Malnutrition is the main risk of hospitalization of the elderly at home. But it concerns everyone. Contrary to popular belief, you can be overweight and malnourished! In France, 2 million people suffer from malnutrition according to the Francophone Society of Clinical and Metabolic Nutrition. It concerns 1 in 10 elderly people who live at home and 4 in 10 people with Alzheimer’s disease, according to the High Authority of Health. 

When can we talk about malnutrition?

Malnutrition definition

Malnutrition is a silent disease. It is the consequence of an imbalance between the body’s needs and nutritional intake. It can be linked to:

• Insufficient food intake compared to needs: in the event of prolonged loss of appetite, for example;
• The increased body needs: in cases of stress, trauma, and illness;
• Insufficient intake is associated with increased needs.

To diagnose malnutrition, the criteria differ depending on age (children, adults, or people aged 70 or over). In all cases, it is based on the simultaneous presence of 2 criteria:

• A weight-related criterion such as weight loss, body mass index (BMI), or reduction in muscle mass;
• A criterion linked to the cause: a significant reduction in food intake for more than a week, any reduction in intake for more than 2 weeks, or a reduction in the absorption of nutrients, or a situation of aggression linked to a pathology for example.

The spiral of malnutrition

Malnutrition depletes the body’s reserves: it’s a real spiral! The sooner we intervene, the easier it is to go backward. We must therefore act as quickly as possible to avoid loss of autonomy and a reduction in quality of life.

Malnutrition has many consequences. It can lead to weight loss, a general state of fatigue, falls and fractures, digestive disorders, a worsening of the prognosis of pathologies already present, bedsores, etc.

Which patients are most at risk of malnutrition?

Anyone can be affected by malnutrition! Children who have a break in their growth curve, people who have difficulty chewing or swallowing, people who no longer have the strength to go shopping or cook or people with illnesses such as cancer who feel nauseous because of their treatment.

What are the signs of malnutrition?

Malnutrition criteria

The 12 signs that should alert you according to Public Health France: 

• Have insufficient income

• Being affected by a loss of physical or psychological autonomy
• Being widowed, lonely, or depressed
• Have oral problems
• Follow a restrictive diet (in salt or sugar for example)
• Have difficulty swallowing
• Eat only two meals a day
• To be constipated
• Taking more than 3 medications per day
• Have lost 2 kg or more in the last month or 4 kg in the last 6 months
• Have an albumin level < 35 g/L and/or cholesterol level < 1.6 g/L
• To be affected by any disease

What promotes the occurrence of malnutrition?

In addition to the 12 warning signs of malnutrition, certain factors can have an impact on a person’s appetite (see  here article on loss of appetite)  :

• a monotonous diet;
• difficulties in obtaining fresh produce or cooking; 
• vision problems;
• a texture of the proposed food not adapted to the person’s abilities…

How to spot someone who is malnourished daily?

You support someone in their daily life, here are some simple points of reference that may interest you: 

• The refrigerator is empty, leftovers are piling up; 
• The food in the cupboards is no longer fresh; 
• The person skips meals;
• Meals are limited to a bowl of soup;
• Unfinished plates;
• Clothes that float; 
• Rapid weight loss;
• Tightened belt notches;
• Loss of strength: difficulty getting up from a chair, or climbing stairs.

Free online self-screening tool:  Outil-PARA-D.pdf (luttecontreladenutrition.fr)

Malnutrition in the elderly: who should I refer?

Do you suspect a case of malnutrition in yourself or a loved one? Who should you talk to?

Daily, the ideal is to discuss the subject with the treating physician who will be able to diagnose malnutrition and refer you to a dietician if necessary.

If you have difficulty accessing your doctor, the pharmacist is a local professional who can also advise you, or a nurse who provides home care, for example.

If you benefit from the support of a Home Help Service, talk to the professional who will be able to help you monitor your diet daily and implement actions to promote eating.

In any case, do not delay in acting and do not remain alone in the face of this suspicion.

Malnutrition, how to remedy it?

In the event of a loss of appetite, several solutions can be implemented: read here all the advice to implement in the event of loss of appetite:  Loss of appetite: stimulate desire and hunger!

In case of malnutrition, a doctor may prescribe Oral Nutritional Supplements (ONS). These are products that are enriched with energy, proteins, and also vitamins and minerals. Different forms exist: milk drinks, fruit juices, dessert creams, bread, biscuits, etc. They allow us to increase the intake in a small volume.

Better energy intake

Enriching homemade dishes is a good solution, to also increase energy intake. The secret weapon? Skimmed milk powder: practical to use, keeps well, and with an affordable purchase cost! How to use it? Add 1 to 2 spoons to soups, mash, preparations such as quiches, and dessert creams, and also to hot drinks or directly to fromage blanc. Other foods provide good quality proteins:

• Eggs: adding egg yolk to mash, adding an extra egg to recipes such as quiche, flans or cakes, deviled eggs, rolled omelets, etc.
• Hard cheeses like Emmental: grated in purées, risotto, or even diced in mixed salads;
• Processed cheeses: in the form of rillettes mixed with fish (sardine or mackerel rillettes) or even with vegetables (cheese and grated radish spreads), in mash, in soup;
• Dried vegetables: add a spoonful with the soup vegetables (lentils, red beans, etc.), chocolate and lentil cake
• Canned fish: tuna, sardines, mackerel, spread, as a filling for savory pies or cakes, in croquettes mixed with egg and white bread browned in a pan…

Continue physical activity

No rest for the brave! Contrary to popular belief, physical activity should be encouraged because it contributes to muscle strengthening. It is therefore essential to combat malnutrition. Different types of activities can be implemented depending on the person’s abilities. There are activities:

• Endurance physical exercises (fast walking, Nordic walking, going up and down stairs, running errands, gardening, housework, etc.) 
• Flexibility: stretching, housework, gardening, pétanque, tai chi, yoga…
• Muscle strengthening: brisk walking, going up and down stairs, DIY, cycling, carrying groceries, strengthening your thighs on a chair by straightening your legs, etc.
• Balance: gardening, pétanque, cycling, scootering, walking on tiptoes, etc. 

How to prevent malnutrition?

Having trouble cooking? Many tools can make everyday life easier and therefore encourage food consumption: jar openers, ergonomic cutlery and tableware, technical aids for preparing meals, such as for cutting food, etc.