Malnutrition: A Public Health Challenge

Simon D. Murray, MD: Welcome to this HCPLive® Geriatric Peers and Perspectives presentation titled, “Proper Nutrition in Older Patient Populations.” I’m Dr Simon Murray. I’m an internist from Princeton, New Jersey. Eating right and staying fit are important no matter what your age. And as we get older, our bodies have different needs, so certain nutrients become essentially important for good health. Over the past decade, the importance of nutritional status has been increasingly recognized in a variety of morbid conditions, including but not limited to cancer, heart disease, and dementia in persons over the age of 65.

Today, to discuss these challenges, I am happy to be joined by Jane Schwartz, a registered dietician and nutritionist who offers a holistic approach to individual and family nutritional counseling. Jane earned her bachelor of science degree in nutrition from Cornell University, and completed a graduate nutrition internship at the Oregon Health & Science University in Portland, Oregon. She’s also served as a nutritional counselor for UnitedHealthcare.

Welcome, Jane, let’s begin.

Jane Schwartz, RDN: Hi, nice to be here.

Simon D. Murray, MD: Most physicians I know, including myself, don’t know very much about nutrition. The best thing I used to tell my patients was, “Never eat anything handed to you from a window.” That was about the best advice I could give them. Or I would say, “Follow a diet and exercise.” I think we would like some perspective about ways that we can improve upon educating our patients about nutrition. How prevalent do you think the problem of malnutrition is?

Jane Schwartz, RDN: I think it’s very prevalent. And whether someone is underweight or even overweight, there can be malnutrition. There’s a misconception…someone who has extra weight actually [can be] lacking in certain nutrients. Because a diet can be very high in processed foods, and lacking in fruits and vegetables and whole grains, and certain things like that, they can have laboratory numbers and disease states that indicate a state of malnutrition.

Simon D. Murray, MD: Are there statistics that talk about the extent of the problem of malnutrition in the elderly in the United States?

Jane Schwartz, RDN: There haven’t been a lot of statistics. There haven’t been that many studies. But in the few that have been done, it can be as high as 50% or more.

Simon D. Murray, MD: Yes. I know in hospitalized patients the rate is rather high.

Jane Schwartz, RDN: Yes.

Simon D. Murray, MD: And that’s a select population of people who come in who are sick. But I know that when people are in the hospital, for my patients, I know for people who are over the age of 65, if they’re in the hospital for a week it may take them 6 months to recover.

Jane Schwartz, RDN: Absolutely.

Simon D. Murray, MD: Because we keep them in bed, and we don’t feed them.

Jane Schwartz, RDN: Yes.

Simon D. Murray, MD: Not deliberately, but they don’t get fed.

Jane Schwartz, RDN: Yes.

Simon D. Murray, MD: What do you think the challenges are there? Why does that happen?

Jane Schwartz, RDN: You mean in the hospital?

Simon D. Murray, MD: Yes.

Jane Schwartz, RDN: Well, people’s appetites are poor, and they don’t feel well. So even if there’s food coming in, they may not be eating very much. It’s going to take a lot for someone to put them on a feeding tube. That’s a very serious decision. Prior to that, they could be lacking in lot of nutrients. Their trays go back, and they’re not eating very much. Plus, I have to say that the hospital food isn’t often all that great. So they may not be getting wonderful nourishment at the hospital. And they’re not feeling well. They’re just not getting what they need.

Simon D. Murray, MD: It may be as simple as not being able to open the packages either. Or having someone to feed them.

Jane Schwartz, RDN: Yes.

Simon D. Murray, MD: Or they’re not being able to order because they’re out for tests, or they’re asleep, or something like that.

Jane Schwartz, RDN: Absolutely.

Simon D. Murray, MD: I see that commonly.

Jane Schwartz, RDN: Yes.

Simon D. Murray, MD: But as outpatients, what are some of the issues that keep elderly people from getting proper nutrition? Do they differ a little bit?

Jane Schwartz, RDN: Well, it depends on what their home situation is, and if they have a caregiver, or if they have a spouse who’s well enough to help take care of someone who’s elderly and not in great shape or able to cook for themselves. Or if they have daughters or sons who are helping them. Part of it is just lack of education. They may not really even understand what constitutes a healthy diet, to get in what they need. So there are many factors.

Simon D. Murray, MD: Yes.

Transcript edited for clarity.