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Publication #FSHN10-09

Malnutrition and the Older Adult1

Wendy J. Dahl2

Why do older adults develop malnutrition?

Many older adults are at risk for developing malnutrition, the lack of adequate nutrition to maintain health. The main cause of malnutrition in older adult is inadequate food and nutrient intake. A poor appetite or problems with chewing and swallowing may lead to lower food intake. Older adults who care for themselves, may have problems purchasing and transporting food to their homes, and may have difficulties preparing nutritious meals. Many common medications contribute to poor food intake, through side effects such as nausea, dry mouth and gastrointestinal complaints. Malnutrition can also result from diseases or health conditions that cause problems with the digestion of food and absorption of nutrients.

Figure 1. 

Weight loss is the most important and often the first sign that food intake is inadequate.


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Spotmatik/iStock/Thinkstock, © Spotmatik


[Click thumbnail to enlarge.]

Why are we concerned about malnutrition?

Malnutrition can lead to many serious health problems including:

  • infections

  • pneumonia

  • falls and fractures

  • digestive disorders

  • skin breakdown, pressure sores

  • confusion, memory problems, dementia

Figure 2. 

Malnutrition directly affects quality of life.


Credit:

Lisa F. Young/iStock/Thinkstock, © Lisa F. Young


[Click thumbnail to enlarge.]

Malnutrition in older adults may lead to a poor quality of life and contribute to higher care needs, hospitalization and increased health care costs. Improving nutrition in the older adult leads to:

  • Briefer illnesses

  • Fewer and shorter hospital stays

  • Fewer complications

  • Improved functional status

  • More independent living

  • Improved quality of life

What nutrients are needed to prevent malnutrition?

Energy and Protein

When weight loss happens, total food intake and energy (calories) are inadequate. This leads to loss of body fat and muscle. Loss of muscle leads to weakness and mobility issues. Loss of body fat means there is less energy stored in the event of illness and less "padding" which may cause discomfort and an increased risk of pressure sores.

Protein intake of frail older adults may be low. Foods high in protein, such as meat, poultry, and fish are recommended. However, some meats may be difficult to chew for those with dental issues or dry mouth.

Figure 3. 

Fish provides high quality protein.


Credit:

Jacek Chabraszewski/iStock/Thinkstock, © Jacek Chabraszewski


[Click thumbnail to enlarge.]

Meats, then, may need to be ground and moistened to encourage intake. (1)

Dairy foods such as milk, yogurt, and cheese are recommended to improve protein and calorie intake.

Figure 4. 

Dairy products like this glass of milk will help to improve protein and calorie intake.


Credit:

Rudyanto Wijaya/iStock/Thinkstock, © Rudyanto Wijaya


[Click thumbnail to enlarge.]

Eggs and meat alternates such as beans are also encouraged. These foods are good sources of protein and are usually easy to chew and swallow.

In addition to protein, added fat may be needed to increase calories, prevent further weight loss, and encourage weight gain if needed. Adding fats may improve the flavor of foods and may also ease swallowing.

Vitamins and Minerals

Older adults often have low intakes of many vitamins and minerals. For example, folate, magnesium, zinc, and Vitamins E, B6, B12, C and thiamin have been found to be low in older adults living in nursing homes (2).

Older adults may need to take a vitamin and mineral supplement, or nutritional beverage or pudding supplements enriched and fortified with vitamins and minerals to meet their needs. Examples of commonly consumed nutritional supplements are Ensure® and Boost®.

What are the vitamin deficiencies of greatest concern?

Vitamin D

Most older adults in the US have intakes of vitamin D well below the recommended level (3). Foods naturally rich in vitamin D are limited (fatty fish, egg yolks, some mushrooms). In the past, most vitamin D was made in our skin following exposure to sunlight. However, this process decreases with aging and many older adults spend most of their time indoors. Public health warnings against sun exposure have also encouraged people to avoid the sun.

Vitamin D inadequacy occurs frequently in older adults, especially those that live in nursing homes (4). Low intakes of vitamin D are related to increased risk of hip fractures, as well as muscle weakness and pain. As diet alone cannot meet vitamin D requirements for the older adults, supplements are required (3).

Vitamin B12

Vitamin B12 deficiency is very common in the older adult. This is a serious deficiency as it leads to irreversible dementia as well as anemia, depression, gastrointestinal disturbances and urinary tract infections.

B12 deficiency in older adults is often due to problems absorbing the vitamin B12 found naturally in foods such as fish, meat, eggs and milk (4). Low dietary intake of B12, such as with a vegan diet, also results in deficiency. Supplements providing B12 are recommended for older adults.

What can caregivers do?

  • As a caregiver or family member of an older adult, there are several steps you can take to prevent malnutrition. If you notice weight loss or poor nutrient intake, try the following tips.

  • Prepare meals high in protein, including foods such as meat, poultry, fish, dairy, eggs, and beans.

  • If you notice difficulty chewing, try soft moist foods and cut up/ground meat.

  • Offer foods with added fats to increase caloric intake and enhance flavor.

  • Offer nutritious snacks or nutritional supplements between meals.

  • Consider giving a vitamin/mineral supplement

Where can I get more information?

The Family and Consumer Sciences (FCS) agent at your county Extension office may have more information and classes for you to attend. Florida Extension offices are listed online by UF/IFAS at http://solutionsforyourlife.ufl.edu or http://SolutionsForYourLife.com/map.

Also, a registered dietitian (RD) can provide reliable information to you. For a referral to an RD in your area, call the Florida Dietetic Association at (850)386-8850 or check the yellow pages of your phone book.

References

  1. Dahl, WJ. Gainesville, FL. 2010. Modifying food texture for the older adult. EDIS – UF/IFAS Extension Data Information Source. http://edis.ifas.ufl.edu/fs156

  2. Lengyel CO, Whiting SJ, Zello GA. 2008. Nutrient inadequacies among elderly residents of long term care facilities. Can J Diet Pract Res, 69, 7–13.

  3. Whiting SJ, Calvo MS. 2010. Correcting poor vitamin D status: Do older adults need higher repletion doses of vitamin D3 than younger adults? Mol Nutr Food Res, 54, 1–8.

  4. Dunne J, Dahl WJ. 2007. A novel solution is needed to correct low nutrient intakes in long-term care residents. Nutrition Reviews, 65, 135–138.

Footnotes

1.

This document is FSHN10-09, one of a series of the Food Science and Human Nutrition Department, UF/IFAS Extension. Original publication date July 2010. Revised December 2013. Visit the EDIS website at http://edis.ifas.ufl.edu.

2.

Wendy J. Dahl, PhD, assistant professor, Food Science and Human Nutrition Department, UF/IFAS Extension, Gainesville 32611.

The use of trade names in this publication is solely for the purpose of providing specific information. UF/IFAS does not guarantee or warranty the products named, and references to them in this publication does not signify our approval to the exclusion of other products of suitable composition.


The Institute of Food and Agricultural Sciences (IFAS) is an Equal Opportunity Institution authorized to provide research, educational information and other services only to individuals and institutions that function with non-discrimination with respect to race, creed, color, religion, age, disability, sex, sexual orientation, marital status, national origin, political opinions or affiliations. For more information on obtaining other UF/IFAS Extension publications, contact your county's UF/IFAS Extension office.

U.S. Department of Agriculture, UF/IFAS Extension Service, University of Florida, IFAS, Florida A & M University Cooperative Extension Program, and Boards of County Commissioners Cooperating. Nick T. Place, dean for UF/IFAS Extension.