In an ageing population, the loneliness epidemic and significance of proper nutrition is becoming increasingly vital.
Good nutrition plays a critical role in promoting health, preventing disease, and improving quality of life. Poor nutrition can lead to malnutrition, exacerbating age-related health issues and escalating healthcare costs. There are many contributing factors.
Chronic health conditions such as diabetes, heart disease, cancer, and gastrointestinal disorders can interfere with nutrient intake and absorption. Physical limitations, sarcopenia, frailty, arthritis, Parkinson’s disease, or post-stroke disabilities can make it hard to shop, cook or feed oneself. Diminished taste and smell reduce the desire to eat.
As people age, they may experience a natural decrease in appetite (cachexia of ageing). Some medications contribute to loss of appetite, nausea, dry mouth or altered taste. Oral health, dental and swallowing problems, missing teeth, poor-fitting dentures, or gum disease limit food choices and intake.
Memory problems can also cause difficulty with remembering to eat, preparing meals, or even recognising hunger. Mental health issues such as depression, anxiety, or social isolation reduce interest in food and poor eating habits. Elderly individuals who live alone or have limited social interaction lose interest in cooking or eating regular meals. Alcohol use or abuse can interfere with nutrient absorption and suppress appetite.
Limited income reduces access to nutritious foods e.g. fresh fruits, vegetables, or high-quality proteins.
These factors often combine, creating a cumulative risk for malnutrition in the elderly population.
Impact of poor nutrition
A weakened immune system, increasing susceptibility to infections and illnesses is apparent. Proteins deficiency can lead to muscle loss (sarcopenia), reduced muscle strength, mobility, frailty and increased risk of falls and fractures. Lack of vitamins A, C, and zinc can delay wound and surgical healing.
Deficiency in essential vitamins (like B12, D, and folate) and fatty acids contribute to dementia and mental impairments. Calcium and vitamin D deficiency increases the risk of osteoporotic fractures. Poor nutrition can precipitate or worsen conditions such as diabetes, hypertension and heart disease.
Nutritional deficiencies (omega-3 fatty acids, B vitamins, and antioxidants), can exacerbate mental health issues such as depression and anxiety in older adults.
Proper nutrition is essential for maintaining overall health, preventing disease, and enhancing quality of life in the elderly. Malnutrition is associated with longer hospital stays, greater need for long-term care, and a higher risk of premature death.
Strategies to manage malnutrition risk in older patients
Start with assessment and monitoring. Routine screening of weight, body mass index (BMI) and nutrient intake help identify malnutrition early.
The MUST (Malnutrition Universal Screening Tool) and the MNA (Mini Nutritional Assessment) are two widely used tools in healthcare to assess the nutritional status of individuals, particularly in clinical settings. Lab monitoring for deficiencies in vitamins and minerals like vitamin D, B12, calcium, and iron can guide specific interventions.
Individualised meal planning includes personalised diet plans, smaller frequent meals and nutrient-dense foods. This is supported by oral nutritional supplements and vitamin and mineral supplements. Meal appeal can be improved by variety in presentation and flavour enhancement.
Physical barriers can be tackled via dental care and dietary modification. Encouraging exercise can aid appetite,
Social support and meal assistance are also helpful. Encourage participation in communal meal programs (e.g. senior centers, Meals on Wheels) to improve social interaction and increase meal enjoyment.
Mealtime assistance and caregiver support, education and training are helpful strategies. Home meal delivery services such as Meals on Wheels can be engaged to ensure access to good quality balanced meals, especially for elderly individuals with mobility issues or limited access to grocery shopping.
Review medications that interfere with appetite or nutrient absorption or cause side effects (nausea, dry mouth, or reduced appetite). Tailor diets to manage chronic conditions such as diabetes, heart disease, or gastrointestinal issues, while ensuring that nutritional needs are met.
For individuals with cognitive impairment, offer simple, familiar foods and assist with mealtime reminders. Treat any associated mental health issue (e.g. depression).
A multidisciplinary approach makes a big difference. Collaborate with dietitians, speech therapists, occupational therapists and geriatricians as needed. Home visits by community nurses or dietitians for assessment of dietary intake and addressing meal preparation barriers.
Ongoing follow up and monitoring includes setting follow-up appointments to assess the patient’s progress, monitor weight, and adjust interventions, as necessary. If there is no improvement, consider more comprehensive interventions in collaboration with a specialist.
By integrating regular assessment, early intervention, and a collaborative approach, general practitioners can effectively manage malnutrition in elderly patients, improving both their quality of life and health outcomes and reduce the burden and cost of care.
Key messages
- Good nutrition is essential for healthy ageing, yet older adults face multiple significant challenges in achieving adequate dietary intake. Screening and monitoring are important
- Addressing nutritional issues requires a comprehensive, person-centered approach including social and psychological interventions aimed at improving access to and quality of food
- Prioritising nutrition in older adults can improve health outcomes, reduce healthcare costs and enhance the well-being of ageing populations.
Author competing interests – nil