Malnutrition is a serious problem in older Australians, screening is needed in aged care, dietitians say

Hair falling out. Weakness and confusion. Wounds that do not heal.

All of these can be signs of malnutrition, but are commonly mistaken for the “normal” aging process.

“People say ‘Oh I’m getting old’ when they are actually undernourished and many people can avoid it altogether,” says Judi Porter, professor of Dietetics at Deakin University.

Older people have higher protein and energy needs than younger adults but their daily intake is often much lower so malnutrition can easily occur.

In fact, 68 per cent of people living in aged care are malnourished or at risk of malnutrition. And up to one in two older Australians in the community may not have an adequate diet.

“It’s a serious problem in Australia,” says Karly Bartrim, dietitian and convenor of the aged care interest group at Dietitians Australia.

Vegetable soup and juice can fill one up but do not provide adequate protein.(Getty Images: Fabián Ponce)

Early intervention is vital and waiting for help can be fatal.

“Unfortunately, you can die from malnutrition in Australia … people definitely die,” says Professor Porter.

Despite the scale of the problem, there are no specific Australian dietary guidelines for older people at risk of malnutrition.

And there is no mandatory malnutrition screening in aged care.

“Malnutrition is so common in aged care but dietitians only get involved when there is weight loss, which often has a knock-on effect,” says Miss Bartrim.

“If we were included earlier we could prevent that weight loss from happening.”

How can it evolve?

Loss of appetite or reduced interest in food can be for a variety of reasons – some physical, some psychological.

The elderly carry a heavy burden of it chronic diseases it can change the appetite, such as kidney and liver disease and congestive heart failure.

And people living with dementia forget to eat, go shopping or forget the food they once liked.

“If a family member asks what you had for lunch you might say ‘Because of a sandwich’ you’ve had a sandwich for the last 80 years but maybe you haven’t had the sandwich,” says Professor Porter.

Unsuitable dentures can discourage a person from eating, and so can dysphagiathat is when a person has difficulty swallowing.

The old man eats a meal at a table alone

Nutritionists say that older people should prioritize high protein foods before vegetables.(Getty Images: Johnce)

Poor emotional well-being can also turn a person off.

Lonelinesswhich affects one in five older Australians, clinical depression and dolás they are common causes.

“It happens to thousands of Australians – their mood is low so their appetite drops,” says Professor Porter.

“That means going to see a GP and treating the depression rather than the low appetite.”

Food insecurity it is another big reason. If a person cannot afford to buy nutritious food they may skip meals or eat cheap, unhealthy options.

In addition, we often take more medication as we age many of them can impair absorption of nutrients including vitamin B12, sodium and magnesium.

What can happen?

Losing 5 to 10 percent or more of their total weight over a period of three to six months is generally an indication of malnutrition.

But there are other things to look out for.

Energy levels fall away and a person may not be seen as cognitively functioning and can affect behaviour.

Theirs was immune system they may also be weaker and may be poor a wound medical.

“We can always say that someone is not eating because it will take forever to heal the wound,” says PhD candidate Miss Bartrim.

They will probably lose too muscle mass because their body is in starvation mode and burning muscle to function.

Close up of the hands of a woman using a walker being assisted by a carer

Being overweight can be more dangerous than being overweight for older people.(Getty Images)

This can lead to what is known as a musculoskeletal disease sarcopeniathat is when muscle strength, quantity or quality is compromised as well as physical performance.

This can stop a person from getting up and doing the things they enjoy.

“And the result is that people become more socially isolated, they often become depressed, they become lonely, and then that’s a feedback loop for them not wanting to stop eating ,” says Professor Porter.

People with sarcopenia are at higher risk falls and fractures and less ability to recover.

“If someone is malnourished and falls they don’t have the reserves in their body to support them,” says Miss Bartrim.

A break can mean a person ends up in hospital and their condition worsens due to hospital-acquired malnutrition, which affects up to 65 per cent of inpatients.

It’s because people are in an unfamiliar environment, they’re confused and they don’t have much choice in food. On average it means the patient stays in hospital for an extra 21 days.

Changes in diet and meal times can help

Early recognition is the name of the game.

Don’t wait to seek help because once muscle is lost it can be difficult to get it back.

“So if you’re starting to see changes in mobility or changes in weight or eating patterns, I wouldn’t hesitate to get a referral for a dietitian,” says Miss Bartrim.

And if a person has a chronic disease, he/she may be entitled to up to five subsidized sessions with an allied health professional such as a dietician or exercise physiologist, who can help rebuild muscle mass.

But there are simple dietary changes that can be made right away.

The emphasis for the elderly must be on eating foods that are high in protein and energywhich means vegetables take a bit of a back seat.

An elderly woman cooks eggs on a stove

Eggs are high in protein and are good for people with dentures or swallowing difficulties.(Getty Images)

“People say to me ‘Okay, I’d better go home and eat more vegetable soups and salads’ but they shouldn’t fill up on that, it adds to the problem because they have no energy,” says Professor Porter .

And don’t buy the “diet” or “low fat” options.. Having a few extra kilos as an older person is a protective measure; it can be the padding that protects against a fracture if it falls or the extra energy needed when undergoing chemotherapy.

“We say the opposite of what they’re told as children,” says Miss Bartrim.

“Don’t skip the dessert, have the ice cream.”

But how do you eat more when you don’t feel like it?

A technique called “eating under the clock” can help establish a routine if your appetite has decreased and you need mental cues to eat.

It involves eating six small meals at the same time every day, even if you are not hungry.

Nutritional supplement drinks Better between meals than tea or coffee food should always be the first choice.

“We know that people get a lot more joy out of eating food than drinks,” says Miss Bartrim.

And finally, your family members should try not to stress about mealtimes by putting a lot of pressure on someone to eat. Take a social approach, choose comfort foods and take your time.

The bigger picture

Current Australian dietary guidelines exclude “frail, elderly people at risk of malnutrition” which is defined as “usually” being over 75 years of age.

The guidelines state that this is because this group has “complex health needs” and that health professionals should be consulted for advice.

However the National Health and Medical Research Council (NHMRC) is currently reviewing the guidelines and the updated version will include those aged 65 and over and provide advice. in preventing malnutrition, frailty, falls and chronic conditions.

The updated guidelines are expected to be released i 2026.

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