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Caring for the Older AdultsUncategorized

When you picture someone with malnutrition, who do you see?

Nursing staff helps senior eat dessert.

By Julie Stefanski MEd, RDN, LDN, CDCES

September is Spotlight on Malnutrition Month for more than one important reason.  Malnutrition decreases the effectiveness of our immune system, increases the risk of infections, effects how quickly wounds heal, and increases risks of falls and fractures.

In your mind, when you picture a resident with malnutrition what do you see?  A person who is underweight?  A resident who already has a pressure injury?  Unfortunately, malnutrition can occur at any weight and to any resident.

Disease-related malnutrition

Many chronic diseases such as COPD, cancer, HIV, and heart failure are often accompanied by malnutrition.  Increased work of breathing can increase calorie needs.  If a resident has a poor appetite, unplanned weight loss will likely occur.  Disease-related malnutrition isn’t unavoidable.  Although residents may be more likely to have a decline in nutrition status, it’s important to monitor, evaluate, and put interventions into place to document what attempts were made to avoid malnutrition.

Muscle is Always Lost When Weight Loss Occurs.

Although we often only see the number on the scale, as weight declines the body breaks down both fat stores and muscle.  Older adults typically already have less muscle due to aging [See what can be done to DECREASE SARCOPENIA here.] As muscle is lost, a person may see a decline in the ability to stand, pivot, or walk.  Malnutrition can contribute to both falls and fractures, especially in those residents with osteoporosis.

Good Nutrition is Vital to Keep Immune Function Working

Without proper nutrition coming in, there is a decrease in antibodies produced and immune components that require minerals such as zinc and phosphate can be compromised.  When a body is not well nourished there is an increased chance of infections.  Our largest barriers against pathogens- our skin, our lungs, and our digestive tract won’t work as well to prevent foreign invaders from taking hold if the cells that line the organs aren’t healthy.  As a person becomes more malnourished they’re more likely to get sick.

Is it good for someone in a larger body to lose weight?

Weight bias, placing a judgement on a person because of their body size, can delay identification of malnutrition.  While many health care providers may think that losing weight in a larger person is beneficial, in reality poor nutrition can lead to a decline in functional capacity.  For a person in a larger body, loss of muscle may mean that they no longer have the strength to support themselves.  Being overweight or obese masks the presence of malnutrition and can delay treatment.

How do we identify malnutrition?

A malnutrition consensus statement from the Academy of Nutrition and Dietetics and the American Society of Parenteral and Enteral Nutrition (ASPEN) sets the standard of care for assessing malnutrition.1 The presence of at least two of these characteristics may indicate malnutrition:

  • Insufficient energy intake
  • Weight loss
  • Loss of muscle mass
  • Loss of subcutaneous fat
  • Localized or general fluid accumulation
  • Diminished grip strength

Why does malnutrition occur in a facility?

Missing one meal doesn’t mean that someone will develop malnutrition.  When meal after meal goes untouched or just picked over though, it can start a vicious cycle of poor nutrition that can be hard to turn around.  When the meal percentage eaten is recorded consistently and accurately, it can show downward trends before significant weight loss occurs.  It may also clue you in to a resident who is having more difficulty chewing, swallowing or feeding themselves.

So who is at risk for malnutrition? Everyone is at risk.  Head malnutrition off by monitoring appetite and weight status on a consistent basis. Putting interventions in place before poor nutrition progresses is the key to supporting healthy residents.


MNA Mini-Nutritional Exam

Journal of the Academy of Nutrition and Dietetics collection on adult/senior malnutrition


  1. White JV, Guenter P, Jensen G, et al. Consensus statement: Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral Nutrition: characteristics recommended for the identification and documentation of adult malnutrition (undernutrition). JPEN J Parenter Enteral Nutr. 2012;36(3):275-283. doi:10.1177/0148607112440285

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