Malnutrition in Older Adults: What to Watch for and How to Help

Malnutrition is all too common in older adults—with one out of two at risk for the condition. Early diagnosis and intervention are key to preventing malnutrition’s adverse health outcomes. That’s why the American Society for Parenteral and Enteral Nutrition (ASPEN) has designated October 4–8 as Malnutrition Awareness Week.

This year’s theme is Nutrition is a Human Right. So take the time to help educate colleagues, older adults and their families and communities about malnutrition, including the importance of early detection and treatment, as well as the role of nutrition in recovery.

Diagnosing and Addressing Malnutrition

Malnutrition occurs when there is either overnutrition or undernutrition, often with inflammation that leads to changes in body composition and ability to function. Frequently the result is loss of the body’s protein stores (muscle mass) which can impact activities of daily living.

Almost 63 percent of people older than age 80 have evidence of olfactory impairment.

The first step is to identify risk for malnutrition, these questions can help. Malnutrition is then diagnosed by a team of medical professionals evaluating an individual’s medical history, social and environmental situation and presenting symptoms. Clinical criteria evaluated include calorie intake, weight trends, fluid retention, body fat and muscle mass loss, and overall functionality.

Early recognition and treatment of malnutrition are key for improving health outcomes. Addressing and improving malnutrition also can help to:

  • Reduce readmissions
  • Support healthy aging
  • Improve quality healthcare
  • Decrease healthcare costs.

Things to Watch for At Home

  • Appetite changes. Many physiological changes occur as we age that can impact appetite, including changes to the digestive system and changes in hormones. Additionally, a person’s environment, mood, current medical condition and medication regimen also can impact appetite.
  • Dehydration. Signs of dehydration include extreme thirst, decreased urination, dark urine color, dizziness, fatigue and confusion. Low blood volume, urinary and kidney problems and even seizures are just a few of the many risks associated with dehydration.
  • Dentition. As we age, our teeth can become weak, which can result in tooth loss. Difficulty chewing tends to increase with age, too, which means older adults may have fatigue earlier during meals and eat less. The inability to chew properly also can affect the taste and texture of foods, further impacting how much older adults eat.
  • Sensory changes. Aging can affect our taste and smell. Almost 63 percent of people older than age 80 have evidence of olfactory (smell) impairment. Foods that used to be “favorites” can often taste “too salty,” “too sweet” or “too bland,” leading to disinterest in eating.
  • Swallowing changes. Occasionally, older adults begin developing dysfunctional swallowing, or dysphagia. You may notice some older adults coughing more frequently during meals, which can be a sign of difficulty swallowing and can reduce how much they eat. If you identify increased coughing with meals, refer the older adult to a speech language pathologist for an evaluation.

Tips for Improved Nutrition

The most efficient way to address malnutrition is to prevent it by providing adequate calories and protein to help meet energy needs and inhibit loss of muscle mass. An older adult’s diet should include a variety of fruits and vegetables, whole grains, lean proteins and foods rich in calcium. Additional tips are:

  • Increase caloric density of meals and snacks. “Caloric density” is the number of calories available in a food. One easy tip to increase caloric density is to add condiments or “extras” whenever possible. For example, preparing foods with olive oil or butter will add calories without adding volume. Topping foods with dried fruit, chopped nuts, bacon bits, cheese, mayonnaise, and/or avocado will also add extra calories.
  • Increase eating frequency. Eating multiple small meals throughout the day rather than just three large meals can help an older adult eat more without feeling overly full. Eating more frequently throughout the day can also help those struggling with taste and smell changes.
  • Add liquid calories between meals. Drinking a fluid is often much easier than eating when it comes to increasing calorie intake, especially if an older adult has a poor appetite. Liquid calories are typically well-tolerated and can also help prevent dehydration. Fluids such as whole milk, shakes, smoothies, or oral nutritional supplements can add up to 350 calories in just 8 ounces. If an older adult quickly feels full, consider providing these higher-calorie beverages between meals rather than during meals, to help increase the amount they may drink.

With increased awareness and action on older adult malnutrition, we can all help support nutrition as a human right.

Rachel Bayse, MA, RDN, LD, is an ASPEN Malnutrition Committee member and a clinical dietitian at University of Florida Health in Jacksonville, Fla.


ASPEN Malnutrition Solution Center provides resources for healthcare professionals and consumers

The Why Nutrition is Important Tip Sheet (for healthcare professionals)

Caring for Your Nutrition Tip Sheet (for consumers)