Malnutrition and older people (detailed factsheet)

This information has been adapted (with permission) from the ‘Essentials in Care’ module of the E-Learning for Healthcare Programme.

Malnutrition - the facts

Losing weight as we get older is not part of the ‘normal ageing process’. Poor nutrition (malnutrition) could be to blame.

Malnutrition is a serious condition. It is caused by a lack of nutrients in our diet, either due to a poor diet or problems absorbing nutrients from our food.

In the UK, over a million people over 65 suffer from malnutrition. Most of these people live in their own home.

Being malnourished can make medicine less effective. Making it harder to recover from illness. Malnourished people see their GP more often. They go to hospital more often and stay in hospital for longer.

Signs and symptoms of malnutrition   Back to top

• Unplanned weight loss (causing clothes, dentures, belts or jewellery to become loose)
  
  
• Low body weight
  
  
• Lack of interest in eating or drinking
  
  
• Tiredness
  
  
• Muscle weakness (increasing the risk of falls)
  
  
• Feeling down or feeling like they ‘can’t be bothered’
  
  
• Getting ill more often and taking longer to recover
  
  
• Confusion and forgetfulness
  
  
• Feeling cold and finding it harder to warm up

Why older people are more at risk of malnutrition   Back to top

There are many factors that can make older people more at risk of malnutrition, including:

Reduced appetite

• We need less food/energy as we age. Our metabolic rate decreases, so our appetite reduces.
  
  
• Metabolic rate is the amount of energy our body needs, just to keep us alive and our organs working properly e.g. breathing, digesting food, repairing cells, etc.
  
  
• People with more muscle tend to have a faster metabolism. This is because muscle cells use more energy than fat cells.
  
  
• But as we age, we tend to lose muscle and gain fat, which slows our metabolism down and reduces our appetite.
  
  
• Medication, constipation, pain and feeling ill can also affect appetite.

Sense of taste and smell reduce with age

• Between the age of 40 and 50 the number of taste buds we have decreases, and the rest begin to shrink!
  
  
• After age 60, it becomes harder to distinguish between different tastes e.g. sweet, salty, sour and bitter.
  
  
• After age 70, our sense of smell begins to fade.
  
  
• This can change the pleasure we get from food and drink. Food preferences can also change.

Gums shrink with age

• This can cause dentures to become loose and poorly fitted.
  
  
• Gums can become sore and ulcerated from the rubbing.
  
  
• Fruit and veg is often left out as a result. 

Dry mouth

• We produce less saliva (spit) as we age. 
  
  
• Many drugs can cause a dry mouth.
  
  
• Older people may find it more difficult to chew and swallow their food, as saliva is needed to moisten food. Saliva also helps us to digest food.

Difficulty digesting food

• Common in older age, due to less saliva production and slower metabolic rate.

Ability and manual dexterity (moving your hands)

Food choice can be affected by ability:

• Does the food need cutting up or scooping?
  
  
• Can they transfer food from their plate to their mouth easily?
  
  
• Do they have to rely on someone else to eat?
  
  
• Do they have a tremor?
  
  
• Can they hold and use a knife and fork or spoon?
  
  
• Do they have arthritic hands, wrists or elbows?

Motivation

• Can be affected by: low mood, tiredness, lack of appetite and getting less enjoyment from food.
  
  
• Some people feel that they ‘can’t be bothered’ cooking for one.
  
  
• Time: Older people may require longer to eat and can become de-motivated if food becomes cold, or if they are being rushed.
  
  
• If people have difficulty feeding themselves, they may feel embarrassed eating in front of others.

Nutritional needs of older people   Back to top

Although we need less food/energy as we age, older people still need a nutrient rich diet.

“Older people need so little… but need that little so much”.

For healthy muscles and bones, older people need:

• Calcium: Makes our bones strong and rigid (which can help to prevent falls and fractures).
• Vitamin D: Helps our bodies to absorb calcium. Older people may have lower vitamin D levels due to not getting out into the sunlight as often. This is particularly true for people who are housebound.
• Protein: Important for muscle strength.

What to do if someone is malnourished?   Back to top

The 3, 2, 1 approach to meal planning

Aim for:

• 3 fortified meals a day, for example add grated cheese to potatoes, or 2 teaspoons of butter to vegetables
• At least 2 high energy snacks a day, for example biscuits, or a mini pork pie
• Use 1 pint of fortified milk a day. You can fortify milk by adding 4 tablespoons of dried milk power to a pint of full fat milk and mix well

‘Fortified’ means adding extra nutrients to food/drink.

3 fortified meals a day examples:

• Add 1 tablespoon of grated cheese or cream to potatoes, soups or casseroles.
• Add 2 teaspoons of butter to potatoes and vegetables.
• Add full fat mayonnaise or salad cream to sandwich fillings or salads.
• Add fortified milk or cream to porridge and breakfast cereal.

2 high energy snacks a day examples:

• Cheese with buttered crackers.
• Toast with butter and jam/ peanut butter/ chocolate spread/ cheese.
• Full fat yoghurt.
• Mini pork pie, sausage roll, cocktail sausages, mini scotch egg, quiche.
• Nibbles e.g. nuts, crisps, chocolates, sweets, crumpets, teacakes, cheese, biscuits and fruit.

1 pint of fortified milk a day:

• Milk is a nutritious drink.
• Fortifying milk makes it even more nutritious.
• It doubles the goodness, without doubling the amount!
• To fortify, add 4 tablespoons of dried milk powder to a pint of full fat milk. Mix well.

For more information, visit the Malnutrition Treatment page of the NHS Website.

Daily living equipment and technology to help with preparing meals and eating food   Back to top

Daily living equipment and technology can help people to keep their independence. There are lots of affordable products out there that can really help. Some things can even be bought from supermarkets or high street shops.

Take a look at our ‘interactive house’ to find out about the range of equipment that’s available.

Examples of daily living equipment and technology to help with preparing meals and eating food:

• Automatic can openers
• Bottle/jar openers
• Foam tubing (placed on cutlery) for easier gripping
• Non-slip trays, non-slip tray liners, and trays with carry handles (to carry food safely)
• Talking tins (voice recording of what’s in tins)
• Non-slip table mats
• Peelers and graters with extra grip
• Trolleys (to move food and drink)
• Slip resistant grips for knives
• Lightweight saucepans
• Talking/large screen display kitchen scales and measuring jugs
• Wire mesh baskets to place in saucepans (so don’t need to lift heavy pans full of boiling water)
• Chopping boards/spreading boards (helps with buttering bread), and work stations that hold food in place
• Bowls and plates with high sides/plate guards (easier to eat one-handed, provides a ‘wall’ to push food against, reduces spillages)
• Stay warm plates and bowls (keeps food warmer for longer)
• Angled cutlery (helps if restricted movement at shoulder, elbow or wrist)