Malnutrition: how to spot the signs in older people

A 75-year-old man showed up at the geriatric ward of a hospital in Vijayapura, Karnataka, in late 2021, showing signs of severe anaemia. The elderly man had already been thoroughly evaluated by multiple physicians. In order to treat his staggering hemoglobin level (4 gm/dl), he was given repeated blood transfusions. Doctors at the geriatric ward handling the case say that they were stumped as they couldn’t figure out what was causing the malnutrition.

“Initially, we were unable to figure out the cause,” says Dr Anand P Ambali, professor, department of geriatric medicine, Shri B M Patil Medical College Hospital & Research Centre, Vijayapura. “We instantly admitted him and initiated blood transfusion. He lost a lot of protein and had severe swelling in his face and feet. His weight was also very low.”

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Doctors say that they continued to treat him for the anemia even though they were unable to figure out the cause.

On day three, the doctors found that he was eating just two slices of bread and some water. “We finally realized the reason behind his anemia. The family used to feed him just two slices of bread (that is against the essential nutritional requirement), which led to malnutrition,” said Dr Ambali, adding that it was a clear case of elder abuse.

“It was a unique case that shocked us. The most common types of cases I have seen in my geriatric practice are that of old women who stay alone and those who face abuse from their families, guardians or caretakers. They are either fed less or given poor quality food,” he says.

What causes malnutrition among the elderly?

Dr Sumaiya A, clinical dietitian and certified diabetes educator at Fortis Hospital, Kalyan, Mumbai, says that the elderly could be consuming less food for several reasons- it could be due to an underlying disease (e.g., diabetes), an inability to chew food, certain foods being restricted from their diets, difficulty in obtaining food and an inability to digest certain foods properly.

Dr Ambali says that poor-quality dentures are one of the leading causes of malnutrition among the elderly.

“Psychological factors also play a major role when it comes to malnutrition among the elderly,” says Dr Sumaiya.

Dr Ambali agrees and adds that he has observed older adults staying alone often lacking the will to cook for themselves every day.

When to consult a doctor regarding malnutrition?

Dr Ambali says that typical signs of malnutrition among older adults include:

• Loss of appetite.
• Significant unintentional weight loss.
• Anemia.
• Skin appearing pale, dry and layered.
• Severe dehydration.
• Feeling easily fatigued.

Dr Lenny Da Costa, preventive cardiologist, geriatrician & functional medicine specialist at Rafael Medicare Centre, Goa, says, “Some of the most common signs that people have presented with include feeling unsteady and weak, and uncontrolled sugar and BP level (despite medication).”

Dr Ambali adds that undernutrition leads to reduced immunity which makes elderly people more prone to infectious diseases. “Another problematic consequence is that when people consume low fiber diet, it leads to constipation. They end up eating less because of the constipation and the cycle repeats,” he says.

Treatment & prevention

According to Dr Sumaiya, it is important to find out what is causing the malnutrition first. “Once we get to know the reason, we can manage the case and the dietary intake accordingly,” she says.

Everyone needs a diet chart packed with proteins, vitamins and other essential micro and macro nutrients, says Dr Sumaiya. In addition, it is also important to look for any underlying conditions in case of the elderly. “It could be body weight or the ability to eat and digest food among other factors,” she added.

Dr Da Costa says that a combination of modern medicine along with dietary and lifestyle changes can improve their quality of life.

“For an elderly person with severe anemia, we give blood transfusions and hematinic (nutrients used to treat anemia),” says Dr Ambali. “Beyond this, one of the first changes to make is getting good-quality dentures- this can change a lot,” he says. He also adds, “Locally sourced nutritious food should be a part of their everyday diet. Family involvement is also very important- for instance, the whole family can have meals together.”

Takeaways

• A common sign of malnutrition among older adults is unintentional weight loss.
• Poor-quality dentures are one of the leading causes of malnutrition among the elderly.
• A diet chart packed with proteins, vitamins and other essential micro and macro nutrients can prevent malnutrition.