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Health

Over-65s face ‘hidden’ scourge of malnutrition

We’re bombarded with stories about obesity, so it’s a shock to discover one in ten over-65s is malnourished or at risk of it, writes Judy Hobson

Most of us associate malnutrition with poor African countries, not with the UK, the fifth biggest economy in the world.

Statistics from the UK’s Malnutrition Task Force (MTF) suggest three million people in this country are suffering from malnutrition, with 1.3 million of them 65 and over. This figure could be much higher because many more are thought to be hidden away in their own homes.

Dr Simon Gabe, consultant in gastroenterology at St Mark’s Hospital in Northwick Park and president of the British Association of Parenteral and Enteral Nutrition (BAPEN), says: “Due to poor detection and reporting, this figure is likely to be a gross underestimation.

“Malnutrition among older people has always been a hidden problem in the UK. It is only recently that the extent of it is coming to light due to the fact that we’re starting to get better at detecting it.

“At least one in ten older people is malnourished or at risk of it, and with the number of over-65s expected to increase by 50 per cent in the next 20 years the problem is only going to get bigger.

“Malnutrition can be thought of as poverty-related or disease-related. In Western countries poverty-related malnutrition is much less common but disease-related, where patients become malnourished in association with acute or chronic diseases or psychiatric conditions, occurs more frequently.”

A warning sign that you are becoming malnourished is losing weight quickly and unintentionally – shedding something like ten per cent of your body weight in just three to six months. The MTF says you can become malnourished in just two to three days if you don’t eat properly.

Early symptoms include loss of energy, not being able to walk as far, poor concentration and a change of mood. A diet that lacks protein and essential nutrients makes people dizzy, tired and weak and leaves them prone to picking up infections. It also causes muscle weakness that can lead to falls.

If they go into hospital for surgery, because of their undernourished state they will take longer to recover. On average, malnourished patients stay in hospital more than three days longer than well-nourished ones. This is often because they are susceptible to complications such as a wound or chest infection.

It is, therefore, not surprising to learn it costs two to three times more to treat a malnourished patient. They need more GP visits and prescriptions, are more dependent on home care and are more likely to be referred to a hospital or admitted into a care home.

Figures from BAPEN for the cost of malnutrition in the UK for 2011/12 show that it was already costing the country £19.6bn. With an ever increasing ageing population coupled with the current lack of awareness of the problem, this figure is set to soar. Doctors, dietitians, nurses and social workers and the charities Age UK and BAPEN are so concerned they have set up the MTF to address the problem.

In October it held its first awareness week and is now campaigning to get health, social care and the voluntary sector to work together to reduce malnutrition in older people and to ensure they get the support and advice they need to stay well-nourished.

Dr Gabe says: “Better and earlier detection and then action to address the problem in people’s own homes, care homes and hospitals could prevent thousands of them suffering the catastrophic consequences of malnutrition and relieve pressure on the NHS and social care.”

The situation has not been helped by repeated public health messages preoccupied with reducing obesity levels, because these do not take into account the fact that such advice is frequently unsuitable for older people.

“For a long time,” Dr Gabe says, “the public have been given health messages focused on reducing levels of obesity. While obesity is a huge problem, people who are malnourished or at risk of becoming malnourished need to hear a different message and to realise that the usual healthy diet message for the general public does not relate to them. They need a high-energy and high-protein diet in order to gain weight and stop losing it.

“Worryingly, a poll carried out ahead of Malnutrition Awareness Week found that almost half of British adults think you should not eat foods like cake and biscuits even if you are underweight. This is simply not true.”

The MTF also maintains that it is an out-of-date perception to think that when someone ages it is inevitable they will become thin and frail.

Those particularly at risk of malnutrition have long-term conditions such as diabetes, kidney disease, chronic obstructive pulmonary disease (COPD) and dementia. Having an underlying health problem can make them feel nauseous and not want to eat or they can have dysphagia and experience swallowing problems. Something as simple as having a painful tooth or dentures that do not fit properly can also make eating difficult.

And someone with dementia may not realise he or she hasn’t eaten anything that day, while those suffering from depression or loneliness may not have the will or energy to prepare a meal.

Those with mobility problems can find it difficult to stand and cook and to get to the shops. According to a BAPEN survey, 38 per cent of those over 70 have mobility problems, as do 18 per cent of those aged 60 to 69.

Sight loss, a problem that affects two million over-65s, can also make food preparation challenging.

The key to addressing malnutrition in elderly people, Dr Gabe believes, is raising awareness and knowing how to spot the tell-tale signs in yourself and your loved ones. “It might be something as small as loose rings, dentures and clothes.

You can check whether you or someone you know is at risk by using the malnutrition self-screening tool: (www.malnutritionselfscreening.org). The site also has dietary advice. “We’d like people to undergo self-screening then seek advice, and would like to see it become compulsory that patients are assessed for their nutritional state whenever they are in a health care setting.”