Something to Chew On Educational Program Aims to Tackle Malnutrition in Seniors

Are area seniors getting enough to eat?
Studies say probably not — and it’s an issue that has captured the attention of Greater Springfield Senior Services (GSSS), which is teaming up with the Springfield College Center for Wellness Education and Research this month for a program called “Elder Nutrition: A Prescription for Health.”
The program — offered to people who work with seniors, including dietitians, social workers, nurses, and other health and social-services professionals — will take place on Wednesday, March 12 from 2 to 4:30 p.m. at GSSS.
“From what we’ve heard from Greater Springfield Senior Services, there was a big gap in understanding senior nutrition among clinical and social workers who work with senior individuals — many don’t really understand what good elder nutrition is and how they can help their clients and patients have better nutrition,” said Sara Gregory, assistant director of the Center for Wellness Education and Research.
The main goal of presenters, said keynote speaker Dr. Donna Chapman, is simply to highlight the importance of good nutrition for the elderly.
“It’s really important for them to maintain their independence,” said Chapman, assistant professor of Exercise Science and Sport Studies at Springfield College. “Once their nutritional status goes down, if something like a fall lands them in the hospital, being malnourished on top of that makes it harder to recover from surgery and other things they’ll encounter down the road.”
Mary Jenewin-Caplin, director of the Area Agency on Aging at GSSS, said it can be challenging for anyone to maintain a properly balanced diet. But while special nutrition practices are commonly accepted for, say, infants and children, the nutritional needs of seniors are not as widely known.
“It is critical that seniors get the right nutrition for their changing dietary needs, as vitamin or nutritional deficiencies can contribute to health problems,” she told HCN. “Dr. Chapman will cover the unique nutritional needs of seniors and some possible solutions.”
These changing needs include lower metabolism and reduced activity; dental problems and gastrointestinal changes; changes to sense of smell and taste that can affect the enjoyment of food; progressive loss of lean body mass — which, while a natural part of aging, can be exacerbated by malnutrition, illness, and injury — and psychological changes that can decrease appetite.
“There is a clear connection between nutritional intervention and positive health outcomes,” Jenewin-Caplin noted.
Digesting the Numbers
Malnutrition among seniors is widespread, but it’s difficult to get a handle on the exact scope of the problem. A study conducted in 2006 by Ellen Furman, now associate director of Graduate Nursing Programs at American International College, noted that some 5{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} to 10{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of elderly people living in the community are malnourished, while about 60{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of hospitalized adults age 65 and up, and perhaps more than that in long-term-care facilities, are experiencing malnutrition.
Citing that study, a 2010 Journal of Nursing article stated that “malnutrition impacts morbidity, mortality, hospital length of stay, functional disabilities, and physical complications. Malnutrition can cause increased infection, electrolyte imbalances, altered skin integrity, anemia, weakness, and fatigue.”
But when Meals on Wheels of Rhode Island claimed, in a fund-raising letter last year, that “half of all hospitalized seniors are suffering from malnutrition so severe that it either caused their illness or it prevents them from getting better,” PolitiFact was skeptical of the allegation. The fact-checking service contacted Furman, who noted that “what is so frustrating when trying to quote prevalence rates for undernutrition in hospitalized older adults is that every study has different rates dependent upon setting and population samples.”
Still, she cited a well-regarded 2010 article in the Journal of the American Geriatrics Society, which used a pool of about 4,500 people, with a mean age of 82 years old, and found that about 40{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} were malnourished — certainly a significant number.
According to the Mayo Clinic, malnutrition in older adults can lead to various health concerns, including a weak immune system, which increases the risk of infections; poor wound healing; muscle weakness, which can lead to falls and fractures; and further disinterest in eating or lack of appetite, which only makes the problem worse.
While the causes of malnutrition might seem straightforward — too little food or a diet lacking in nutrients — in reality, the condition is often exacerbated by a combination of physical, social, and psychological issues, the clinic notes. These include:
Health concerns. Older adults often have health issues that can lead to decreased appetite or trouble eating, such as chronic illness, use of certain medications, difficulty swallowing or absorbing nutrients, or trouble chewing due to dental issues. A recent hospitalization might be accompanied by loss of appetite or other nutrition problems. In other cases, a diminished sense of taste or smell decreases appetite. Dementia also can contribute to malnutrition.
Restricted diets. Dietary restrictions — such as limits on salt, fat, protein, or sugar — can help manage certain medical conditions, but might also contribute to inadequate eating.
Limited income. Some older adults might have trouble affording groceries, especially if they’re taking expensive medications.
Reduced social contact. Older adults who eat alone might not enjoy meals, causing them to lose interest in cooking and eating.
Depression. Grief, loneliness, failing health, lack of mobility, and other factors might contribute to depression, causing loss of appetite.
Alcoholism. Too much alcohol can interfere with the digestion and absorption of various nutrients. In addition, nutrients are lacking if alcohol is substituted for meals.
Recognizing how varied the causes of malnutrition are, the March 12 event will also feature several area senior-living professionals who will discuss various ways to help older people eat more healthfully. These cameo presentations include:
“Spice of Life,” by Beth Edelberg Cardillo, executive director of Armbrook Village Retirement Community;
“Eating for Energy,” by Lisa Normile, a registered dietitian with MercyLife;
“Community Gardening Enhances Meal Programming,” by Laurie Cassidy, executive director of the West Springfield Council on Aging; and
“Socialization Improves the Dining Experience,” by Linda Galarneau, a nutritionist with Greater Springfield Senior Services.
“Nutrition can really impact health,” Chapman said. “We know a lot of elderly people don’t eat as much as they need to, whether it’s difficulties making their own meals, or not being connected to support services out there, things like Meals on Wheels.
“We’ll talk a little bit about how seniors can maximize their nutrition, to keep them independent and as healthy as possible,” she continued. “We’ll try to offer practical advice. For instance, with their body changes, when they lose skeletal muscle, we want to make sure they get enough protein, so they don’t start losing muscle mass.
“Also, we’re talking about people on limited incomes or food stamps,” she added. “We know there’s a very vulnerable population in the Springfield area, people on low incomes, so we’ll talk about how to stretch their money and maximize their nutritional status.”
To Their Health
Gregory said it’s important to identify some of these challenges in order to promote nutrition in the elderly population. “It seems to be a big problem — elderly individuals not getting adequate nutrition, not enough calories, and not enough quality of those calories. They really don’t understand how to eat well, and it affects their overall health and function.”
The program, she added, “will be useful for people in different professions, whether working with elder individuals in a clinical setting or social workers doing a home visit.”
Danielle Maher, student nurse, and Carol Eliadi, chief nursing officer, at the Massachusetts College of Pharmacy and Health Sciences in Worcester, recently wrote in RN Journal that home-care workers are on the front lines of the nutrition battle because living alone, especially for men, results in the decreased intake of food. Meanwhile, factors ranging from culture and religion to allergies and, yes, poverty can lead to more restrictive diets.
“These restrictive diets increase the risk for malnutrition, especially for protein malnutrition,” they noted. “Medical factors such as dementia, polypharmacy, chronic illness, and depression can cause malnutrition in the elderly population as well. Dementia and cognitive disabilities can cause self-neglect and decreased food intake.”
In other words, it’s a widespread problem with a host of causes.
“Even taste perception changes over time as people age; they have decreased ability to identify certain smells and tastes,” Chapman said. “So when people are preparing food for the elderly, we’ll have some tips to make it easier to enjoy meals. They can use a variety of spices to help them pick up flavors more readily.
“Other things are related to textures of food,” she added. “Almost a quarter of older adults are missing some teeth, and that can impair their ability to chew food. So we need to make sure they’re not getting overcooked meats, for example.”
Maher and Eliadi agree that more information for caregivers is better. “As the research statistics indicate, not only is malnutrition prevalent in the elderly, it is also frequently misdiagnosed or unrecognized. Many nurses and other healthcare professionals are not properly screening or assessing malnutrition in the elderly.”
Area elder-care leaders hope to change that trend with an afternoon of education on March 12. The cost is $5, plus $10 for earning three continuing-education credits. Space is limited. More details and the registration form may be found at www.gsssi.org.