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The Triple Threat of Poor Nutrition in Seniors

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There are plenty of reasons why older adults are at risk for poor nutrition.  Studies have shown a prevalence of malnutrition or at-risk nutritional deficits around the world.  In one study utilizing the Mini Nutritional Assessment on over 4500 older adults (mean age 82 years old), two-thirds were nutritionally at risk or malnourished.

Malnutrition is a state in which a deficiency, excess or imbalance of energy, protein and other nutrients causes adverse effects on body form, function and clinical outcome (source).  Older adults battling chronic disease, loneliness, medication side-effects, and major life events don’t always get the same pleasure from food they once did.  Inadequate nutrition and hydration only exacerbates their struggles.

Let’s look at the three intersecting causes of malnutrition risk:

Aging

  • Aging Sensory Organs- fewer taste buds, decreased sense of smell, decreased tactile sense for managing utensils and cups
  • Dentition- broken teeth, gum disease, ill-fitting dentures
  • Isolation- loss of spouse, eating alone not worth the hassle
  • Depression- appetite changes in depressions
  • Chronic Disease- medication side effects that cause nausea and decreased appetite, kidney failure, GI issues, COPD, diabetes, arthritis

Poverty

  • 13% of US citizens over age 65 live in poverty (Kaiser Family Foundation, 2012).   Other measures put the over 65 poverty rate somewhere between 9% and 16%.
  • Often food dollars are the only non-fixed expense in an older person’s budget.  Many times an older adult will cut back on food to pay for medication, or make nutritional choices based on quantity, not quality.
  • According to The Food Action and Resource Center’s website:
    • Studies reviewed in the report Nutrition and Dementia have shown that up to 45 per cent of those living with dementia experience clinically significant weight loss over one year, and up to half of people with dementia in care homes have an inadequate food intake.  Low-income neighborhoods frequently lack full-service grocery stores and farmers’ markets where residents can buy a variety of fruits, vegetables, whole grains, and low-fat dairy products (Beaulac et al., 2009; Larson et al., 2009). Instead, residents – especially those without reliable transportation – may be limited to shopping at small neighborhood convenience and corner stores, where fresh produce and low-fat items are limited, if available at all. One of the most comprehensive reviews of U.S. studies examining neighborhood disparities in food access found that neighborhood residents with better access to supermarkets and limited access to convenience stores tend to have healthier diets and reduced risk for obesity (Larson et al., 2009).
    • When available, healthy food is often more expensive, whereas refined grains, added sugars, and fats are generally inexpensive and readily available in low-income communities (Drewnowski, 2010; Drewnowski et al., 2007; Drewnowski & Specter, 2004; Monsivais & Drewnowski, 2007; Monsivais & Drewnowski, 2009). Households with limited resources to buy enough food often try to stretch their food budgets by purchasing cheap, energy-dense foods that are filling – that is, they try to maximize their calories per dollar in order to stave off hunger (Basiotis & Lino, 2002; DiSantis et al., 2013; Drewnowski & Specter, 2004; Drewnowski, 2009). While less expensive, energy-dense foods typically have lower nutritional quality and, because of overconsumption of calories, have been linked to obesity (Hartline-Grafton et al., 2009; Howarth et al., 2006; Kant & Graubard, 2005).
    • When available, healthy food – especially fresh produce – is often of poorer quality in lower income neighborhoods, which diminishes the appeal of these items to buyers (Andreyeva et al., 2008; Zenk et al., 2006).
    • Low-income communities have greater availability of fast food restaurants, especially near schools (Fleischhacker et al., 2011; Larson et al., 2009; Simon et al., 2008). These restaurants serve many energy-dense, nutrient-poor foods at relatively low prices. Fast food consumption is associated with a diet high in calories and low in nutrients, and frequent consumption may lead to weight gain (Bowman & Vinyard, 2004; Pereira et al., 2005).

Dementia

  • Studies reviewed in the report Nutrition and Dementia have shown that up to 45 per cent of those with dementia experience clinically significant weight loss over one year, and up to half of people with dementia in care settings have inadequate food intake.
  • People with memory loss may not remember to eat, or may have forgotten that they’ve already eaten.
  • Problems with cognition including memory loss, errors in judgment and reasoning, and insight into his or her own deficits may result in not preparing food safely or making healthy food choices.
  • Sensory processing issues:  texture aversion, sound sensitivity, psychomotor agitation, visual disturbances, sensory-seeking or sensory-avoiding behaviors.
  • Difficult behaviors: hallucinations, delusions, repetitive behaviors, agitation, apathy, paranoia

Aging + Povery + Depression = The Triple Threat of Malnutrition

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