Malnutrition can be defined as the condition whereby a person’s diet does not meet their nutritional needs. It can also describe a condition where their diet does not provide the right balance of nutrients needed for their optimal growth.
There are several causes of malnutrition. They include difficulty getting food, a low income, inappropriate dietary choices, mental health conditions, and physical conditions. Undernutrition is a type of malnutrition that occurs when the human body does not get food.
Undernutrition often leads to low weight, wasting, or delayed growth. Malnutrition can also occur if there is an imbalance of nutrients. It is for this reason that obese people can have malnutrition.
The body may not get the right balance of nutrients if a person’s diet is limited, if they have too little food or if they have a health condition that interferes with the body’s ability to absorb nutrients. This condition can become life-threatening in some cases.
Anyone can have malnutrition. However, the elderly population is at a higher risk of malnutrition. This is mainly because older adults suffer from chronic conditions that are likely to put them at risk for malnutrition.
Malnutrition does not only occur due to hunger or lack of food. Some health conditions may interfere with the way the body absorbs nutrients and this too can cause malnutrition. Health conditions such as Alzheimer’s disease, cancer, and diabetes can affect a person’s appetite making it difficult for them to eat. These conditions can also require dietary restrictions like in the case of diabetes or a change in metabolism.
In addition, older adults are more likely to get hospitalized compared to other age groups. This means that they spend a lot of time in hospitals which puts them at risk of malnutrition. There is malnutrition in over 65% of older adults who are hospitalized.
Malnutrition occurs when a person does not get the proper amount of nutrients their bodies need to function normally. Malnutrition involves an imbalance of nutrients such as proteins, vitamins, and calories that the body needs daily.
The effects of malnutrition are usually harmful at any age. However, these effects are more difficult for older adults. Malnutrition in older adults makes them more vulnerable to possible hospitalizations, re-hospitalizations, slower recovery, increased risk of falling, and possible death.
Causes of malnutrition in older adults include the inability to chew and swallow, increased use of prescribed medications, and lack of appetite. Additional risk factors for malnutrition in older adults are chronic diseases, dementia, depression, and lack of access to nutritious food.
Malnutrition in older adults is not only caused by hunger but also due to other chronic health conditions. Adults with cancer, Alzheimer’s disease, and diabetes have difficulties eating since these conditions interfere with their appetite.
Additionally, management of such conditions interferes with the person’s metabolism. Some conditions like diabetes come with dietary restrictions. This puts older adults at an increased risk for malnutrition.
Older adults are more likely to be in long-term care facilities and are hospitalized more compared to people in other age groups. Long-term hospitalization may put them at risk of malnutrition.
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Common signs and symptoms of malnutrition include:
Some cases of malnutrition can be treated while others can have long-term effects.
Malnutrition in older adults is likely to put them at risk of the following health concerns:
Malnutrition is often caused by too little food or a lack of nutrients. However, it is more complicated and can be caused by a combination of social, physical, and environmental factors.
Factors that lead/contribute to malnutrition include;
Some cases of malnutrition are due to lack of enough food or due to difficulty absorbing nutrients or difficulty eating. This can occur due to:
Examples of stomach conditions and digestive disorders that may lead to malnutrition are:
Alcohol contains calories which are why people often do not feel hungry after taking alcohol. This reduces their consumption of food and the body does not get enough essential nutrients.
Old age is accompanied by physiological changes. These changes can negatively affect the nutritional status of a person. Sensory changes such as reduced sense of smell and taste may reduce a person’s appetite.
Dental problems and poor oral health that come with old age may cause inflammation and make chewing difficult. A person in such a situation is likely to stick to a monotonous diet which restricts their nutrient intake and may lead to malnutrition.
Progressive loss of hearing, sight, and osteoarthritis limits a person’s ability to move around and limits their ability to shop for food and prepare their meals. As people age, their energy needs reduce while nutritional needs remain the same. This automatically leads to malnutrition.
Old people are likely to experience psychosocial and environmental changes like loneliness, insufficient finances, isolation, and depression. All of the factors affect their feeding habits thereby affecting their nutritional status which can lead to malnutrition.
With old age comes reduced physical activities and lean body mass becomes depleted. Combined with dietary changes, this can easily lead to loss of muscle mass, decreased functional ability which leads to increased dependence on others. The effect of interaction between aging changes and nutrition changes on whole leads to progressive undernutrition
It is very important to diagnose malnutrition early enough to avoid diminished cognitive function and reduced ability to care for oneself that comes with a late diagnosis.
Formulating mealtime strategies can help maintain a healthy diet among the elderly. Good eating habits among the elderly should include:
When should you see the doctor?
It is important to see the doctor if you are concerned or feeling worried about your changes in weight, appetite, or any other concerns about your health and nutrition. Talk to the doctor if you are concerned about the health and nutrition of an older adult you may know.
Talking to the doctor is important because the doctor can help you by:
It is good to maintain good nutrition throughout the life of an individual to prevent illnesses. Early diagnosis of malnutrition gives the best outcomes possible.
Once signs of malnutrition are seen or noticed, the next step would be to find out why these signs are there. Laboratory tests may be done to confirm the diagnosis if the doctor suspects celiac disease, Crohn’s disease, or any other medical condition that could have the same signs and symptoms.
If these health conditions are treated, it is possible to improve the nutritional status of the person. The doctor may also carry out;
If malnutrition is diagnosed, the doctor makes a treatment plan for the patient. It may be necessary to also see other healthcare providers such as nutritionists. Treatment given will be determined by the presence of underlying conditions and the severity of the malnutrition.
Treatment may include;
In severe malnutrition, there may be a need for a person to:
The healthcare team will continue to work together to monitor the person to make sure they get the nutrition they need.
Once it has been established that a person is at risk of malnutrition, the next step is to establish goals that are centered on the person. In these goas, people who contribute to their care such as family and nurses should be included.
There should be communicated across the different settings such as care homes, the community, and hospitals. Based on the local policy, management should address social issues, food availability, eating activity, and the environment.
The goals should include the use of oral nutrition and a food-based approach. Food and energy intake can be improved through:
When food intake is inadequate, oral nutritional supplements can be useful. These supplements should be included in the integrated care pathway. Oral nutritional supplements are available on prescription.
Evidence supports this combined approach because it can help old people to gain weight and reduce their mortality rate.
Prescription rates vary from one country to another due to lack of expertise and malnutrition. Oral nutritional supplements are used to augment meals in the long run but they should not be used to replace food.
There is a need for more research to understand the impact of various nutritional interventions. Other influencing factors should also be addressed. Social interactions and relationships also affect how people enjoy the food they eat and drink. Social interactions include interacting with visitors, family, staff, and health professionals where the elderly live.
Most cultures include food as part of socializing. Helping the elderly to maintain a sense of community can be helpful. This can be achieved through:
Primary care nurses are at the forefront of identifying risk factors for malnutrition. They are part of the multidisciplinary team that works in the management and treatment of malnutrition in older adults.
Primary care nurses are in the best position to screen older patients with malnutrition. Some guidelines emphasize the need for identifying people at risk of malnutrition. This should be followed by setting goals that are person-centered to manage weight gain which can positively impact the well-being and health of older adults.
The easiest way to prevent malnutrition is to consume a variety of nutrients from the different types of foods. Older adults and especially those with chronic illnesses need additional care and support to ensure they obtain all the nutrients they need for their bodies to function well and to avoid malnutrition.
If you or someone you know starts to show signs of undernutrition or malnutrition, you should see the doctor immediately for diagnosis and treatment. Early diagnosis and treatment improve the prognosis. Prognosis or outlook and the recovery time will depend on the cause of malnutrition.
Malnutrition in older adults is caused by factors such as low intake of food, depression, alcohol use disorder, mental health conditions, social and mobility problems among others. However, it can be prevented by ensuring older adults have access to a variety of nutrients needed by the body.
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