Malnutrition: how to spot early signs of unplanned weight loss or gain in older people

Nurses and social care staff are ideally placed to identify those who are struggling and help them regain their independence, health and confidence

Age UK has been listening and conducting research with older people throughout the COVID-19 pandemic, and the latest insights we have paint a sad picture of some who are struggling to get through their day.

Hearing from older people, and their friends and family, has helped Age UK to understand how well-being, physical and mental health has been affected during this time.

Age UK’s research has also highlighted how the pandemic has affected some more than others, particularly older people from lower socio-economic groups and minority ethnic communities. And one of the most concerning issues – as well as loss of motivation to do the things they used to enjoy – is reduced resilience.

Feelings of anxiety, low mood and depression mean some older people are scared to leave home

Finding it hard to cope, older people describe small things becoming big things, which cause stress and panic. Minor setbacks sometimes feel impossible to deal with, and there is a growing nervousness in feeling not being able to solve problems and make decisions.

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Alongside this, feelings of anxiety, low mood and depression mean that some are too scared to leave their homes. This leads to self-neglect, not eating well, not taking care of personal hygiene, and generally a lack of self-care, including incorrectly taking medication.

Specific reported concerns from older people are:

• Moving slower and feeling stiffer.
• Experiencing new aches and pains, as well as chronic pain.
• Becoming easily breathless.
• Struggling to walk short distances.
• Having a far greater reliance on walking aids.
• Feeling less steady on their feet and worrying more about falling.
• Worsening of long-term conditions.

Living alone, loss, bereavement, loneliness and lockdowns have cut people off from people and activities they love. This has all contributed to a cumulative negative effect on the ability to carry out activities of daily living.

Malnutrition is a cause and consequence of ill health

Less support with meal preparation and prompts to cook and eat have led to unplanned weight loss. Both can be early signs of malnutrition. Community and practice nurses and social care staff are in a great position to identify those who are struggling and to support and signpost to keep older people independent for as long as possible.

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Malnutrition is a cause and consequence of ill health – it’s not just about disease-related malnutrition, it’s about picking up symptoms of unplanned weight loss or gain early. Good nutrition and hydration sit across all conditions and underpins keeping well. Preventing malnutrition is key at a time when we all need to take the pressure off health and social care.

Before the pandemic, 1.3 million older people in the UK were at risk of malnutrition. Malnourished older people saw their GPs twice as often and had three times the number of hospital admissions, longer hospital stays, and experienced more ill health.

How nurses and social care staff can help prevent the risk of malnutrition

As part of UK Malnutrition Awareness Week – which runs from 11-17 October – the Malnutrition Task Force has tips and advice on how community and practice nurses and social care staff can help mitigate the risks of preventable malnutrition in the following ways:

Ask about the person’s appetite – are there difficulties in shopping or food preparation; do they need help to eat and drink; can they chew and swallow; and do they have access to enough food?

Look for signs of unplanned weight loss, loose clothes and rings, small appetite or a general loss of interest in food

Listen carefully to what you are being told, it may not always be about eating and drinking directly. Perhaps you can see a lack of interest in life in general, or worries about general health or physical well-being

As winter approaches, nurses and social care staff can help by:

Signposting older people to get their winter vaccines, such as the flu jab

Knowing how to recognise the early symptoms of unplanned weight loss, what to do and how to signpost people on accordingly

Sharing Age UK’s Winter Wrapped Up guide, which is full of practical advice and tips for older people on keeping themselves and their home warm and in optimal health during the colder months

Encouraging older people to have the confidence to start eating and drinking better again

There must be a priority in nursing practice to identify risk as soon as older people meet health or social care services. There are new easy to use tools that can be used by anyone, are simple to use, with no need for weighing scales, and can identify risk and help to start conversations.

The Malnutrition Task Force has produced a video animation showing how to use the tools, and a resource Eating Well in Later Life.

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Sometimes, starting a conversation, giving a resource or signposting to a local voluntary sector organisation might be all that’s needed for an older person to have the confidence to start eating and drinking better than they have been.

Lunch clubs are opening again, so signposting older people in your community will help their loneliness and lack of confidence, as well as being better nourished.

Find out more

• Age UK (2020) Age UK Research Lays Bare the Drastic Impact of the Pandemic on our Older Population’s Health and Morale
• Malnutrition Task Force (2019) Eating Well in Later Life
• National Institute for Health Research/BAPEN (2015) The Cost of Malnutrition in England and Potential Cost Savings from Nutritional Interventions

Lesley Carter is a registered nurse and clinical lead at Age UK, she is also programme lead for the Malnutrition Task Force