Starvation in the land of plenty: why Australians are malnourished 180



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By Karen Charlton, University of Wollongong and Karen Walton, University of Wollongong

Malnutrition is a significant issue around the world, especially in developing countries. But it’s not just a problem for poor nations; a large number of older Australians also suffer from this insidious condition, which has some very serious repercussions.

Encompassing both under-nutrition and over-nutrition, malnutrition is when the body doesn’t receive enough nutrients for proper function.

Under-nutrition occurs when insufficient food is consumed, resulting in weight loss or muscle wasting – or both. Or it can occur when the diet is of poor quality and results in micronutrient deficiencies such as anaemia (iron, vitamin B12 or folate) or scurvy (vitamin C). Over-nutrition refers to excess energy intake, or too much food, and leads to obesity and other chronic diseases.

Nutritional deficiencies in older people can result in impaired immune function, poor wound healing and loss of muscle mass, strength and function. The type of malnutrition that affects older Australians is generally under-nutrition, with too little energy or protein consumed.


A serious problem

A third of hospitalised Australians aged 65 years and older are overtly malnourished. A further 50% of this group are at high risk of malnutrition. Of greater concern still is the fact that most of these frail older adults are discharged home, where they face the possibility of a downward spiral of ill health.

Even among older adults living in the community, almost 10% are malnourished, while another 40% are considered to be at high risk of malnutrition.

The many reasons older adults don’t meet their dietary requirements include dementia, depression, delirium, decreased vision, dental health issues, polypharmacy (taking three or more over-the-counter or prescribed medications) and acute or chronic diseases.

Certain medical conditions can impair the ability to properly digest or absorb nutrients from consumed food. Commonly prescribed medications may cause a loss of appetite, drugs such as antibiotics and aspirin may induce nausea and anti-cancer drugs may impair swallowing because of reduced saliva production and dry mouth.

Social factors such as isolation, loneliness, poverty and lack of access to an adequate food supply (food insecurity) also contribute. Among bereaved widowers in particular, inadequate knowledge about food preparation compounds the problem as they are ill-equipped to plan and prepare balanced meals.

On top of all this are age-related physical changes that impact nutrient digestion and absorption. The stomachs of up to a third of older adults have reduced capacity to secrete hydrochloric acid. This lowers their vitamin B12 and folate absorption, which, in turn, may lessen calcium and iron uptake and place them at risk of anaemia.

About half of total muscle mass is lost between 30 and 80 years of age. This natural consequence of ageing reduces strength, slows the metabolism and affects other key bodily functions, such as the performance of the heart.

All these changes compromise longevity. What’s more, coupled with older people’s lower energy expenditure and requirement, there is an increased need for nutrients such as calcium, vitamin D and some B vitamins. Put simply, older people need to run on less fuel but that fuel needs to be super-charged to provide sufficient nutrients for good health.


Cost to the health service

Malnutrition increases the risk of falls, osteoporosis, fractures, chronic disease, prolonged hospitalisation and increased complications, all of which heighten the risk of premature mortality and reduced quality of life. Even accounting for underlying illness and age, it predicts a greater than threefold risk of death within 12 to 18 months in older Australians.

The high proportion of elderly people occupying hospital beds means that malnutrition in this age group places a large burden on the health-care system. And it’s something of a vicious circle.

Being malnourished increases the risk of repeated hospitalisations in this age group, and nutritional status declines during each hospital stay because of poor appetite, dislike of hospital meals, lack of assistance at mealtimes, meal interruptions because of diagnostic tests and procedures, and general malaise.

The cost of treating a nutritionally-at-risk patient is 20% higher than the average for age-matched patients who have a similar underlying illness. In the United Kingdom, malnutrition-related costs are estimated to exceed €9.2 billion per year, which is more than the cost of treating conditions associated with obesity. Similar data from Australia is not available.


Mind the gap, but how?

Poor referral systems between hospital and community services means that many frail older people may fall between the cracks, and have to fare for themselves in the critical two-week period of recovery following discharge. And community-based services generally require an in-home assessment that may take several weeks to complete.

Older people themselves often do not recognise that they need additional dietary support. The problem is often not a lack of foods in the home, but rather an inability or desire to prepare meals. Many older people may feel too ill or frail to shop or prepare their own meals, may have poor appetite, or simply forget to eat if there is some cognitive decline.

Malnutrition is a wicked problem that will require a complex of solutions provided by a range of intersectoral players, including health, community and social services.

General practitioners can play an important role by focusing on early identification and management of malnutrition. A model of care piloted at three general practices in the Illawarra region of New South Wales, for instance, demonstrated the feasibility of including a malnutrition screening tool in the routine management of older patients.

Getting general practitioners and practice nurses involved – so they can screen older people for malnutrition, recognise the problem early and refer them to relevant community services – is a crucial, but currently missing, key piece in the puzzle.

The Conversation

This article was originally published on The Conversation.
Read the original article.


Do you know of anyone who has been hospitalised for malnourishment? Are you eating enough yourself? Tell us below.

Karen Charlton

Karen Charlton is an accredited practising dietitian and registered public health nutritionist who teaches on the nutrition and dietetics programmes at the University of Wollongong. Her research interests include diet and lifestyle interventions across the lifespan, including ageing in developing countries. Her work in micronutrient nutrition focuses on prevention of iodine deficiency for optimal pregnancy outcomes. On a population level, Karen works on strategies to lower blood pressure and was instrumental in providing evidence for mandatory regulation for salt target levels in various processed foods in South Africa.

  1. Mal-nourishment is not just not enough, but bad nourishment. Diabetes is a form of malnourishment even if patient is overweight…..

    2 REPLY
    • Maybe type 2, but not type 1. Also some meds can cause type 2 as happened to me. I strictly follow a low GI Diet and exercise routine. Still have Type 2 due to pancreas damage. Point is more than an eating problem.

    • I too suffered pancreatitis due to prescribed medication… I agree it is more than an eating disorder, but I wanted to draw attention to the need to eat HEALTHILY not just too much. There is so much confusion with people at early stages or pre-diabetes. Go well !

  2. I did know this & it’s a complex issue with many causes like addictions eg gambling,alcohol/ drug abuse ,poor education on nutrition to depression,dementia or inability to purchase replacement false teeth etc.etc.

  3. yes, I do have the oppotunity to see patiens that have been hospitalised,and oftemn if they are not eating or just <not hungry, I can question, and deem it nessesary to report this to a nurse or supervisery person. there may be they dont like what is cooked, not appertising enough. or, not hungry. you cant forse a person to eat and to be honest, some meals lookrevolting, all miced up, but thet is because the patient has a swallowing problem how to make things better is a problem and needs to be seen to. not in the future, but NOW.

  4. You said a third of hospitalised pAtients are malnourished. Might I add they get even more so in hospital if rellies don’t go in to feed them. When I was nursing in the sixties, one of my jobs was to feed those who were too feeble to do it themselves. Nowadays food is delivered and then removed by staff without anybody checking to see if it has been touched. It is hard to encourage appetites in the frail, but relatives need to keep in touch and make sure they are eating. If not, then meals on wheels could be utilised.

    8 REPLY
    • Yes, Morvyth, and we nurses actually served meals from a meal wagon and delivered them to our patients, ensured they could sir up and reach them and fed patients when necessary. Also, most hospital food is just dreadful. One patient’s father took the boy’s tray down to the CEO, and asked if he’d eat this slop.. NO, but you expect my sick son to do so.

    • Yes this happened to my late husband food delivered then taken away not eaten then the Dr’s would tell him off for not eating I had a row about this at the hospital, as they don’t know that they are not eating just like the little drinks my husband wasn’t strong enough to pull the top off them so he had no drink I had to stay with him every day for about 7 hrs to make sure he was looked after

    • Agree Pam we did all that! And then we fed those who were unable to do it themselves. If they weren’t eating it was recorded in their reports. Today meals delivered by the dietary staff and collected by same. The trouble with food now is the hospitals are not cooking their meals at the hospitals. They are sent up from a central place many kilometres away. All prepared from the same place and sent to various hospitals. I was horrified when I found this out last year.. Newcastle hospitals food comes up from Sydney! Sadly nursing care in hospitals is not what it used to be

    • I would like to add re patients not being fed their meals. I have to say I’ve seen this happen also. There should be no excuse for nursing staff not feeding those in their care. I get annoyed when I hear them say how busy they all are. These staff could be charged with neglect, because that is what it is. They are failing to care for these people in their care, specially if they are seen to be malnourished. Please speak up for your loved ones and let them know you are unhappy with their care. If it continues go higher.

    • My father had dementia & was in hospital to have a leg off. The yoghurt etc would be left in front of him….stacked up!!’ We had to make sure someone was there to feed him. Nurses & doctors would come in & talk to him & he wasn’t capable of answering. We continually had to make sure one of us was there for him. Some of the doctors etc. need training to understand the different needs of patients. We were frustrated beyond …… Trying to get the medical staff to understand! Feel for people that don’t have caring family, it would be dreadful!!!!!

    • Every elderly parent needs a kind caring family member to constantly watch over them as they age.
      Old age is hard work.

  5. Yes, all if the above is true, however as we age our bodies don,t absorb nourishment as they used to. I was low in vitamin D…I live in Queensland!! It is a malabsorption problem.I agree with the lack of caring re hospital patients unable to access their trays…this is because the food I’d delivered by ward staff, not nurses as was the case. I think I may volunteer to help at the midday meal time at my nearest hospital!

    1 REPLY
  6. Eating for the frail elderly in a huge problem. Kitchen staff just leave a tray and nursing staff don’t have the time to arrange tray and assist with nutrition. Small packs of butter, jam etc are extremely hard for people to open. There needs to be a system where staff are responsible for ensuring food is eaten and assistance given where required. Plus the food is often not what an elderly patient is used to. A few years ago my mother in hospital had been ordered a purée diet, she lifted the lid and refused to eat the meal, it looked revolting. Back home she ate a full roast meal provided by my sister.

    3 REPLY
    • my mum had cancer on her tongue & had to have part of it removed so i made her food, puree all the items individually she would love roast dinner day as she had a little jug of gravy to pour over her dinner

    • My Mum was in an Aged Care Facility for 8 years and I saw her change from a relatively robust person to one who looked as though she was suffering from Anorexia. Due to the fact that she had suffered a stroke, she had limited function in her left hand and therefore had trouble using cutlery. The only people around to provide assistance, were the ones that shared her meal table. I fully understand that staff are in short supply, but maybe volunteers are needed to help out at mealtimes. A friend of mine had a similar experience with her Mum who was in a different Aged Care Facility. In both cases the food also left a lot to be desired. It was not suitable to older people who were used to plain simple cooking, not these fancy concoctions that the current crop of caterers in these places seem to serve up.

  7. It’s easy to slip into the ‘lazy’ easy way which is nutrient deficient. Especially if living alone.

  8. Very interesting article. I think too that many probably can’t be bothered making a meal for just one once their spouse dies.

  9. I live in Qld. and we definitely suffer from a shortage of basic nursing staff,partly because of all the Public Health jobs that were done away with and very much because there are very few practical nurses in the system. There is no one to do the essential care,such as feeding,backs and bed pans. I recently had a friend in hospital who developed pressure sores three days after surgery ! She was not malnourished just unable to move.
    There is definitely a need for more home visitors to help to keep our Seniors safely in their own homes!

  10. When the care returns to hospitals and nursing homes, maybe there wont be so many starving patients. Very sad to watch food trays taken to patients and then removed within minutes. Care is lacking in our world and its so sad………

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