonplace
• social isolation, loneliness and financial strain can also play a large part in the emphasis we place on food.

 

Signs and symptoms of malnutrition

• weight loss and loose-fitting clothing
• fragile or pale skin
• hair loss
• mental confusion
• poor wound healing
• muscle wasting

Diagnosing malnutrition can be complex and needs to be done by a health professional. Blood tests may also identify any specific nutrient deficiency.

 

Improving nutritional intake

The key to improving nutritional intake is to eat a wide variety of foods to meet nutritional needs. It’s important to ensure adequate amounts of protein, vitamins and minerals, and kilojoules are included as part of a healthy eating plan.

A convenient and effective way to meet nutritional requirements is to include high energy and high protein nutritional supplements in the diet. These can be convenient and effective, particularly if mood and/or appetite is low. Good nutritional supplements for seniors include nutritional top up powders, such as the SUSTAGEN Hospital Formula range which offers different flavours such as Coffee to suit both the taste and nutritional needs of individuals. oral supplements such as Forticreme. Taking micronutrient supplements can also help when levels of particular nutrients (e.g. vitamin A, vitamin C and vitamin D) are low.

Other tips to improve nutrition in the elderly and the sick include:

• eating small, frequent meals and snacks throughout the day
• consuming full-cream milk between meals
• adding more oil, cream or margarine to food when cooking
• fortifying foods with skim milk powder
• adding grated cheese to cooked foods
• using flavour enhancers to make food tastier
• ensuring that food suits chewing and swallowing ability
• ensuring nourishing snacks are readily available and easy to access or prepare.

References:

Charlton, Karen and Walton, Starvation in the land of plenty  https://theconversation.com/starvation-in-the-land-of-plenty-why-australians-are-malnourished-27640

Charlton, KE, Nichols, Bowden S, Lambert K, Barone L, Mason M, Milosavljevic M, Older rehabilitation patients are at high risk of malnutrition:Journal; of nutrition, Health & Ageing, Volume 14, No. 8, October 2010, pp 622-628

Dietitians Association of Australia, Malnutrition – who is at risk and things to consider https://daa.asn.au/smart-eating-for-you/smart-eating-fast-facts/medical/malnutrition-who-is-at-risk-and-things-to-consider/

Royal Australian College of General Practitioners, Managing undernutrition in the elderly: Prevention is better than cure, Psychological strategies, Volume 41, No. 9, September 2012, pp 659 – 699 https://www.racgp.org.au/afp/2012/september/managing-undernutrition-in-the-elderly/