2.4 Describe reasons why older people may be at risk of malnutrition

This guide will help you answer 2.4 Describe reasons why older people may be at risk of malnutrition.

Older people in the UK, and worldwide, face many risks that make malnutrition more common in this age group. Malnutrition means having too few nutrients, protein or energy (calories) for the body’s needs. This can make people unwell and cause many health problems. It is important to understand why older people have a higher risk, so people working in health and care can help them eat well.

In this guide, we will cover the reasons by looking at physical health, mental health, social issues, practical barriers, economic problems and specific medical needs.

Changes In Physical Health

Appetite Reduces With Age

As people get older, their appetite often gets smaller. They might not feel hungry or enjoy food as much. This means they might skip meals or eat very little. Taste and smell may also get weaker. Food may taste bland, so older people lose interest in eating.

• Saliva production decreases, causing a dry mouth
• Chewing becomes difficult if there are dental problems
• Medication side effects can worsen appetite loss

Problems With Digestive System

The body’s ability to digest and absorb nutrients can change. Stomach acid decreases, making breaking down some foods harder. The bowel may slow down, causing constipation or discomfort, making eating less attractive.

Some nutrients are harder to absorb with age, including vitamin B12, vitamin D, iron and calcium.

Dental Issues

Tooth loss, gum disease or ill-fitting dentures are common in older people. Chewing tougher foods may become hard or painful, so some avoid meat, salads or fibre-rich foods. This means meals may lack key nutrients.

Physical Disabilities

Mobility problems, arthritis, tremors or muscle weakness may make cooking and feeding oneself more difficult. People may be unable to open jars, chop food or even bring a spoon to their mouth. Some may sit in armchairs and eat ‘easy’ foods, missing out on balanced meals.

Mental Health Challenges

Dementia And Memory Problems

Conditions like dementia cause confusion, forgetfulness or disinterest in food. People may:

• Forget they have eaten or not eaten
• Have difficulty recognising food items or even their use
• Be unable to express hunger or thirst

It’s not unusual for those with severe dementia to need support to eat at every meal.

Depression

Loneliness, depression and sadness are common in older people. Depression lowers appetite and motivation to shop, prepare food or eat. If someone lives alone, eating can feel pointless or a chore.

Anxiety And Other Illnesses

Worry, health anxiety or other mental health problems can distract from eating or lead to unhealthy food choices.

Social Issues

Loneliness And Isolation

Living alone can reduce interest in food. Many people view eating as a social activity; meals mean less when eaten alone. Widowed and isolated individuals are especially at risk. They may not bother to cook, leading to skipped meals or eating snacks rather than proper food.

Examples of social factors:

• Lack of visitors or family support
• Fewer invitations to meals
• Reduced community engagement

Lack Of Support

If there’s no family to help with shopping or cooking, older people might have limited food supplies or rely on packaged foods with low nutritional value.

Care services, if limited, might not include help with meals.

Practical Barriers

Difficulty Shopping

Getting to the shops can be difficult. Reasons include:

• Reduced mobility
• Lack of transport
• Bad weather concerns

Heavy shopping bags are hard to manage if someone is frail or has joint problems.

Online shopping and delivery services are not always accessible or easy to use for everyone.

Problems Cooking And Preparing Meals

Arthritis, poor vision, stroke, or Parkinson’s disease can all affect the ability to cook. Using sharp knives, hot pans or even complex kitchen gadgets may be dangerous, so cooking stops.

Some homes lack adaptations for disabilities, such as lowered worktops or handrails, so preparing meals independently becomes impossible.

Problems Feeding Themselves

Loss of hand control (for example, after a stroke) can mean someone finds it difficult to use cutlery. They might start avoiding full meals and snack instead.

Hospital Stays And Transitions

After a hospital stay, some people leave weaker and find it harder to get back to their normal eating patterns. Time in hospitals or care homes may change food habits and portion sizes.

Economic Difficulties

Low Income and Poverty

Many older people—especially those living alone—are on a low pension. Heating and housing costs may reduce money for food. Healthy and fresh food can appear more expensive.

Some will prioritise paying other bills and cut back on meals.

Food Insecurity

Some older people struggle to access good-quality food shops in their area. Limited availability of nutritious food can force reliance on tinned or processed foods, which may be low in vitamins, minerals or protein.

Medical Problems And Illnesses

Disease-Related Malnutrition

Long-term health conditions make eating hard. Some examples:

• Stroke can cause loss of swallowing ability or weakness on one side
• Parkinson’s disease may cause tremor, slow movement and difficulty with swallowing (dysphagia)
• Cancer and its treatments can reduce appetite and cause taste changes

Other chronic illnesses like heart failure, lung disease, or kidney problems can reduce the desire or ability to eat, especially when symptoms flare up.

Medication Side Effects

Older people often take several medicines at once (polypharmacy). Many medications:

• Reduce appetite
• Change taste
• Cause dry mouth or nausea
• Lead to diarrhoea or constipation

These side effects make eating less appealing and may reduce nutrient intake.

Swallowing Problems (Dysphagia)

Dysphagia is when swallowing is difficult or painful. It is more common after strokes or in neurological diseases. Swallowing issues may cause coughing, choking or fear of eating, leading people to refuse food and drink.

Increased Need for Nutrients

Some illnesses mean the body needs extra calories, protein or vitamins, but these needs are not always met. Recovery from infections or wounds is slower if nutrition is poor.

Changes In Body Systems

Muscle Loss (Sarcopenia)

Sarcopenia means loss of muscle mass and strength linked to ageing. When protein intake is low, and physical activity drops, muscle loss speeds up. This leads to weakness and makes independence harder. Over time, less muscle means lower appetite and higher risk of falls and injuries.

Altered Thirst Sensation

Older people may not feel thirsty, so they forget to drink enough. Dehydration is a risk, especially in hot weather. Sometimes they reduce fluid to avoid going to the toilet often, especially at night, or if they worry about incontinence. Dehydration can be severe and is sometimes mistaken for confusion or infection.

Cultural And Personal Beliefs

Dietary Restrictions

Some older people keep to food beliefs or dietary rules, such as vegetarian or religious diets. If support is lacking, they might avoid key food groups because they are unsure how to meet nutritional needs. Limited dietary variety can worsen malnutrition.

Habits And Lifelong Patterns

Long-held eating habits can be hard to change. If someone grew up eating very basic or limited diets, they might not be open to trying different foods or taking supplements.

Other Relevant Issues

Lack Of Nutrition Knowledge

Misunderstanding about what foods are healthy may mean older people eat too little protein, vitamins or minerals. They might over-rely on convenience foods with little nutritional value.

Alcohol Misuse

Alcohol can replace food calories and worsen appetite. Heavy alcohol use also affects absorption of B vitamins and can progress to malnutrition and nerve problems.

Ignored Signs Of Malnutrition

Sometimes, early signs of malnutrition such as weight loss, loose clothing or poor skin condition are ignored by carers or health staff. Regular checks may be missed if support is not in place.

Institutional Food

In care homes or hospitals, large numbers of people are served the same meals. If food is unappealing or not liked, some people may not eat properly. Mealtime support is sometimes limited, and rushed or impersonal feeding can discourage eating.

Signs That Malnutrition May Be Present

It is useful to be aware of signs that suggest older people may already be malnourished or at high risk. These signs include:

• Unintentional weight loss
• Loss of appetite or avoidance of meals
• Ill-fitting clothes or loose rings and belts
• Muscle weakness and tiredness
• Frequent infections or slow recovery from illness
• Dry, thin skin and poor wound healing
• Swelling in legs and feet (oedema)

These signs prompt further action and may mean the person needs a nutrition assessment.

What Can Be Done?

Actions to reduce the risk include:

• Encouraging enjoyable, social meals where possible
• Providing meals that fit with cultural and personal preferences
• Supporting shopping and preparation of healthy food
• Regularly checking weight and signs of malnutrition
• Involving dietitians and doctors if needed
• Adapting food texture for swallowing problems
• Checking for dental problems and supporting oral health

Final Thoughts

Older people have a real risk of malnutrition because of many combined physical, mental and social changes. These might be obvious—such as poor appetite or loneliness—or less visible, such as the effects of multiple medicines or hidden costs of food. Identifying those at risk takes a careful look at the person’s lifestyle, health and how well they can look after themselves.

It is important to work with older people, their support network and health professionals to help keep meals nutritious and enjoyable. Early spotting of warning signs allows for better prevention and support. This may include making small changes to meal routines, finding community resources to help, or even making adaptations to the home and kitchen.

Supporting nutrition and health in later life improves not just length of life, but enjoyment, independence and wellbeing. Workers and carers who speak up and support good nutrition make a real difference every day. A focus on the unique needs of every older person, and attention to these risk factors, helps protect both health and dignity as people age.