Malnutrition in the elderly

Malnutrition affects 10% to 15% of elderly people in Ireland. Margaret Hawkins talks to a community dietitian about the importance of eating properly later in life.

Margaret Hawkins

25 June 2014

Many older people are at risk of malnutrition.

The role of nutrition in supporting healthy ageing, particularly in relation to bone health and skeletal muscle mass and strength, was the focus of a specialist symposium for dietitians organised by the Irish Nutrition and Dietetic Institute (INDI) and the National Dairy Council (NDC), at Dublin’s Clyde Court Hotel (Tuesday evening, 13th May, 2014). Pictured were (L-R): Senior community dietitian Leán O’Flaherty; Dr. Catherine Logan, nutrition manager, National Dairy Council; Professor

Have you noticed that granny’s clothes are too big for her or that grandad’s false teeth are getting loose? Malnutrition affects 10% to 15% of elderly people in Ireland and often families or individuals don’t realise it is happening.“Malnutrition in older people is costing the country €1.4 billion per year – more than obesity,” says Margaret O’Neill, dietitian manager with HSE Dublin South Central and a speaker at a recent symposium on healthy ageing.

“Malnutrition in older people is costing the country €1.4 billion per year – more than obesity,” says Margaret O’Neill, dietitian manager with HSE Dublin South Central and a speaker at a recent symposium on healthy ageing.

“An estimated 10% to 15% of the free-living population over 65 years of age are at risk of malnutrition and a lot of it is quite invisible.

We know that from research done into hospital admissions. One in three older people admitted to hospital are at risk. It’s only when they are being treated for something else that it’s identified.”

Poor nutrition will make it difficult to get over any illness, she says. It will also mean more medical care than if the person’s BMI was correct.

“A malnourished patient, for any given diagnosis, will have more GP and outpatient visits, more hospital admissions, longer stays in hospital, higher prescription costs and a higher need for long-term care. Also, if the situation is not corrected, they will be almost twice as likely to be readmitted to hospital.

“What can happen is that the frail, elderly person gets flu, their appetite goes and they can’t get it back up afterwards. That person can then go on to get a chest infection that they can’t shake off. There may be other illnesses going on too and malnutrition can lead to infections, bed sores and being bed bound. Good nutrition is absolutely crucial to pulling them out of all that.”

Protein in the diet

Protein in your diet is really important, she states.

“Often older people forget that and the protein slips away.”

The recommended amount for an adult is two servings a day – a playing card pack size portion of meat is a serving and two eggs is a serving, for example.

“As we get older, our appetite often decreases, but protein is really important for your energy levels, to maintain your muscle, rebuild them and keep them strong. Calcium and vitamin D are also needed for bones. It’s not a good idea to be just having tea and a slice of bread for your supper. The balance must be right.”

Tips

While appetites may decrease as people get older, they should “hold their own”, Margaret says.

Here are some of her tips if you are living alone and concerned about your nutrition or are caring for an elderly person whose appetite has decreased:

• Keep portion sizes small so they will appeal.

• Keep it nutritious.

• A little and often rather than big meals.

• Give foods they like (to stimulate appetite).

• Maximise the nutrient content of these foods.

• Make a meal out of soup by adding cooked, chopped cold meat or chicken, milk, grated cheese, leftover potato or vegetables.

• Add extra cheese, butter or cream to mashed potato, vegetables or scrambled egg.

• Make porridge with full-fat milk.

• Make enriched milk by adding two to four tablespoons of skimmed milk powder to a pint of full-fat milk.

• Improve flavour of sandwiches by adding mayonnaise, mustard or pickles.

“Observation is important,” Margaret adds. “Ask yourself are your older relatives’ clothes getting too big for them or are their false teeth getting loose because they’ve lost so much weight?

“Or are they having more difficulty getting up and down out of the chair because of muscle wastage? “Encouraging the person to take fluids is important too. Dehydration can be a big problem among older people.”

“Remember – if people are concerned about their nutritional status and have lost weight, they should discuss it with their GP, practice nurse or public health nurse and ask them to refer them to a HSE Community Dietitian in primary care.

They can also use the “Find a dietitian” feature on the www.indi.ie website to contact a dietitian privately in their area.

Margaret O’Neill was one of the speakers at a recent symposium organised by the INDI and the National Dairy Council (NDC) with the title “Tailoring Dietary Advice to Support Healthy Ageing”.