WHOLE: Wellbeing and Healthy Choices for Older Adults and their Carers

Transcription

1 WHOLE: Wellbeing and Healthy Choices for Older Adults and their Carers Malnutrition in Older Age This dietary information fact sheet is intended for informational purposes only. It is not a substitute for proper medical diagnosis or dietary advice given by health professionals. The information was correct at time of publication in Nutritional Content by Aisling Snedkar RD Editing and design by Emma Murtagh Proofreading by Amanda Ramirez and Rose Snyder On behalf of ProActivate Ireland Project number: DE02-KA This project has been funded with support from the European Union. This publication reflects the views only of the author, and neither the Commission nor the National Agency can be held responsible for any use which may be made of the information contained therein.

2 WHOLE: Wellbeing and Healthy Choices for Older Adults and their Carers Malnutrition in Older Age INTRODUCTION WHOLE: Wellbeing and Healthy Choices for Older Adults and their Carers Malnutrition in Older Age Malnutrition can be a serious problem among older people and can have many negative health impacts. It often presents itself with acute and chronic illness, but can also happen insidiously as we age. Early detection and intervention is vital in order to minimise its negative effects. This fact sheet aims to help you identify signs and symptoms of malnutrition and provide methods for coping with it. STEPS FOR IMPLEMENTING A NUTRITIONAL INTERVENTION 1. Screening and identifying malnutrition 2. Creating an intervention 3. Continuous monitoring and assessment of nutritional state 1

3 1. SCREENING AND IDENTIFYING MALNUTRITION SIGNS AND SYMPTOMS OF MALNUTRITION Low mood, depression, reduced cognitive function; Reduced energy levels and, as a result, reduced self-care behaviours; Reduced quality of life; Reduced independence and ability to carry out daily activities; Slow recovery from illness and impaired wound healing; Depressed immune system and increased risk of illness and infection; Increased risk of falls due to loss of muscle mass, frailty, and reduced mobility. IDENTIFYING MALNUTRITION It is common for older people to experience a decrease in appetite. Sense of taste and smell can also change, making food less interesting. However, it is still very important to eat a healthy and balanced diet in order to be wellnourished and maintain independence and quality of life. WHOLE: Wellbeing and Healthy Choices for Older Adults and their Carers Malnutrition 2

4 QUESTIONS TO CONSIDER IF YOU ARE CONCERNED BY LACK OF APPETITE Have you lost weight unintentionally? If you do not have a weighing scales to check this, you may be able to see if your clothes, belts, or dentures have become loose. Are you feeling tired and lethargic? Have you had a change in your mood? Are you feeling low? Are you disinterested in food and drinks? Do you find it easy to skip meals? Have you lost your muscle strength? WHOLE: Wellbeing and Healthy Choices for Older Adults and their Carers Malnutrition in Older Age TWO SIMPLE STEPS TO ASSESS IF YOU ARE MALNOURISHED STEP 1: CALCULATE YOUR BMI Your BMI gives a basic guide to whether you are at a healthy weight for your height. It is defined as a person's weight in kilograms divided by the square of his height in meters (kg/m2). BMI below 18.5: underweight BMI : lean for height (at risk) BMI : healthy weight BMI : overweight BMI above 30.0: obese People of South Asian origin are considered overweight if their BMI is greater than 23 because they are at greater risk of diabetes and heart disease. Your GP or health care professional can also help you calculate your body mass index! 3

5 *Created by User:InvictaHOG using gnuplot and Adobe Illustrator 9/23/06, released into public domain (Created by User:InvictaHOG) [Public domain], via Wikimedia Commons STEP 2: IDENTIFYING UNINTENTIONAL WEIGHT LOSS Have you had 5% to 10% unintentional weight loss? If your BMI is healthy, but have lost weight unintentionally because of a reduced appetite, you are still at risk of malnutrition. Weigh yourself regularly and if you lose 5% to 10% of your usual weight, or 2 kilograms, unintentionally, it should be brought to the attention of your generational practitioner (GP). WHOLE: Wellbeing and Healthy Choices for Older Adults and their Carers Malnutrition 4

6 2. CREATING AN INTERVENTION TIPS FOR DEALING WITH A SMALL APPETITE WHOLE: Wellbeing and Healthy Choices for Older Adults and their Carers Malnutrition in Older Age Try to have three main meals and three nourishing snacks that are evenly spread throughout the day; Eat when you feel at your best; forcing yourself to eat can make a poor appetite worse; Remember, food provides energy. If you are too tired to eat, try to have a couple of bites and it may give you the energy you need to eat more later; Avoid too many choices; loss of appetite may occur while trying to decide what to eat; Include 2 3 portions of protein-based food each day, e.g. meat, fish, poultry, eggs, nuts, beans, or tofu; Include a starchy carbohydrate food at each meal, e.g. pasta, bulgur, quinoa, rice, bread, or potatoes; Eat some fruit and vegetables every day; they can be fresh, frozen, tinned, or dried; Keep it simple! Meals like tinned fish or beans on toast with some salad or vegetables or a glass of orange juice can provide a balanced nutritional intake; Structure at least two meals to include a source of protein, a starchy carbohydrate, and a vegetable each day; Stay hydrated by drinking 6 8 glasses of fluids each day; If malnutrition is an issue, use fluids as a means of taking in more calories. Choose milky coffee, hot chocolate, smoothies, or milkshakes. See our fact sheet on Increasing Calorie Intake for more details; If preparing meals is too tiring or if cooking smells impact appetite negatively, try to 5

7 avoid cooking and consider other options, like meal delivery services for older people; Try and get a little bit of fresh air before eating and, if possible, move around, in order to work up an appetite. WAYS TO MAKE FOOD MORE CONVENIENT On good days, make extra meals that can be frozen and reheated when you do not feel like cooking; If possible, eat out more often as this encourages a good appetite; Good quality convenience meals may also be helpful; buy a variety for when you are too tired to cook; Use a meal delivery service for older people if available. USING HIGH CALORIE INGREDIENTS People who are malnourished can try to get more calories into their diets in a variety of ways: Avoid using low fat or diet versions of foods, e.g. exchange diet yogurt or skimmed milk for their full fat versions; Add extra butter or margarine to mashed vegetables, sauces, pasta, bread, crackers, etc.; Add extra mayonnaise to sandwiches and salads; Add extra oil when cooking or drizzle over pasta, bread, dips, etc.; Mix a teaspoon of rapeseed oil into other foods like yoghurt or cereal, to increase calorie content; WHOLE: Wellbeing and Healthy Choices for Older Adults and their Carers Malnutrition 6

8 WHOLE: Wellbeing and Healthy Choices for Older Adults and their Carers Malnutrition in Older Age Add cream into hot drinks like coffee, pour it over cakes, pies or tinned fruits, and add it to soups and sauces; Use fortified, full-fat milk (see our Increasing Calorie Intake fact sheet) in cereals, porridge, hot drinks like coffee or hot chocolate, sauces, mashed potatoes, milkshakes, and smoothies; Add sugar to hot drinks and cereals. This is not recommended for those with diabetes; Add maple syrup, jam, honey, or golden syrup to rice pudding, porridge, pancakes, crumpets, or toast. This is not recommended for those with diabetes; Add cheese to sandwiches, baked potatoes, pasta dishes, omelettes, scrambled egg, or baked beans, or have as a snack with crackers; Consult our Increasing Calorie Intake fact sheet for more tips. If after introducing these changes, there is no change to your weight and overall nutritional status or there is continued weight loss or if these suggestions have already been introduced and you are still underweight, it is important to consult a clinical dietician for nutritional drinks with added calories. SNACKS Below is a list of snacks that can be eaten in addition to main meals to increase calorie intake throughout the day. 7

9 Scone or toast with jam and butter Small bowl of cereal with fortified Hot chocolate milk Milky coffee 2 plain digestive biscuits Sponge cake with full-fat custard Handful of nuts Pot of thick, creamy yogurt A packet of raisins or a handful of Rice or semolina pudding made with figs or dates fortified milk Rice cakes or crackers with cheese, Mini muffin or cupcake paté, or hummus Stewed, chopped, or tinned fruit with Scrambled eggs made with fortified thick, creamy yogurt or ice cream milk Flapjacks Cereal bar or breakfast bar Glasses of fortified milk Bowl of soup with bread 3. Continuous monitoring and assessment of nutritional state Weigh yourself up to 3 times per week and calculate an average. If your weight is increasing by 0.5 kg 1 kg per week, you are on track. If the changes suggested in this fact sheet have been implemented and weight loss continues, or weight gain is very slowly, consult your doctor and a dietician. Try keeping a food diary for four days. This may help you to be conscious to eat on time and not miss main meals or snacks and will let you know if you do miss anything. For continuous monitoring, keep the diary for four days every two weeks. Showing the food diary to a health care professional will help them to assess your dietary intake. They may undertake additional measures such as measuring your mid upper arm muscle circumference (MUAMC), taking blood tests, or testing your hand grip strength. WHOLE: Wellbeing and Healthy Choices for Older Adults and their Carers Malnutrition 8