Malnutrition in older people: signs, causes and what helps

The NHS describes malnutrition as a serious condition that happens when your diet does not contain the right amount of nutrients. It means "poor nutrition" and can refer to undernutrition, not getting enough nutrients, or overnutrition, getting more than needed. In older people the concern is almost always undernutrition.

It is easy to overlook, because many people assume that eating less and losing weight is a normal part of getting older. The NHS says the opposite: weight loss is not an inevitable result of old age.

The main symptom is unintentional weight loss, although this is not always obvious. The NHS says you could be malnourished if you unintentionally lose 5 to 10% of your body weight within 3 to 6 months, your BMI is under 18.5 (although a person with a BMI under 20 could also be at risk), or your clothes, belts and jewellery seem to become looser over time.

• Reduced appetite or lack of interest in food and drink.

• Feeling tired all the time and feeling weaker.

• Getting ill often and taking a long time to recover.

• Wounds taking a long time to heal.

• Poor concentration.

• Feeling cold most of the time.

• Low mood, sadness and depression.

The NHS says anyone can become malnourished, but it is more common in people who have long-term health conditions that affect appetite, weight or how well nutrients are absorbed by the gut, such as Crohn's disease; have problems swallowing (dysphagia); are socially isolated, have limited mobility or a low income; or need extra energy, for example people recovering from a serious injury or burns.

Several of these apply more often with age, including limited mobility, social isolation and swallowing problems. The NHS also lists low mood and depression among the symptoms of malnutrition.

The NHS says a GP can check if you are at risk of malnutrition by measuring your weight and height and asking about any medical problems and any recent changes in weight or appetite. If they think you could be malnourished, they may refer you to a healthcare professional such as a dietitian to discuss treatment.

It encourages people worried about a friend or family member to encourage them to see a GP, since the person themselves may not notice or may minimise the problem.

Treatment depends on the underlying cause and how malnourished a person is. The NHS says you may be given advice to follow at home, supported at home by a dietitian or other healthcare professional, or in severe cases treated in hospital. A dietitian may create a tailored diet plan and suggest a healthier, more balanced diet, fortified foods that contain extra nutrients, snacking between meals, drinks that contain lots of calories and supermarket deliveries.

If these measures are not enough, taking extra nutrients as supplements may be recommended on the advice of a healthcare professional, with regular appointments to check that changes are helping. If someone cannot eat enough, for example because of swallowing problems, the NHS lists a nasogastric tube, a PEG tube into the stomach, or nutrients fed directly into a vein, usually started in hospital but sometimes continued at home.

The NHS says some people who are malnourished need extra care to cope with underlying issues such as limited mobility, which may include home care visitors who can help with shopping or cooking, occupational therapy to identify problems with daily activities, a "meals on wheels" or meals at home service, often provided by the local authority with a charge, and speech and language therapy to teach exercises for swallowing problems and advice on foods that are easy to swallow.

It also directs carers to information on how to feed someone you care for, and notes that the person's consent is needed for treatment when starting or stopping nutrition support, and that if they cannot consent professionals must act in their best interests following medical guidelines.

The NHS says the best way to prevent malnutrition is to eat a healthy, balanced diet with a variety of foods from the main food groups: plenty of fruit and vegetables, starchy foods, some milk and dairy or alternatives, and some sources of protein such as meat, fish, eggs and beans. People with a health problem that puts them at increased risk should speak to a GP or specialist because they may have more complex dietary needs or need supplements.

On the NHS, care starts with the GP or practice nurse and may involve a dietitian, community nursing and local authority care services. The NHS says supplements should only be taken on the advice of a healthcare professional.

Private dietitians can see people sooner and some families arrange paid carers or meal delivery services. Supplements and special products should be used with professional advice, because some have particular indications.