Malnutrition affects half a million older people in the UK and it can cause serious health problems – but it is easily dealt with. Dan Parton reports.

In this article:

  • Elizabeth’s story
  • Other causes of malnutrition
  • Symptoms of malnutrition
  • Effects of malnutrition
  • Treatment of malnutrition

Elizabeth’s story

Elizabeth Jones’ mother, Audrey, was keen to remain independent, but finding shopping, standing, cooking and holding pots and pans harder to do as she got older.

“We started looking at prepared meal solutions and scoured the local stores, tried different products, but couldn’t find anything she liked,” Elizabeth said.

She tried meals on wheels, but found because of government and council cut-backs, the subsidies have gone and meals have increased from £2 to £5.  That is a significant increase in weekly food bills for pensioners. The gap has largely been plugged by private home delivery services where individuals can choose from a catalogue of meals, but normally orders are in bulk, a couple of weeks in advance of eating.  Shopping from a catalogue, for a generation used to being independent, can be difficult.

Elizabeth admits her mother started to suffer from malnutrition, but it was some time before the family noticed.

Malnourishment is what happens when the body does not have enough nutrients to work properly to stay healthy. It can come from not eating enough. It can also be caused by eating an unbalanced diet or one that is low in nutrients – ironically, obese people can be malnourished. About one in five people aged over 60 who live alone and are admitted to hospital are malnourished.

“We all want to stay in our own homes for as long as possible. Eating well and having adequate nutrition is key to achieving this”.  Elizabeth added: “When I was caring for my mother the prepared foods available did not provide the range of nutrients we needed to meet her dietary needs and the portion sizes were typically too large for her”. “Frozen meals are important for older adults, particularly those dependent on care providers who only have a short time in which to prepare meals. Food is safer in the freezer and is less likely to run the risk of passing the ‘use by’ date of chilled food – a real problem for those who struggle to see small dates on packaging”.

Elizabeth consulted and worked with a nutritionist to design tailored meals for her mother.  Audrey quickly regained her health and has been able to retain the independence she cherishes.

The experience with her mother inspired Elizabeth to set up a prepared meals business focusing specifically on the nutritional needs of older adults. The company provides ready-to-eat meals that comply with GDA recommended guidelines (GDA stands for Guideline Daily Amount and is the recommended amount of nutrients an adult should consume each day). The meals provide one of the five-a-day portions of vegetables that achieve a high protein status and are lower in salt and saturated fat. The meals are also free from digestive irritants for those with digestive system disorders.

The meals have also been packaged sympathetically towards older adults needs with

  • larger writing on the exterior packaging
  • a large tab on the clear sleeve for ease of peeling it back
  • meals can be frozen and then cooked either in a microwave or oven
  • sustainable recyclable packaging

The Cooperative (UK wide), Booths (in the North West) and One Stop (in England) are stocking meals produced by ‘On the Menu’, making them available at the heart of local communities and providing a convenient location shop for older adults and their carers.  Details of current stockists are available on their website.

Other causes of malnutrition

Eating or swallowing can become difficult after a stroke, so the individual may not take in the food they need.

Malnutrition can also be a symptom of intestinal problems. If food is not digested properly, then the body cannot absorb the nutrients it needs to stay healthy.

Alcoholism can also cause malnutrition; alcohol contains enough calories to stop someone feeling hungry, but none of the other nutrients needed to stay healthy.

High risk groups include:

  • People on low incomes
  • People with cancer
  • People who use drugs or regularly drink alcohol beyond recommended limits
  • People with longer-term conditions like diabetes or kidney-disease
  • People over 65

Symptoms of malnutrition

Malnutrition can be something of a hidden condition; it goes unnoticed in about 70% of hospital cases, according to the British Medical Journal. Nevertheless, there are symptoms to look for, including:

  • Acute weight loss (3.5% total body weight lost per month when not on a diet)
  • Hair loss
  • Changes to nails
  • Muscle wastage
  • Dull eyes
  • Listlessness and tiredness
  • Brown stained teeth
  • Depression
  • In more serious cases, a swollen abdomen, a dull yellow complexion and dry, crinkled skin

If your Body Mass Index (BMI) is under 18.5 and you experience the symptoms listed above, it’s recommended that you visit your GP.

Metric BMI = your weight in Kg/(height in M x height in M)

e.g. if your weight is 60Kg and your height is 1.60M, your BMI = 60/(1.6x1.6) = 23.44

Effects of malnutrition

Malnutrition can have a hugely negative effect the health of older people, including:

  • Reducing immune responses, which increases vulnerability to infection
  • Impairs wound healing and delays recovery from illness
  • Increases the risk of admission to hospital and increasing the length of stay there
  • Reduced muscle strength, fatigue and depression

If left untreated, it can also lead to conditions such as anaemia, beri-beri, goitre, scurvy and rickets.

Treatment of malnutrition

The type of treatment depends on the severity of the malnutrition and ranges from dietary improvements to tube feeding.

In many cases, as in Audrey's, an improved diet, which is balanced and contains enough of the nutrients, vitamins, minerals, calories, protein and water needed to stay healthy, is all that is needed. Sometimes doctors recommend eating high-calorie foods, or eating more meals and snacks throughout the day. In addition, special nutrition-rich drinks or high-protein snack bars can also help.

However, in cases where the individual cannot eat or drink, it may be necessary for them to be given liquid food directly into the stomach or small intestine via a tube.

Here, a tube is placed in the stomach or small intestine directly or through the nose. The other end of the tube is attached to a small container carrying a liquid feed with all the calories and nutrients needed. If the individual is unable to take nutrients into their stomach or small intestine, they can be fed a sterile liquid feed directly into the blood. Tube feeding can be gradually stopped if the person regains the ability to eat and digest food normally again.