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
“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
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
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
“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
“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.’’