You greet a new client for a physical therapy or fitness assessment – Ms. J appears to be a “young” 75 year old with a recent hip replacement, who is excited to regain her strength. She smiles as she reports that her struggle with joint pain is now in the rear-view mirror and is relieved to have avoided weight gain with a strict diet. After all, she says she had to limit her exercise and had significant pain before and right after surgery and comments, “Now it’s time to build back my muscles!”
Concerns arise when Ms. J reports she actually lost 15 pounds over the past 6 months (over 10% of her initial body weight of 130 pounds). While her current weight may not seem like an issue (weight of 115 pounds for her height of 60” is within an acceptable range) it’s important to remember she’s likely lost more lean body mass than fat. And as you begin your assessment, you identify her muscle strength is well below average for her age and gender.
What do you do? Certainly, creating a strength-building and flexibility exercise plan is in order. But, is it possible that Ms. J is malnourished? Could her weakened state put her at risk for a fall or negatively impact her progress with physical therapy? What are important next steps?
When we think about malnutrition, the images that often comes to mind are the frail and elderly – and many times the need is for individuals to just eat more. But malnutrition can be caused by a host of factors, from chronic health conditions and use of medications, to one’s ability to shop for and prepare food. It’s about eating right for our age and ensuring the proper intake of protein, calories and other nutrients.
However, malnutrition can be a problem for both underweight and overweight individuals.
Good nutrition is a critical component of active aging. Malnourished individuals may have decreased strength and limited physical mobility, and are more likely to have hospital readmissions and longer hospital stays. This leads to a significant spike in health care costs and a host of negative health consequences from weakened immune systems to the increased rate of infections.
What’s tricky is how to identify malnutrition, and the how to establish a process for intervention and/or referral. In fact, up to one out of every two older adults is at risk for malnutrition and nearly 35-50% of older residents in long-term care facilities are malnourished. Community-based organizations (CBOs) can play a key role in tackling this problem, from Area Agencies on Aging to local services and organizations focused on healthy living, hunger and/or other nutrition related issues.
Two new resources can help active aging professionals integrate malnutrition care across the care continuum. The first is the National Blueprint: Achieving Malnutrition Care for Older Adults, which outlines a number of strategies to help prevent and treat malnutrition among older adults.
The second is the Community Malnutrition Resource Hub. This hub is a great example of bringing the Blueprint recommendations to life, particularly for active aging professionals working in the community. The hub contains videos, fact sheets, policy overviews, screening tools, patient education materials, and more. All materials are free to download (except some journal articles).
Now, back to thoughts about Ms. J; suggestions include:
“Have you talked to your doctor about your weight loss?” Include a comment in your evaluation, or write a note (with her permission), to her doctor - documenting the 10% weight loss in 6 months and suggesting a nutrition assessment. Suggest she visit NCOA’s website which has an excellent education tool on “talking to your doctor about malnutrition.”
“Be sure to eat and drink regularly. Eating protein, and a variety of foods is an important part of building strength.” Provide Ms. J with a MyPlate for Older Adults handout.
Add weekly weigh-ins to the fitness/strength plan or suggest Ms. J weigh herself regularly to help avoid further weight loss. Plan to share healthy eating education materials with her at each visit, like those available on the USDA Supertracker website.
Would a session with a Registered Dietitian Nutritionist be helpful? Here’s a one-stop shop on how to find a dietitian.
Visit the Community Malnutrition Resource Hub for more resources and ideas on working with CBOs to address malnutrition.
Judy Simon, MS, RD, LDN, Nutrition & Health Promotion Program Manager, Maryland Department of Aging
Mary Walsh, Med, Senior Technical Assistance Liaison, CDSME Resource Center, National Council on Aging (NCOA)
Alexandra Lewin-Zwerdling, PhD, MPA, Vice President, International Food Information Council (IFIC)
Note: This information is not intended to replace a one-on-one relationship with a qualified healthcare professional and is not intended as medical advice. It is intended as a sharing of knowledge and information from research. The view expressed here are not necessarily those of the ICAA, we encourage you to make your own health and business decisions based upon your research and in partnership with a qualified professional.