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The NSPA Blog

Malnutrition and Senior Health

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Posted on September 16th, 2019 by Bettina Carlson, under Caregiver, Nutrition, Patient Advocacy, Take Charge, Tips & Resources

Diet, nutrition and their relationship to our health and well-being, or lack thereof, are known facts. Yet, unfortunately, many seniors are at risk of eating a diet lacking in nutrients, which in turn, can lead to malnutrition and health concerns.

Inspired by my own observations and concerns of how food and eating impacts one of my client’s health and independence, I decided to look deeper into the relationship of food, eating and aging. In this week’s blog post, I want to take the opportunity to share my findings with you with the hope, it will raise your awareness to this very vital issue, just like it did mine.

As you can imagine, there is plenty of information on this issue available. I really appreciate the linked article by the Mayo Clinic for its excellent and concise overview. (https://www.mayoclinic.org/healthy-lifestyle/caregivers/in-depth/senior-health/art-20044699?p=1). A lot of the information presented in this blog post, is drawn from there.

Quoting the Mayo Clinic, here are some of those health concerns that can and, all too often, do arise due to poor nutrition:

  • A weak immune system, which increases the risk of infections
  • Poor wound healing
  • Muscle weakness and deceased bone mass, which can lead to falls and fractures
  • A higher risk of hospitalizations
  • An increased risk of death

This list makes it easy to see why a proper diet and nutrition is vital in older age. 

Malnutrition in the Elderly

What are causes of the malnutrition in the elderly? I will keep the information I share to basic and common facts.

Biologically, very basic to the aging process is, that as we age we are burning less calories. That is because muscle and bone mass, as well as the water content of our body decreases, while the fat content of our body increases. Add the fact, that a large number of seniors don’t have the level of physical activity they may have enjoyed in younger age. So generally speaking, our aging bodies have different dietary needs than our younger bodies. Considering that our appetite decreases as we age, and thus our food consumption declines, the quality of what we eat is becoming increasingly more important in providing us with the basic nutrition needed to keep our health up. 

Causes of Malnutrition

1) Decrease in Appetite

Very often we observe, that our elderly family members or our elderly patients, don’t really enjoy eating. They may just pick at their food on their plate, eating very little, or they may be “picky” eaters, eating only a limited range of foods. And equally often, they also struggle with adequate hydration; they just don’t drink enough. The cause of this can have various different reasons. Following I’m listing some of the most common reasons for decreased appetite: 

  • In older age, our taste buds change and often diminish our sensation to taste. I think we can all relate to how taste buds impact our relationship to food – remember when you have a stuffy nose and can’t smell your food: are you excited about eating? Or are you more likely to  pick your plate a bit just because you know you have to eat something, and just keep it to a couple of bites?
  • It could be chewing difficulties. That could be caused by ill fitting dentures or infections in the mouth cavity.
  • It could be a decrease in the production of saliva, which makes swallowing more challenging and may cause fear of eating.
  • It could be medications that suppress appetite. 
  • It could be depression. 
  • It could be the fear of having to go the bathroom. As we age due to changes  in our digestion and contributed to by the types of food we eat, the elderly all too often experience constipation. In regards to liquids, the elderly might be afraid of having to go to the bathroom to often. If impaired mobility is involved, this fear is especially pronounced. 
  • It could be dementia. Aside from the commonly heightened experiences of loss of of hunger, loss of food satisfaction, and swallowing challenges in dementia patients; other additional challenges with dementia patients are facts like, that they may no longer have the ability to identify food and drinks as such; or they might not have the skills/ability to eat effectively with cutlery any-longer.

2) Other Causes

  • Limited income. Some elderly might not be able to afford groceries, especially if they are taking expensive medications. 
  • Reduced social contact. Most of us can relate how nice it is to enjoy meals together at the table. Senior who live alone, may miss this stimulus and it may reduce their appetite. 
  • Limited access to food. Many elderly do not drive and may not have access to food or the right types of food.
  • Alcoholism. We may not think about this very often, but it is a rising problem (https://www.aging.com/alcohol-abuse-amongst-the-elderly-a-complete-guide/). Too much alcohol can interfere with the digestion and absorption of nutrients. Nutrients might also be lacking if alcohol is substituted for meals. 

What can we do to detect the causes that lead to malnutrition?

Tips to Detect Malnutrition

  • Observe your loved one’s eating habits. Seems easy enough, but I can’t tell how often this is just forgotten or brushed off as “Oh, they are just old”. If your loved one lives at home, and you don’t do so already, take the time to observe their eating habits. If your loved one lives alone and buys their own food, start by finding out what they buy. 
  • Watch for weight loss. Help your loved one monitor their weight at home. You might also watch for other signs of weight loss, such as changes in how clothing fits. 
  • Be alert to other red flags. In addition to weight loss, malnutrition can cause poor wound healing and dental difficulties. It may also cause weakness, which can result in falls. We observe this a lot! 
  • Know your loved one’s medications. Many drugs affect appetite, digestion and nutrient absorption. 

Once you suspect or identify a red flag, you can implement any or any combination of the following options to help your loved one prevent or improve from possible nutritional concerns:

 Tips to Help

  • Engage your health care provider to help identify the problem and the contributing factors. Fortunately, often the problem is fairly easily remedied. In case of a suspected medication decreasing your loved one’s appetite, a change in medication might solve the problem. In case of chewing problems, a newly adjusted denture might help. In case of swallowing problem, a change to a soft diet might help. Sometimes more invasive medical interventions might be needed. 
  • Encourage your loved one to eat foods packed with nutrients. When every bite matters, make sure those bites are full of nutrients; especially Vitamin B12, Vitamin D,https://www.eatright.org/health/wellness/healthy-aging/special-nutrient-needs-of-older-adults Iron, Calcium, Fiber, Potassium. Spread your nut butter of choice or cottage cheese on your toast, crackers or fruits. Sprinkle finely chopped nuts or seeds (like flax, sesame or wheat germ) on yoghurt, fruit and cereal. Add extra egg whites to scrambled eggs and omelets and encourage whole milk. Add cheese to sandwiches, vegetables, soups, rice and noodles. 
  • Consider adding a supplement to provide extra nutrients your loved one may not be getting from their diet. Consulting with your care provider or a nutritionist is recommended. 
  • Encourage regular physical activity. Even if it’s just light activity, physical activity not only stimulates appetite, but can strengthen bones and muscles. We cannot emphasize enough how important this is, as physical strength is vital to help reduce the risk of falls. 
  • Promote alternatives to common food habits. Encourage or provide smaller nutrient rich snacks throughout the day. And where the use of cutlery is an obstacle to eating, encourage and provide “finger foods”, that can be easily eaten with fingers. 
  • Add more flavor to foods. Sometimes, just adding more flavor with spices and herbs (as tolerated by the individual, and in consideration with prescribed medications) can help stimulate taste buds and increase interests and appetite.
  • Consider outside help. If necessary, hire a home health aide to shop for groceries or (help) prepare meals. Also consider meal delivery services: more traditional like Meals on Wheels, or what is getting increased attention these days is a service like UberEats, that will deliver restaurant orders. A Patient Advocate might be helpful, too.  And as always, your local Area Agency on Aging or a county social worker also might be helpful.

Finally

Being aware of the causes that can lead to malnutrition and health concerns, being able to identify them early on, and thus being empowered to step into action to tackle red flags before they become a bigger health concerns, is vital to your loved ones good health and independence. Keep the lists above in mind. Bon Appetite! 

Sources and Further Reading

https://www.mayoclinic.org/healthy-lifestyle/caregivers/in-depth/senior-health/art-20044699?p=1
https://www.nia.nih.gov
https://eldercare.acl.gov/Public/About/Aging_Network/AAA.aspx

ICOPA CONFERENCE 2019

On another note we at NShore Patient Advocates would like to share some of our latest news with you… The Patient Advocacy Symposium is back but bigger, better, and brighter than ever before! It has evolved into the International Conference on Patient Advocacy (ICOPA), and will be held right here in Northfield, IL on October 3rd-5th, 2019! We hope you will join us! Please see below for a link with more information: Home ICOPA 2019

For a no-cost 30 minute initial consultation, please call 847-612-6684 or click here to fill out our online callback request form.