Feature: Malnutrition in the elderly

The latest figures from NHS England show that three million, or 1 in 20 adults, are affected by malnutrition. This is currently costing the NHS £20 billion per year.

With the right training, social workers can provide caregivers with the vital support they need, linking them to services to prevent and treat malnutrition. First and foremost, it’s important to identify the signs, which include the following:

Tiredness and low energy
Loss of appetite
Unintentional weight loss
Clothes, jewellery or dentures becoming loose over time

Malnutrition affects every system in the body and results in increased vulnerability to illness and complications, which can lead to prolonged hospital stays, more visits to the doctor and in some cases, death. The main bodily systems malnutrition affects and its consequences are:

Fatigue and lethargy
Falls
Difficulty coughing which increases the risk of chest infection
Heart failure
Anxiety and depression
Reduced ability to fight infection

Malnutrition is also associated with several psychological issues. Mental health problems such as depression and anxiety or a change in mental state due to bereavement can affect a person’s appetite and interest in eating. If insufficient nutrients are consumed as a result of this loss of appetite, a change in mood and energy levels will occur and a negative cycle will ensue.

Due to the complex nature of malnutrition and myriad causes, there are no blanket measures to prevent its occurrence. However, once the causes of each case are recognised, there are steps which can be taken to manage, treat and prevent reoccurrence of these. These steps fall broadly into two categories: clinical and social interventions.

So once you’ve identified the signs, what are effective dietary solutions for malnutrition? If someone suddenly loses their appetite, becomes thinner, or steadily loses weight unintentionally for a while, it is important to speak to a GP or a Registered Dietitian. If you do not have access to a dietitian, your GP can refer you to one.

For some time now, the treatment for malnutrition has often included the prescription of oral nutrition supplements. However, for dietitians, the preferred first step to treating malnutrition is to encourage a ‘food first approach’ where possible. This is likely to focus on encouraging people to eat higher calorie and protein foods more often.

Taking a ‘food first’ approach can be seen as a straightforward solution, however increasing food intake for people with a smaller appetite, which is likely to be the case if they have been undernourished, can be challenging. Adding things like a slice of cake, cheese and full fat milk to one’s diet can all be beneficial, as these are energy dense foods. Loss of appetite can be especially common amongst older adults, so smaller and energy dense meals are crucial.

Malnutrition remains one of the most common nutritional challenges among older adults in the UK. Social workers and other health and care professionals have a key role to play in the recognition and prevention of this challenging disease, as they often have close and regular contact with older adults in the community. A multidisciplinary (MDT) approach is important for all aspects of care of the elderly, and this is no different for nutritional care. Regular contact between MDT members can improve nutritional care of older adults, by alerting dietitians, who can treat the individual as necessary.”

“Anyone who comes into close or regular contact with an older person has the potential to spot some of the signs and symptoms of malnutrition, as outlined above. Remember that weight loss is not an inevitable part of ageing and it is always worth asking an older adult some gentle questions about their dietary intake and any recent, unintentional weight loss if you are concerned.”

There are also screening tools that can be completed, the most commonly used one being the Malnutrition Universal Screening Tool (MUST). The MUST is simple to complete with a few details, is useful for identifying if someone is malnourished or at risk of becoming so and can guide toward the appropriate referral to a dietitian. If you are unsure, you can always check with a dietitian who can advise on the correct use of the tool.

Whilst a food first approach, often with additional use of oral nutritional supplements, is the cornerstone of treatment for malnutrition, there are several key social aspects to consider as well. Loneliness and social isolation have been linked to an increased risk of malnutrition, particularly among older adults. Simple strategies like attending a local lunch club, encouraging eating with friends or family members or a visit from volunteers from services such as Age UK’s Befriending Service, can all have a positive impact on the amount an older person eats at mealtimes.

When it comes to preventing and treating malnutrition, we should all be thinking of both the clinical and social interventions that can help. Dietitians are best placed to manage malnutrition in the community, although a MDT approach can be the link between identifying more people who are at risk, which can have a positive impact on their wellbeing, overall health and clinical outcomes.

Please visit https://www.specialistnutrition.com/malnutrition/ for more information.

Emily Stuart is a dietitian for apetito and Wiltshire Farm Foods.