Are your elders eating enough?

May 19, 2016 Providence Health Team

By Terese Scollard, MBA, RD, LD, FAND, regional clinical nutrition manager for Providence Nutrition Services in Oregon

As many as one in four older adults do not get the nutrition they need. This is a big problem, and it can happen to anyone.

Under-eating can start with appetite changes, functional changes or dental problems. It can be triggered by a personal loss or a health condition. It can happen to people at any income level and any weight. It is very common, but often overlooked, and it can have very serious consequences.

When older adults don’t eat enough, their thinking becomes confused and muddled. Walking becomes more difficult and falls are more likely. When an injury or illness strikes, they get sicker, develop more infections and have a harder time recovering. Mentally, undernourished people just feel worse. They are more likely to die sooner.

This isn’t meant to scare you, but to encourage you to be on the lookout for this problem in the elders in your life. Malnutrition sneaks up on people. But there are signs you can watch for and ways to prevent it; and help is available if you suspect a problem.

What to watch for in older adults:

  • Weight loss of 5 percent of body weight or more per month, even if overweight
  • A shrunken appearance to the large muscles
  • Clothing that looks loose or baggy
  • Eating less, leaving more food on the plate or skipping the usual snacks
  • Difficulty getting to the store or preparing food
  • Failing strength, wobbly walking or weakened grip
  • Changes in denture fit, or dentures that appear to be floating in the mouth

Malnutrition in overweight people

Malnutrition in people that are overweight is one of the most commonly overlooked problems. While gradual weight loss is healthy in an overweight person, rapid weight loss is dangerous, especially in older adults, and particularly if they have a medical condition. When the body is stressed, it burns muscle instead of fat for fuel. If the body doesn't get enough nutrition when dealing with an injury or illness, it uses all of its reserves on the problem, leaving little to maintain normal functions. This leads to more problems, including suppressed appetite.

Don’t let it slide

If you notice signs of possible under-nutrition or malnutrition in an older family member or friend, don't let it slide. The worse it gets, the more damage it does and the more difficult it is to turn around. Let the person know that you've noticed some weight loss, and that you are concerned. Ask how he or she has been eating lately – but understand that it's common for older adults to make excuses or to downplay potential problems, particularly if they've battled excess weight all their lives.

Consider involving a respected third party, such as the person's physician or a registered dietitian – or, ideally, both. A dietitian can perform a thorough assessment of the problem and can work with the person and the care team on strategies to prevent problems from getting worse.

How to boost nutrition at home

In addition to working with a dietitian, there are a number of ways you can work directly with an older person to help boost nutrition at home. When a person hasn’t been eating enough, even 200 or 300 extra calories per day can make a huge difference in how the person feels, thinks and functions. Here are several things you can try:

  • Encourage more of the foods the person likes most.
  • Add a dietary supplement drink every day.
  • Drizzle olive oil on top of soups or salads to boost healthy fats and calories.
  • Stir a little milk powder into custards or puddings before cooking for extra nutrition.
  • Add sauces, such as tartar sauce with fish.
  • Stock the freezer with heat-and-eat meals.
  • Provide pre-chopped produce if meal prep is a problem.
  • If appetite is an issue, encourage eating several smaller meals.
  • If nausea is an issue, suggest chilled foods, and ask the doctor about medication that can help.
  • Ask the doctor or pharmacist to review all medicines – some may reduce appetite.
  • Suggest a little snack in the mid afternoon and evening.
  • Lighten up on food rules – don't sacrifice needed nutrition to a principle that may not apply at this stage of a person's care.
  • Eat together – company can make meals more pleasant.
  • Look into the Supplemental Nutrition Assistance Program (SNAP) for people with limited means.
  • Make sure dental care is current – one sore tooth can affect eating.

We’re here to help

Nutrition is vital to strength, healing and quality of life. Providence's registered dietitians can provide excellent nutritional guidance. Our occupational therapists can help with self-feeding difficulties. Our home health teams can provide in-home nutrition therapy. And our social workers can refer you to social service agencies, such as Meals on Wheels and others.

Don't let malnutrition sneak up on the older people in your life. Check in with them, share a meal together every now and then, and stay in touch. If you suspect a problem, don't let it turn into a crisis. Request a nutritional risk screening with your elder’s provider, or fill out this simple mini nutrition assessment at home and take it with you to the appointment.

Looking for a provider? Find a Providence caregiver here.

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