Research shows that around 50% of older Australians in aged care and the community are either at risk of malnutrition or already classified as malnourished. With several studies linking malnutrition in the elderly with poorer health outcomes and a reduced quality of life, it’s important to understand exactly what malnutrition is, how it occurs and how you can prevent and treat it.

What Causes Malnutrition in Elderly People?

Malnutrition occurs when the body’s nutritional needs are not being met. Common causes of malnutrition in elderly people is a poor-nutrient diet born from either not eating enough, not eating the right types of food, or digestive issues that impede proper nutrient absorption. Aging populations have an increased risk of developing malnutrition due to poor-nutrient diets that can stem from dental problems, psychological distressers (such as cognitive decline due to dementia and/or depression and grief), medications that may be disrupting usual appetite, injury and/or disability, and financial and/or cooking difficulties.

Sometimes malnutrition can also occur due to something as simple as not eating the right types of food or not eating enough protein and energy. Elderly people who suffer from digestive issues may not be able to absorb certain types of nutrients through food, while some medications can affect appetite and nutrient absorption by increasing the nutritional needs of the body. This can include those with gastrointestinal symptoms, those who suffer from kidney failure or cancer, those who have Crohn’s disease and those who may suffer from an eating disorder.

As we age, there are also natural occurrences that can lead to malnutrition. This can include a reduced appetite, feeding or swallowing difficulties, the onset of chronic illness as well as social isolation.

How to Recognize Malnutrition Symptoms in the Elderly

Understanding the causes and risk factors of malnutrition is key to recognising symptoms in the elderly. Regular diagnosis and screening of symptoms, as well as being aware of any cognitive function or mental decline, can help detect, prevent and treat malnutrition before it becomes severe. Some symptoms of malnutrition in the elderly to look out for are:

Appetite Loss
Weight Loss
Muscle Wasting
Hair Loss
Pale Skin
Fatigue
Mental Confusion
Poor Wound Healing

At older ages, mental health is shaped by a cumulation of our earlier life experiences - meaning that often there’s an increased risk of psychological distress. Alongside this, elderly populations also have increased risk to their emotional wellbeing from mental strains such as clinical depression, grief and loneliness. Research has shown that clinical depression and grief can cause a decline in mood and drop in appetite. In these instances, it’s important to familiarise yourself with the signs of malnutrition and seek support.

Impact of Malnutrition in Elderly

The impacts of malnutrition in the elderly are significant and often irreversible for older people with the complications and consequences of malnutrition leading to poorer health outcomes, increased hospital stays and a significant decline in quality of life.

Increased Risk of Falls and Infections

Older people with malnutrition have a higher risk of falls, infection and pressure wounds. They may take longer to recover from illness or injury and can require increased aid with everyday tasks. They’re also more vulnerable to disease and have a higher rate of hospital admittance.

Reduced Immunity and Wound Healing

As the body grows older, natural aging changes in immunity will occur - meaning that your immune system slowly weakens. Studies have shown that malnutrition in the elderly leads to even weaker immune systems, causing impaired wound healing, muscle wasting, extended hospital stays, and an increased care needs and adverse outcomes on mortality rates.

Musculoskeletal Disease (Sarcopenia)

When an individual eats a diet poor in nutrition and energy for a prolonged period of the time, the body automatically goes into starvation mode and begins burning muscle to function. This can cause what’s known as musculoskeletal disease (also known as sarcopenia). When sarcopenia occurs, muscle strength, quantity or quality as well as physical performance are compromised - which leads to further social isolation and potential for depression.

Not only does this take a toll mentally, but people with sarcopenia have a higher risk of falls and fractures and less ability to recover due to immunodeficiency.

Crucial Approaches to Address Malnutrition in Seniors

The treatment and management of malnutrition requires a comprehensive multifaceted approach aimed at increasing nutritional intake and addressing any underlying causes. If malnutrition is being caused by physiological factors such as feeding and/or swallowing difficulties, it’s best to consult a healthcare professional to learn what options may be best for your situation. Otherwise, some areas to look at are as follows:

Dietary and Lifestyle Changes

Proper nutrition and hydration are crucial to the continued health of older populations across Australia. It’s a common myth that as we age we need less nutrients. However, this is actually untrue. In fact, the increased risk of malnutrition in aging populations means that it’s important to ensure a diet including foods high in energy, protein, vitamins and minerals such as fibre and antioxidants. These nutrients are crucial to promoting weight gain, building and repairing the body’s cells, and promoting normal bodily functions. In short, meals matter.

Nutritional Supplements

Studies have shown that the use of oral nutrition supplements and nutrition products can improve weight, protein and energy intake, physical function, quality of life and length of stay in acute care. The most common nutritional supplements on the market are milk-based and can come in either a powder, liquid or pudding form.

Scheduled Eating

One of the easiest things to implement when treating malnutrition is to take what is known as a “Food First” approach to dining. This means encouraging frequent small, high energy and protein meals and snacks throughout the day as opposed to just three single larger meals.

Care and Support Services

Working with an Accredited Practicing Dietitian (APD) can work with people who are either at risk of malnutrition or who are malnourished. They can offer specialised advice that can help identify and plan for increased nutritional needs.

Prevention of Malnutrition

Early intervention is paramount to preventing malnutrition in the elderly. While there aren’t specific Australian dietary guidelines for older Australians at risk of malnutrition, the Australian Dietary Guidelines outline what a nutrient-rich diet should contain (most importantly it should be high in protein and energy). Updated guidelines will be released in 2026 detailing a diet for those 65 and older on preventing the development of malnutrition, frailty, falls and other chronic conditions.

How Long Does It Take to Recover from Malnutrition?

Recovering from malnutrition depends wholly on the severity of the situation. Close monitoring is required over several weeks to ensure physiological and mental improvement (such as increased awareness and energy). However, it can take months to see significant physical improvement once a proper nutritional plan has been put in place.

Treatment should always be delivered in the form of a multidisciplinary approach, meaning that it involves a combination of care and support changes. When treating and recovering from malnutrition, it’s crucial to consult a healthcare professional.

Final Thoughts on Malnutrition in the Elderly

Addressing malnutrition in the elderly requires education and awareness surrounding symptoms, prevention and treatment. With nearly half of the elderly population at risk or already affected by malnutrition, being appropriately educated on the effects of malnutrition in elderly populations is essential for carers in Australia. By learning more about malnutrition and advocating for increased nutrition for our aging populations, we can work towards ensuring that older Australians remain healthy and engaged members of our communities.

Sources

The Source. (May 23, 2023). 50% of older Australians are at risk of malnourishment. https://www.theweeklysource.com.au/topic-aged-care/50-of-older-australians-are-at-risk-of-malnourishment

National Library of Medicine. (April 15, 2009). Protein and energy supplementation in elderly people at risk from malnutrition. https://pubmed.ncbi.nlm.nih.gov/19370584/

HelpGuide.org. (n.d.). Depression in Older Adults. https://www.helpguide.org/mental-health/depression/depression-in-older-adults

Aged Care Quality and Safety Commission. (n.d.). Why meals matter. https://www.agedcarequality.gov.au/providers/food-nutrition-dining/why-meals-matter

MedicinePlus. (n.d.). Aging changes in immunity. https://medlineplus.gov/ency/article/004008.htm

Better Medicine. (n.d.). Strategies to improve nutrition in elderly people. https://bpac.org.nz/bpj/2011/may/elderly.aspx

Eat For Health. (n.d.). The guidelines. https://www.eatforhealth.gov.au/guidelines/guidelines