Malnutrition in older people – how does that happen?

As an experienced community nurse and carer, I was glad the newspapers have recently highlighted the increase in admissions of older people to hospital due to malnutrition.

My own 91 year old mother had a fall earlier this year.   No cause was found for this tumble that resulted in a fractured pelvis and hospital admission, except for the fact that she weighed only 39kgs.  She lives alone (widowed 5 years ago), has mild Alzheimer’s and, up until this point, has always done her own shopping and cooking.  My weekly visits supplemented her fridge and freezer contents, but I was unable to encourage her to accept help.

Following her fall, I have finally been able to persuade her to accept some help and we are luckily able to pay for private social care to visit her each day for 3 hours in total to encourage her to eat. I have asked the lovely carers to ensure they make enough time to eat with my mother. This makes eating more of a social event. She is still able to get out to shop but she has more help.

However, there are two significant issues. The first is that my mother is unaware how much we pay for her care. If she did know, she would certainly stop it. The second is that she resents the intrusion and reports that the carers are only interested in what is in her fridge and want to eat her “out of house and home!”. She would almost certainly be deemed to be of sound mind (have mental capacity) to make decisions on her own and she only agrees to the care “to stop me worrying.”  Had a social care assessment offered care in this way without my encouragement, she would certainly reject it. She would not recognise her low food intake as a problem. I have seen this a lot in my specialist care for elderly people in the community.

The lack of mention of social care in the Chancellor’s Autumn Statement is very important of course but we must remember that few, if any, local councils will fund care just to encourage nutrition. Loneliness, highlighted in the AgeUK campaign this winter has a huge effect on the eating patterns of older people. Inactivity does not stimulate appetite.  In my own area, social care would not be provided by the council for someone who is capable of washing and dressing themselves but who is not eating. Meals on Wheels services do not provide company to eat and, marvellous as they are, if people accept them they are not always something that you might fancy sitting alone to eat.  Some councils also advocate a fortnightly provision of frozen ready meals.  This even negates the need for the daily contact of someone delivering the meals.

Encouraging someone to eat is a skill not always taught to social carers. The difference between the question “what would you like for your breakfast?” where the answer is usually “oh, nothing now I’ll get something later” to “Would you like toast or porridge for your breakfast?” which engenders a positive response is significant. This is not forcing someone to eat but helping them to choose and giving them the opportunity to eat.

A recent visit with my Mother to her GP revealed she has now put on weight and is fit and healthy.   The newspapers quote Stephen Dalton, Chief executive for the NHS Confederation (which represents hospitals), as saying that “people are most at risk of serious consequences if denied basic compassionate care.” He is right but basic care includes recognising the social element of eating.

Luckily there are resources and organisations out there that can make a difference.   As well as Age UK that I mentioned earlier, the Royal Voluntary Service is a great place to start.


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