Malnutrition in older adults: Strategies for addressing this common problem

As people age, a variety of factors can make it more challenging to eat a healthy, balanced diet. Over time, this can lead to malnutrition.

What is malnutrition and how common is it in older adults?

Older adults may need fewer calories each day compared to a younger person, but have similar or even increased nutrient needs.

Malnutrition occurs when someone is not consuming enough important nutrients, such as vitamins, minerals, carbohydrates, fats, and proteins. As a result, their body cannot function well. Malnutrition can affect a person's ability to participate in everyday activities and can negatively impact their quality of life. Someone who is malnourished is more likely to experience physical and mental decline and have a higher risk of serious illness.

You can't always tell if someone is malnourished by looking at them. Malnourished older adults may be underweight or overweight. For example, someone who is obese may be eating enough calories but not the key nutrients they need to stay healthy.

In the U.S., malnutrition in older adults is surprisingingly common. According to a study in The Lancet, in the U.S., about one in four adults ages 65 and older are malnourished or at risk for malnutrition.

Why are older adults vulnerable to malnutrition?

Malnutrition in older adults may result from a variety of physical, psychological, social, and practical factors:

• poor appetite due to a health condition or medication side effects
• trouble chewing or swallowing, often due to dental or oral motor problems
• cognitive decline
• depression
• altered or diminished sense of smell or taste
• lack of motivation to cook after a spouse passes away
• being unable to get to a grocery store or cook for oneself
• not being able to afford healthy foods
• isolation.

Signs and symptoms of malnutrition in older adults

Warning signs and symptoms of malnutrition include:

• muscle weakness
• feeling tired
• irritability or depression
• having less of an appetite
• unplanned weight loss
• dental problems
• easy bruising
• frequent illness or infection.

Some people experience a reduced sense of thirst as they age. Dehydration, which is caused by not drinking enough fluids, is closely related to malnutrition, and the two can occur together. Drinking plenty of water each day is important to avoid dehydration, constipation, and urinary tract infections.

How malnutrition affects health and well-being

Some of the health problems that result from malnutrition include:

• higher risk of heart disease, cancer, and osteoporosis (fragile bones)
• loss of muscle mass
• longer recovery from illness or surgery
• higher risk of infection
• slower wound healing.

If you or a loved one is experiencing symptoms of malnutrition, talk to your doctor. There are special tests to evaluate whether someone is at risk for or suffering from malnutrition. One quick test, the Mini Nutritional Assessment (MNA) looks at dietary intake, weight loss, mobility, psychological stress, and body mass index (BMI).

Strategies and solutions for healthful eating

Treating malnutrition entails not simply eating more, but eating more healthy foods. The USDA website has nutrition tips and information on dietary needs for people ages 60 years and older.

The following practical tips can help overcome some of the obstacles that may be interfering with proper nutrition:

• Prepare large quantities of foods, stews, and soups, and load your freezer with individual portions that can be easily reheated.
• If you don't like to cook alone, try cooking with a friend.
• See a dentist if you are having trouble chewing.
• Add herbs and spices to your food if you have a reduced sense of smell or taste.
• If you have trouble swallowing, drink plenty of liquids with each meal. (Also let your doctor know so that they can work with you to identify the cause of the swallowing difficulty.)
• If you don't have much appetite, eat smaller meals and add a couple of nutritious snacks or meal replacement shakes during the day.
• Look into meals offered at nearby senior centers or religious facilities. This can help with issues related to isolation.

Ask your doctor about working with a nutritionist who has experience with malnutrition in older adults.

If the act of cooking has become too difficult, your doctor can recommend an occupational therapist, who can help you find ways to make food preparation and mealtime easier.

Treating underlying depression, if present, can also help improve appetite.

Community resources for meal delivery

If it's hard to get out to shop for food, many stores will deliver grocery orders at little or no charge. There also are senior markets, food pantries, and food banks. Feeding America offers a website where seniors can find these free food distribution services.

Meals on Wheels America is a network of 5,000 community-based programs that deliver nutritious meals to nearly 2.2 million seniors annually, for free or at very low cost, depending on income.

If affording healthy food is a problem, the Supplemental Nutrition Assistance Program (SNAP) is the largest federal food assistance program. It can be a lifeline for older adults, helping them buy the food they need to maintain good health.