11.5: Malnutrition among the Elderly

Malnutrition is widespread and occurs frequently among the elderly. Providing precise estimates of the extent of malnutrition and the specific nutrients involved is difficult. Interestingly, many cases occur even when adequate food and professional assistance are available, such as in nursing homes. The high incidence of malnutrition among the elderly is due to many factors, many of which become more common or severe with age. These factors may be biological, social, psychological, or economic. (Suggestion 239.01.02)

See Table of Factors that Influence Amounts and Types of Food Eaten and Table of Factors Contributing to Malnutrition in the Elderly.

For a list of factors contributing to malnutrition among the elderly, see https://www.biologyofhumanaging.com/tblmal - true.htm .

Reducing and Preventing Malnutrition

Though the factors causing extensive malnutrition among the elderly are numerous and diverse, the following steps can be taken to reduce malnutrition in this segment of the population.

Evaluating Nutritional Status

To reduce and prevent malnutrition, one must determine which individuals are malnourished and what types of malnutrition they have. Several approaches are used in making such determinations. These include developing a dietary history; keeping records of food intakes; performing physical examinations; performing chemical analyses of blood samples; analyzing records of body weight; and taking body measurements such as skin fold thickness, height, and weight. The values obtained are compared with the recommended values. Combining two or more of these approaches provides determinations of nutritional status having increased accuracy and reliability.

Identifying Factors Contributing to Malnutrition

Once cases and types of malnutrition have been identified, the second step is to attempt to identify factors that have contributed to the malnutrition. Though this may be difficult, correcting malnutrition is easier if the causes can be reduced or eliminated.

Evaluating and Adjusting Diet

A third step in solving malnutrition is to compare individuals' diets with dietary recommendations based on My Plate, RDAs, U.S. RDAs, and ESADDIs. When one uses these general guidelines and tables, individualized diets can be designed to provide nutritional homeostasis while minimizing problems that may be caused or amplified by specific dietary components.

See Table of Factors that Influence Amounts and Types of Food Eaten and Table of Factors Contributing to Malnutrition in the Elderly.

Implementing dietary adjustments can be a difficult task because many factors besides hunger caused by low nutrient levels influence the amounts and types of foods people eat. Some of these factors (e.g., taste preferences) influence voluntary choices. Others (e.g., religion, culture, disease) impose dietary requirements or restrictions. Considering these factors improves the likelihood that recommended dietary adjustments will be adopted.

Many elderly people are able voluntarily, independently, and effectively to implement dietary modifications and changes in exercise to improve their nutritional status. However, any others require regular assistance. Effective programs for these people are provided by government agencies, social organizations, and volunteer groups. (Suggestion 239.02.05)

Using Supplements

For some individuals, eating a proper diet or implementing dietary adjustments cannot adequately reduce or prevent malnutrition or cannot do so quickly enough. Examples include people taking certain medications (e.g., antibiotics); individuals who have or are recovering from certain diseases (e.g., atrophic gastritis, diverticulitis); people recovering from surgery or from certain types of injury (e.g., burns); and individuals who are smokers or alcoholics. In many of these cases the desired nutritional levels can be attained through other means, such as taking dietary supplements (e.g., fiber, vitamins, minerals) and drinking extra water. Other individuals are helped by taking medications that affect appetite or alter the absorption of specific nutrients such as cholesterol.

Supplements and medications should be taken only when nutritional homeostasis cannot be achieved through diet and evidence suggesting the presence of a specific nutrient deficiency is available. Inappropriate ingestion of nutrient supplements can lead to additional malnutrition, toxicity, and serious or life-threatening malfunction or failure of many body systems because of (1) age-related decreases in mechanisms, such as nutrient storage, conversion, and excretion, that permit adaptation to excess materials and (2) the likelihood that excess nutrients will aggravate existing problems or cause new ones in weakened organs or systems.

A Continuing Process

The processes involved in maintaining nutritional homeostasis and reducing and preventing malnutrition should be viewed as ongoing even after malnutrition has been identified and rectified. Evaluation of nutritional status should continue since adjustments may be necessary as age changes occur and new situations and conditions arise. Examples include (1) the onset of, worsening of, or improvement in a disease, (2) changes in social situations (e.g., family structure), (3) alterations in psychological status (e.g., grief, life review process), and (4) modifications in economic conditions (e.g., declining real income).