Spotting Signs of Malnutrition in Elderly

Malnutrition seems to be an epidemic taking over long term care with some facilities reporting over 75% of their patients diagnosed with malnutrition. Spotting signs up malnutrition in elderly people is of top priority to improve survival rates.

As Registered Dietitians one of our primary responsibilities is identifying and addressing malnutrition.  The signs of malnutrition can be subtle and easily overlooked, making early detection and nutrition intervention crucial. 

Here you can find the critical aspects of spotting malnutrition in the elderly, equipping dietitians with the knowledge and tools needed to identify at-risk individuals, conduct comprehensive assessments, and develop tailored nutrition plans. 

By honing our ability to recognize the subtle indicators of malnutrition, we can make a significant difference in the well-being of our elderly clients and ultimately enhance their overall quality of life.

elderly sitting at tables in what appears to be a nursing home.

What is Malnutrition?

Malnutrition is a state in the body in which it is not getting enough nutrients to meet its daily needs to function optimally.  It is characterized by an insufficient intake of essential nutrients, such as proteins, vitamins, and minerals, in the elderly specifically. 

This condition can result from a combination of factors, including reduced appetite, difficulty in chewing or swallowing, limited access to nutrient-rich foods, chronic illnesses, and medications that may interfere with nutrient absorption. 

Why Older Adults are More Likely to Be Malnourished?

While we may see a decrease in appetite in older adults, this does not mean that all will become malnourished.  Malnutrition is common among older adults, specifically those in long term care, but that does mean it is normal or acceptable.

Older adults, especially those residing in long-term care facilities, are more likely to suffer from malnutrition due to a combination of physiological, psychological, and social factors.

Here are some key reasons for this increased vulnerability.

Reduced Appetite

As people age, their sense of taste and smell may diminish, leading to a decreased appetite. This can result in a decreased intake of food, making it more challenging to meet their nutritional needs.

If you want more information on reduced appetite check out: 9 Tricks to Stimulate Appetite in the Elderly.

Chewing and Swallowing Difficulties

Many older adults experience dental issues or difficulty with chewing and swallowing, which can hinder their ability to consume certain foods, particularly those rich in fiber and protein. As we age our throat muscles weaken which puts individuals at higher risk of swallowing difficulty the older they are.

Dysphagia has been reported in up to 68% of elderly individuals, with the highest rates in those who had strokes. Difficulty swallowing leads to increasing discomfort if not managed, which can lead to malnutrition.

Chronic Health Conditions

Older individuals often have a higher prevalence of chronic diseases like diabetes, heart disease, and gastrointestinal disorders. These conditions can impact nutrient absorption and utilization, leading to malnutrition.

Medications

Older adults frequently take multiple medications, which can have side effects that affect appetite and nutrient absorption. Some medications may also lead to nausea or changes in taste perception.

Social Isolation

Loneliness and social isolation are common among the elderly, particularly in long-term care settings. These emotional factors can lead to a lack of motivation to eat and can affect mealtime habits. Depression has been found to be significantly associated with malnutrition in the elderly as well.

Cognitive Impairment

Dementia and cognitive decline can interfere with an individual’s ability to eat, depending on the level of cognitive impairment. In one study among elderly individuals it found that 41% were malnourished that also had Dementia.

Dementia can affect ones ability to remember to eat, remember how to eat, lose their independence with eating, lose interest in food, increase their energy expenditure, and reduce swallowing ability among other symptoms. All leading to malnutrition.

Limited Mobility

Reduced physical activity or mobility issues can lead to muscle wasting and a decrease in appetite, exacerbating the risk of malnutrition. Limited mobility also puts individuals at higher risk of pressure injuries which requires much higher protein and calorie needs. This is another factor leading to malnutrition.

Signs of Malnutrition

There are two different ways to evaluate the signs and symptoms of malnutrition.  

The first way is to go with the officially accepted ASPEN definition, and the second is the Dietitian using their clinical judgement to identify it.  I’ve compiled a list here that is a combination of both.  Though the ASPEN definition is very useful in spotting signs of malnutrition, in practice we know there is a lot more to malnutrition.  

The first five are ASPEN’s official criteria for diagnosing malnutrition, and the last few are what I have found in my patients that have a higher propensity of malnutrition.

elderly holding hands.

Inadequate Energy Intake

Malnutrition may manifest as insufficient calorie intake, leading to weight loss, muscle wasting, and fatigue.

Weight Loss

Unintentional weight loss, particularly when it exceeds 5% of usual body weight in one month or 10% in six months, is a significant indicator of malnutrition.

Loss of Muscle Mass

Malnutrition often results in the loss of muscle mass, leading to muscle weakness and decreased functional capacity.

Loss of Subcutaneous Fat

A decrease in subcutaneous fat stores can be a visible sign of malnutrition, with individuals appearing emaciated or frail.

Fluid Accumulation

In some cases, malnutrition can co-occur with edema (fluid accumulation), particularly when there is concurrent protein deficiency.

Diminished Functional Status

Malnourished individuals may experience a decline in physical and functional abilities, such as difficulty with mobility, activities of daily living, and wound healing.

Changes in Skin and Hair

Dry or flaky skin, brittle nails, and thinning or loss of hair can be indicative of malnutrition.

Impaired Wound Healing

Delayed wound healing and increased susceptibility to infections are common in malnourished individuals due to a weakened immune system.

Laboratory Findings

Abnormal laboratory values, such as low serum albumin, prealbumin, or total lymphocyte count, may indicate malnutrition. Take these with a grain of salt as these are more related to acute changes, not long term as we see in the elderly. But you will still see some Doctors using it.

Dietary Intake

Poor dietary intake, including inadequate consumption of macronutrients (carbohydrates, proteins, and fats) and micronutrients (vitamins and minerals), can be a strong indicator of malnutrition.

It’s important to note that not all of these signs need to be present for a diagnosis of malnutrition, and the severity and combination of these indicators can vary among individuals. 

Identifying malnutrition early is key to preventing its adverse effects.  It’s not only the Dietitian that can look out for signs of malnutrition.

It takes a team approach to catch malnutrition early, this means that everyone from nurses, doctors, health care aides, and therapeutic recreation to spot signs of malnutrition.

Problems Caused by Malnutrition

Malnutrition in the elderly can have severe consequences on their health and well-being. Here are the top five negative health consequences of malnutrition in older adults:

Muscle Weakness and Functional Decline

Malnutrition often leads to muscle wasting, making the elderly more susceptible to muscle weakness and functional limitations. This can result in reduced mobility, difficulty performing daily activities, and an increased risk of falls and fractures.

Impaired Immune Function

Malnourished elderly individuals may have weakened immune systems, making them more susceptible to infections and illnesses. They may also experience slower wound healing and an increased risk of complications following surgeries or injuries.

Cognitive Decline

Malnutrition can have adverse effects on cognitive function in older adults, potentially contributing to conditions like dementia and cognitive impairment. Adequate nutrition is essential for brain health and optimal cognitive functioning.

Increased Hospitalization

Malnourished elderly individuals are more likely to require hospitalization and experience longer hospital stays. Malnutrition can exacerbate existing health conditions, leading to complications that necessitate medical intervention and prolonged recovery periods.

Higher Mortality Rate

Malnutrition is associated with an increased risk of mortality in the elderly. Insufficient nutrition can weaken the body’s ability to fight off diseases and recover from illness or surgery, leading to a higher likelihood of death in malnourished individuals.

‘Curing’ Malnutrition

nurse serving dinner to a smiling elderly woman in what appears to be a nursing home.

Malnutrition is a condition that can be corrected if it is caught early enough, and if the root cause is able to be treated.

Improving Nutrition

Addressing malnutrition in the elderly requires a multifaceted approach that considers their specific needs and challenges. Here are the top five ways to improve malnutrition in older adults:

Nutritional Assessment

Regularly assess the nutritional status of elderly individuals through screenings and evaluations. This helps identify those at risk of malnutrition and allows for tailored interventions.

Individualized Meal Plans

Develop individualized meal plans that take into account the person’s dietary preferences, cultural considerations, and any specific dietary restrictions due to medical conditions. These plans should aim to provide a balanced and nutrient-dense diet.

Social Support and Meal Companionship

Combat social isolation by encouraging social interactions during meals. Eating with others can make meals more enjoyable, improve appetite, and enhance the overall dining experience. In long-term care facilities, fostering a sense of community during mealtimes is vital.

Fortify Foods

Ensure easy access to a variety of nutrient-rich foods that are easy to prepare and consume. Providing a range of choices, including fruits, vegetables, lean proteins, and whole grains, can help meet nutritional needs and cater to different tastes.

Education and Training

Educate caregivers, family members, and healthcare professionals about the importance of nutrition in older adults and provide training in techniques to address chewing and swallowing difficulties, adapt meal plans to specific conditions, and create an environment that promotes healthy eating habits.

By implementing these strategies, we can significantly improve the nutritional status of the elderly and reduce the risk of malnutrition, leading to better overall health and well-being.

Role of Family Members in Supporting Nutrition

Family members can play a crucial role in supporting the nutritional health of older adults. By staying involved and informed, they can help reinforce the importance of good nutrition and encourage their loved ones to participate in meals.

Family can also provide valuable insights into the older adult’s eating habits, food preferences, and past dietary patterns, which can aid healthcare providers in developing a more personalized care plan.

If you’re a Dietitian always make sure that you’re connecting with loved ones to come up with a patient’s favourite foods, likes and dislikes as this may help to improve their intake.

The Importance of Hydration

Water plays a crucial role in overall health and well-being.

Older adults, however, may not always consume enough water, leading to dehydration, which can exacerbate the effects of malnutrition. Dietitians need to ensure that hydration is considered as part of the overall nutritional plan.

This could include adding in extra fluids to the nutrition care plan, ensuring a drink cup is beside the patient’s bedside, or having family members bring in preferred beverages and leave them in their rooms.

Collaborative Care Approach

Addressing malnutrition in older adults requires a multidisciplinary approach.

Dietitians, nurses, doctors, caregivers, and family members must work together to ensure that the older adult’s nutritional needs are met.

This collaborative approach ensures that all aspects of the older adult’s health and well-being are considered and addressed, offering them the best chance of maintaining good nutrition and overall health.


Closing Thoughts

Malnutrition is a serious issue that can significantly impact the health and quality of life of older adults in long-term care. As dietitians, we play a crucial role in identifying, preventing, and addressing this issue.

Through comprehensive assessment, tailored nutrition interventions, collaboration with other healthcare providers, and the support of family members, we can help ensure that our residents receive the nutrition they need to thrive.

We must remain vigilant and proactive, constantly monitoring for signs of malnutrition, and adjusting our approach as needed. Through our efforts, we can help improve the nutritional health and overall well-being of older adults in our care.

Other Articles You May Find Helpful

Top Foods for Elderly With No Appetite.

High Energy High Protein Diet: A Dietitian’s How to Guide.

Michelle saari dietitian
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Michelle Saari is a Registered Dietitian based in Canada. She has a Master's Degree in Human Nutritional Sciences and is a passionate advocate for spreading easy to understand, reliable, and trustworthy nutrition information. She is currently a full time online entrepreneur with two nutrition focused websites.

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