Malnutrition: back to basics

August 12, 2022
/ Aging, Malnutrition

You don’t hear much about malnutrition in Australia, which is astonishing given that a whopping 50% of older adults living in the community or aged care are now thought to be malnourished or at risk for malnutrition.

Despite growing recognition of this silent epidemic by scientists (or perhaps because of it due to better detection) estimates seem to be rising rather than falling. It’s clearly time to shine another spotlight on this serious yet preventable public health problem.

How can you spot malnutrition?

To address malnutrition, which “refers to deficiencies, excesses or imbalances in a person’s intake of energy and/or nutrients”, you first need to look for the signs. This isn’t always easy as someone might look okay – even be overweight – and still be malnourished.

Obvious signs are unintentional weight loss and muscle wasting. These can – and often do – lead to sarcopenia, another far too common condition that occurs with accelerated decline in aging.

Other clues include feelings of tiredness, muscle weakness or dizziness due to insufficient energy from food and low mood which can be caused by lack of essential nutrients. Poor appetite is a clear sign, which can both cause and be exacerbated by low food intake.

Perhaps less obvious clues to possible malnutrition include poor oral health, such as bleeding gums, and hair loss. Dry, brittle nails are another indicator, along with frequent illness, infections, easy fractures and slow wound healing. Constipation can signal poor food intake, and diarrhoea can be a warning sign of nutrient malabsorption.

What can we do about it?

Identifying malnutrition – or risk of malnutrition – and addressing it early is critical to avoid further decline, poor clinical outcomes, morbidity and mortality. To this end, hospitals have been calling for routine screening of patients to flag early warning signs, bearing in mind it is also rife in the community.

The condition, its causes and consequences, are very complex so diagnosis and treatment requires a multifactorial approach, ideally with a team of health professionals and family members.

Because it often leads to other problems such as sarcopenia and frailty, the role of malnutrition can easily be overlooked so a nutritionist should always be included in multimodal care. One study of more than 1700 older deceased adults, for instance, found they had underlying risk of mortality from malnutrition despite the cause of death.

Once the cause has been identified, the ultimate aim of course is to find appropriate ways to increase intake of macronutrients – energy and protein – and micronutrients.

As simple as this sounds, a persistent, multipronged approach and a good dose of ingenuity are needed to enhance appetite, palatability and access to nutritious foods, goals that some aged care centres are slowly embracing, along with nutritional supplements where appropriate.