10 Reasons for Elderly Malnutrition and What You Can Do to Help
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When it comes to nutrition, the elderly are an especially vulnerable population. There are a number of reasons this population is susceptible to poor nutritional status. Malnutrition in the elderly does not discriminate between race, gender or socioeconomic status. All elderly can be at risk of declining nutrition. Some reports estimate that only 17% of the elderly population in the United States are eating a balanced diet, with 30% of seniors skipping at least one meal or living on less than 1000 calories per day. Family members often feel helpless in preventing the nutritional deterioration of their aging loved ones. However, there are steps that can be taken to improve the nutritional status of seniors. The first step to help fight malnutrition in our seniors is to identify the root causes. Here are 10 factors which can contribute to malnutrition and what family can do to help.
Poor Mobility
Whether poor mobility is due to decreasing physical ability or simply poor energy levels, it can seriously impact a senior’s nutrition. Younger adults may not fully appreciate how much energy it takes for the elderly to do the things they do so readily. A trip to the grocery store may be only thing an elder suffering from poor mobility can do in a day. There may be days when seniors decide it isn’t even worth going to the store to pick up groceries. This could mean they go to the nearest convenience store or fast food restaurant to pick up their next meal or they simply do without. The problem with acquiring food at local convenience stores or fast food joints is that the foods available at these locations are quite limited and often times devoid of much nutrition.
What family can do:
Lending a hand with grocery shopping can make a huge difference in the nutrition of an elderly individual. Sometimes all an elderly person needs is a ride to the store as travelling (and toting home bags of groceries) can be the most strenuous part of the experience. If you’re not available to help, perhaps try connecting with your loved one with a local grocery delivery service. Many times these services provide free delivery for seniors. Meal delivery programs are also available in many communities and are used by a number of seniors that either don’t have the energy or ability to obtain their own meals.
Your elderly loved one may also appreciate receiving meals you have cooked, especially if pre-portioned in freezable containers. It doesn’t need to be much, it could just mean making an extra big batch of soup for your family and portioning off a little to give away. Having extra single serve portions of meals can make all the difference in the lives of the frail elderly.
Poor Mental Health
Just as physical health can play a role in the nutritional status of older seniors, so can mental health. Failing memory and cognition as well as depression can significantly impact dietary intake. Poor memory and cognition often can lead to forgetting to eat or drink putting them at risk for weight loss, malnutrition and dehydration. Depression can limit motivation to eat, cook and shop for food.
What family can do:
If a senior’s mental health is putting their lives at risk a consultation with a geriatric medical team is in order. Together with the appropriate health professionals, you can devise an individual treatment plan to improve your loved one’s overall well being, including nutrition.
If memory and cognition are declining and nutrition is failing as a result, your loved one may benefit from some additional attention. This may be in the form of more visits and gentle reminders. Depending on the nature of the memory loss, sometimes using a visual meal schedule, that can be checked off as meals are eaten, can work as a reminder to eat. Other times, having in-home care may be needed. Whether that is someone who is present full-time or someone who drops in a few times per day, it can help ensure nutrition is being attained.
Cooking for One
Let’s face it, cooking for one isn’t always the most exciting. For many seniors living alone, eating for one can be a huge factor in their poor nutritional status. Many people, whether young or old, experience a lack of motivation when cooking for only themselves. They may be more likely to eat the same thing over and over again or skip out on nutritionally valuable but more time consuming to prepare foods. This can lead to a diet that is either deficient in calories or essential nutrients, or both.
What family can do:
While it may not be feasible to have all your meals with your aging loved one, it doesn’t hurt to make an effort to have some meals together. You can also encourage your elder to make connections with their friends for meal dates, as this may not only benefit your loved one but their friends as well. Many communities have senior’s centers or community kitchens for seniors in which communal meals are served or cooked together. A number of these organizations also have buses that will transport seniors to and from their programs. Even having a few extra meals in a social setting can make a difference in the life of a senior living alone.
You can also try spending some time cooking together. This has the added benefit of providing some social time for both your loved one and yourself. Cook something big enough that it can be frozen in batches for later use.
Poor Dental Health
Dental health is often overlooked when sussing out for the root cause of an elderly person’s poor nutritional status but it can cause significant dietary problems. Whether this is because of missing teeth, dental pain, or poor fitting dentures, dental problems can seriously impact nutrition. Food choices and, therefore, nutrition are limited when dental issues exist.
What family can do:
Ensure your elderly loved one gets routine checkups by their dentist or denturist, as well as, maintains good daily oral hygiene. For those wearing dentures, family members should take note of any extreme weight loss as this can influence how dentures fit in the mouth and they may need to be resized.
For those with limited ability to chew, obtaining proper nutrition may be as simple as finding foods with appropriate texture. A Registered Dietitian is a great resource to help you brainstorm ideas to bring more balanced nutrition and, perhaps, some excitement into your loved one’s diet.
Trouble Swallowing
Trouble swallowing, otherwise known as dysphagia, is a serious problem and is fairly common among the elderly population. Some estimate that at least 15% of elderly exhibit some form of swallowing difficulties. Dysphagia can be a result of an age-related decline in swallowing function, stroke, dementia, radiation to the head or neck or a neurodegenerative disease. Signs that your elder is having swallowing difficulties could be gagging or coughing while eating, pain with swallowing, the sensation of food being stuck in the throat, or hoarseness of voice. The dangers of dysphagia are not only that it impacts ability to obtain proper nutrition but those with dysphagia are at high risk for the very serious aspiration pneumonia.
What family can do:
As mentioned before, dysphagia is a serious medical issue and, as such, consultation with a doctor is the first thing that should be done. A team of medical professionals, including an ear, nose, and throat (ENT) doctor, speech language pathologist and/or an occupational therapist will likely be consulted for a diagnosis. After the specific type of dysphagia is identified, an appropriate (and safe) dietary texture will be recommended. A Registered Dietitian can discuss food choices and help with meal plans that will provide a safe and nutritionally balanced diet.
Decreased Thirst and Hunger Sensations
As we age our body goes through a number of physiological changes including a decreased sensitivity to hunger and thirst. Many elders do not receive strong signals from their body telling them that they need to nourish or hydrate themselves. When this happens, especially in combination with other factors on this list, malnutrition and dehydration can result.
What family can do:
There are a few strategies that can be used when the body is no longer giving strong hunger and thirst signals. Encouraging regularly scheduled and balanced meals is very important. Abiding by a meal schedule can assure that your loved one is obtaining nutrition throughout the day. Meals should be nutrient dense meaning that they should be higher in calories as portions will likely be small. The goal is to get the most bang for your buck with meals in this situation - avocados, mashed potatoes with sour cream, nut butter sandwiches, and full fat dairy are just a few examples of nutrient dense foods. As for thirst, a good rule of thumb for an adult is 1.5 L of fluid per day unless on a medically necessary fluid restriction. This fluid can be water, juice, milk, coffee or tea. One suggestion that many find helpful is filling a pitcher of water each morning and finishing it by the end of the day.
Incontinence
What does bowel or urinary incontinence have to do with poor nutrition, you ask? Many individuals, whether old or young, limit their intake of food or drink when they suffer from incontinence to avoid having embarrassing ‘accidents’. While at home incontinent individuals may feel more comfortable eating and drinking but if social events or errands are planned intake may be purposefully limited. For nutritionally vulnerable seniors, skipping meals can be quite damaging.
What family can do:
As with any issue affecting your loved one’s health, discussing it with them is always the first step. Incontinence isn’t always an easy topic to discuss but if it is negatively influencing the quality of their lives, including their nutrition, it is important to bring it up. Doctors and qualified nutrition professionals can provide specially tailored advice for your senior’s needs. Along with the use of protective underwear, the rearranging or meals and drinks, or the addition of fiber may be able to help your loved one depending on their particular issue.
Money Worries
For a large number of elderly, poor nutrition in their golden years stems from their financial worries. Many seniors depend on an ever dwindling savings or a small pension to survive. Sometimes that money just doesn’t seem to be quite enough. As a result, the quality or quantity of food they buy is sacrificed leaving them nutritionally at risk.
What family can do:
Now, it’s true that not everyone has the economic well being to give financial support to their elderly loved ones but there are other things that can be done to help. Whether it is providing them with extra meals to slip in their freezer, rides to more economical grocery stores or keeping an eye out for good grocery deals you can help them ease their financial woes. Many communities also have resource centers for seniors that may be able to connect your loved one to local community kitchens, drop-in meals, or low cost meal delivery services to help stretch their budget a bit.
Chronic Illness & Medication
As we age, we are more likely to be dealing with some sort of chronic disease. One estimate finds that 74-90% of seniors have at least one chronic illness with almost three quarters of seniors taking at least one medication. The most common chronic diseases within the elderly community are cardiovascular disease, diabetes and respiratory diseases. Each of these can influence the nutritional status of those suffering with them in a number of ways. Medications can affect one’s appetite, bowel movements, taste perception, saliva production, and alertness level among other things. All of these side effects can have a negative impact on nutrition, especially that of a frail elder.
What family can do:
Being aware and on the look out for nutritional complications of diseases and side effects of medications is number one here. If you or your loved one is concerned regarding medication side effects, consult a doctor for a medication review. A Registered Dietitian can make recommendations for food choices to combat those nutritionally related side effects including increasing nutrient density, palatability, and digestibility of foods.
Digestive System Changes
A healthy digestive system is necessary for proper nourishment. With age, the digestive system’s ability to function optimally declines. This decline can be seen throughout the digestive tract, from the mouth all the way through to the anus. A decline in upper digestive tract function can cause decreased saliva production, cause trouble swallowing (as mentioned earlier) and create an increase in gastroesophageal reflux disease (GERD) due to a dwindling strength of the muscle connecting the stomach and esophagus. Age related changes to the stomach lining put the elderly at higher risk for gastric ulcers and B12 deficiency, as well as a decreased capacity to hold food. With time, our body also loses its ability to digest lactose, the sugar in milk, which may cause certain individuals to experience pain, bloating and possibly bacterial overgrowth within the small intestine. As well, overall movement of food through a senior’s digestive tract tends to be slower contributing, in part, to constipation.
What family can do:
Age-related changes to the digestive tract are normal. And we need to respect the fact that our body does go through changes as we age. Some individuals may not notice the effects of these digestive system changes while others will, unfortunately, notice a number of them. A doctor or trained nutrition professional can help your loved one manage these changes. Soft, moist foods, proper hydration and lemon infused water can help with a dry mouth. Food texture changes, as advised by an speech language pathologist or occupational therapist, can help one cope with swallowing difficulties. Medication and/or dietary changes can aid in decreasing the discomfort associated with GERD, ulcers, lactose intolerance and constipation. Your loved one’s family doctor should be screening for B12 deficiency as up to 30% of older adults have poor absorption of this nutrient. If found deficient, a B12 supplement will likely be prescribed as this vitamin in supplement form is readily absorbed.
Ensuring proper nutritional status of our elderly is important to help them live out their golden years to the fullest. At times it may seem difficult but there are community resources and knowledgeable healthcare professionals available to work with you and your loved one through all of their challenges.
