With Age Comes a Growing Risk of Malnutrition

Diet, Inactivity and Chronic Ailments Leave a Surprising Number of People Vulnerable

For most older Americans, malnutrition may seem like a remote worry. But evidence is mounting that they should start paying attention-and that a range of age-related factors can interfere with the intake of nutrients necessary to ward off illness, keep the immune system strong, and maintain overall health and well-being.

The biggest culprits include obvious ones such as poor dietary choices and physical inactivity. But chronic ailments such as heart disease and diabetes and the drugs used to treat them can interfere with food intake and nutrient absorption. And loneliness, grief and depression, such as after the breakup of a marriage or death of a spouse, can disrupt healthful eating habits.

“A whole host of medical and social issues or underlying medical conditions can be responsible for poor nutritional status in older adults,” says Donald Hensrud, a nutrition specialist at the Mayo Clinic in Rochester, Minn., and editor of the health system’s Mayo Clinic Diet program. For example, adults living alone may eat the same thing over and over again because it’s easy, or lose interest in cooking and eating for one, so they end up on a “cookies and milk” diet, Dr. Hensrud says.

A study of older adults published last July in Geriatric Nursing found that while those who were depressed, widowed or both had higher intake of some nutrients, the majority of nutrient levels along with caloric intake were below the amounts recommended by national dietary guidelines. The study cited other research showing that, in comparison to peers who were married, widowed individuals are also more likely to consume fewer vegetables and eat foods that aren’t nutritious, and less likely to prepare homemade meals.

Growing Risk
The swell of aging baby boomers, makes it increasingly important for medical professionals to evaluate older patients for nutritional deficiencies and ensure they are consuming a balanced diet, Dr. Hensrud says. Often, malnourishment may be recognized only when older adults are admitted to the hospital, including for elective surgeries.

Malnutrition associated with eight diseases costs the U.S. health-care system $156.7 billion annually, according to a recent study published in the Journal of Parenteral and Enteral Nutrition. The researchers received funding from Abbott Nutrition, which makes nutritional supplements used in hospitals.

Patients with diseases such as diabetes or congestive heart failure may be at risk of malnourishment because of dietary restrictions such as limits on salt, fat, protein or sugar that may lead to inadequate eating. Smokers who suffer from chronic obstructive pulmonary disease, also known as emphysema, are at risk of malnourishment due to poor eating habits, lack of exercise and suppressed appetite, as well as changes in their metabolism, which make it harder for the body to absorb nutrients from food. Heavy drinkers are also at risk because excess alcohol interferes with the digestion and absorption of food.

While unintentional weight loss is often a sign of problems, overweight and even obese adults can be malnourished if they are sedentary and consuming unhealthy food.

The Mayo Clinic recommends a plant-based diet with plenty of fresh fruits and vegetables, whole-grain carbohydrates, healthy fats such as olive oil and canola oil, and leaner types of protein. Most studies show that popping handfuls of dietary supplements is of little use and can even be harmful in large quantities. But in some cases, such as vitamin D, which is essential for strong bones, and Vitamin B12, which is important for the function of the brain and nervous system, it may be advisable to supplement the diet in some way. Because some people over 50 have trouble absorbing the vitamin B12 found naturally in foods, the National Institute on Agingrecommends foods fortified with B12 such as cereal.

Protein consumption, along with regular physical activity, is vital for maintaining muscle mass and strength, “but many older individuals do not consume enough protein to maintain their muscle mass,” says Edward Archer, a researcher at the Nutrition Obesity Research Center at the University of Alabama, Birmingham. That can trigger what he calls “a downward spiral to frailty.”

Bigger Appetite
New evidence shows that older adults need more dietary protein than younger adults to make up for age-related changes in the way the body metabolizes protein. In a Journal of the American Medical Directors Association report in 2013, an international study group recommended average daily intake in the range of 1.0 to 1.2 grams of protein per kilogram of body weight per day (divide your weight in pounds in half, and the result is roughly how many grams of protein you need daily), along with endurance and resistance-type exercises to help those over 65 maintain or regain lean body mass and function. Those with acute or chronic diseases need even more dietary protein, or as much as 1.5 grams per kilogram of body weight, the group said.

Hospitals are increasingly educating their staffers on how to recognize malnutrition in older patients, screening patients within 24 hours of admittance and at regular intervals throughout their hospital stay. They are using new guidelines from the leading nutrition and dietetic societies, which say at least two of six factors must be present to diagnose malnutrition: insufficient food intake, weight loss, fat loss, loss of muscle mass, fluid buildup that can mask weight loss, and diminished functional ability measured by hand-grip strength.

According to the Alliance to Advance Patient Nutrition, a nonprofit group that includes the Society of Hospital Medicine, the Academy of Medical-Surgical Nurses, and the Academy of Nutrition and Dietetics, malnourished patients are up to three times as likely as others to develop an infection at the site of surgery or pneumonia after an operation, and twice as likely to develop bedsores. Close to half of patients who fall in a hospital are malnourished.

LAURA LANDRO, The Wall Street Journal