Elder hunger: New efforts to combat common malnutrition among seniors
7th December 2015 · 0 Comments
By Nell Lake
Contributing Writer
(Special from WBUR Common Health/New America Media) – After her stroke, a 95-year-old woman in New York State found she could no longer taste her food. She was also unable to feel hunger, so she didn’t know when she was supposed to eat. As a result, the woman began losing weight, grew weak and wasn’t getting the nutrients she needed.
Enter Meals on Wheels, a national home-delivered meals program established by the 1965 Older Americans Act. The woman (who asked that her name not be used) began receiving meals at her home five days a week. This, she says, helped her remember to eat regularly. Her weight improved, and so did her general health.
Malnutrition like hers is surprisingly common. Six percent of elders living at home in the United States and in other developed countries are malnourished, according to a 2010 study in the Journal of the American Geriatric Society.
Skyrocketing Levels
The level of elder malnutrition doubles among those in nursing homes, where it is 14 percent, according to the same study.
And malnutrition skyrockets among elderly populations in rehabilitation facilities and hospitals: Various measures show an astonishing one-third to one-half of seniors are malnourished upon being admitted to the hospital.
“Malnutrition is a serious and under-recognized problem among older adults,” said Nancy Wellman, a nutritionist and instructor at Tuft University’s Friedman School of Nutrition Science and Policy. She spoke on a panel at the Gerontological Society of American’s (GSA) 68th Annual Scientific Meeting in Orlando, Fla., last month.
It’s not a new problem. But growth in the older population, and concerns about healthcare costs, have helped renew efforts by nutritionists and other advocates to establish screenings for malnutrition in medical settings, and to improve interventions that can prevent or reverse the issue.
Basically, malnutrition means not getting enough nutrients for optimal health. In older adults, the causes are complex, experts say. Illness, disability, social isolation, poverty — often a combination of these — can all contribute to malnutrition. An older person may become malnourished because she has trouble chewing or swallowing. The medications she takes may suppress appetite. She may be unable to get to a grocery store. She may live alone, be depressed or simply be uninterested in eating.
It’s important to know, said Connie Bales, a dietician and faculty member at Duke University Medical Center, that obese and overweight seniors can be malnourished, too. Eating too many calories doesn’t necessarily mean you’re getting the right nutrients for maintaining muscle and bone.
“One can be quite malnourished, yet not be skinny,” said Bales, who also spoke one the GSA conference panel.
High Costs and Food Insecurity
Whatever the cause, malnutrition leads to further trouble. It increases older adults’ risk of illness, frailty and infection. Malnourished people visit the doctor and are admitted to the hospital more often, have longer hospital stays and recover from surgery more slowly.
The association between malnutrition and hospitalization goes both ways, say Wellman and other experts: The sick are more likely to become malnourished, and the malnourished are more likely to get sick.
Thus, said elder advocate Robert Blancato, on the panel, improving nutrition among older people is important not just to their well-being and quality of life, but to containing healthcare costs. The malnourished generate bills of $2,000 to $10,000 higher per hospital stay than others do, according to findings in the Journal of the American Dietetic Association.
Another study published in the journal Clinical Nutrition found a threefold increase in medical costs among the malnourished. (Hospital stays can also cause or worsen elder malnourishment: Older patients often don’t eat well in the hospital, and doctors may prohibit them from eating or drinking in preparation for medical procedures.)
Not surprisingly, financial hardship is a central cause of elder malnutrition. According to a 2014 AARP Foundation report, nearly nine million older people in the United States can’t afford nutritious food. About one-quarter of low-income adults 65 and older say they’ve reduced the size of their meals or have skipped meals because they didn’t have enough money.
Senior Meals
Jeffrey Bubar might have been among them — his fixed income places him barely above the federal poverty line. Yet he’s well-fed.
One day in November, Bubar, 76, dug happily into a Sloppy Joe lunch with a baked potato and vegetables. He chatted with four other elderly men, also regulars at a congregate meals program in Northampton, Mass. — one of hundreds of such programs across the country. (Another provision of the Older Americans Act.)
Bubar — who has no family, lives alone and has no car — walks to the program every weekday. The meals provide him with both companionship and nourishment — sources of health and well-being that would otherwise likely elude him. “I like being with people,” he said.
His fixed income places him barely above the federal poverty line. Without the meals, food would make a much bigger “dent” in his budget, he says; and the program’s nourishment “helps keep my health up.” It’s a nutritional and social anchor in his otherwise isolated life.
But many eligible seniors don’t receive such benefits. The AARP report, for example, found that of those elders eligible for the Supplemental Nutrition Assistance Program (SNAP), only 13 percent receive the benefit.
It’s an important gap to address, said Lura Barber, director of Hunger Initiatives for the National Council on Aging, and there are many reasons for it. One, she said, is the “huge stigma” attached to food benefits.”
Older people worry, for example, that by receiving help they’ll take benefits away from children who need it. But, Barber added, “Seniors are also less likely than other age groups to know about the program, about how to apply, and [to know] that they might be eligible.”
Following hospital stays, these programs could also help patients recover from illness or surgery. Yet very few hospital patients receive information about nutrition benefits.
A recent GSA survey found that only six percent of hospitalized elderly received information about SNAP. Only three percent of hospitalized older people received information about group meals programs such as the one Bubar benefits from. And merely three percent learned about the availability of delivered meals to home-bound seniors.
Good Nutrition, Better Outcomes
Such lack of information is another problem worth addressing, Barber says. “There’s a huge gap in how we’re providing vulnerable older adults with help as they move from a healthcare setting” back to their homes. Even those simply “going to a doctor for a regular visit are not learning about [nutrition] programs.”
Rose Ann DiMaria-Ghalili, a nurse and researcher with Drexel University’s College of Nursing, said better nutrition can improve hospital outcomes and reduce hospital readmissions. She continued, “We know that weight loss increases the risk of 30-day readmission and that failure to thrive and weight loss are frequent reasons for readmission in surgical patients.”
Nancy Wellman stressed, “If you can’t eat well, you’re going to end up in a nursing home, or you’re going to end up back in the hospital.”
Two weeks ago, Bubar was looking forward to joining his friends at the congregate meals program for Thanksgiving. He’d already checked out the menu: “It’ll be turkey and whipped potatoes and butternut squash,” he said.
He expected that the program’s cook would make the pies right there in the kitchen, so Bubar was eagerly anticipating house-made pumpkin pie with whipped cream.
This article originally published in the December 7, 2015 print edition of The Louisiana Weekly newspaper.
