We all have days where we just don't feel like eating. But in older people, that might be every day - and the results can be disastrous. Malnutrition contributes to depression as well as more hospital admissions and slower recovery from illness. How can you help if you think a loved one is affected?
How do I know if mum might be malnourished?
You may need to do some detective work if you think your loved one is losing weight but they deny it. Is the food from Meals on Wheels (also known as Meals at Home) ending up uneaten in the bin? It's worth bearing in mind that your mum might be terrified of losing her independence, and may ignore the signs that's she's struggling. Remember - she doesn't have to be painfully thin to be malnourished.
When doctors look at whether someone might be malnourished, they often use a scoring system called MUST to decide how high their risk is. You may be able to estimate if the person you're worried about is severely underweight without using the scales:
- BMI or body mass index - a ratio of height to weight. Under 18.5 is severely underweight (score 2); 18.5-20 is underweight (score 1); 20-25 is 'ideal' weight; over 25 is overweight or obese
- Weight loss. It's quite possible to be malnourished without being underweight, because you may be short of vitamins and minerals. Weight loss of more than 10% in the last 3-6 months scores 2; 5-10% scores 1
- Have they been severely ill? If yes, score 2. This is most commonly seen in patients ill enough to be in hospital - if they haven't eaten, or are unlikely to eat anything worth mentioning, for five days in a row. However, problems with swallowing (eg after a stroke), tummy troubles and other medical conditions can make malnutrition more likely.
- Add the scores from these three areas together. A score of two or more puts them at high risk of malnutrition - do speak to the doctor.
MEALS ON WHEELS - teasing out the causes of not eating
Because there are so many reasons for not eating and other conditions, doctors often use lists that remind them of all the possible causes - the first letter of the causes adds up to a 'mnemonic' to help us remember everything! MEALS ON WHEELS is a good example.
If someone you love is off their food, ask yourself if it could be due to:
M edicines (lots of medicines have nausea, tummy pain or changes in bowel habit as a side effect) - it's worth considering if they've recently had a new medication prescribed. There may be a patient information leaflet with the medicine which lists the side effects, or you can speak to your pharmacist
E motional problems (especially depression) - change in appetite is a common feature of depression
L ate life mental health problems (confusion and anxiety get more common as you get older, and these can affect both appetite and ability to buy food or prepare meals)
Swallowing problems (especially after a stroke etc)
O ral factors (do their dentures fit? Do they have painful teeth?)
N o money (sadly, older people often worry about money and living on white bread and tea may be their way of saving the pennies)
W andering (are they getting dementia?)
Hyperthyroidism or hypothyroidism (problems with the thyroid gland, which affects how fast the body 'ticks over')
E nteric (gut) problems - cancer is by no means inevitable, but we do need to think about it
E ating problems (can they feed themselves properly?)
L ow-salt, low-fat diet (some older people react to health advice to reduce heart disease or high blood pressure and take it too far)
S ocial isolation (can they get out to get foods they like?)
Getting help for a loved one when they're scared to admit they need help
Lots of services offer practical support to those with health problems, including possible malnutrition. However, older people can be fiercely independent, so don't spring visits from social services on them without telling them, and do make sure they understand you have their welfare at heart.
Unless your loved one has dementia, their doctor can't give out any information about them to you without their permission. However, even if they can't talk back about your parent's case, they can certainly take note of your concerns if you get in touch. If they suspect malnutrition, they may do a formal malnutrition assessment themselves or refer your loved one to a dietician. The dietician can look at all the factors that might be stopping them from eating properly and see if these can be addressed. It's always best to tackle risk of malnutrition with food and drink rather than medical prescriptions if possible. Your dietician can help you think outside the box in terms of getting more calories in by adapting their diet. If that's not enough, their doctor may be able to prescribe oral nutritional supplements if the dietician thinks they're necessary.
With your parent's permission, you can contact social services directly to ask for a full assessment of their needs, including meals on wheels, shopping, help with feeding etc. They may also know about voluntary services in the area.With thanks to 'My Weekly' magazine where this article was originally published.
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. EMIS has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions.