Combating Malnutrition in the Elderly: A Dietitian’s Perspective on Protein-Deficiency

By Zoe Cottrell, registered dietitian, member of the British Dietetic Association and registered with the Health and Care Professions Council

Malnutrition among the elderly, particularly those residing in care homes, is a prevalent and concerning issue that demands our attention. As a registered dietitian working on both medical and surgical wards, often with older people who had experienced a fall, I have seen too often the effects of low appetite on overall health in this vulnerable population.

In this article, I will delve into the latest statists on malnutrition among the elderly, explore the specific consequences of malnutrition with a particular focus on protein-deficiency, and provide practical advice on constructing menus that ensure optimal protein intake for residents.

The Alarming Rates of Malnutrition:
Malnutrition is a pervasive problem in care homes and among the elderly population at large. The British Association for Parenteral and Enteral Nutrition estimates 1.3 million over the age of 65 are affected by malnutrition or undernutrition. According to a recent survey on malnutrition from BAPEN covered in this publication, about 45% of all adults living in community settings, including care home were found to be at risk of disease-related malnutrition, and the data show the trend is getting worse.

Understanding Protein-Deficiency:
Protein is a fundamental nutrient crucial for maintaining muscle mass, promoting immune function, and supporting overall health, especially in the elderly. Protein-deficiency occurs when the body does not receive an adequate amount of protein to meet its physiological needs.

Studies show that adults over 50 years generally need between 1.2-1.5g per kg of body weight. For example, someone weighing 70kg needs 84-105g protein per day. The amount of protein older adults should be consuming is actually nearly twice the current recommended daily amount for adults in general.

In care homes, where meal planning and dietary choices can be strategically planned, we have an opportunity to counter the trend, which otherwise can lead to severe consequences.

Consequences of Protein-Deficiency:
Muscle Wasting and Weakness: Protein plays a vital role in preserving muscle mass. In the absence of adequate protein intake, elderly individuals may experience muscle wasting, known as sarcopenia, a process that begins around the age of 40 and accelerates after 75. Sarcopenia leads to weakness, decreased mobility, and an increased risk of falls and fractures. Without sufficient strength, individuals can’t stand up from a chair, and the ability to lead a full and independent life declines.

Compromised Immune Function: The immune system relies on protein to produce antibodies and other essential components. Protein-deficiency can compromise immune function, making elderly individuals more susceptible to infections and illnesses.

Delayed Wound Healing: Adequate protein is necessary for the repair and regeneration of tissues. Protein-deficient individuals may experience delayed wound healing, increasing the risk of infections and complications.

Impaired Cognitive Function: Protein is essential for the production of neurotransmitters that regulate cognitive function. Insufficient protein intake may contribute to cognitive decline and an increased risk of conditions such as dementia.

Building a Menu for Optimal Protein Intake:
Creating a well-balanced and protein-rich menu is imperative in addressing protein-deficiency among elderly residents in care homes. When ill, older people will require even higher amounts of protein.

Here are some practical tips for dietitians, caregivers, and kitchen staff:
Incorporate Protein Sources: Include sources of protein such as dairy, fish (including tinned), meat, eggs, beans, legumes, and nuts and seeds in daily meals. These options provide essential amino acids necessary for muscle maintenance. Unlike with fats and carbohydrates, your body can’t store protein for future needs. Ideally you should include good protein sources with every meal.

Fortify Snacks and Beverages: Enhance the protein content of snacks and beverages by incorporating protein-rich ingredients. For example, offer Greek yogurt with fruit, nut butter on whole-grain crackers, add grated cheese to meals, or serve protein-fortified smoothies. I always recommend incorporating protein into diet through food first, but there are times when people struggle to reach their recommended amount, especially when appetite is low. In these cases, a protein powder can help. Look for supplements that contain whey protein, a pure and complete form of protein containing all 20 amino acids. Whey protein supplements have high nutritional value and bioavailability, meaning the body absorbs it well.

Personalised Nutrition Plans: Recognize that each resident may have unique dietary needs. Develop personalised nutrition plans that consider individual preferences, allergies, and medical conditions to ensure optimal protein intake.

Educate Caregivers and Staff: Provide training to caregivers and kitchen staff on the importance of protein in the elderly diet. Foster an understanding of how dietary choices can impact overall health and well-being.

Addressing malnutrition among the elderly, with a specific focus on protein-deficiency, is a crucial step toward improving the quality of life for residents in care homes. By raising awareness, implementing practical strategies, and fostering a collaborative approach among caregivers and dietary professionals, we can make significant strides in combating malnutrition and promoting optimal health in our elderly population.