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Malnutrition in the Elderly: An Unrecognized Health Issue

by Danielle Maher, Student Nurse and Carol Eliadi EdD, JD, APRN, Massachusetts College of Pharmacy and Health Sciences Worcester MA

Malnutrition is defined as an imbalance of nutrients caused by either an excess intake of nutrients or a nutritional deficit. Malnutrition is becoming increasingly more common among the elderly population. This is a cause for concern considering malnutrition negatively affects the health of the older adult. An estimated 5-10% of elderly people living in the community setting are malnourished (Furman, 2006). About 60% of hospitalized older adults (age 65 or older) and 35-85% in long-term care facilities are experiencing malnutrition (Furman, 2006). From these statistics, malnutrition seems to be even more prevalent in hospitals and long-term care facilities, as compared to community-dwelling older adults. In the United States, the elderly population is expected to double and reach approximately 72 million people by 2030 (NIH, 2006). Addressing the more complex needs of the older adult, including nutritional needs, represents an important public health issue given the changing demographics. 

Several risk factors for malnutrition have been identified, including physical, social, and medical factors. Physical factors that affect malnutrition include oral health, physical impairments, early satiety, and taste and smell changes (Hall & Brown, 2005). Poor dentition can cause difficulty with chewing food and swallowing, leading to a decrease in nutrient intake. Physical impairments such as physical immobility or the inability to feed oneself, can cause difficulty in acquiring, preparing, and eating foods. Elders also experience early satiety and physiological appetite loss (Visvanathan & Chapman, 2009). Older adults experience less of a feeling of hunger and experience a feeling of fullness more quickly as compared to younger adults (younger than 65 years old). A decrease in both taste and smell are normal parts of aging. This alteration can cause a decreased interest in food as well and a subsequent decrease in the intake of nutrients. 

Social factors that affect malnutrition include, living alone, financial concerns, and restrictive diets. Living alone, especially for men, results in the decreased intake of food. Elders experiencing financial concerns, such as poverty or low-income, may not be able to buy a sufficient amount of food. Many times choices need to be made between buying food and paying for other necessities such as medications, heat, rent, etc. Cultures, religions, allergies, and preferences can also cause some elders to have more restrictive diets. These restrictive diets increase the risk for malnutrition, especially for protein malnutrition. Medical factors such as dementia, polypharmacy, chronic illness, and depression can cause malnutrition in the elderly population as well. Dementia and cognitive disabilities can cause self-neglect and decreased food intake. Many older adults take multiple medications daily. These medications interact with food and impact absorption, metabolism, and excretion of nutrients (Visvanathan & Chapman, 2009). 

Malnutrition in the elderly is a major concern because it can cause adverse outcomes. Malnutrition impacts morbidity, mortality, hospital length of stay, functional disabilities, and physical complications. Malnutrition can cause increased infection, electrolyte imbalances, altered skin integrity, anemia, weakness, and fatigue (Furman, 2006). Loss of appetite and unintentional weight loss are two of the most obvious signs of malnutrition. Other signs include, dull and dry hair, conjunctival dryness, receding gums, mental confusion, sensory loss and motor weakness. 

As the research statistics indicate, not only is malnutrition prevalent in the elderly, it is also frequently misdiagnosed or unrecognized. Many nurses and other health care professionals are not properly screening or assessing malnutrition in the elderly (Furman, 2006). 

In “Recognition by medical and nursing professionals of malnutrition and risk of malnutrition in elderly hospitalised patients”, Adams, Bowie, Simmance, Murray and Crowe developed a study that examined the level of recognition of nutrition risk factors and malnutrition in the elderly (over the age of 70) by health care professionals. The article also studied the views held by health care professionals involving those risk factors that they believed impacted malnutrition and treatment options (Adams et al., 2008). This study found that 97% of these patients were either malnourished or at risk for malnutrition, however only 19% were recognized by healthcare professionals as malnourished or at risk and only 7% of those identified were referred to the dietician. Fifty-three patients experienced a loss of appetite, yet only 9% were referred to a dietician. The study also noted that only 3 of the 100 patients had their body weight documented in their medical record. From the questionnaire, the researchers found that the doctors and nurses demonstrated deficient knowledge of malnutrition risk factors such as loss of appetite or unintentional weight loss (Adams et al., 2008).

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