When we think of malnutrition, it brings to mind images of starving children in famine-ravaged countries. It’s not something we tend to associate with life in New Zealand. But malnutrition is a real risk for a growing segment of our population: the elderly.
Recent Massey University research found 28 per cent of people aged 85-plus who were recently admitted to hospital were malnourished. A further 43 per cent were at risk of malnutrition. For someone in that age group, who has other health issues, this is a life-threatening situation.
Malnutrition is a term for any deficiencies, excesses or imbalances in a person’s energy and/or nutrient intake. The term also covers overweight, obesity and diet-related chronic diseases, such as heart disease, stroke, diabetes and cancer.
Malnutrition that affects our elderly most is undernutrition: the problems of wasting and being underweight.
Interestingly, research suggests that as we age, being slightly overweight is associated with living longer. It’s being too thin or very overweight that holds the most risk.
So why are older people malnourished? There are a few factors. Widowhood and transition from living with others to living alone means people can become lonely or depressed and lose motivation to prepare meals for themselves.
Another factor can be swallowing problems, known as dysphagia. This can be due to a decline in muscle function, called age-related-sarcopenia, which can affect the muscles needed in swallowing. When you have problems swallowing, the natural inclination is to eat less. The Massey researchers found a third of their study participants were at risk of dysphagia, and called for screening to be done for both dysphagia and malnutrition.
Once older people are malnourished, the researchers point out, it can start a vicious circle. “It is often interlinked with reduced immune function, weakening their defence against other conditions such as pneumonia and diarrhoea,” they report. In turn, just as nutrient requirements increase, they often experience lower appetite.
This paints a depressing picture of life in advanced age. But there are some solutions. If malnourished older people can be identified through screening, something that’s not difficult to do, their nutritional status and overall health can be improved through follow up with a nutrition care plan.
There are also community-based solutions that can help before people end up in hospital. The New Zealand Nutrition Foundation runs a ‘Just Cook for Healthy Ageing’ programme of practical cooking classes for older people, covering planning and cooking economical dinners for one or two, shopping tips and time-saving cooking strategies. The classes are perfect for those who find themselves living alone. As noted in the Massey study, 50 per cent of the participants were living alone, and people are staying in their homes as long as possible, rather than moving to residential care facilities. So, having the skills to nourish oneself is as important in later years as it is when we’re young.
How to help
Massey University researcher Carol Wham shared these tips to help an older person who might be at risk of undernutrition:
- Unintentional weight loss can be a first sign that an older person isn’t eating enough
- Be alert when someone loses a spouse. This is a time when people often lose motivation to eat. Lack of appetite along with depression, other health issues and lack of social contact all play into this
- Make sure they’re not skipping meals. At least three meals a day is ideal
- Older people need protein spread throughout the day and consuming it at every meal is ideal. Eggs are a great way to get protein at breakfast, along with milk and yoghurt
- People eat more when they eat with others. Take the time to share meals with your older family member. Making them food is good, and eating food with them is even better.