Are You Innocently Starving Your Older Relative?

At 77, your aunt is still beautiful, with a slender build and great charm. Active and outgoing, she walks, plays chess, and entertains her large extended family. By all objective measures, your aunt is thriving, but in fact, like many of her counterparts, she is starved and malnourished.

It is estimated about 85% of adults in long term care facilities, and more than half of all seniors cared for at home, are starved or malnourished, suffering from low or seriously low levels of protein and other nutrients. But an increasing number of active, independent older adults are also malnourished, especially women who live alone and low-income seniors. According to experts, identifying people who are  losing weight and muscle tone, or becoming weak and confused, is easier than  identifying people who appear well nourished but are not.

 Tracing the causes of malnutrition

The causes of malnutrition are more than just too little food, a deficient diet, or problems with absorption of nutrients. It’s a mixture of physical, emotional and social issues that imprison vulnerable people in a continuous cycle of dependence and deteriorating health.

For instance, older single adults, even energetic and self-sufficient ones like your aunt, often don’t cook for themselves. So unless invited out to a proper meal, their typical dinner may be nothing more than corn porridge , slices of bread with cup of tea. If this is continued long term, a nutrient poor diet quickens the loss muscle mass and strength that normally comes with aging. Shopping and food preparation become more difficult thus increasing the tendency to subsist on easy but empty fare like biscuits, bread, cold corn meal, crisps, or street snacks. In the end, the severe lack of nourishment leads to increased frailty and dependence which can trigger depression, another appetite drainer.

Malnutrition weakens the immune system, increasing the risk of pneumonia and other serious infections and worsening existing health conditions. It can also contribute to mental confusion making healthy eating an issue, exacerbating admission into a hospital or long-term care facility, where they become exposed to bed sores, infections, surgery complications and more malnutrition.

When does malnutrition begin?

The start of malnutrition is a series of factors which prompt people to eat poorly, often triggered by various problems normal among people who are getting old:

Long-term illness. Older people face long term debilitating illnesses that impact their ability to visit the supermarket or feed themselves. In addition, severe and long lasting ailments often reduce appetite, aside pushing the body to need more nutrients. Illnesses that impact mental capabilities such as dementia, Alzheimer’s disease, alcoholism and others, also have a huge effect on appetite and on the capacity to prepare and eat healthy meals.

Hospitalisation. Acute illness or surgeries that result in hospitalisation can take a tremendous toll on the health of seniors, often resulting in loss of appetite, weakness, weight loss and debilitation.

Depression. Often under-reported in older adults, depression affects millions of people over 65, including more than a third of those in nursing homes. As with other areas of ageing, depression occurs as result of complex and interlinked factors such as sadness, isolation, loneliness, poor health, retirement, poor mobility, coexisting illnesses such as Parkinson's disease, cancer,  diabetes, and malnutrition. 

Alcoholism. Experts believe the number of alcohol related problems in older adults is far greater than suspected even fifteen years ago.  A major contributor to malnutrition is of course alcoholism which suppresses appetite, aiding leak out of vital nutrients, and often serving as meals replacements.  

Poor absorption. Physiological changes with ageing impact the way the body absorbs and uses nutrients. The production of certain digestive enzymes and acids diminishes, interfering with protein breakdown and with the absorption of vitamin B12, folate, and possibly calcium and iron. Lack of vitamin B12 can have a devastating effect on the nervous system, leading to an unsteady gait, muscle weakness, slurred speech and psychosis. Other illnesses like cancers of the gastrointestinal tract, inflammatory bowel disease and even diarrhea can interfere with absorption. 

Medications. Most drugs older adults take have negative side effects which contribute to malnutrition by reducing appetite, changing the taste of food, causing nausea and vomiting, or limiting proper absorption of nutrients. Culprit medications include antidepressants, certain blood pressure and osteoporosis medications, and even common pain relief medicine like aspirin. The problem is most times worsened because older adults take multiple medications which may impact the ability to eat and digest nourishing foods. 

Struggle to chew and swallow. Dental problems, including gum disease, cavities and poorly fitting dentures can affect the taste of food and make chewing nearly impossible. When people with chewing problems eat nutritious foods, they may have trouble digesting them. A dry mouth, a side effect of many drugs, and diseases such as Parkinson's that affect the nervous system, can interfere with swallowing. 

Poor taste and smell. Food is not only for survival but also to be enjoyed, and may be true as people age. Taste and smell diminish later in life depriving food of much of its flavor. While some sensory diminishes with age, certain medications and diseases can worsen matters, especially Alzheimer's, which affects part of the brain related sense of smell.

Restricted diets. Seniors are more likely than any other group to have dietary limitations, including limits on salt, fat, protein and sugars. While they are necessary diets to manage several medical conditions, the food end up being tasteless and undesirable that adults simply stop eating.  As a result, some nutrition experts propose a reappraisal of restrictive diets, observing that malnutrition is more harmful to overall health than rich or salty foods are. 

Inadequate income. Some seniors with limited pensions go hungry, particularly if expensive medications are recommended for their wellbeing. It’s normal for older adults to want to choose between drugs and groceries at the end of the month when pensions are stretched thin.

Isolation and loneliness. One of the biggest contributors to malnutrition is a lonely life and the isolation, depression, anguish, dullness and anxiety that repeatedly go with it.

What to search for

The signs of malnutrition are not easily perceived, particularly in people who don’t appear to be at risk. To assist in unraveling issues before they become more severe:

·         Question older people about what they eat, but don’t depend on what they tell you, because they don’t want to be burdensome.  Make the attempt to spend quality time with them during normal meals at home, not just when you go out for meals in restaurants or at special times. And if an older relative or family member is in a hospital or long-term care facility, ensure you visit during mealtimes to monitor what is on offer and how well your relative eats what’s being served. If it’s weight management you’re worried about, ask for a calorie count from the hospital or nursing home dietitian. 

·         Search for physical problems such as easy bruising, poor wound healing, and dental problems.

·         Be informed about the medications family members take and how these impact appetite and digestion. A lot of generally prescribed medications can decrease hunger and stop nutrient absorption.

·         Request from the older person’s doctor a check of certain protein levels such as serum albumin, prealbumin or retinol binding protein levels.  These tests can often aid in isolating chronic malnutrition.

What can be done

Admit malnutrition is a multifaceted issue, the solutions are seemingly simple.  Even small changes make a big difference in an older person's health and well-being:

·         Enrich scanty diets. To boost nutrition of seniors, for those who like nuts, encourage them to spread peanut or other nut butters on bread, on fresh fruits such as apples and bananas, and on raw vegetables. Mashed avocado is also a good substitute for nuts. Beans mixed with rice or corn is another way to enrich diets.  But cook the beans and corn soft to allow easy chew and swallow. You can also make bean soup with rice balls, or sprinkle enriched protein powder, nuts, or wheatgerm on corn gruel or oatmeal, fruit and cereal; adding extra egg whites to egg stews and omelets; and crumbling steamed seasoned fish on sandwiches, vegetables, soups, stews, rice, pasta and noodles. Basically look for protein enriched foods in your area and add to meals.

·         Put the zest back into bland food. Try to make special diets more appealing by using lemon juice, herbs and spices and by varying the texture, color and temperature of foods. If loss of taste and smell is a problem, try using strong seasonings and flavors. Careful chewing can sometimes increase enjoyment because more flavor molecules come into contact with taste receptors. A dietitian can also suggest ways to perk up dull meals.

·         Work out between-meal snacks. For people who get filled up quickly, in between-meal snacks can be helpful. A piece of fruit or natural yogurt, a spoonful of peanut butter or handful of nuts if chewing is no problem, even a protein shake for people who are lactose tolerant can add nutrients and calories. 

·         Give nutritional supplements. Underfed seniors are likely to be deficient in protein, vitamins B-6 and B-12, folate, niacin, vitamin D, calcium and zinc. Supplements are important because they can help supply missing nutrients, but they should not become a substitute for meals since they lack the needed protein or calories.

·         Employ outside help. If an older adult is very weak, consider employing a home health assistant to help prepare meals or arrange home visit from registered dietitians. Local religious and civic groups often have volunteers willing to shop and cook for seniors who live alone. Check out from your community hospital for information on programs in your area. 

·         Discuss with doctors. During routine visit to doctors, discuss screening for nutrition problems and the possibilities of changing medications that affect appetite and nutritional status. Be certain to let your doctor know if you notice that an older adult is losing weight. And talk to a dentist about oral pain or chewing problems.

·         Make meals a social event. This is likely the most important step to check starvation or malnutrition since older people visibly light up when they have company. Drop by during mealtime or invite seniors to your house. Or try eating out on a regular basis, which can boost spirits along with appetite. Encourage older adults in your life to join programs where they can eat with others or arrange for them to have meals with friends. In one study, older adults who attended nutrition classes improved their nutritional status, but the change seemed to result from the social interaction the classes provided, not from the information they received. 

·         Encourage regular exercise. Many seniors, even those with serious health problems, can benefit from daily exercise. Exercise stimulates appetite, helps depression, and strengthens bones and muscles. Exercising with others also provides motivation and social interaction. 

What to do now

It’s not about adding monthly allowance to the existing meager pension given out to older adults in our lives. It’s more about being available and getting increasingly involved in the wellbeing of our loved ones. Yes, money does help, but the social interaction more than anything reduces the onset of malnutrition or, to put it more bluntly, takes starvation off the table. 

Photo Credit: Creative Commons