Dietitians say malnutrition is a ‘serious problem’ in older Australians, screening is needed in aged care

Hair loss. Weakness and confusion. Wounds that do not heal.

These can all be signs that a person is malnourished, but they are often confused with the “normal” process of aging.

“People say ‘I’m getting old’ but they’re actually malnourished and that’s completely preventable for many people,” says Judi Porter, professor of dietetics at Deakin University.

The protein and energy requirements of older adults are higher than those of younger adults, but their daily intake is often much lower, so malnutrition can easily occur.

In fact, 68% of people living in aged care are malnourished or at risk of malnutrition. And one in two older Australians in the community may be malnourished.

“This is a serious problem in Australia,” says Karly Bartrim, a dietitian and aged care interest group coordinator at the Dietetic Association of Australia.

Early intervention is crucial and waiting to get help can be fatal.

Despite the magnitude of the problem, there are no specific Australian dietary guidelines for older people at risk of malnutrition.

There is also no mandatory malnutrition screening in nursing homes.

“Malnutrition is very common in aged care but dietitians only become involved when there is weight loss, which often has side effects,” says Ms Bartrim.

“We could have prevented this weight loss from happening if we had gotten involved sooner.”

How can it arise?

Loss of appetite or loss of interest in food can be due to a variety of reasons, some of which are physical and some are psychological.

Old people carry a heavy burden chronic diseases Conditions that may alter appetite, such as kidney and liver diseases and congestive heart failure.

And living people dementia They may forget to eat, go shopping, or enjoy foods they once enjoyed.

“If a family member asks what you had for lunch, you might say ‘A sandwich’ because you’ve been eating a sandwich for the last 80 years, but maybe you’ve never actually had a sandwich,” says Professor Porter.

Unsuitable dentures can discourage someone from eating and likewise DysphagiaIt is a term used for someone who has difficulty swallowing.

Poor emotional well-being can also cause a person to become disinclined to eat.

LonelinessAffecting one in five Australian seniors, clinical depression And age are common causes.

“It happens to thousands of Australians; their mood is low and so their appetite is low,” Professor Porter says.

“This means going to a GP and treating depression rather than low appetite.”

Food insecurity is another big reason. If someone cannot afford to buy nutritious food, they may skip meals or consume cheap, unhealthy options.

Moreover, we usually get more medicines As we age, the absorption of many nutrients, such as vitamin B12, sodium and magnesium, can become impaired.

What could it be?

If a person loses 5 to 10 percent or more of their total weight in three to six months, this is usually an indication of malnutrition.

But there are other things to pay attention to.

Energy levels A person may become disoriented and feel unwell as it can affect their cognitive functions and behavior.

They immunity system They can also be thinner and weaker wound improvement.

“We can always tell when someone isn’t eating because the wound takes forever to heal,” says Ms Bartrim, a PhD candidate.

They will also probably lose muscle mass Because their bodies are in starvation mode and are burning their muscles to work.

This can lead to musculoskeletal disease. SarcopeniaIt is a condition in which muscle strength, quantity or quality as well as physical performance are compromised.

This condition can prevent a person from getting up and doing things they enjoy.

“This leads to people becoming more socially isolated, often depressed, lonely, and this creates a feedback loop that leads to them not wanting to eat,” says Professor Porter.

People with sarcopenia are at higher risk fall And fractures and less ability to recover.

“If someone is malnourished and falls over, their body doesn’t have the reserves to support them,” Ms Bartrim says.

A fracture can result in a person being hospitalized and their condition worsening due to hospital-acquired malnutrition, which can affect up to 65 percent of inpatients.

It occurs because people are in an unfamiliar environment, confused and have few food options. On average, it means the patient stays in hospital for an additional 21 days.

Changes in diet and meal times may help

Early diagnosis is the secret.

Don’t wait to seek help because once muscle is lost it can be very difficult to put back in place.

“So if you start to see changes in your mobility or your weight or your eating patterns, I would recommend without hesitation that you get referred to a dietitian,” says Ms Bartrim.

And if someone has a chronic illness, they may be eligible for up to five subsidised sessions with a healthcare professional. For example, a dietitian or exercise physiologist who can help rebuild muscle mass.

But there are simple dietary changes that can be made right away.

For older people, emphasis should be placed on consuming healthy foods. rich in protein and energyThis means that vegetables take a backseat.

“People say to me, ‘OK, I’d better go home and eat more vegetable soup and salad’ but they shouldn’t fill up on that, it makes the problem worse because there’s no energy in it,” says Professor Porter.

And Don’t buy “diet” or “low-fat” optionsExcess weight gained in old age is protective; it can act as a cushion to prevent fractures in the event of a fall or it can be the extra energy needed during chemotherapy.

“We tell people the exact opposite of what they were told as children,” Ms. Bartrim says.

So how can you eat more when you don’t feel like it?

A technique called “eating by the clock” may help establish a routine If you have a decreased appetite and need mental stimulation to eat.

This means eating six small meals at the same time every day, even if you’re not hungry.

Nutritional supplement drinks It is better than drinking tea or coffee between meals but Food should always be the first choice.

“We know that people are getting more enjoyment out of eating and drinking,” Ms Bartrim says.

And finally, family members should: Try not to make mealtimes stressful By putting too much pressure on someone to eat. Take a social approach, choose comfort foods, and take your time.

The bigger picture

Australia’s current dietary guidelines do not include “frail, older people at risk of malnutrition”, “generally” defined as those over the age of 75.

The guidance states that this group has “complex health needs” and that health professionals should be consulted for advice.

However, the National Health and Medical Research Council (NHMRC) is currently reviewing the guidelines and the updated version will include people aged 65 and over and will make recommendations to prevent malnutrition, weakness, falls and chronic diseases.

Updated guidelines are expected to be published 2026.