Malnutrition and seniors: When a relative doesn't eat enough
Malnutrition is a serious problem among older adults. Discover the warning signs of nutrition problems and what steps to take to avoid poor nutrition in seniors.
Good nutrition is critical to senior health, but many older adults don't eat right. Older people are more likely to have inadequate nutrition than younger adults are — and are more susceptible to numerous health problems related to an inadequate diet.
Many older adults in long term care facilities have poor nutrition. While seniors cared for at home or living independently generally fare better, patterns leading to inadequate nutrition — also called malnutrition — often begin at home. Knowing the causes and danger signs of nutrition problems, as well as taking steps to ensure a diet rich in protein and other necessary nutrients, is critical in maintaining senior health and strength.
Problems caused by malnutrition
Over time, malnutrition in older adults can lead to fatigue and increase the risk of digestive, lung and heart problems. Malnourished seniors are at increased risk of death. Malnutrition weakens the immune system, increasing the risk of pneumonia and other serious infections. It can worsen existing health conditions and mental confusion. Over time, poor nutrition can lead to a low red blood cell count (anemia) and muscle weakness leading to falls and fractures. Poor nutrition can also cause blood clots, bed sores, and depression and other senior health problems.
Good nutrition is especially important for the very ill or seniors who have dementia. These older adults are more likely to be admitted to a hospital or long term care facility — and are vulnerable to post-surgical complications and other problems linked to poor nutrition.
Healthy, independent seniors need good nutrition too — often, nutrition problems develop gradually. Identifying dietary problems as early as possible and taking steps to eat well can make a big difference later.
Malnutrition in seniors: A web of factors
At first glance, the causes of malnutrition seem straightforward: too little food, a diet lacking in nutrients or absorption, eating or digestion problems related to getting older. But the causes of malnutrition are often more complex.
For instance, older single adults, even those who are energetic and self-sufficient, often don't cook for themselves. Their typical dinner may be nothing more than a handful of popcorn or a cup of tea. Carried on for a long time, a nutrient-poor diet accelerates the loss of muscle mass and strength that normally comes with aging. Shopping and preparing food become more difficult, which reinforces the tendency to subsist on easy but empty fare — such as toast, cold cereal or saltine crackers. Eventually, the chronic lack of nourishment leads to increased frailty, dependence and illness, which in turn can trigger depression — itself a major drain on appetite.
When does malnutrition begin?
Often, the cause of malnutrition isn't a single event, but a cascade of difficulties that can include physical, social and psychological issues.
Physical causes of malnutritionOlder adults often have health issues that can lead to decreased appetite or trouble eating. These include:
Chronic illness. Older adults may have debilitating, long-term conditions that affect their ability to shop, prepare meals or feed themselves. What's more, both short- and long-term ailments often suppress the appetite — even as they increase the body's need for nutrients. Dementia, stroke and other illnesses that affect mental functioning also have a profound influence on appetite and on the capacity to prepare and eat healthy meals. Caregivers also are often at risk, neglecting themselves while they tend to an ailing loved one.
Trouble chewing and swallowing. Dental problems, including gum disease, cavities and poorly fitting dentures, can affect the taste of food and make chewing nearly impossible. When people with chewing problems do eat nutritious foods, they may have trouble digesting them. A dry mouth — a side effect of many drugs — and diseases such as Parkinson's that affect the nervous system can interfere with swallowing.
A recent hospitalization or nursing home stay. Illness or surgery can take a tremendous toll on the health of seniors, often resulting in loss of appetite, weakness, weight loss and debilitation.
Trouble absorbing nutrients (malabsorption). Some of the physiological changes that occur with aging affect the way the body absorbs and uses nutrients. In many older adults, the production of certain digestive enzymes and acids diminishes, interfering with protein breakdown and with the absorption of vitamin B-12, folate, and possibly calcium and iron. Lack of vitamin B-12 can have a devastating effect on the nervous system, leading to an unsteady gait, muscle weakness, slurred speech and psychosis — signs and symptoms similar to those of such age-related diseases as Parkinson's and Alzheimer's. Other illnesses — cancers of the gastrointestinal tract, inflammatory bowel disease and even diarrhea — can interfere with absorption.
Medications. Many drugs commonly prescribed for older adults can contribute to malnutrition by suppressing appetite, altering the way food tastes, causing nausea and vomiting, or interfering with absorption. Offending drugs include some antidepressants, certain blood pressure and osteoporosis medications, and even common over the counter medications such as aspirin. The problem is often compounded because many older people take several medications, all of which may affect the ability to eat and digest nourishing foods.
Diminished taste and smell. For most people, food is as much about comfort and enjoyment as it is about survival, and this may be especially true as people age. Yet taste and smell often diminish later in life, robbing food of much of its flavor. Although some sensory loss seems to be a normal part of aging, certain medications such as antibiotics decrease the sense of taste and smell, as do some health conditions such as Alzheimer's disease.
Frailty. Major loss of muscle and fat itself can cause loss of appetite due to changes in body chemistry, especially in seniors who have a serious illness. Frailty is a common problem among older adults. Medical experts are researching how it affects nutrition and other factors, and the best ways to treat malnutrition related to frailty. Frailty doesn't always mean weight loss — some seniors who are overweight are malnourished.
Social and psychological causesSometimes social factors and other factors are linked to malnutrition. These include:
Limited income. Some seniors with limited incomes go hungry, especially if they're taking expensive medications. Some older adults to have to choose between drugs and groceries when Social Security checks are stretched thin.
Depression. Although frequently unrecognized and untreated in older adults, depression affects as many as 6 million Americans over 65. As with other aspects of aging, the reasons for depression are complicated and interrelated: grief, loneliness, isolation, failing health, retirement, lack of mobility, concurrent illnesses such as Parkinson's disease, cancer or diabetes, medications, and malnutrition itself, which makes depression worse.
Alcoholism. It's not clear how many older adults have alcohol-related problems, but the number is far larger than suspected even a decade ago. Affecting both men and women, alcoholism is a leading contributor to malnutrition — it decreases appetite, destroys vital nutrients and frequently serves as a substitute for meals.
Reduced social contact. One of the biggest contributors to malnutrition is a solitary life — and the loneliness and depression that can go along with it. Social contact has a positive effect on eating well and increases morale and well-being, factors that contribute to lack of appetite.
Restricted diets. Seniors are more likely than any other group to have dietary restrictions, including limits on salt, fat, protein and sugars. Although such diets play a central role in managing many medical conditions, they can be so bland and unappealing that older adults simply stop eating. For that reason, some nutrition experts recommend rethinking a restrictive diet if it might interfere with an older adult getting adequate nutrition.
What to look for
The signs of malnutrition in older adults are often hidden, especially in people who don't seem at risk. To help uncover problems before they become more serious:
Ask an older loved one about eating habits, but don't rely on self-reports alone. Try to spend time with them during normal meals at home, not just in restaurants or on special occasions. If you have an older friend or family member in a hospital or long term care facility, make a point of visiting during mealtimes. When you're concerned about weight loss, request a calorie count from the hospital or nursing home dietitian. If the older person lives alone, make sure you know who is buying food.
Look for physical problems such as poor wound healing, easy bruising and dental difficulties. Keep track of weight loss. But keep in mind, not all seniors with nutrition problems are thin — in some cases, malnutrition occurs in seniors who are overweight.
Know what drugs an older loved one takes, and how they affect appetite and digestion. Many commonly prescribed medications can reduce hunger and prevent nutrient absorption. Make sure an older senior takes medications as directed. A good way to do this is to put all the medications out on a table — including nonprescription medications — and go over the directions.
Ask an older loved one's doctor to check certain protein levels (serum albumin, prealbumin or retinol binding protein levels). These tests can often help identify chronic malnutrition.
What you can do
Malnutrition is a complex problem, but even small changes make a big difference in an older person's health and well-being:
Enrich diets. To boost nutrition, encourage seniors to spread peanut or other nut butters on toast and crackers, on fresh fruits such as apples and bananas, and on raw vegetables. Other suggestions include sprinkling nuts or wheat germ on yogurt, fruit and cereal; adding extra egg whites to scrambled eggs and omelets; and melting cheese on sandwiches, vegetables, soups, rice and noodles.
Restore life to bland food. Try to make special diets more appealing by using lemon juice, herbs and spices and by varying the texture, color and temperature of foods. If loss of taste and smell is a problem, experiment with strong seasonings and flavors. Careful chewing can sometimes increase enjoyment because more flavor molecules come into contact with taste receptors. A dietitian can also suggest ways to perk up dull meals.
Plan between-meal snacks. This can be particularly helpful for people who get full quickly. A piece of fruit or cheese, a spoonful of peanut butter, even a milkshake for people who aren't lactose intolerant can add nutrients and calories.
Use nutritional supplements. Undernourished seniors are especially likely to be deficient in protein, vitamins B-6 and B-12, folate, niacin, vitamin D, calcium and zinc. Supplements are important because they can help supply missing nutrients, but they can't provide protein or needed calories and shouldn't become a substitute for meals. Older adults should talk with a doctor before taking a supplement.
Consider outside help. If an older adult is very frail, consider hiring a home health aide to help prepare meals or look into Meals On Wheels and other community services, including home visits from registered dietitians. Local churches and civic groups often have volunteers willing to shop and cook for seniors who live alone. Your department of health or community hospital can usually provide information on programs in your area.
Engage doctors. Talk to doctors about changing medications that affect appetite and nutritional status and about screening for nutrition problems during routine office visits. Be sure to inform doctors if you notice that an older loved one is losing weight. If you suspect depression, be sure to tell doctors about your concerns. Consult a dentist about oral pain or chewing problems
Make meals social events. This may be the most important step in curbing malnutrition; older people clearly do better when they have company. Drop by during mealtime or invite seniors to your house. Or try eating out on a regular basis, which can boost spirits along with appetite. Take advantage of discount meals at earlier hours, and ask for small portions of food. If you can't share meals with the older adults in your life, encourage them to join programs where they can eat with others or arrange for them to have meals with friends.
Encourage regular exercise. Many seniors, even those with serious health problems, can benefit from daily exercise — it stimulates appetite, helps depression, and strengthens bones and muscles. Resistance exercise — such as weightlifting — can be especially beneficial in increasing lean muscle mass and appetite. Exercising with others also provides motivation and social interaction.
Treating nutrition problems: Critical to senior health
Aging-related changes, health conditions and medical treatments can affect appetite, chewing, swallowing and digestion — and can cause other problems that make eating well a challenge for older adults. Overcoming these problems can be difficult. But identifying and treating nutrition problems as soon as possible is critical to senior health, longevity, independence and well-being. Take steps to ensure adequate nutrition in an older loved one, Look for signs of poor nutrition and discuss any concerns with doctors and other care providers.
Alzheimer's disease
Depression (major depression)
Parkinson's disease
Dry mouth in older adults: Causes and treatments
Food pyramid: An option for better eating
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MayoClinic.com Bookstore
'The Mayo Clinic Plan for Healthy Aging' (Hardcover)
Web Resources
U.S. Administration on Aging
American Dietetic Association
Meals on Wheels Association of America
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