Malnutrition in the elderly and unwell – how you can support your loved ones

In Eat well, Nutrition educationby RebeccaLeave a Comment

Our bodies need energy and nutrients from our diet to grow, repair, protect against illness and infection, and maintain health. When there’s a mismatch between what we eat and what we require, we’re at higher risk of malnutrition.

We can be malnourished at any body size, and at any age.

Malnutrition is quite common in hospitals; it is estimated that around 30% of hospitalised patients are malnourished, and over 50% are at risk of malnutrition [1]. Older people living alone or in residential care are also at higher risk of malnutrition – research suggests between 10-30% are malnourished [2, 3].

Hospital patients and the elderly are at increased risk of malnutrition because there are lots of factors that impact their ability to consume enough nutrients, such as:

  • Increased nutrition requirements – for a range of illnesses and injuries, we need more energy and nutrients than normal – we mightn’t be physically doing much but our bodies are running a marathon on the inside!
  • Reduced ability to eat/drink – patients deal with many challenges that impact their ability to consume enough, such as reduced appetite, physical barriers to eating, and nausea
  • Reduced ability to absorb nutrients – patients who have digestive issues or who are older may not absorb nutrients well
  • Environmental impacts – difficulties eating in a noisy/busy hospital, eating while in bed, mealtime interruptions, not being able to eat meals you’re used to
  • Being less active – being confined to a hospital bed or having limited movement can lead to further muscle wasting

Malnutrition is both a cause and a consequence of ill health.

Malnutrition leads to a loss of muscle and fat, which in turn means we lose strength and function:

  • it can be harder to get around independently (reduced mobility)
  • the risk of falls and injury is higher (because we’re weaker and have less physical protection)
  • the risk of infection and complications is higher
  • recovery can be slower, leading to longer hospital stays or more frequent readmissions [4]

To reduce the impact to our health, we need to make sure we’re eating enough of the right kinds of food so that our bodies can heal, while keeping our body’s muscle stores intact.

Protein and energy are the priority nutrients

Our bodies demand more energy and protein when we’re acutely unwell. Energy fuels the work, and protein provides the building blocks for repair and immunity. If we’re not eating enough energy and protein our body will use its own reserves to meet this critical need. This can lead to muscle wastage and weight loss. That’s why protein- and energy-rich foods are often recommended for people who are malnourished or at risk of malnutrition.

Dietitians perform a range of nutrition assessments, including calculating individual patients’ estimated energy and protein requirements, in order to recommend dietary adjustments to meet this increased need.

How you can help

Malnutrition screening is routine in hospitals and residential care. If you notice changes in your loved one’s appetite, dietary intake, or ability to eat, discuss it with medical staff.

Malnutrition is not a normal part of ageing, and with appropriate support and intervention, weight loss can be minimised.

Here’s what you can do to support your family member to eat enough to aid their recovery:

  • Eat first: meat and dairy desserts
  • Eat second: soup, rice, pasta and potato
  • Eat last: vegetables- they are lowest in energy and protein
  • Drink nutritious drinks (nutritional supplements, milk, and juice) before tea, coffee and water
  • Ensure your loved one is in a comfortable eating position- sitting out of bed at a table or sitting up in bed, if possible
  • Ensure meals, snacks and drinks are within reach
  • Assist with opening packets, lids and containers if needed
  • Provide encouragement and support at mealtimes
  • Bring food you know your loved one enjoys- make sure you clear this with medical staff first
  • Alert a health care provider if you think further assistance is needed, such as adaptive eating utensils and no-slip placemats, or if you notice they are having issues with chewing or swallowing
  • Alert medical staff if your loved one is eating and drinking less than half their meals over a few days

Accredited Practicing Dietitians are experts in nutritional support to prevent, treat and manage malnutrition. They can provide you with extra information at all stages of care, including how to fortify foods at home if your loved one is leaving hospital but requires ongoing nutritional support.

References

[1] Sharma Y, Thompson C, Shahi R, Hakendorf P, Miller M. Malnutrition in acutely unwell hospitalized elderly – “the skeletons are still rattling in the hospital closet”. J Nutr Health Aging 2017; 21(10).

[2] van der Pols-Vijlbrief R, Wijnhoven H, Schaap L, Terwee C, Visser M. Determinants of protein-energy malnutrition in community-dwelling older adults: a systematic review of observational studies. Ageing Res Rev 2014; 18: p. 112-31.

[3] Pitt E. Guidelines support older Australians to live at home longer (media release); 2016. https://media.uow.edu.au/releases/UOW211572.html

[4] Agarwal E, Ferguson M, Banks M, Batterham M, Bauer J, Capra S, Isenring E. Malnutrition and poor food intake are associated with prolonged hospital stay, frequent readmissions, and greater in-hospital mortality: Results from the Nutrition Care Day Survey 2010. Clinical Nutrition 2013; 32(5): p. 737-745.

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