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Eating well to prevent malnutrition

Eating well in later life is essential to maintain good health and keep the body working normally. A balanced diet will provide enough nutrients, such as calories, protein and vitamins, needed for a healthy body. An inadequate diet can lead to malnutrition.

Malnutrition affects around 10% of older people in the UK and 30-40% of those admitted to a hospital or a care home.

Older adults are at higher risk of developing malnutrition and it often goes unrecognised and under treated.  It can develop due to inadequate intake, inadequate digestion or a combination of the two.  It can be both a cause and a consequence of ill health.  

Malnutrition can lead to problems such as anaemia due to lack of iron in the diet.  It can also make us feel low, weak and tired due to insufficient dietary protein or calories. It can hamper recovery from injuries and illnesses, affect mood, mobility and the ability to fight infections.  In general, malnutrition can make everyday life much harder and make us more likely to become unhappy and unwell. 

Spotting the signs of malnutrition

The most common sign is unintentional weight loss.

Please note that unexplained weight loss can also signify a serious underlying medical condition and should always be discussed with a health professional. New symptoms like difficulty swallowing and loss of appetite should always prompt further investigation. 

Losing weight is not a normal part of ageing.

With loss can be evident as:

  • Loose clothing eg shirt collars becoming a bit big, skirts and trousers becoming looser around the waist, needing to fasten belts on a tighter hole
  • Loose dentures
  • Rings and watches becoming looser than normal 
  • Limbs and face looking thinner than before

Other signs of malnutrition can include:

  • Weak muscles
  • Feeling tired all the time
  • Low mood
  • An increase in illnesses or infections

Also, listen out for changes in attitudes towards food - phrases such as "I'm not feeling as hungry" or "I can't be bothered to cook" should raise levels of suspicion.

A national screening tool for use by individuals and carers

There is a national screening tool for carers and individuals to assess their risk of malnutrition – you can access the tool here.

If you think that someone you care for might be at risk of malnutrition you should seek medical help. A health professional can check for signs of malnourishment, investigate any underlying causes and advise on care. If appropriate, a community dietician might get involved.

Eating well to prevent and treat malnutrition

In the absence of any serious underlying condition, diet is the key to both prevention and treatment.   However other issues like stimulating appetite or tackling dental problems may be relevant too.  

Certain medical conditions (eg diabetes, kidney disease, coeliac disease, inflammatory bowel disease ) require special diets which should be developed in consultation with medical experts and dietitians.  

Specialist dietary advice and support is also essential for those adults who have conditions which affect the way food and drink can be taken into, and/or absorbed and digested by, the body eg difficulty chewing or swallowing (dysphagia), bowel or stomach surgery, needing to be fed by a tube.   This advice should also extend to the best way to take essential medicines eg liquid or injectable alternatives to tablets. 

Sometimes specialist supplements might be required but eating well with nutrient rich foods (a ‘food first’ approach) can be effective.

Sometimes, older people become undernourished simply because they are not eating well enough.  Common contributors include poor appetite, difficulty shopping for food or preparing suitable meals.  Bereavement, social isolation, cognitive decline and excess sleepiness can also play a key role. Often, co-existing conditions such as frailty, dementia, COPD or depression contribute too.

This NHS video (it lasts 23 minutes ) explores malnutrition in more detail and the various ways dietary support can help to prevent or treat this condition. 

Eating the right amount of food to maintain a healthy weight may mean eating less for some and eating more for others.  Healthy weight for some older people may be higher than healthy weight for younger adults.

Eating well for adults living with dementia

This video gives some helpful information and tips. it was developed by Bournemouth University, and is linked with a workbook which is available here.

Links to online help and advice about eating well to prevent malnutrition

In recent years, a lot of online advice and information has been developed to prevent and manage malnutrition. This means there is plenty of information to explore. Our online highlights are listed below:

Eat Well Age Well is a national project tackling malnutrition in older people living at home in Scotland. It is delivered by an award winning Scottish Charity known as Food Train and is funded by the Scottish Government.

There are three helpful yet concise advice sheets which are definitely good to read:

From the charity BAPEN:
Making the most of your food

From the British Dietetic Association:
A fact sheet about malnutrition
And another summarising general advice about good nourishment in older age.

For anyone affected by COPD this collection of resources about nutrition is invaluable:

Dysphagia is the term used to describe “difficulty swallowing”. It is a common complication of many neurological conditions including stroke and dementia.

Appropriate nutrition in dysphagia is a highly specialised field which requires input from a dietitian. Additional information is available from Dysphagia Kitchen.

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March 2022

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