Look out for signs of malnutrition at Christmas

Age UK and the Malnutrition Task Force are urging everyone to look out for warning signs of malnutrition in older relatives and friends at Christmas time.

NHS Digital figures show that between 2007/08 and 2017/18 the numbers of older people aged 60 or over diagnosed with malnutrition have more than trebled from 1,405 to 4,988[i].

Of the 12.2 million older people who live in the UK, over a million (around one in 10 people) over the age of 65 are malnourished or at risk of malnutrition - and the vast majority of those (93%) live at home so often their malnourishment goes unnoticed[ii]. However, at Christmas as families and friends come together to eat meals and celebrate it’s the ideal time to spot signs that someone may be struggling to eat enough to keep themselves well.

Data from the English Longitudinal Study of Ageing (ELSA) shows that various complex factors are contributing to the rise in diagnosis of malnutrition among older people. These include over 230,000 people aged 75 and over having difficulty with the physicality of eating, such as cutting up food, and above 1.9 million having difficulty eating food because of a dental condition[iii].

Not being able to afford to eat may be another cause of malnutrition, particularly for those older people living in poverty[iv]. ELSA’s data states that over 360,000people aged 50-64 and over 29,000 65-74 year olds admitted having to cut or skip meals because they didn’t have enough money[v].

Dianne Jeffrey, Chair of the Malnutrition Task Force, said: “It is shocking that 1.3 million older people suffer from or are at risk of malnutrition in our country and the root of the problem doesn’t just lie with poverty[vi]. There are other contributing factors which add to the risk.  Public health messages that don’t always relate to this age group; a lack of ability to shop, eat and drink at home without help. As well as loneliness and isolation, grief and bereavement, poor physical and mental health or a lack of awareness of the risks by health and social care staff.

“However, whether you are slim or even if you are seemingly overweight, you can still be malnourished and a couple of days of not eating can have serious physical effects for older people. If this is not addressed many of these people will eventually be admitted to hospital which is often the first time malnutrition will be identified. This is why we are appealing to everyone to look out for tell-tale signs at Christmas time that might mean an older person is not eating enough or needs help to plan, shop for, or cook meals.”

Increasing numbers of people diagnosed with malnutrition is a cause for concern because poor nutrition can be both a cause and consequence of ill health. Signs will often go unnoticed until they have made a negative impact on health and wellbeing. Malnourishment can cause long-term health problems for otherwise healthy and independent older people. It can also mean more visits to the GP, increased chances of being admitted to hospital and longer recovery times from illness.

Treating someone who is malnourished is two or three more times expensive for the health care system than someone who is not malnourished and identifying and addressing the problem could result in significant savings.6 Estimates put the cost of malnutrition on health and social care is expected be at around £13 billion by 2020 and that figure is estimated to rise further with the rapidly ageing population7.

How to spot malnutrition 

It is sometimes quite difficult to recognise that you or a loved one is unintentionally losing weight. At Christmas look out for warning signs like rings being loose and slipping off, clothes looking too big, belts needing to be tightened. Look for dental problems, lose teeth, sore mouth or loose dentures. All will make chewing and swallowing difficult or some may just have a small or general lack of appetite.

How to help 

If an older family member or friend is not getting enough to eat and drink, here are some practical tips that may help: 

• Encourage a visit to their GP to rule out other health conditions and offer to go with them.

• GPs can arrange for referrals to a dietitian or speech and language therapist if required as they can teach exercises to help with swallowing difficulties and offer advice about dietary changes (such as foods that are easy swallow).

• If teeth or dentures are a problem, make an appointment with a dentist. Some dentists will make home visits.

• If older people can’t face a large meal, offer small meals and snacks throughout the day.

• Move to full-fat foods like milk, yoghurt and cheese.

• If there is difficulty with chewing, try eating soft foods such as scrambled eggs or yoghurts, but suggest they visit the dentist.

• If you do the shopping, draw up the shopping list together.

• If there is difficulty opening items, make sure to pick up items that are easy to open.

• Make food smell and look appealing as the aroma of cooking can stimulate the appetite.

• If eyesight is a problem, try using a blue coloured plate – this helps people to see what they are eating.

• Introduce a regular snack around a favourite TV programme.

• Suggest an outing to a local café with you or that they go with a friend.

• If you can’t help with the shopping, look into online shopping. Find out what support local Age UK’s can offer to older people who have difficultly shopping or are lonely.

• If they have a care worker that prepares their meals, ensure the care worker is aware of the previous suggestions and that your loved one’s requirements are in the care plan.

For a guide on eating well later in life visit: https://www.malnutritiontaskforce.org.uk/resources