August 16, 2021

Malnutrition in the elderly population

Malnutrition in the elderly is associated with a decline in functional status, and can adversely impair one’s health and well-being. Unfortunately, the condition is rather common in the elderly, and it is often underdiagnosed.

Elderly people are particularly vulnerable to malnutrition. This may be attributed to changes in physiology with increasing age, or due to living/home environment. The issues faced by the elderly include:

  • Lack of appetite
  • Difficulty in chewing or swallowing food
  • Inability to prepare meals or feed oneself due to:
    • Loss of cognitive function
    • Deteriorating vision
    • Fatigue
    • Poor mobility
  • Change in sense of smell and taste, causing food to become less appealing
  • Poor access to healthy food, due to financial difficulties or poor quality meals provided at home or hospital
  • Living alone/social isolation
Individuals with low mobility, or other difficulties such as chronic pain or tiredness, may face barriers in preparing nutritious food and feeding themselves. These individuals will need family members or caretakers to provide assistance at mealtimes.

Generally, 16% of adults aged above 65 years and 2% of adults aged above 85 years are malnourished. Most people lose weight as they age; however, the loss is often not only of fat tissues but also lean muscle mass. Loss of lean tissue is associated with reduced muscle function, lower bone mass, anaemia, immune dysfunction, slow wound healing, and increased morbidity and mortality. Unlike in younger people, lost lean muscle mass can be difficult to regain in elderly people.

In a study involving 181 elderly patients admitted to a single hospital in Kuala Lumpur, over half were classified as malnourished. Female patients seemed to have slightly worse nutritional status compared to men. Furthermore, 1 in every 4 patients showed indication of muscle wasting, as assessed using calf circumference measurements.

Specific nutritional needs for the elderly

Hospitalised elderly patients have been shown to benefit from aggressive nutritional support. Nutrient-dense foods are recommended for nutritionally compromised patients. In addition, counselling is also an effective way to improve dietary habits.

Consuming the right type of foods are important to ensure wellness. Some diseases frequently seen in the elderly, such as cardiovascular/cerebrovascular disease, diabetes, osteoporosis and cancer, are closely related to one’s diet. Reducing saturated fat and salt intake, and increasing fruit and vegetable consumption, could lower the risk of cardiovascular disease. Research also suggests that supplementation with omega-3 fatty acids and consumption of cruciferous vegetables (such as broccoli, cauliflower, cabbage, bok choy, etc.) are associated with reduced incidence of cardiovascular disease.

Micronutrient deficiencies are also common in the elderly, due to low food intake and diets lacking variety. Increased intake of micronutrients have been suggested to improve outcomes in the elderly. For example, simultaneous intake of vitamins C and E was shown to reduce the incidence of Alzheimer’s disease. Moreover, low blood vitamin C levels are highly predictive of mortality in elderly patients between 75–84 years old.

Strategies for optimising oral nutrition in elderly people

Individuals with poor appetite should be encouraged to eat small but frequent meals, with snacks in between. The meals and snacks should be appealing, and high in protein and energy. They should also maximise a meal whenever they have better appetite or are hungry (e.g. to have a full cooked breakfast if hungry in the morning).

The goal of nutritional strategies in the elderly is to achieve adequate nutrition and address any nutritional deficiencies. Foods taken should be appetising to encourage consumption and nutrient-dense to provide sufficient nutrient.

Individuals with difficulty chewing should have their oral care checked. They should also be provided soft foods to eat easily. Individuals with difficulty swallowing (e.g. stroke patients), on the other hand, may be referred for a speech and language therapy assessment. The food's consistency may also be modified as required.

Individuals who face difficulty preparing foods (such as due to fatigue or poor mobility) can utilise convenience foods such as frozen meals, canned foods (e.g. soup, beans, fish), or other ready-to-eat foods such as snack bars or cereals. On better days, these individuals may prepare home-cooked meals in bulk to freeze and eat later. Family members or caretakers can also provide assistance in shopping and preparing daily meals.

If required, foods prepared can be enriched with added fats or sugar (e.g. oil, butter, cheese, honey, or spreads) to increase energy intake. Instead of plain water, opt for nourishing fluids such as soups, milky drinks and juices. Desserts may be taken regularly to increase total food intake, as well.

Ageing is associated with a decline in certain physiological functions, which can affect one’s nutritional intake and health status. Preventing malnutrition involves strategies to encourage adequate food intake by adjusting meals to meet individual requirements. In addition, nutritional supplements may be considered if one’s body weight is not maintained with a normal balanced diet, or if normal food cannot be eaten safely.

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