Preventing malnutrition in older people

Malnutrition happens when the body isn’t getting the right amount of nutrients it needs from a person’s diet. It isn’t exclusive to people who are undereating – malnutrition can occur in people who are eating excess calories but not foods that contain the nutrients their bodies need.

Malnutrition in elderly people statistics

Malnutrition is more common in older people, with 20% of people between 60 and 70 years old being diagnosed as having malnutrition. This figure rises steadily as age increases, with 45% of nonagenarians being malnourished.

The reasons for this vary, from people simply having smaller appetites as they age, to finding cooking and eating more physically challenging, to a strong link between malnutrition and conditions such as cancer and heart disease, which are more common in older people.

Approximately 46% of people living with dementia have malnutrition.

One big reason that older people can become malnourished is dysphagia, which is a difficulty with swallowing. This can be due to dementia, plus other conditions such as stroke or alcohol misuse.

What are the effects of malnutrition?

Malnutrition can significantly affect a person’s quality of life. They may feel weak and ill a lot of the time, as well as suffering a persistent low mood. For older people, malnutrition poses a significant risk of social isolation, as they find getting out and about and making conversation more difficult.

In the long term, malnutrition can also lead to a host of diseases. We remember Scurvy as a sailor’s disease of yore but anybody deficient in Vitamin C can get it, which can lead to loss of teeth. Similarly, Rickets was prevalent in children of Victorian slums but its is possible to develop the disease today from lack of Vitamin D.

Undernutrition in older people can eventually lead to sight loss, cognitive issues and brittle bones, while overnutrition can cause diabetes, heart disease and even cancer.

Signs and symptoms of malnutrition in elderly people

Which signs and symptoms a person shows can depend on which nutrients they are deficient in. For example, somebody is more likely to suffer hair loss if they are not eating enough protein.

Signs of malnutrition can include:

• Weight loss or gain
• Dry, brittle hair, or a lot of hair falling out
• Flaking nails
• Hollow cheeks and sunken eyes
• Feeling cold more than they used to
• Fatigue and sleeping a lot
• Physical weakness
• Joint pain
• Falls
• Wounds taking a long time to heal
• Frequent coughs and colds as their immune system is weaker
• Cognitive issues such as difficulty with concentration, memory and speech
• Low mood or struggling to raise a smile even when they want to
• Heart palpitations, sometimes they may experience bouts of heart palpitations, shortness of breath and dizziness all at once due to lack of electrolytes

If somebody appears to be intentionally avoiding food, they may have physical trouble with eating that they are embarrassed to talk about or may even be living with an eating disorder. 

Care home nutrition: How do care homes protect residents from malnutrition?

Screening

Care homes use malnutrition screening tools, such as Malnutrition Universal Screening Tool (MUST) to assess residents’ nutrition levels. This is a step-by-step method whereby a resident’s weight, weight loss and any acute diseases they have, are calculated to create an ‘overall risk of malnutrition’ score. Each resident is screened when they first move into a care home and on a monthly basis thereupon, or more often if their risk score was high.

Emily Stuart, company dietician at Apetito, explained in a webinar as part of The Alzheimer’s Show: “What malnutrition screening does is help to identify those at risk of malnutrition and it can guide the treatment plan or lead on to further expert nutritional assessment.”

Care plans

Care professionals consider residents’ dietary needs when creating the plan for their care. They regularly review and edit the care plan whenever a resident’s needs change. The care home’s kitchen staff are aware of every resident’s dietary needs and preferences, and can cater for any deficiencies in meals that the resident will enjoy.

They make sure that food is the appropriate texture for each resident to ensure that they can eat as much of it as possible, whether that be minced, pureed or bitesize, with support from care staff. An approach they use to support those with small appetites is to prepare smaller, more nutrient-dense meals, and drinks that can provide additional nutrients.

Medication for malnutrition, such as supplements and prescribed oral nutritional drinks, will also be included in the care plan.

Policies for preventing malnutrition in care homes

Care homes should have policies for managing malnutrition. These detail how they manage screening, how they plan practical delivery of nutritional care and what guidance they follow.

Dietician Ms Stuart said: “As well as national guidance, it’s important to have local guidance that is related to the local environment, to the specific care home and the types of residents and resources they have. Practical, manageable strategies for managing malnutrition in care homes are an essential part of care.”

Understanding dementia and food

Joanne Holmes, senior lecturer in nutrition at Bournemouth University recommends improving the mealtime experience in care homes. She explains: “People who are living with dementia forget what different types of food there are. So they will often choose the same food every day as they don’t know what anything else is. It will help to give them visual prompts. If you know your residents you will get to know their food preferences.”

Older people tend to prefer sweet food, particularly if they are living with dementia. Ms Holmes recommends: “Cakes with vegetables in like beetroot cake. You can also put fruit in savoury dishes. This will make sure residents still get the nutrients they need.

“As people with dementia tend to lose their sense of smell, it may help to use herbs and spices in the food to give it a distinct smell. Also offer residents food with a strong smell such as tomato puree or cheese.”

Supporting hydration

In some cases, people with dementia won’t recognise what a cup of tea is and don’t realise it is a drink. In term of fluids, Ms Holmes recommends sometimes thinking outside the box and getting fluids into people with ice lollies or watermelons. She has carried out research in care homes on nutrition and hydration and has found residential settings don’t tend to like serving tea and coffee as it is a diuretic but says: “Some people have been drinking 10 cups of tea a day all their life, who are we to say when they are 78, you can’t have 10 cups of tea a day”.

The actual mechanics of eating and drinking can also be problematic and care homes often purchase adapted cutlery and plate guards which will reduce spillages.

Healthcare professionals

Many care homes also make use of dieticians to help plan care for people at risk of malnutrition. They often also use speech and language therapists, as these professionals are trained to help those with chewing or swallowing difficulties.