Malnutrition & Unintended Weight Loss
Even in an environment in which there is ample food available to eat, older patients may still experience malnutrition. Such malnutrition may represent a failure to eat or may involve a deficiency in a specific element such as a single vitamin. As with most health problems, it is better to prevent malnutrition than to treat it. Each of us has food likes and dislikes. For the older patient, it is a short step from picky eating to poor nutrition. The common causes of poor nutrition are given below. Correction begins with recognizing the potential causes. Often several factors, none alone serious enough to be a problem, combine to produce true malnutrition.
Activity often decreases with advancing age. Appetite seems to wane with the decrease in exercise. It is common for older patients to lose weight. In addition, changes in the teeth, particularly poorly fitting dentures, may make eating uncomfortable, subtly leading to decreased total food intake.
Age-related changes in the digestive tract, particularly in the swallowing mechanism, can cause avoidance of some foods. Grilled meats and soft white bread are particularly hard to swallow. Combinations of diffi- culty with chewing and swallowing may result in a diet so restricted in variety that specific vitamin or mineral deficiencies develop.
Aging produces major environmental changes. Isolation because of loss of mobility, loss of spouse, or depression impairs the willingness to prepare food and to eat regularly and well. The loss of social contacts alone can be enough to impair nutrition. The substitution of institutional food may not resolve the problem. In fact, bland foods and the loss of traditional favorites may worsen intake. Poverty is an ever-present issue affecting the ability to obtain and prepare an adequate diet.
Disease affects nutritional needs both directly and indirectly. Almost any disease process increases the body’s energy needs. Most younger people meet this need by increasing their food intake. Older patients may be too debilitated to respond. In addition, as mentioned previously, they may lack the appetite response. Serious illness is a nutritional burden.
Illnesses that involve the digestive tract may directly impair the ability to eat. These diseases may impair the ability to digest and absorb food as well. These problems in nutrition are the most severe, but they also are usually the most apparent.
Some medications can interfere with appetite. Also, some foods may interfere with the absorption of medications. The timing of meals and medications can be important to treatment. Many patients are placed on a restrictive diet to help in their treatment. The worst problems occur with imposition of several restrictions at once. A patient placed on a pureed, low-fat, low-salt diet has very restricted food choices. Often only the help of a professional dietitian can sort out these choices into tasty, acceptable food.
Important Points in Treatment
Visit patients while they are eating on a frequent, but not necessarily regular, basis. The feature to look for is whether they have changed their customary eating habits. If they are not eating what they used to eat, they are probably not eating as much as they used to eat. The correct intervention is not always easy to determine. The following checklist may help:
- Is help needed for shopping?
- Is help needed for menu selection?
- Is help needed for food preparation?
- Is help needed for the act of eating?
- Does the patient need company during meals?
- Will a dietitian help?
- Is a visit to the physician necessary?