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Malnutrition and seniors: When a relative doesn't eat enough
Malnutrition is a serious problem among older adults. Discover the warning signs of nutrition problems and what steps to take to avoid poor nutrition in seniors.
By Mayo Clinic staffGood nutrition is critical to senior health, but many older adults don't eat right. Older people are more likely to have inadequate nutrition than younger adults are — and are more susceptible to numerous health problems related to an inadequate diet.
Many older adults in long term care facilities have poor nutrition. While seniors cared for at home or living independently generally fare better, patterns leading to inadequate nutrition — also called malnutrition — often begin at home. Knowing the causes and danger signs of nutrition problems, as well as taking steps to ensure a diet rich in protein and other necessary nutrients, is critical in maintaining senior health and strength.
Problems caused by malnutrition
Over time, malnutrition in older adults can lead to fatigue and increase the risk of digestive, lung and heart problems. Malnourished seniors are at increased risk of death. Malnutrition weakens the immune system, increasing the risk of pneumonia and other serious infections. It can worsen existing health conditions and mental confusion. Over time, poor nutrition can lead to a low red blood cell count (anemia) and muscle weakness leading to falls and fractures. Poor nutrition can also cause blood clots, bed sores, and depression and other senior health problems.
Good nutrition is especially important for the very ill or seniors who have dementia. These older adults are more likely to be admitted to a hospital or long term care facility — and are vulnerable to post-surgical complications and other problems linked to poor nutrition.
Healthy, independent seniors need good nutrition too — often, nutrition problems develop gradually. Identifying dietary problems as early as possible and taking steps to eat well can make a big difference later.
Malnutrition in seniors: A web of factors
At first glance, the causes of malnutrition seem straightforward: too little food, a diet lacking in nutrients or absorption, eating or digestion problems related to getting older. But the causes of malnutrition are often more complex.
For instance, older single adults, even those who are energetic and self-sufficient, often don't cook for themselves. Their typical dinner may be nothing more than a handful of popcorn or a cup of tea. Carried on for a long time, a nutrient-poor diet accelerates the loss of muscle mass and strength that normally comes with aging. Shopping and preparing food become more difficult, which reinforces the tendency to subsist on easy but empty fare — such as toast, cold cereal or saltine crackers. Eventually, the chronic lack of nourishment leads to increased frailty, dependence and illness, which in turn can trigger depression — itself a major drain on appetite.
When does malnutrition begin?
Often, the cause of malnutrition isn't a single event, but a cascade of difficulties that can include physical, social and psychological issues.
Physical causes of malnutrition
Older adults often have health issues that can lead to decreased appetite or trouble eating. These include:
- Chronic illness. Older adults may have debilitating, long-term conditions that affect their ability to shop, prepare meals or feed themselves. What's more, both short- and long-term ailments often suppress the appetite — even as they increase the body's need for nutrients. Dementia, stroke and other illnesses that affect mental functioning also have a profound influence on appetite and on the capacity to prepare and eat healthy meals. Caregivers also are often at risk, neglecting themselves while they tend to an ailing loved one.
- Trouble chewing and swallowing. Dental problems, including gum disease, cavities and poorly fitting dentures, can affect the taste of food and make chewing nearly impossible. When people with chewing problems do eat nutritious foods, they may have trouble digesting them. A dry mouth — a side effect of many drugs — and diseases such as Parkinson's that affect the nervous system can interfere with swallowing.
- A recent hospitalization or nursing home stay. Illness or surgery can take a tremendous toll on the health of seniors, often resulting in loss of appetite, weakness, weight loss and debilitation.
- Trouble absorbing nutrients (malabsorption). Some of the physiological changes that occur with aging affect the way the body absorbs and uses nutrients. In many older adults, the production of certain digestive enzymes and acids diminishes, interfering with protein breakdown and with the absorption of vitamin B-12, folate, and possibly calcium and iron. Lack of vitamin B-12 can have a devastating effect on the nervous system, leading to an unsteady gait, muscle weakness, slurred speech and psychosis — signs and symptoms similar to those of such age-related diseases as Parkinson's and Alzheimer's. Other illnesses — cancers of the gastrointestinal tract, inflammatory bowel disease and even diarrhea — can interfere with absorption.
- Medications. Many drugs commonly prescribed for older adults can contribute to malnutrition by suppressing appetite, altering the way food tastes, causing nausea and vomiting, or interfering with absorption. Offending drugs include some antidepressants, certain blood pressure and osteoporosis medications, and even common over the counter medications such as aspirin. The problem is often compounded because many older people take several medications, all of which may affect the ability to eat and digest nourishing foods.
- Diminished taste and smell. For most people, food is as much about comfort and enjoyment as it is about survival, and this may be especially true as people age. Yet taste and smell often diminish later in life, robbing food of much of its flavor. Although some sensory loss seems to be a normal part of aging, certain medications such as antibiotics decrease the sense of taste and smell, as do some health conditions such as Alzheimer's disease.
- Frailty. Major loss of muscle and fat itself can cause loss of appetite due to changes in body chemistry, especially in seniors who have a serious illness. Frailty is a common problem among older adults. Medical experts are researching how it affects nutrition and other factors, and the best ways to treat malnutrition related to frailty. Frailty doesn't always mean weight loss — some seniors who are overweight are malnourished.
Social and psychological causes
Sometimes social factors and other factors are linked to malnutrition. These include:
- Limited income. Some seniors with limited incomes go hungry, especially if they're taking expensive medications. Some older adults to have to choose between drugs and groceries when Social Security checks are stretched thin.
- Depression. Although frequently unrecognized and untreated in older adults, depression affects as many as 6 million Americans over 65. As with other aspects of aging, the reasons for depression are complicated and interrelated: grief, loneliness, isolation, failing health, retirement, lack of mobility, concurrent illnesses such as Parkinson's disease, cancer or diabetes, medications, and malnutrition itself, which makes depression worse.
- Alcoholism. It's not clear how many older adults have alcohol-related problems, but the number is far larger than suspected even a decade ago. Affecting both men and women, alcoholism is a leading contributor to malnutrition — it decreases appetite, destroys vital nutrients and frequently serves as a substitute for meals.
- Reduced social contact. One of the biggest contributors to malnutrition is a solitary life — and the loneliness and depression that can go along with it. Social contact has a positive effect on eating well and increases morale and well-being, factors that contribute to lack of appetite.
- Restricted diets. Seniors are more likely than any other group to have dietary restrictions, including limits on salt, fat, protein and sugars. Although such diets play a central role in managing many medical conditions, they can be so bland and unappealing that older adults simply stop eating. For that reason, some nutrition experts recommend rethinking a restrictive diet if it might interfere with an older adult getting adequate nutrition.
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