When we think of malnutrition our first thought is probably of Third World countries where drought and disease have af­fected a population, where children are dying of malnutrition, where the Red Cross is delivering food parcels and medical support for those suffering.

The cost of malnutrition to the NHS is an estimated €16 billion a year
- Kathryn Borg

Sadly, the effects of malnutrition are being felt a lot closer to home.

The effects of malnutrition are felt by over three million people in the UK and one million are older people living in their own homes. As a result, the cost to the National Health Service is an estimated £13 billion a year (€16 billion), which includes more visits from local doctors, more hospital admissions and longer hospital stays. Who would have thought this problem could be a major issue in the European community?

We are all aware of obesity. However, what do we know about malnutrition? How can we spot the signs? How do we treat it?

Malnutrition can affect anyone. However, it is particularly common among older people and those who are socially isolated as a result of poor mobility, poor physical health or mental health problems.

It can occur over a long period of time, which often makes it difficult to spot.

Many of the common indicators are similar to those in anorexia. However, the targeted age is usually the older person.

Some of the signs to look for are weight loss. In the elderly, look for jewellery, dentures, belts and clothes becoming loose.

Malnutrition also leads to tiredness and lethargy, alterations in mood, loss of appetite and sometimes difficulty with swallowing, disinterest in food or drinking and a general slowness, such as taking a long time to understand and answer questions.

Dementia is not always the problem, so a close watch should be kept on lifestyle, in terms of the daily intake of food and fluids.

Also affecting the elderly and going hand in hand with malnutrition is dehydration. The signs of this problem are a dry mouth or dry lips, thirst, headaches, tiredness, dry and loose skin and dark-coloured or strong-smelling urine.

If the elderly person suffering from malnutrition is living at home and you have noticed the symptoms, the most important action is to coax them into eating again, little and often.

Over-facing the sufferer with a huge meal will usually trigger sickness or rejection.

Offering high-calorie food in small amounts is more successful. Small nourishing meals and snacks every two to three hours will be beneficial.

Advice has included encouraging the sufferer to eat full-fat and full-sugar products rather than reduced/low-fat varieties.

The suggestions are to add double cream or butter to mashed potatoes, add cheese to soups and sauces, add four tablespoons of milk powder to one pint of full-fat milk and use throughout the day in drinks or cooking.

Add honey or syrup to porridge and rice puddings. This is fortifying the food to add extra calories and protein.

Other high-calorie foods that could be used to tempt someone who has lost interest in eating are nuts, peanut butter, cheese and crackers, thick yogurt, biscuits and chocolate.

However, if there are any health concerns that previously required a limit to fat and sugar, then they would have to be taken into consideration, and advice from the medical profession sought.

This advice, and more, is available on the Mind the Hunger Gap website (, which supports the British Dietetic Association’s campaign against malnutrition.

The BDA is focusing on malnutrition levels in older people still living within the community setting or the ‘invisible population’.

A screening tool commonly used in the UK is MUST (Malnutrition Universal Screening Tool) – which is a list of questions, used in care homes and hospitals, leading to a way of ascertaining the severity of malnutrition.

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