Sarah Coe, Nutrition Scientist at the British Nutrition Foundation shares some of the key risk factors and warning signs for malnutrition in adults.
Good nutrition is important at every stage in life, but particularly in older age when we are more vulnerable to health implications. Though there are screening tools in place to help detect malnutrition among older adults, it can often be difficult to recognise, leaving people at greater risk of hospitalisation and prolonged hospital stays. According to the latest UK figures, three million people are affected by malnutrition, costing the health service approximately £20 billion per year, a figure likely to increase in light of rising living costs and current health system challenges.
Among those at risk of malnutrition, 1.3 million are over the age of 65 with 30-42% of patients at risk when admitted to care homes. Unless suitably addressed, malnutrition among older adults is likely to increase in tandem with population ageing; current estimates suggest that one in every five people will be aged 60 or over by 2050, and with that, an increase in the prevalence of chronic conditions and comorbidities that can make many susceptible to malnutrition.
There are many factors that can hinder a person’s desire or ability to eat a balanced diet, whether physical or psychological. For instance, older persons in care may not have a say in when or what they eat, or they may not want to eat communally if they have swallowing difficulties (dysphagia). Likewise, those living alone who may have been used to making meals with a loved one or have impaired mobility can struggle to prepare or buy nutritionally rich foods.
To discuss the complex nature of malnutrition, Lorna Rothery spoke to Sarah Coe, Nutrition Scientist at the British Nutrition Foundation, a UK-based, public-facing charity whose remit involves facilitating access to evidence-based information on nutrition to promote healthy, sustainable diets.
Can you give an overview of the prevalence of malnutrition among older adults living in the UK? What are some of the key risk factors?
It is estimated that around one in ten (around one million) older adults over 65 years in the UK are malnourished or at risk of malnutrition, in the form of undernutrition. Malnutrition particularly affects older adults in care homes and hospital settings but can also affect those living in the community.
There are many reasons why malnutrition can develop, and the causes of malnutrition are often interrelated. The main factors that can contribute to malnutrition include long-term health conditions or diseases, physical difficulties that can affect the ability to eat and drink such as poor dentition, disabilities like sight loss that can affect the ability to shop for and cook food, and social risk factors such as living on a low income, bereavement, or loneliness.
How can malnutrition impact an older person’s short and long-term health?
Being malnourished can have several impacts on health and wellbeing in later life. In particular, malnutrition is associated with poorer recovery from illness, a weaker immune system leading to more infections, and an increased number and length of stays in hospital. Older adults’ wellbeing is also impacted as if you are malnourished you are more likely to have a low mood, reduced energy levels and less independence, which can reduce quality of life.
What are the current challenges regarding the identification and management of older adults at nutritional risk or potentially at risk?
Malnutrition can affect everyone regardless of size, weight or body shape and can develop slowly over a long period of time, sometimes making it harder to spot. There is an incorrect assumption that losing weight unintentionally is a normal part of the ageing process when it should actually be considered a warning sign of malnutrition or another serious condition. Some of the key signs of malnutrition in older adults include unintentional weight loss apparent through loose-fitting clothing or jewellery, loss of appetite, tiredness and difficulties chewing and swallowing.
Malnutrition should be everybody’s concern and everybody’s responsibility. Screening, identification, and treatment of malnutrition are key to ensuring that older adults get appropriate treatment. Awareness and recognition of malnutrition among healthcare professionals have increased with national guidance on screening and nutrition care applied in most hospitals and care settings. However, malnutrition remains under-recognised and under-treated so increasing awareness further of how common malnutrition is and how serious the consequences can be could help prevent malnutrition in those at risk.
In light of increasing living costs and food insecurity, how do you feel policies around the nutritional needs of the older adult population can be strengthened?
In the current cost of living crisis, it seems more relevant than ever that we do more to identify older people who are struggling, seem vulnerable or isolated, have health problems or difficulties with activities of daily living such as shopping for, accessing or cooking food.
British Nutrition Foundation