MALNUTRITION IN THE ELDERLY

Definition:

Malnutrition is a pathological condition caused by insufficient or unbalanced nutrient intake, leading to loss of body mass, muscle strength, and functional impairment.

In elderly individuals, it is often multifactorial and associated with a general health decline.

Epidemiology:

• Affects about 10–60% of older adults, depending on the setting:

• 5–10% among independent elderly

• 30–50% in nursing homes

• 30–70% in hospitals

• More frequent in people with chronic illnesses, disability, or social isolation

Pathophysiology:

• Reduced caloric and protein intake

• Impaired intestinal absorption

• Increased catabolism (due to chronic diseases or infections)

• Consequences: muscle mass loss (sarcopenia), weakened immune system, frailty, and slower recovery from illness or surgery

Main Causes:

• Physiological factors: decreased appetite (anorexia of aging), changes in taste/smell, reduced gastric motility

• Chronic diseases: dementia, heart failure, cancer, COPD

• Oral/dental problems: difficulty chewing or swallowing

• Depression, social isolation, grief

• Polypharmacy: drugs that reduce appetite or impair absorption

• Alcoholism

• Poverty or lack of nutritional education

Risk Factors:

• Age over 75

• Multiple chronic conditions

• Institutionalization

• Functional dependence

• Cognitive decline

• Loneliness

• Frequent hospitalizations

Diagnosis:

• Nutritional assessment: weight, height, BMI, arm/calf circumference

• Involuntary weight loss >5% in 3 months or >10% in 6 months

• Lab tests: albumin, prealbumin, total protein, electrolytes

• Screening tools:

• MNA (Mini Nutritional Assessment) – specific for elderly

• MUST (Malnutrition Universal Screening Tool)

• Assessment of muscle strength and functional capacity (e.g., handgrip test)

Treatment:

Nutritional interventions:

• Personalized diet high in calories and protein

• Small, frequent meals with preferred foods

• Oral nutritional supplements (ONS) when needed

• Speech therapy support in case of dysphagia

• Enteral or parenteral nutrition in selected cases only

Treatment of underlying causes:

• Address infections, depression, or GI issues

• Review and simplify medication therapy

Nursing Care:

• Weekly weight monitoring

• Tracking food and fluid intake

• Assistance during meals (quiet environment, enough time)

• Swallowing assessment

• Nutritional education for patient and caregiver

• Emotional and motivational support

• Collaboration with dietitian, speech therapist, and physician

Advice and Prevention:

• Regular nutritional screening, especially at admission or in long-term care

• Stimulate appetite with varied and appealing meals

• Promote autonomy during meals

• Encourage social meals

• Correct dental or prosthetic issues

• Promote light physical activity to preserve muscle mass

• Don’t forget to exercise as much as you can.