Guarding Against Malnutrition in Care Homes: Spotting Early Signs and Using Nutrition to Combat Frailty
By Zoe Cottrell, registered dietitian, member of the British Dietetic Association and registered with the Health and Care Professions Council
Malnutrition remains a significant issue in care homes, where the elderly are particularly vulnerable. As a registered dietitian working in the community and in hospital wards, often with elderly people who have experienced fall, I wish more people knew about the prevalence of malnutrition and how to combat it before they ended up in hospital.
Recent statistics paint a stark picture: Around one in 10 people over the age of 65 are malnourished or at risk of malnutrition , and this figure rises alarmingly to 45% among those in their 90s. According to the British Association for Parenteral and Enteral Nutrition (BAPEN) , malnutrition costs the UK approximately £23.5 billion annually, with older adults being disproportionately affected.
As the population ages, addressing malnutrition and its associated complications, such as frailty and sarcopenia, becomes ever more critical. By focusing on early detection and strategic nutritional interventions, including the use of protein, care homes can play a vital role in safeguarding the health of their residents.
Spotting the Early Signs of Malnutrition
The first step in combating malnutrition is recognizing its early signs. The Malnutrition Universal Screening Tool (MUST) is a valuable resource for this purpose, enabling caregivers to systematically assess the risk of malnutrition in residents by considering factors such as Body Mass Index (BMI), unintentional weight loss, and the impact of acute illness on nutritional intake.
Key Early Signs to Monitor:
1. Unintentional Weight Loss: A significant early indicator of malnutrition is unintentional weight loss. Regularly monitoring residents’ weight and comparing it to previous measurements is essential. A loss of even 5% of body weight over a few months can signal malnutrition and warrants immediate attention.
2. Decreased Appetite: A reduced appetite is often a precursor to malnutrition. Residents may skip meals, eat smaller portions, or show a lack of interest in food. It’s important to understand the reasons behind these changes, which could be linked to dental issues, depression, or medication side effects.
3. Physical Changes: Signs such as muscle wasting, thinning hair, dry skin, or dental problems may indicate nutritional deficiencies. These physical symptoms are often subtle but crucial indicators of potential malnutrition.
4. Fatigue and Weakness: Increased tiredness or difficulty performing daily activities can be related to inadequate nutrition. This could also signal the onset of sarcopenia, where the loss of muscle mass and strength makes everyday tasks increasingly challenging.
The Role of Nutrition in Preventing and Managing Frailty
Frailty, a condition characterized by decreased strength, endurance, and physiological function, is closely linked to malnutrition and is a major concern in care homes. Proper nutrition is key to preventing and managing frailty, particularly through the adequate intake of protein, which is essential for maintaining muscle mass and function.
Strategies for Nutritional Interventions:
1. Prioritize Whole Foods: Ensuring a diet rich in whole foods is foundational. Protein-rich foods like eggs, lean meats, fish, dairy products, and legumes should be emphasized, as they not only support muscle health but also provide essential vitamins and minerals that contribute to overall well-being.
2. Incorporate Protein Supplements When Necessary: In cases where residents struggle to meet their protein needs through diet alone—perhaps due to a lack of appetite or difficulty chewing—protein powders or fortified drinks can be effective. These supplements can be easily added to meals, snacks, or beverages, ensuring that residents receive the protein they need without overwhelming them with large portions of food.
3. Distribute Protein Throughout the Day: Research shows that distributing protein intake evenly across all meals is more effective for muscle protein synthesis than consuming large amounts at a single meal. Caregivers should ensure that residents receive adequate protein at breakfast, lunch, and dinner to maximize the benefits for muscle maintenance and frailty prevention.
Addressing Barriers to Adequate Nutrition
While boosting protein intake is essential, we should also address the barriers that may prevent residents from consuming enough nutrients. Factors such as taste preferences, difficulties with swallowing, or digestive issues can all impact nutritional intake. Caregivers should work closely with dietitians to develop personalized nutrition plans that accommodate these challenges, potentially incorporating protein powders and other supplements in palatable and easy-to-digest forms.
Nutrition is key to Increasing Healthspan
Malnutrition in care homes is a pressing issue that requires vigilant monitoring and proactive management. While the numbers alone tell us the stakes are high, intervention is more than about reducing costs. The ability to stand up from a chair unaided allows our elderly residents independence. By spotting the early signs of malnutrition and implementing strategic nutritional interventions, caregivers can help prevent and manage frailty, significantly improving the quality of life for residents. By addressing malnutrition and frailty head-on, care homes can help residents not only avoid the adverse effects of these conditions but also thrive in their later years.
