Nourishing Your Golden Years

MALNUTRITION among Malaysia’s elderly population is a matter of immediate concern as it brings forth a multitude of challenges which include physical and health consequences. Elderly individuals experiencing malnutrition often have weakened immune systems, making them more susceptible to infections. Additionally, they face difficulties in wound healing, muscle wasting and an increased risk of frailty. These health issues not only diminish their quality of life but also drive up healthcare costs. A 2021 study revealed malnutrition is prevalent among Malaysia’s elderly with rates at 7.3%, and that the risk of malnutrition is even higher at 23.5%. These statistics highlight the gravity of the situation and emphasise the urgent need to address this issue for the well-being of Malaysia’s elderly population.

Factors affecting elderly nutrition

Damansara Specialist Hospital 2 dietitian Gan Wan Jing reveals, “Many elderly Malaysians face financial constraints that limit their access to nutritious food. This is particularly true for those who rely solely on a fixed income, such as pensions or social welfare. The rising cost of living and healthcare expenses can further strain their budgets, making it difficult to afford a well-balanced diet.” The sense of taste and smell often decline with age, resulting in a decreased appetite and a lessened enjoyment of food in the elderly.

Moreover, problems like tooth loss or dental difficulties can make chewing troublesome, especially for hard or fibrous food. This prompts them to avoid foods that are difficult to eat but rich in nutrients. Besides this, limited mobility due to physical disabilities or chronic health conditions is a significant factor contributing to poor nutrition among the elderly. These limitations hinder their ability to shop for groceries, prepare meals or access community programmes offering food assistance.

Loneliness and social isolation also play a role in malnutrition among the elderly. These factors reduce their motivation to prepare and consume meals, ultimately resulting in inadequate nutrition. Mental health challenges, particularly depression, can also impact appetite and eating habits. Elderly individuals dealing with depression may lose interest in food, experience fluctuations in weight and neglect proper nutrition.

Gan also notes, “Malaysian cuisine often includes rice and other carbohydrate-rich foods as staples. While these foods are a significant part of the diet, excessive consumption without a balance of other nutrients can contribute to malnutrition.” She further elaborates on how urban areas are witnessing a shift towards processed and convenience foods, which may lack the nutritional value of traditional homemade meals.

Assessing the Signs 

In addressing malnutrition among the elderly, the crucial first step is to effectively identify and assess its signs, and dietitians play a crucial role in this process. Components that a dietitian will assess during nutrition assessment include: 

1. Medical history: Examining the individual’s medical history, including chronic illnesses and recent hospitalisations or surgeries that may have affected their nutritional status. 

2. Weight changes: Monitoring weight fluctuations over time, particularly unexplained weight loss exceeding 5% of body weight in one month or 10% in six months.

3. Laboratory tests: Performing blood tests for nutritional markers such as serum protein (prealbumin, haemoglobin and haematocrit). Dietitians may suggest micronutrient testing if specific deficiencies are suspected (e.g., vitamin D, vitamin B12).

4. Nutrition-focused physical examination: Performing a comprehensive physical examination to identify signs such as fat or muscle wasting, oedema (swelling), chewing or swallowing difficulties, and changes in hair face, eyes, lips, nails or skin which may indicate micronutrient abnormalities.

5. Functional assessment: Assessing the individual’s functional status and daily living activities, as malnutrition can lead to weakness and reduced physical function.

6. Dietary assessment: Reviewing the individual’s dietary intake and preferences, including appetite and any challenges with chewing or swallowing. Dietitians may also conduct a 24-hour dietary recall or food diary to assess recent food intake.

7. Psychosocial evaluation: Considering psychological and social factors like depression, isolation and cognitive impairment, which can influence dietary choices.

Gan explains, “Based on the assessment findings, dietitians will help develop individualised nutrition plans to address the issues faced by elderly individuals. This is why a dietitian asks a lot of questions during diet counselling. Don’t be surprised by it.”

Adapting MNT to preferences  

One effective approach to combat undernutrition in the elderly is Medical Nutrition Therapy (MNT), which involves evidence-based dietary interventions to manage and treat various medical conditions. Gan emphasises, “Adapting MNT to meet the cultural and dietary preferences of elderly Malaysians is essential for its effectiveness. Dietitians should always discuss the individual’s food preferences and dislikes. Besides that, they must work collaboratively with patients to identify foods they enjoy and find appealing.

This can help create a meal plan that patients are more likely to follow.” Malaysian cuisine is rich and diverse, with many traditional dishes. “Dietitians can help patients modify these traditional recipes to make them more nutritious while still preserving cultural flavours and familiarity. Depending on the individual’s medical conditions and dietary habits, focus on one or two achievable dietary goals at a time. This approach ensures that changes are gradual and sustainable, taking into account the individual’s readiness for change,” says Gan.

Other strategies include:

• Using clear and simple language in nutrition education materials and counselling sessions, providing examples and analogies to convey information effectively.
• Communicating in the patient’s preferred language or dialect to overcome language barriers.

While Malaysia lacks specific national healthcare policies or guidelines exclusively promoting MNT in aged care facilities, collaborative efforts among healthcare professionals and organisations can significantly improve the nutritional outcomes of elderly people.

Enhancing Elderly Nutrition Care 

As a valuable suggestion to enhance the prevention and treatment of malnutrition among the elderly in aged care facilities, Gan proposes the adoption of routine nutrition screening procedures. This helps identify seniors at risk of malnutrition, allowing timely dietitian referrals for personalised care plans. Nutrition education programmes for elderly residents and their caregivers also play a crucial role in emphasising the significance of maintaining the health of elderlies through a balanced nutrition and diet.

Raising public awareness through campaigns, educational materials and workshops can also help family members and caregivers understand their role in supporting proper nutrition and MNT for their elderly loved ones. Furthermore, it is crucial to advocate for government policies that prioritise elderly nutrition in aged care facilities.

This involves allocating sufficient funding and resources such as nutritious foods, kitchen equipment and staff training to support proper nutrition. Additionally, advocating for the inclusion of dietitians as essential members of the healthcare team in aged care facilities is vital to achieving overall improvement in elderly health. To further enhance the nutritional care of its elderly population, Malaysia can draw inspiration from successful practices in countries such as Singapore.

These may include implementing meal delivery services specifically for elderly individuals, community-based nutrition programmes and volunteer initiatives designed to combat social isolation and promote healthy eating habits. Such practices have demonstrated positive effects on the overall health and well-being of elderly individuals and can serve as valuable models for Malaysia to consider. Gan assures, “By advocating for the importance of proper nutrition among the elderly, Malaysia can work toward enhancing the nutritional care and well-being of its elderly population.”

For more information, contact 03-7717 3000.