Merck Manual

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Spotlight on Aging: Undernutrition

Spotlight on Aging: Undernutrition

Undernutrition in older people is serious because it increases the risk of fractures, problems after surgery, pressure sores, and infections. If any of these problems occur, they are more likely to be severe in people who are undernourished.

Older people are at risk of undernutrition for many reasons.

Age-related changes in the body: In the aging body, production of and sensitivity to hormones (such as growth hormone, insulin, and androgens) change. As a result, older people lose muscle tissue (a condition called sarcopenia). Undernutrition and decreased physical activity worsen this loss. Also, the age-related loss of muscle tissue accounts for many of the complications of undernutrition in older people, such as a higher risk of infections.

Older people tend to feel full sooner and have less of an appetite. Thus, they may eat less. They may also eat less because as people age, the ability to taste and smell decreases, reducing the enjoyment of food. The ability to absorb some nutrients is reduced.

Some older people produce less saliva, resulting in dental problems and difficulty swallowing.

Disorders: Many disorders that contribute to undernutrition are common among older people.

Drugs: Many of the drugs used to treat disorders common among older people (such as depression, cancer, heart failure, and high blood pressure) can contribute to undernutrition. Drugs can increase the body’s need for nutrients, change how the body uses nutrients, or decrease the appetite. Some drugs cause diarrhea or have side effects that interfere with eating, such as nausea and constipation.

Living situation: Older people who live alone may be less motivated to prepare and eat meals. They may have limited funds, causing them to buy cheap, less nutritious food or less total food. They may be physically unable or afraid to go out to buy food or may not have transportation to a grocery store.

Older people who live in institutions have even more obstacles to adequate nutrition.

  • They may be confused and unable to say when they are hungry or what they would like to eat.

  • They may be unable to choose foods they like.

  • They may be unable to feed themselves.

  • If they eat slowly, especially if they need to be fed by a staff member, the staff member may not have or allow enough time to feed them adequately.

Older people who are hospitalized sometimes have the same problems.

Prevention and treatment: Older people can be encouraged to eat more, and food can be made more appealing. For example, strongly flavored or favorite foods, rather than low-salt or low-fat foods, can be served.

Older people may be following a special diet (such as a low-salt diet) because they have a disorder (such as kidney or heart failure). However, such diets are sometimes unappealing and lack taste. If so, people may not eat enough food. In such cases, they or their family members should talk to the dietitian or doctor about how to make foods that taste good to them and that fit with their dietary requirements.

Older people who need help with grocery shopping or feeding themselves should be given more help. For example, they may need for meals to be delivered to their home.

Occasionally, people are given a drug to stimulate their appetite (such as dronabinol) or to increase the amount of muscle tissue (such as nandrolone or testosterone).

Depression and other disorders, if present, should be treated. Treating these disorders may remove some of the obstacles to eating.

For older people living in institutions, making the dining room more attractive and giving them more time to eat may enable them to eat more.