Malnutrition in the elderly
Sep 09, 2021
It is estimated that more than half of elderly Australians living in aged care or at home are at risk of undernutrition. It is important to note that overweight people can still have malnutrition and that it is not possible to identify undernourished patients based on their physical appearance, weight or body mass (BMI) alone.
Malnutrition is caused when a person does not meet their body’s requirements for macro- and micronutrients and can occur when a person does not eat enough foods, they do not eat the right types of foods to nourish their bodies or when their body is unable to absorb enough nutrients from the foods they eat.
Other contributing factors can include medical conditions, acute illness, low mood, poor dentition, side effects from medications, reduced appetite, early satiety and changes in taste and smell, constipation, nausea, pain, social isolation and reduced motivation to prepare meals to name a few.
The most obvious symptoms of malnutrition include:
- Unintentional weight loss
- Muscle loss and/or signs of wasting
- Hair loss
- Wounds that do not heal
- General weakness and fatigue
- Increased falls
The potential consequences of malnutrition include:
- Weight loss in the elderly is associated with a loss of muscle mass which has implications for mobility, strength and activities of daily living.
- Increased mortality, reduced quality of life related to loss of independence, increased need for treatment and frequent and/or prolonged hospital admissions.
- Increased morbidity including increased risk of infection, recurrent infections and delayed recovery associated with impaired immune function.
- Poor wound healing and increased risk of pressure areas and ulcer.
- Sarcopenia - which is defined as a progressive loss of skeletal muscle mass and strength, and frailty.
- Increased risk of osteoporosis, recurrent falls and fractures.
How can malnutrition be treated?
Screening within general practice is important for identifying those most at risk. This may involve weighing elderly patients at every visit and completing a nutritional screen if any weight loss is recorded. The Mini Nutritional Assessment – Short Form (MNA-SF) or MST are two screening tools that could be easily incorporated into the general practice processes.
If a patient is assessed as malnourished or “at risk of malnutrition” based on the screening tool the following interventions are suggested:
- Commence a nutrition supplement such as a HE/HP supplement
- Recommend dietary strategies such as food fortification, using full fat dairy products and having milky drinks, adding high energy foods (such as cream, butter, oil) in cooking, encouraging small frequent meals/snacks, and adequate fluid intake
- Continue to monitor weight regularly
- Consider referral to a dietitian for a full nutritional assessment and dietary recommendations. Malnutrition can be treated by a dietitian by working with the individual to help them find strategies to promote optimal oral intake.
Prevention and early intervention are key because it is difficult to reverse the effects of undernutrition and weight loss once it has already occurred in this population.
If you have a patient that you feel we can help, an appointment can be made at
Ramsay Health Plus Thirroul
Lawrence Hargrave Private Hospital
72 Phillip Street Thirroul
Phone: 02 4268 9127 Fax: 02 4268 9140
About Renae Eastlake
Ramsay Health Plus Dietitian
Renae has over 10 years of experience working as a dietitian in a range of settings including the hospital, community, aged care, chronic disease management programs and corporate health. Renae has been providing dietetics services at Figtree Private Hospital, Lawrence Hardgrave Hospital and Wollongong Private Hospital since late 2019. During this time she has provided dietetic support and education to patients who have had gastrointestinal surgery, bariatric surgery, malnutrition support and nutrition care during rehabilitation.
Renae also has had many years working in the community and nursing home setting. She has a broad range of experience managing patients with a variety of health conditions including vascular issues, chronic kidney disease, cardiovascular health, bariatric surgery and weight management, gastrointestinal health including pre and post-surgery support, food allergies and intolerances, malnutrition support, diabetes management and nutrition care in the aged care setting.