June 2025: Malnutrition in Older Adults
The issue
Malnutrition (undernutrition) is widespread among older adults and leads to disability, longer hospital stays, poorer recovery, lower quality of life, and higher medical costs.
What do I need to know?
Risk climbs with age: roughly 7–13 % of community‑dwelling seniors, 22 % of hospital in‑patients, and up to 50 % of nursing‑home or rehab residents are malnourished.
Causes are usually multifactorial — age‑related appetite loss (“anorexia of aging”), poor oral health or swallowing problems, chronic diseases and medications, cognitive decline, social isolation, financial hardship, and restrictive diets all interact.
Doctors screen with the Mini Nutritional Assessment–Short Form (MNA‑SF); diagnosis follows GLIM criteria (weight loss / low BMI / low muscle mass plus low intake or inflammation). In people ≥ 70 yr, BMI < 22 signals malnutrition.
Untreated malnutrition accelerates frailty, sarcopenia, rehospitalization, and mortality — but evidence‑based strategies (routine screening, individualized meal fortification, oral nutrition supplements, and team‑based care) can prevent or reverse it.
Potential risk of malnutrition
Older adult shows mild appetite decline, minor (≤ 5 %) weight loss in 6 mo, or recent illness but still meets calorie needs.
Recommended Actions
Track weight and food intake monthly.
Discuss eating changes with the doctor; ask for an MNA‑SF screen.
Encourage nutrient‑dense snacks (e.g., yogurt, nuts) and shared mealtimes.
Imminent risk of malnutrition
Noticeable weight loss > 5 % in 3–6 mo, poor appetite, chewing/swallowing pain, or multiple medications that blunt taste.
Recommended Actions
Complete MNA‑SF and basic bloodwork; review dental health, swallowing, and drug side‑effects.
Begin meal fortification (add protein powder, eggs, oils) and schedule small, frequent meals.
Arrange help with grocery shopping, cooking, or feeding as needed.
Confirmed malnutrition
Meets GLIM criteria (e.g., > 10 % weight loss, BMI < 22, or low muscle mass + low intake). Functional decline may be evident.
Recommended Actions
Dietitian‑led care plan targeting ~ 30 kcal / kg day and ≥ 1 g protein / kg day.
Prescribe oral nutritional supplements; treat dental, swallowing, pain, or mood problems; review and deprescribe appetite‑suppressing drugs.
Consider short‑term tube feeding or parenteral nutrition if oral intake will remain < 50 % of needs for > 1 wk.
Monitor weight, strength, and intake weekly; adjust interventions promptly.
What can I do?
As a caregiver or concerned family member:
Weigh your loved one once a month and note any clothing that suddenly loosens. Report any weight loss or appetite drop to the physician early.
Serve protein‑rich foods first (eggs, fish, dairy) and offer between‑meal snacks or shakes. Shared, pleasant mealtimes can spark appetite.
Schedule regular dental exams and ask about a swallowing assessment if coughing or choking occurs at meals.
Review all medicines with the doctor or pharmacist to identify appetite‑blunting or mouth‑drying side‑effects.
Explore community supports such as Meals on Wheels, congregate lunches, or home‑health aides who can help with shopping and cooking.
Ask the clinician directly: “Is my relative at potential, imminent, or confirmed risk of malnutrition? What specific steps should we take now?”
