Malnutrition among older adults is increasing worldwide and is a major public health issue. Researchers estimate that about one-third of older adults are malnourished, and one-half are at risk nutritionally, leading to serious health declines, diminished quality of life, and reduced mortality. Consequences of malnutrition include cognitive decline, sarcopenia [muscle wasting], anemia, poor wound healing, impaired immunity, decreased bone mass, and overall failure to thrive (Amarya et al., 2015). Annually, malnutrition among older adults costs $51 billion to treat diseases related to it (Aging Today, 2017). The purpose of this posting is to provide awareness of the importance of nutritional screening and to eat a balanced diet to avoid malnutrition. If identified early, it is both treatable and reversible.
Malnutrition is defined as an imbalance of nutrients as the result of ingesting foods low in nutrients or not eating a balanced diet to maintain optimum health. Sometimes, it is not how much food is eaten, but what kind of foods are eaten. Therefore, malnutrition is prevalent among overweight, obese, thin, and healthy looking older adults, and from all socioeconomic groups. Some signs of malnutrition among older adults are muscle weakness, fatigue, increased illness, infection, confusion, and feeling irritable.
Causes of malnutrition include limited income, trouble swallowing and chewing, poor dental health, poor appetite, taste disturbances, living alone, bereavement, lack of mobility, pricey medications, living in a food desert [more than 7 miles from a grocery store], and inability to prepare food. Older adults who live too far from grocery stores may resort to shopping for groceries in mini-marts and gas stations, resulting in a diet lacking in fresh fruits and vegetables. Older adults have diminished taste sensors, and therefore do not realize that food is salty. Diminished taste receptors result in “normal” or highly salted foods that taste bland. Hot dogs and canned soup are the two foods most often eaten by older adults. Why? Hot dogs are cheap and easy to cook in the microwave. Canned soup is also cheap, and most have pop lids, easy on arthritic hands. Both can be heated in the microwave. Unfortunately, hot dogs and canned soup are loaded with sodium, and a steady diet of soup and hot dogs may lead to malnutrition and excessive sodium intake.
Community advocacy using a multidisciplinary approach has shown to increase awareness and create solutions and promote policy change (Aging Today, 2017). One solution to address food insufficiency caused by poverty is the SNAP Program, which is an acronym for Supplemental Nutrition Assistance Program, formerly known as “food stamps.” For older adults who meet the threshold, a credit card is provided to help pay for food. Gone is the “shame” factor, as paying for groceries with a credit card is commonplace. In Alabama, a one-person household qualifies with an annual income of $15, and for a two-person household, $20k qualifies. More information about this program is available on the AL.gov website. Another strategy for combating malnutrition is funded by the Older American’s Act of 1965. Hot noon meals are served five days per week at senior and community centers throughout the United States. These meals are FREE, but those who wish to contribute a nominal amount are encouraged to do so. In Limestone County, there are five nutrition centers, and in Madison County, there are six centers. There, seniors gather to share a nutritious and healthy noon meal. An added benefit is social interaction, which may alleviate social isolation so common among older adults. I have eaten a noon meal at the Athens Senior Center on Pryor Street, and it was a wonderful experience. Many of the diners arrived by bus and after we settled in, were served a delicious meal, which we ate at round tables. I met a lot of new friends and I hope to return there and to dine at other facilities around Limestone County.
Screening for nutritional status is another way to reduce malnutrition. For professionals, the Mini Nutritional Assessment [MNA] or the short form [MNA-SF] from the Nestle Nutrition Institute are two accepted screening for determining malnutrition among older adults. In the community, I use the Nestle MNA or the MNA-SF for assessing nutritional status.
There are several screening tools including the Nutritional Risk Index (NRI), Geriatric Nutritional Risk Index (GNRI), Subjective Global Assessment (SGA), Mini Nutritional Assessment Screening Form (MNA-SF), Malnutrition Universal Screening Tool (MUST) and Nutritional Risk Screening 2002 (NRS 2002). While the MUST screening has been shown to have the highest reliability, it is most often administered upon hospital admission (Poulia et al., 2012).
Resources:
Aging Today (2017), American Society on Aging, 25(5), p. 1, 14. San Francisco, CA.
Amarya, S., Singh, K., & Sabharwal, M. (2015). Changes during aging and their association with malnutrition. Journal of Clinical Gerontology & Geriatrics, 6(3), 78-84. Retrieved from http://www.sciencedirect.com/science/article/pii/S2210833515000672?via%3Dihub
Mayo Clinic: http://www.mayoclinic.org/healthy-lifestyle/caregivers/in-depth/senior-health/art-20044699
NCOA Fact Sheet: The Unseen US Health Crisis of Malnutrition https://www.ncoa.org/resources/fact-sheet-the-unseen-us-health-crisis-of-malnutrition/
NCOA Urges Older Adults to Know the Warning Signs of Malnutrition https://www.ncoa.org/news/press-releases/abbott-malnutrition-week/
Poulia, K., Yannakoulia, M., Karageorgou, D., Gamalestou, M., Panagiotakos, D.B., Sipsas, N.V., & Zampelas, A. (2012). Evaluation of the efficacy of six nutritional screening tools to predict malnutrition in the elderly. Journal of Clinical Nutrition, 31(3), 378-385.
World Health Organization: Nutrition for Older Persons: http://www.who.int/nutrition/topics/ageing/en/index1.html
