When Weight Loss After 65 Is a Warning Sign

Undernutrition in older adults is common. Family caregivers should know the signs and how to address the problem

For much of adulthood, losing a few pounds without trying might seem like a welcome surprise. Later in life, unexplained weight loss can mean something very different.

A recent article published by Stansberry Research highlighted undernutrition in older adults and made an important point: Decades of messages about cutting calories and losing weight can obscure the fact that inadequate nutrition also becomes a health concern as we age.

Undernutrition is a form of malnutrition in which the body doesn't get enough energy, protein or other nutrients to meet its needs. It is a recognized problem in geriatric medicine, particularly among older adults dealing with illness, frailty, cognitive impairment, social isolation or difficulty shopping and preparing food.

And you don't necessarily have to look dangerously thin to have a problem.

Why older adults may start eating less

There isn't one cause. Appetite can diminish with age. Medications can affect appetite, taste or digestion. Dental problems can make chewing painful, while swallowing difficulties can make some foods difficult or dangerous to eat.

Then there are practical problems. Arthritis can make opening containers or cooking difficult. Giving up driving can make grocery shopping harder. A spouse who always cooked may die. Depression, loneliness or cognitive decline can interfere with regular meals.

Georgia's Division of Aging Services identifies food costs, transportation, lack of nearby affordable groceries and dietary restrictions related to chronic illnesses among the barriers older Georgians can encounter in obtaining adequate food.

For family members, that means looking beyond whether Mom has food in the refrigerator.

Is she actually eating it?

A refrigerator filled with spoiled food, unopened containers or little more than condiments may reveal a problem that isn't obvious during a weekly phone call.

The Stansberry article also highlighted research suggesting that some older adults may be consuming less protein than is desirable for maintaining muscle. That concern is supported by geriatric nutrition experts.

The longstanding U.S. Recommended Dietary Allowance for adults is 0.8 grams of protein per kilogram of body weight per day. But the European Society for Clinical Nutrition and Metabolism notes that expert groups have suggested 1.0 to 1.2 grams per kilogram daily for healthy older adults to help preserve lean body mass and function. Needs can be different for people who are ill or frail.

That matters because aging is already associated with gradual muscle loss. Poor nutrition can accelerate the loss, potentially affecting strength, mobility and the ability to live independently.

Families shouldn't interpret those numbers as a prescription, however. People with kidney disease and certain other medical conditions may need individualized dietary recommendations. A physician or registered dietitian can determine what's appropriate.

Is undernutrition connected to cognitive decline?

The Stansberry article highlighted emerging research examining a possible connection between nutritional status and cognitive health. The findings are intriguing, but families shouldn't conclude that inadequate nutrition causes dementia, or that eating more protein will prevent it.

The relationship may run in both directions. Poor nutrition could contribute to declining health. But cognitive impairment can also cause poor nutrition. Someone with early dementia may forget meals, lose the ability to follow recipes, stop shopping regularly or have difficulty recognizing spoiled food.

The practical takeaway is more modest but still important: A sudden decline in appetite or unexplained weight loss shouldn't automatically be dismissed as a normal part of getting older.

What should families watch for?

Weight is an obvious place to start. Pay attention when an older relative loses weight without deliberately changing diet or activity. Clothes becoming noticeably loose can provide another clue, particularly when the person isn't stepping on the scale regularly.

Other warning signs can include increasing weakness or fatigue, loss of muscle, repeatedly leaving meals unfinished or suddenly losing interest in foods that were previously enjoyed.

Families should also watch the mechanics of eating. Does Dad have difficulty chewing? Does Mom cough or choke while eating? Can she safely use the stove? Can he still get to the grocery store? Is arthritis making food preparation difficult?

Behavioral changes matter, too. Someone who once cooked regularly but now subsists largely on crackers and coffee may need help even if their weight hasn't yet fallen dramatically.

Don't simply buy a case of nutrition shakes

When an older adult is losing weight unexpectedly, the first step should be figuring out why.

A physician can look for underlying illness and review medications. A dentist can address painful chewing. Swallowing difficulties may require evaluation. Depression or cognitive changes may need treatment.

Once medical problems have been considered, families can make eating easier. Someone with a small appetite may do better with several smaller meals and snacks than three large meals. Nutrient-dense foods such as eggs, Greek yogurt, cheese, fish, beans, nuts and nut butters can provide protein and calories without requiring enormous portions.

Protein also doesn't have to wait until dinner. Eggs or yogurt at breakfast and beans, tuna, chicken or other protein-rich foods at lunch can spread intake throughout the day.

Most importantly, adapt the solution to the actual problem. Grocery delivery can help someone who no longer drives. Prepared meals can help someone who has stopped cooking. Eating together may help someone who has become isolated.

Georgia has resources that can help

For some families, undernutrition isn't primarily a medical problem. It's an access problem.

Georgia operates both "congregate" meal programs and home-delivered meal programs through its aging-services network. Congregate meals provide food in settings such as senior centers and community facilities while also offering social interaction. Home-delivered meals combine nutrition with a regular social check-in.

Georgia's Division of Aging Services also offers nutrition education and individualized nutrition counseling through the state's Area Agencies on Aging. Families can reach the Georgia Aging and Disability Resource Connection at 866-552-4464.

Georgia also has reason to pay particular attention to the issue. The state's Senior Hunger Initiative says Georgia has remained among the top 25 states with the highest rates of food insecurity among older residents.

Source note: This article was inspired in part by a Retirement Millionaire/Stansberry Research article that discussed undernutrition, protein intake and emerging research on nutrition and cognitive aging. Next30ATL independently checked the central health claims against geriatric-nutrition guidance and Georgia aging-services information.