From doctors and nurses to physical therapists and social workers, healthcare practitioners across the professional spectrum can combat geriatric malnutrition. Learning about malnutrition and why some seniors go hungry, the consequences to their health, and the elements to a healthy eating plan will enhance a healthcare professional’s ability to be part of the solution.
Causes and Symptoms of Senior Malnutrition
If you work with older adults long enough, you will likely encounter someone who is malnourished. According to Disabled World, approximately 3.7 million older Americans are malnourished, and a lack of nutrients can have a profound effect on the body. Consequences range from wreaking havoc on a senior’s immune system to weakening muscles, significantly increasing the risk of falls. Seniors with chronic diseases often face the dual challenge of combating diseases that may exacerbate poor nutrition and, because of medication side effects and treatments, drumming up enough appetite to eat.
Depression and poor nutrition often go hand in hand. A depressed person might have no motivation to eat, and his lack of nutrients could worsen the depression. Other causes of malnutrition include:
- Income and poor budget management
- Lack of access to food
- Dietary restrictions
- Alcoholism and substance abuse
- Social isolation
Most instances of malnutrition are not immediately obvious. Still, there are telltale signs and symptoms to watch for. Some of these include:
- Unplanned weight loss
- Difficulty staying warm
- Decreased mental capacity
- Higher rates of infections and slow healing
- Mood swings
What Is Healthy Eating?
The National Institute on Aging publication Healthy Eating After 50 says that a somewhat active woman over age 50 should eat approximately 1,800 calories per day. More active women should consume between 2,000 and 2,200 calories. For men with similar activity levels, the amounts are 2,200–2,400 and 2,400–2,800, respectively. The human body needs more than calories, however; it requires adequate amounts of minerals, carbohydrates, vitamins, fats, and protein. Vitamin supplements help, but only a proper diet can supply what seniors need to thrive.
When to eat is also important. Many seniors abide by the practice of eating three square meals daily, while others eat when they can during an otherwise busy lifestyle. While both approaches may work for some, they may lead to unhealthy eating habits in others. Recommend that your senior patients eat balanced meals on a regular schedule to help them maintain a healthy diet.
Adequate hydration is another aspect of healthy eating, and yet it is a common problem among seniors. Parent Giving reports that in one study, nearly a third of nursing home residents were dehydrated; another study found that nearly half of seniors admitted to the emergency room showed signs of dehydration. The report assigns three reasons for seniors being more prone to dehydration: changes in renal function, altered thirst perception, and lowered body water composition.
Signs of dehydration include dry mouth, cramping limbs, crying with few or no tears, dark urine, and fatigue. Complications resulting from dehydration include severe constipation, kidney stones, and an increased risk for both thrombosis and infectious diseases. The best solution for seniors is a simple one: Drink more water. Instead of waiting until they are thirsty, seniors should drink water throughout the day. Seniors on fluid restrictions may require a more complex plan for proper hydration.
Barriers to Nutrition
Successful aging strategies to address malnutrition begin with an assessment to understand what the obstacle(s) might be before developing a healthy eating plan. A wide variety of factors can impede a healthy diet; many seniors live with more than one. The majority of nutrition deficits result from either a decreased appetite or improper absorption of nutrients. Some of the more common causes of these issues include:
- Medications and treatments
- Sensory deprivation
- Medical problems
- Dietary restrictions
- Dental and denture problems
- Dry or burning mouth syndrome
- Cognitive disorders
- Long-term dietary habits and preferences
- Fear of falling when leaving home (e.g., to buy groceries)
Tips to Ensure Healthy Eating
Senior patients and their family caregivers might turn to healthcare professionals for successful aging strategies that include ideas for a healthy eating plan. Here are some areas you might address with your patients:
Healthy lifestyle changes greatly enhance the effects of a healthy eating plan. Quitting smoking and reducing or eliminating alcohol intake are excellent starting points. Activity is important; something as simple as walking can benefit the body. Learning relaxation techniques such as imagery and proper breathing can calm stress, and therapy is widely available for more serious issues.
Microwave cooking is an excellent solution for those who cannot use a range. Microwave meals can include a host of nutritious and tasty frozen foods that are easy to prepare — provided that seniors watch out for meals that are high in sodium and fat. You might also suggest a medical alert device that can automatically detect a fall and call for help should a senior slip while cooking.
Delivery services may benefit those who find it difficult to travel to the store and shop. These services vary from free to expensive, primarily depending on the vendor. Transportation to and from food outlets can be more easily accomplished using public and senior transportation services, taxis, and the assistance of family, friends, or neighbors.
Congregate meal sites can be found in nearly every community. These government-sponsored programs employ volunteer staff who work to ensure that seniors have at least one hot and nutritious meal. These meals are offered at senior community centers, such as local Area Agencies on Aging, and in many cases transportation is provided to and from the site. The United Way is an excellent resource for locating these sites.
Food stamps are an option for those who cannot afford to buy enough food. The program is based on an individual’s income, and seniors must apply at their local department of social services.
Church and community charities nationwide serve free food either prepared or in bulk for distribution. Feeding America, for example, organizes and distributes tons of food to charity organizations every day.
Meals on Wheels is a government-funded program staffed largely by volunteer workers. Every day, tens of thousands of hot and nutritious meals are delivered to homebound seniors through this program.
Social mealtimes with family, friends, or neighbors can improve a senior’s diet. Eating alone encourages poor eating habits, especially in older adults. Although microwaveable frozen foods are good in some ways, seniors living alone may rely on them too heavily. Many of these dinners contain high amounts of sodium and fat, and lonely seniors may eat faster or at more sporadic times. Arranging to have meals with others makes eating a social event, giving seniors an activity to look forward to.
Altering medications that may cause a decrease in appetite is another option, though it requires physician approval. Seniors should talk to their healthcare providers and pharmacists to determine which medicines may be adversely affecting their diet and whether they can be switched to different medication.
Appetite stimulants, especially pharmacological agents, may be used if other methods have failed. Anecdotal evidence points to multivitamins as a way to improve appetite. While there is no concrete scientific evidence for this, a lack of proper nutrients could potentially lead to a decrease in appetite, and taking vitamins helps restore those nutrients. Drugs such as oxandrolone and megestrol acetate are sometimes used to promote weight gain and appetite, respectively, but they have shown mixed results. Dronabinol (Marinol) is a synthetic cannabinoid used primarily to improve appetite in AIDS patients and reduce nausea in cancer patients. If a senior is not responding to other appetite stimulants, this option may be worth exploring with his healthcare provider.
What-if scenarios for when a senior is alone can help ensure senior safety and health in the event of an emergency. For instance, if a storm causes a senior to remain homebound and her caregiver is unable to reach her, prepared meals or stored food supplies may prevent her from having to skip a healthy meal.
Developing a Healthy Eating Plan
Guides to healthy eating abound on the Internet, and providing your senior patients with books and pamphlets may benefit them as well. Starting a new healthy eating plan slowly improves its chances of success. Changing habits that may have taken decades to develop involves time and sacrifice, so encourage your senior patients to stay positive. In many cases, older adults do not have to entirely give up the foods they love; they may only need to reduce the amount.
A healthy eating plan begins with assessing problem areas and which changes may be easiest to implement. Help seniors set small, manageable goals that they can accomplish within certain time frames, taking steps toward their larger goal. Initial successes, however small, encourage persistence. Positive reinforcement from healthcare professionals encourages older adults to keep up a healthy diet.
The National Institute on Aging describes two healthy eating plans for adults over age 50. One is the US Department of Agriculture’s USDA Food Patterns, which focuses on calories and lists suggested quantities from a variety of food groups. For example, recommendations for a 1,600 daily calorie intake include two cups of vegetables, five ounces of protein, and five ounces of grains.
The second plan is the DASH (Dietary Approaches to Stop Hypertension) diet. DASH aims to reduce blood pressure by restricting individuals to a high-fiber, low-sodium diet of vegetables, grains, low-fat dairy products, lean meats and fish, and nuts and beans. The plan recommends numbers of servings needed to achieve a certain amount of calories daily. No added salt is allowed and quantities are limited. Combined with lifestyle changes, the DASH diet may benefit your senior patients.
As baby boomers begin to retire and the number of older adults increases over the next several decades, successful aging strategies become more important. A healthy eating plan is an integral component to these strategies. Tailored thoughtfully to the needs of the individual senior, such a plan has the potential to greatly improve her quality of life.
Prevention and education is the best way to the best way to ensure your senior patients’ safety — whether it’s helping them with nutrition or informing them about medical alert systems, which can increase independence and peace of mind when it comes to the “What if?” scenarios that tend to keep a senior housebound. Learn more about how to refer your patients for Lifeline medical alert systems.