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Malnutrition in the community: what you can do to support older people

Why it’s vital nurses recognise risk factors and challenge myths about weight loss and ageing

Why it’s vital nurses recognise risk factors and challenge myths about weight loss and ageing

Picture: Alamy

Living longer means little if it’s not living well. The fact so many people are living into late old age is a cause for celebration. However, it means that, if nothing changes, there will be many older people who could become malnurished.

Older people continue to be at risk of malnourishment and dehydration, and the number of people dying in hospitals from malnutrition is increasing.  

Undertaking nutritional assessments is vital, as is making the appropriate referral or prescribing and evaluating an intervention. Ensuring people who need it receive support to eat and drink is fundamental, and when a patient is discharged, information about their nutritional status must follow them home.

Addressing the underlying causes

It is shocking and unacceptable that patients in hospital are malnourished and that some are not being given appropriate food or the right support to eat and drink – but this only tells half the story.

A third of people aged over 65 are already malnourished or at risk when they are admitted to hospital from their own home, as are almost half of those admitted from a care home.

Clearly, more support is needed in the community to address the underlying causes of malnutrition in older people.

The risks of undernourishment for older people usually start in their own homes and are vast. Around 90% of older people at risk of malnutrition are living in the community and many will not be in contact with health or care services.

The risk factors

We know that people can become malnourished if they don’t eat enough for two or three days. The physiological effects start very quickly. This means that people who appear overweight can also become malnourished and will experience adverse effects.

The Malnutrition Task Force (MTF) identifies three risk factors:

  • Medical: malnutrition that is a consquence of a particular disease.
  • Physical factors such as arthritis, disabilities, sight loss, limited mobility and pain, as well as dentition complications, loose teeth or denture problems. These factors can make it difficult for an older person to get to the shops, prepare and cook food and eat independently.
  • Social risk factors are possibly the most complex and difficult to diagnose, and tricky to solve. They include low income, inability to cook nutritious meals, acquiring a caring responsibility later in life, lack of understanding of weight-loss and nutrition messages, bereavement, social isolation and loneliness.

What should I be looking out for?

  • The most obvious sign of malnutrition is unexpected weight loss. This may be gradual or sudden, as a result of illness, or unexplained
  • There are subtle signs to look out for, such as loose clothing, dentures and jewellery
  • Other warning signs may begin with a change in personal circumstances, such as loss and bereavement or low mood, recent ill health or a diagnosis that could lead to loss of interest in food, eating a restricted diet, loss of appetite or even not eating

 

Unfortunately, knowledge of malnutrition, its risk factors and signs remains low among older people, their families and many health and care professionals.

There is little professional recognition that widely publicised advice about diet and nutrition is often unsuitable for older or more vulnerable individuals. This is not helped by public health messages and policy that are preoccupied with reducing obesity, so that weight loss is seen as desirable; indeed, the myth perpetuates that weight loss in later life is normal.

More needs to be done to ensure that the public, and health and care staff, understand the risks of unintended weight loss. Nurses and other professionals need to give clear and helpful advice to older people and their families.


Watch: Lyn's story – Malnutrition Task Force case study


Mixed health messages

We know this is a particularly confusing issue for the ‘sandwich’ generation – those caring for older relatives as well as young children. They are concerned about making sure their children have little sugar and eat their five portions of fruit and vegetables a day. They find it difficult to go against health messages and encourage older people to eat cake and full-fat products.

Older people themselves may be reluctant to change long-established eating habits to help them maintain a healthy weight, for example, by introducing regular snacking, drinking milky coffees and adding cheese, cream and honey to food.

There are many examples of positive practice with teams up and down the country making progress in tackling malnutrition in the community. Other examples include:

  • The Malnutrition Task Force and BAPEN (British Association of Parenteral and Enteral Nutrition) launched the first UK Malnutrition Awareness Week in 2018 to shine a spotlight on the issue, to encourage everyone to recognise unintentional weight loss in later life, to take it seriously, and to take action to prevent it. This will be repeated in 2019 (date yet to be confimed). 
  • As part of the Malnutrition Task Force prevention pilot, Age UK Salford developed the PaperWeight Armband – a simple tool that helps volunteers identify people in the community who may be losing weight.
  • There are numerous clubs run by voluntary sector organisations that help older people manage their weight, teach older men to cook, or bring people together to do an online shop or go to the supermarket.
  • Some supermarkets now offer slow-lane shopping to help older people, people with disabilities or dementia to shop in a relaxed environment, and often offer cut-price meals in their café to encourage people to turn their shopping trip into a social occasion.
  • Food delivery companies offer good quality, nutritious food at a competitive price delivered to the door. This also includes mashable and texture-modified foods for people who have dysphagia.

These schemes and initiatives help older people in the community eat well. Unfortunately, availability is patchy and older people are not always aware schemes exist in their area. It’s important that health and care professionals can direct older people and their families to support where it is available.

The number of people aged 85 and over is projected to rise rapidly, and it is they who are most likely to be at risk of malnutrition. 

It is more important than ever that we all work towards combatting malnutrition in older people and make sure that everyone knows the risks and what to do about it. Tackling malnutrition is everyone’s responsibility. 


Further information


Lesley Carter is clinical lead health influencing, Age UK, and programme lead, Malnutrition Task Force

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