- By Rita Rubin
As you gather with family for upcoming holiday feasts, malnutrition might be the furthest thing from your mind. Over-indulging, yes, but not getting enough to eat? No way.
Yet, research suggests that malnutrition — defined by the Academy of Nutrition and Dietetics as a lack of “adequate calories, protein or other nutrients needed for tissue maintenance and repair” — is common but underdiagnosed in older adults. Not surprisingly, it’s linked to declines in physical health as well as intellectual activity, such as memory and reasoning.
One recent study, published by the Annals of Emergency Medicine, found that six out of 10 patients age 65 and older who sought emergency care at a University of North Carolina at Chapel Hill teaching hospital were either malnourished or at risk for malnutrition. Of the malnourished patients, three-fourths had never been diagnosed.
The study of 138 older adults wasn’t huge, and it was conducted at only a single hospital, but co-author Dr. Timothy Platts-Mills says it highlights the fact that emergency departments don’t do a good job of identifying the underlying reasons that patients seek care.
For example, Platts-Mills says, if they fell but avoided breaking their hip, they might be sent on their way with a simple, “Be careful and try not to fall and good luck,” when instead doctors should have tried to figure out why they fell, such as weak leg muscles stemming from malnutrition.
The patients in his study were evaluated with a short standardized nutrition assessment, not typically administered in the ER, that includes questions about weight loss, mobility, dementia and depression. Those who scored seven or less on the 14-point scale were considered to be malnourished, while those who scored eight to 11 were considered at risk for malnutrition.
Causes of Malnutrition
Malnutrition was found to be more common in patients with symptoms of depression, those residing in assisted living facilities, those who had trouble eating and those who said they had difficulty buying groceries. Whether malnutrition causes depression or the other way around is difficult to tease out, Platts-Mills says.
About 10 percent to 15 percent of the patients in his study said grocery shopping was difficult because they couldn’t afford it, Platts-Mills says.
“Socioeconomic status is very important to consider,” says Dr. Jennie Wells, chair of the division of geriatric medicine at the University of Western Ontario. “Seniors on a fixed income may not be able to afford what is healthy or perhaps not want to buy fresh produce, fearing it may spoil if they live alone. People who live alone often have poorer diets, because they don’t bother to prepare well-balanced meals.”
Geriatrician Dr. Marie Bernard, deputy director of the National Institute on Aging, part of the National Institutes of Health, recalled one patient, an 80-pound woman recovering from a hip fracture, who needed to take in more calories.
“The only thing she really liked was biscuits and gravy,” Bernard says. The woman was delighted when Bernard told her to eat as much biscuits and gravy as she wanted, anything to pack on some pounds. By the time someone is in their 80s or 90s, Bernard says, they’re often past the point of having to worry about their cholesterol levels or salt intake, although they still need to consult with a doctor about whether it’s ok for them to eat whatever they like.
The patients in Platts-Mills’ study did not have dementia — having it complicates the situation. Wells says she encourages families of dementia patients to make sure their loved ones frequently have someone with whom to share a meal. “That provides time orientation, cognitive stimulation and nutrition,” she notes.
Platts-Mills says the relationship between nutrition and health in older people can be a vicious cycle. Often, seniors don’t eat as much as they used to because they’ve lost their sense of smell and their taste buds aren’t as sharp as when they were younger, Bernard says. They become frail and more susceptible to illnesses that further reduces their appetite, as do certain medications to treat those illnesses.
Even if your parents have always been overweight, if they become ill or injured, they might not be getting enough to eat, Bernard says. “We have a tendency to gain weight from about 30 on to about 50 or 60, with much of that being fat,” she says. But by the time you reach your 60s or 70s, fat and muscle mass begin to decline, she says. “There is some degree that seems to be a usual consequence of aging,” Bernard notes.
But if an older person loses more than five percent of his or her body weight without trying, that could be a sign of underlying serious health problems, Bernard says.
“Every doc should worry about unexplained weight loss in an older person,” Wells says. It could signify new or poorly controlled diabetes, an overactive thyroid or hidden cancers. In addition, weight loss is common in people with late-stage dementia, she says.
7 Ways to Check Nourishment
You don’t have to be a doctor to figure out that your aging parents might be suffering from malnutrition. Here are seven simple ways to make sure they’re getting enough nourishment:
1. “Looking at function is a good place to start,” Platts-Mills says. In other words, if your mother or father has stopped taking the dog for a daily mile-long walk, that could be a red flag.
2. Check their fridge and cupboards for packaged foods and leftovers that are past their prime.
3. Look in the trash for evidence of what Wells calls “tea and toast syndrome.” Seniors who lack cooking skills often rely on cheap packaged foods, such as cookies and bread. A diet of sweets and other simple carbs might not cause weight loss, but it could lead to micronutrient and protein malnutrition.
4. Make sure their refrigerator and cupboards are stocked with healthful foods they like and can easily prepare and eat.
5. Nutrition supplement drinks such as Ensure or Boost can be helpful, but they’re best as between-meal snacks, not as meal replacements, Bernard says.
6. Don’t just bring groceries or cooked meals to your parents; sit down and eat with them. Take them out to eat if they’re up to it. “We all eat more in a social setting,” Wells says.
7. If you don’t live near your parents and they have trouble getting out and about, contact their local Meals on Wheels program. One caveat, Bernard says: Make sure they find the food palatable or else they'll just end up giving it to their neighbors.
For more information, check out the National Institute on Aging e-pamphlet, What’s on Your Plate? Smart Food Choices for Healthy Aging.
Rita Rubin is a former USA Today medical writer who now writes about health and science for publications including Next Avenue, U.S. News, WebMD and NBCNews.com.