06 Dec 2016 Elderly Malnutrition – A Modern Western Scandal
The significance of good nutrition and wellbeing for the elderly population is of great public health interest, especially as we now have an ageing population in the UK with over 18% of the population 65 years and over and predictions stating this will rise to nearly one quarter by 2030.
However, the senior population are identified to be at great risk of nutritional deficiencies due to clinical factors including changes in metabolism, appetite, immune functions and impaired absorption of nutrients in the body. In addition, social and economic factors such as social isolation, with over 3.5m over 65’s currently living alone, reduced mobility and poor finances can also contribute to a poor nutritional intake. Age UK claim that 1 in 6 elderly currently live in poverty with a further 1.2m on the brink of poverty, meaning managing finances and accessing a nutrient rich diet is often out of reach for many older adults.
Consequently, malnutrition is a significant and neglected threat to the elderly population, currently affecting over 10% of over 65’s in the UK costing the NHS a staggering (and preventable) £7.3bn every year. Those diagnosed with malnutrition experience reduced immune function, impaired muscle function, decreased bone mass, poor mental health, delayed recovery and finally, mortality.
The number of days accounted for by a patient with malnutrition has increased by 61% in just 5 years, with many attributing rising poverty, cutbacks for funding for community meals and social care as the primary causes. Furthermore, when compared to their well-nourished counterparts, malnourished elderly see their GP twice as likely, have 3 times the number of hospital admissions and remain in hospital on average 3 days longer.
To worsen the situation, nutritional status tends to deteriorate further during hospital stays with research indicating 40% of hospital food is wasted, which could be due to poor appetites, too large of portions or unappetising meals, consequently patients are only consuming 70% of the recommended amount of energy and protein – macronutrients which are incredibly important at this stage of life. Therefore, a self-perpetuating circle of decline exists where patients are often released from hospital in a worse nutritional state than when they entered, who may be readmitted further down the line with symptoms of malnutrition.
So how can we reduce admittances, length of stays and prevent re-admittance in hospitals and care-home settings for the malnourished elderly population?
The Malnutrition Task Force claim that maintaining independence, preventing social isolation, guaranteeing access to food services and reducing poverty are key components of preventing malnutrition in the elderly. In order to reduce admittance to hospitals for malnutrition, cuts to community meals services funding must stop and money must be put back into these services, such as ‘Meals on Wheels’ and incorporating an element of care into the service which to ensure the elderly person is well, safe and in good health at the point of contact.
Furthermore, The Caroline Walker Trust have formulated a set of nutritional standards for all meals in care homes and community meals, to ensure all meals provide sufficient amounts of nutrients to keep their patients in good health thereby preventing malnutrition.
In addition, research suggests nutritional education of the over 65’s is linked to a better health and nutritional status, which could ease pressure on caregivers, family members and friends. Residential home staff, caregivers and social care workers should too be educated further to pick up the signs of poor nutritional intake before they are admitted to hospital with malnutrition. The Carers UK recognise that there is a need for greater support and advice for carers, with one study indicating 60% of carers were worried about the nutrition of the person they care for and 1/6 carers are looking after an elderly person at great risk of malnutrition, yet they still received no support as a caregiver.
Moreover, the length of stay in hospitals could be minimised by improving hospital meals, through measures such as providing manageable sized portions which do not overwhelm patients, foods that they enjoy and catering for different minority groups. The British Nutrition Foundation has also recommended adequate staffing, consistent meal times, in-between meal snacking and fortified meals as methods to reduce the length of stay, less waste and better clinical outcomes.
Additionally, The Malnutrition Task Force claim that ONS (oral nutritional supplement) reduce hospital readmissions by 30%, with NICE deeming ONS as a cost-effective treatment of malnutrition. In contrast, there is some evidence to suggest ONS can interfere with prescribed medications and should therefore be taken with caution. However, patients admitted from hospital should be subject to nutritional screening and assessment to ensure they are not at risk of being malnourished again.
To conclude, it is shocking in 21st century Britain we cannot guarantee the correct food and nutrition for our elderly generation, and the prevalence of malnutrition in this demographic is considered as a modern western moral scandal which poses a huge financial cost.
Further reading:
Brownie, S. (2006). Why are the elderly at risk of nutritional deficinices? Int. Journ of Nursing Practices. V.12 (2), pp.110-118
The Carers UK. (2012). Malnutrition and Caring: the hidden cost to families. London: The Carers
The Caroline Walker Trust. (2004). Eating well for older people. London: Wordworks
British Nutrition Foundation. (2009). Health Ageing: the role of diet and lifestyle. London: Wiley-Blackwell Publishing
Donini, L.M., Savina, C. and Cannella, C. (2004). Eating habits and appetite control in the elderly: the anorexia of ageing. International Psychogeriatrics. V.15 (1), pp.73-87
