Is your elderly parent malnourished? Here's how to tell and what to do
With age comes change — and a lot of those changes can make eating a healthy, well-balanced diet more challenging. Loss of mobility, a change of social situation, chronic health problems like diabetes or heart disease, and tight finances all make it tougher for older adults to buy and prepare healthy food, as well as know what to eat.
But that doesn’t mean good nutrition becomes any less important. Good nutrition minimizes fatigue, provides energy to be mobile and active, supports a healthy immune system to fight disease or infection, and bolsters the body’s defense against chronic diseases or conditions someone may be fighting, says Leanna Tu, RD, Clinical Dietitian at Stanford Health Care.
You may associate malnutrition with being way too thin. But being malnourished doesn’t always mean you’re not getting enough calories; it can also be a result of not getting the nutrients you need. Someone who is heavier can also have trouble eating enough healthy fats, carbohydrates, protein, vitamins and minerals. “Even if somebody doesn’t look super-thin, they can still be malnourished,” Tu says.
Why older adults are at risk of malnutrition
Research suggests that between five and 15 percent of people over 65 may unintentionally lose weight, and roughly 20 percent of nursing home residents are estimated to be malnourished. Usually a combination of factors leads to inadequate eating among older adults. Here are a few:
- Fatigue. One big problem as we get older is not having the energy or mobility to get to the grocery store and/or cook, Tu explains. “Access to food and ability to prepare it can be a big problem,” she says.
- Limited income. Seniors may have limited incomes and may face increasing expenses due to medical bills, prescription drugs, services the individual can no longer do for themselves, and more. So the price of food itself may prevent some older adults from buying and eating the food they need.
- Other health problems. Older adults are more likely to be dealing with chronic health problems, such as heart disease, kidney disease, diabetes, and other illnesses (or a combination) that may require them to follow certain diets, such as a low-sodium diet or carbohydrate-restricted diet. “That can make it difficult to figure out what exactly they should be eating, or they feel like they can’t eat the foods they like,” Tu says. Other health problems, such as multiple sclerosis, Parkinson’s disease, and some cancers and cancer treatments, can cause difficulty swallowing, which makes it harder to eat in general.
- Medications. Certain medications can cause changes in someone’s sense of taste, smell, and/or appetite, which could prompt a change in eating habits.
- Age-related taste changes. A person’s sense of taste can also change and dull with age, affecting cooking and eating habits.
- Safety concerns. Worrying about accidentally leaving the oven or stove on, for example, may make older adults reluctant to cook for themselves.
- Dental health. Deteriorating dental health that happens with aging may make it more difficult to continue usual eating patterns. And older adults with dentures may have trouble with fit that leads to difficulty chewing or swallowing.
- Changing social dynamics. Older adults may find themselves eating alone more often after the loss of a spouse or other friends who they would typically eat with. Or limited mobility may make it more difficult to meet up for meals with family or friends. “Eating alone can decrease interest in food and eating,” Tu explains. “Or they may not feel motivated to put together a full meal.”
- Depression and/or psychological factors. Older adults may face additional stress and anxiety because of the deaths of family or friends or changing social dynamics. These can all affect mood, which may affect appetite.
Early warning signs of malnutrition
The first step in helping older adults who are malnourished is preventing it from happening in the first place. When someone becomes malnourished and loses a significant amount of weight, they become more fatigued. They may also lose some mobility, and with it the ability to do everyday tasks.
Research shows that even as little as a 10 percent loss of lean tissue in otherwise healthy adults can have negative effects on the immune system, increasing infection risk and mortality.
“There are steps we can take to reverse some of that, but prevention is important,” Tu says. “There are early warning signs you [as a family member, friend, or caregiver] can pick up on.”
- Smaller portion sizes or eating fewer meals per day
- Changing weight trends
- Loss of muscle (often most noticeable in the arms, face or around the collarbone)
- Changing patterns in physical activity (which may be a result of decreased energy or muscle)
- Weakness and/or fatigue
It’s important to remember to pay attention to trends over time in an individual for any of these specific factors. For instance, even if someone doesn’t look extremely thin, notice if they are down from their typical weight or someone has changed their eating habits.
How to help someone who is malnourished
If you suspect someone you know is at risk of being malnourished, try to eat with that person regularly and observe what they’re eating. Depending on what kind of food challenges they’re facing, there are different things you can do to help.
- If cost of food is contributing to poor eating habits, you may be able to help that person purchase food in bulk. Or connect them with food assistance programs that can help (such as Meals on Wheals America or Feeding America, both of which offer services across the U.S.).
- If lack of interest in food seems to be the problem, try suggesting different food and meal choices. Eating three large meals a day may be difficult, but more frequent, smaller meals might be more manageable for that person. Also, having high-calorie and high-protein snack and meal choices around can help. Or look for community meals in your area where older adults can eat in a more social environment. Many churches and community centers organize such events on a local level.
- If a health problem or illness is preventing good nutrition, help the person talk to his or her medical team about the eating issues, Tu adds. There may be an underlying medical problem or medication that is causing the problem. Or maybe a special dietary restriction needs to be adjusted.
In some cases a medical professional may recommend dietary supplements or protein shakes to help increase calorie intake — or intake of a particular nutrient, Tu explains. “They can be helpful and appropriate for some people — and they may not be for others — depending on the reasons behind the individual’s not eating.”
You can also request a referral to a dietitian if there are multiple health conditions that need to be taken into consideration or for a personalized recommendation.
Don’t be afraid to get more help. “Some people are hesitant, but sometimes you really just need a shortcut, whether that’s a meal delivery service or a supplement,” Tu says.
Help is out there:
- Meal delivery services, such as Mom's Meals, Meals on Wheels America and Healthy Chef Creations, are available in many areas for free, as well as for cost, to provide food and meal options to seniors who are unable to grocery shop and cook for themselves.
- The National Council on Aging’s Benefits CheckUp helps seniors or their caregivers find programs in their area that help pay for food, among other benefits.
- Supplemental Nutrition Assistance Program (overseen by the U.S. Department of Agriculture) provides nutrition assistance to low-income individuals and families. According to the National Council on Aging, three out of five seniors who qualify for SNAP do not participate. You must apply in the state in which you live.
These additional resources include more information about specific foods older adults should be focusing on and tips for eating well:
- The National Institute on Aging
- United States Department of Agriculture
- MyPlate for Older Adults
- World Health Organization
Written by Sarah DiGiulio, reviewed by John K. Min, MD
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