Malnutrition is a ‘serious problem’ among older Australians, screening is needed in aged care, dietitians say

Hair loss. Weakness and confusion. Wounds that do not heal.

These can all be signs that someone is malnourished, but they are often mistaken for the ‘normal’ aging process.

“People say, ‘Oh, I’m just getting older,’ when in reality they’re malnourished. For many people, this is a completely avoidable problem,” says Judi Porter, a professor of dietetics at Deakin University.

Older people have a higher need for protein and energy than younger adults. However, their daily intake is often much lower, which can easily lead to malnutrition.

In fact, 68 per cent of people living in aged care facilities are malnourished or at risk of malnutrition, and up to one in two older Australians in the community may have an inadequate diet.

“It’s a serious problem in Australia,” says Karly Bartrim, a dietitian and aged care advocacy group convener at Dietitians Australia.

Early intervention is of the utmost importance and waiting for help can be fatal.

Despite the scale of the problem, there are no specific dietary guidelines in Australia for older people at risk of malnutrition.

And there is no mandatory screening for malnutrition in elderly care.

“Malnutrition is common in elderly care, but dietitians are only called in when there is weight loss, which is often an indirect effect,” Bartrim said.

“If we got involved earlier, we could prevent weight loss from happening.”

How can this happen?

Loss of appetite or decreased interest in food can occur for a variety of reasons, some physical, others psychological.

The elderly bear a great burden of chronic diseases that can affect appetite, such as kidney and liver disease and congestive heart failure.

And people who with Dementia may forget to eat, go grocery shopping or simply forget the foods they used to enjoy.

“If a family member asks what you had for lunch, you might just say, ‘A sandwich’, because you’ve had a sandwich for the past 80 years, but in reality you might not have had a sandwich at all,” says Professor Porter.

Bad fit false teeth can prevent someone from eating, and that can also dysphagiawhere someone has difficulty swallowing.

A bad emotional state can also cause a person to lose interest in food.

Lonelinessaffecting one in five older Australians, clinical depression And mourning are common causes.

“It’s happening to thousands of Australians: they’re depressed and have a reduced appetite,” Professor Porter says.

“The point is to go to the doctor and treat the depression, rather than the poor appetite.”

Food insecurity is another important reason. If someone can’t afford to buy nutritious food, they will skip meals or eat cheap, unhealthy options.

In addition, we often take more medicines As we age, our absorption of nutrients, including vitamin B12, sodium and magnesium, may decrease.

What can happen?

If a person loses 5 to 10 percent or more of their total weight over a period of three to six months, this is usually an indication of malnutrition.

But there are other things you should pay attention to.

Energy level can disappear and a person may seem less like themselves, as this can affect cognitive function and behavior.

Their immune system can also be weaker and they can have a bad wound healing.

“We can always tell if someone isn’t eating because it takes ages for the wound to heal,” says PhD candidate Bartrim.

They will probably lose too muscle mass because their body is in starvation mode and burning muscle to function.

This can cause a musculoskeletal disease known as sarcopeniawhere muscle strength, quantity or quality, as well as physical performance are compromised.

This can prevent a person from getting up and doing the things they enjoy.

“And this leads to people becoming socially isolated, often depressed and lonely, which in turn makes them not want to eat,” Professor Porter said.

People with sarcopenia have a higher risk of fall And fractures and less recovery capacity.

“If someone is malnourished and falls, they simply don’t have enough reserves in their body to support them,” Bartrim said.

A fracture can lead to hospitalization and worsening of the patient’s condition due to hospital-acquired malnutrition. This can happen to as many as 65 percent of hospitalized patients.

It is caused by people being in unfamiliar surroundings, confused and having little choice about food. On average, this means that the patient has to stay in hospital for 21 days longer.

Changes in diet and meal times can help

Early recognition is the key.

Don’t wait too long to seek help, because once you have lost muscle mass, it can be very difficult to build it back up.

“So if you start to notice any changes in your mobility, weight or eating habits, I wouldn’t hesitate to ask for a referral to a dietitian,” Ms Bartrim said.

And if someone has a chronic illness, he or she may be eligible for up to five subsidized sessions with a paramedical professional. such as a dietician or an exercise physiologist, who can help rebuild muscle mass.

However, there are simple changes to your diet that you can make right away.

For older adults, the emphasis should be on eating foods that rich in proteins and energywhich means that vegetables come somewhat second.

“People say to me, ‘OK, I’ll just go home and eat more vegetable soups and salads,’ but they shouldn’t stuff themselves with that. That makes the problem worse because there’s no energy in it,” Professor Porter said.

And Don’t buy the “diet” or “low fat” options. Carrying a few extra pounds as you get older is protective; it could be the padding that protects against a fracture if you fall or the extra energy needed during chemotherapy.

“We tell people the opposite of what they were told as children,” says Ms. Bartrim.

But how can you eat more if you don’t feel like it?

A technique called “eating by the clock” can help establish a routine if your appetite has decreased and you need mental cues to eat.

It involves eating six small meals at the same time every day, even if you’re not hungry.

Dietary supplements drinks between meals are better than just tea or coffee, but food should always be the first option.

“We know that people get much more pleasure from eating food than drinking beverages,” says Ms Bartrim.

And finally, family members should: Try not to make mealtimes stressful by putting a lot of pressure on someone to eat. Take a social approach, choose comfort food and don’t rush.

The bigger picture

The current Australian Dietary Guidelines do not include “frail, older people at risk of malnutrition”, who are defined as “usually” over 75 years of age.

According to the guidelines, this is because this group has “complex health needs” and healthcare professionals should be contacted for advice.

However, the National Health and Medical Research Council (NHMRC) is currently reviewing the guidelines and the updated version will include people aged 65 and over and provide advice on the prevention of malnutrition, frailty, falls and chronic diseases.

The updated guidelines are expected to be released in 2019. 2026.