Battling Malnutrition in Vulnerable Age Groups

Despite modern-day advances in medicine and consumer education, two age groups continue to be susceptible to a condition not often thought of as a problem in the United States—malnutrition.

For older adults, malnutrition is often a function of isolation.

“If anything, malnutrition is more widespread than it was in the past when families lived together and people weren’t living as long as they are now,’’ says Richard Gottlieb, president and CEO of Senior Services Inc. of Forsyth County for more than 30 years. “I think nutrition really can affect peoples’ well-being and be a factor in so many health issues. Proper nutrition is one of the keys to aging well.’’

Malnutrition in children and adolescents occurs for different reasons than older adults, but those causes often are just as much a sign of modern times.

“If kids are eating on the go, not paying attention to whether they’re hungry or full, eating in front of the TV, it’s a problem,’’ says Holly Van Poots, RD, a pediatric nutritionist with Wake Forest Baptist Health. “And food insecurity, which is not having access to enough healthy foods, or to nutritionally adequate foods, can lead to hunger and may be present in the undernourished population.’’

Why Nutrients are Critical

Malnutrition is a lack of proper nutrients in a person’s diet that contributes to health issues. Although it is frequently thought of in the sense of undernourishment, those who work with seniors and adolescents say it applies to overeating as well, because the lack of proper nutrients based on overeating or eating poorly can cause health issues such as obesity and type 2 diabetes.

Mary Christiaanse, MD, a developmental pediatrician with Wake Forest Baptist Health, started the Kids Eat program based at Amos Cottage in Winston-Salem 15 years ago.

The program is geared to address eating difficulties children have up to age 18. The work covers physical issues such as swallowing disorders, neurodevelopment and motor skills issues, and behavioral problems.

Christiaanse says the lack of proper nutrition in children and adolescents can result in health problems that last a lifetime. For example, iron deficiency at a young age can result in lower learning ability.

Van Poots works with children in different units at Wake Forest Baptist Medical Center to ensure they are getting proper nutrition while hospitalized or during treatment for long-term illnesses.

She says when children don’t get the right nutrition, it can worsen medical problems or increase their length of hospital stays.

For older adults, the physical changes associated with aging can affect eating, as can chronic conditions and dementia.

“As you get older, you need fewer calories to maintain your weight and health, but at the same time, you need at least as many nutrients if not more,’’ says Denise Houston, PhD, RD, a nutritional epidemiologist with Wake Forest Baptist Health who specializes in nutrition, chronic disease and physical function in older adults.

“But changes with age affect nutritional status. You lose some of your sense of taste and smell, so food no longer tastes as good. Poor oral health or dentures can make it difficult to chew,’’ she says. 

Many older adults avoid meats and raw fruits and vegetables, which contain essential protein and nutrients, because of chewing difficulties. Others have arthritis, which limits their ability to open jars or cans. Depression, another major problem for older adults, impacts the desire to eat, too, Houston says.

“We do know that people in poor nutritional states have longer hospital stays, which can exacerbate their chronic conditions such as diabetes or heart disease, and face more health complications.’’

Educating on Eating

Senior Services offers one of the oldest Meals-on-Wheels programs in the nation, as well as two other food programs, which cumulatively provide more than 1,000 older adults throughout Forsyth County with regular healthy meals.

Kathy Long, vice president of adult day services for Senior Services, says educating families about their older relatives is a critical part of her organization’s work.

“We try to make sure that families know how important it is that their older relatives are eating a well-balanced diet,’’ she says. In addition, relatives must understand the importance of their loved ones drinking water and getting proteins from snacks such as nuts, yogurt, cheese or peanut butter, or correct meal portions of chicken or fish.

Linda Kearsley, vice president of nutrition services for Senior Services, says older adults can pose unique challenges because of their life circumstances.

“We have some men that we serve who just don’t know how to cook. When they lost their wives, they had no idea what to do,’’ she says. 

There also are generational issues to deal with.

“A lot of these folks grew up in a different lifestyle of cooking,’’ Kearsley says. “They cooked with fat and they cooked with salt and they weren’t as nutritious as they should have been.’’

For children and adolescents, modern-day marketing, combined with the hectic lifestyles of many parents, can make meals tough from a nutritional standpoint.

“What I have noticed is a tremendous amount of marketing misinformation, misleading information for products that don’t even need to be on the shelves,’’ says Christiaanse, the developmental pediatrician. 

Indeed, with healthy foods costing more than junk food (a single apple typically costs more than a bag of potato chips) and the temptations of an ever-expanding array of fast foods and prepared foods, parents often struggle to provide a balanced diet for their children.

“People have really busy lives and I think just being aware, trying to promote intuitive eating is important for everyone to do,’’ Van Poots says. “But it’s hard to do in this day and age. Leading busy lives is not necessarily conducive to sitting down and eating three healthy meals a day.’’

 

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Last Updated: 07-10-2014
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