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Nourishing the Golden Years: Tackling Malnutrition in the Elderly
A longer life doesn’t always mean a healthier one. Ageing brings challenges that often go unnoticed - loneliness, frailty, and malnutrition.
Giulia Viroli
Researcher at University of Pavia
Published: March 19, 2025
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Many elderly people struggle with proper nutrition due to illness, social isolation, or economic hardship. Addressing this requires awareness, early intervention, and a holistic, personalized approach.
The elderly population is rapidly increasing. Although often out of sight, we all know them well. The friend’s grandmother, who always forgot to turn off the gas, searched for the oil she had just placed on the table while recounting the same family anecdote for the umpteenth time. Now, she lives in a nursing home, unable to recognize her granddaughter’s face. "Who are you?" she asked with questioning eyes as she refused a plate of food left on the table, unappealing in its appearance.
Or the self-sufficient father of a colleague who tripped on a sidewalk hole. “Displaced fracture”, the doctors said. From that day on, he went out less and less and talked to fewer and fewer people until he spent his days at home in front of the TV, minimising movement, including the effort needed to prepare a warm meal. "I can’t go grocery shopping, but don’t worry, I’ll manage somehow," he tells his daughter, who cannot find the time to accompany him because she works all day, with her only free time on the weekends.
We know these people because they live next to us, like the neighbor who lost her husband, whose days have become monotonous repetitions of the same actions without joy. "Waiting for the moment to come, I have nothing else to do," she says as she shrinks daily.
For a long time, humanity has sought immortality in various ways. Life expectancy has increased worldwide, and in 2023, Italy confirmed a significant leap forward in life expectancy at birth: 83 years, compared to 40 years at the beginning of the century. People over 65 represent 24.3% of the total population—one in four. For every child under ten, there is an octogenarian. Fifty years ago, this ratio was 9:1. Our lives are getting longer, but at what cost?
Healthy Aging vs. Malnutrition
While increasing life expectancy is a significant achievement, not everyone ages similarly. The World Health Organization defines healthy ageing as "the process of developing and maintaining functional abilities that enable well-being in older age" 1. Therefore, longevity as an absolute value is not the only concern—participation in society is becoming a privilege for the few.
The other side of healthy ageing is the loss of autonomy, multiple pathologies, and reduced quality of life. In 2019, among those over 65, more than one in two Italians lived with more than three chronic diseases, and 43.2% reported at least one severe condition (cancer, Alzheimer’s, dementia, cardiovascular diseases, diabetes, Parkinson’s disease, chronic respiratory diseases) 2. Chronic conditions and multimorbidity negatively impact autonomy and overall quality of life.
It is not just the disease that creates a difficult situation for the elderly. Dental problems, loss of appetite, reduced mobility, and physiological changes (decreased thirst perception, altered taste and smell, loss of muscle mass, and increased fat mass) also put them at high risk of malnutrition. Social factors such as economic insecurity and loneliness also contribute to this.
Malnutrition refers to the discrepancy between what the body needs and what is provided through diet. It can take various forms: excessive or deficiency malnutrition or vitamin and mineral deficiencies. The latter can occur in isolation (e.g., iron deficiency) or alongside excess or deficiency malnutrition. That’s a less recognized but highly prevalent condition, affecting 6% of elderly individuals living in the community, 25% of hospitalized elderly patients, and even up to 100% in cases of certain diseases.
The consequences are numerous, potentially worsening or exacerbating negative outcomes such as falls, fractures, susceptibility to infections, increased hospitalizations, depression, and loss of autonomy, ultimately reducing the quality of life not only for the elderly but also for those around them 3.
How to Address Malnutrition
In the context of a globally ageing population, elderly malnutrition is a challenge that must be tackled at the community level. While family remains the primary support system, informal family assistance networks are changing, making adequate welfare measures essential.
Unfortunately, care pathways often overlook timely nutritional assessments, leading to worsening malnutrition and increasing adverse events. Therefore, the early adoption of personalized dietary models can help improve nutritional status, therapeutic outcomes, and patient quality of life. Recognizing this issue legally is a crucial first step in implementing effective and cross-sectoral interventions.
A significant advancement was made in January 2024 with the approval of Deliberation No. XII/1812 by the Lombardy Region, which became fully active in December 2024. This document formally states that nutritional screening must be integrated into the routine practice of healthcare, social healthcare, and home care structures in Lombardy.
These screenings, which take just 5-10 minutes to complete, allow for the early identification of malnutrition signs and the initiation of targeted interventions. Furthermore, the resolution mandates an appropriate care plan that should be defined after each screening based on the patient's risk level. This ensures timely intervention, restoring proper nutritional status, improving therapeutic responses, reducing hospital stays, preventing complications, and preserving autonomy.
To promote long-term well-being through proper nutrition, it is crucial to consider all aspects of an individual, including nutritional, health, cultural, ethical, religious, social, economic, and environmental factors. Nutritional intervention must always be personalized. Especially for the elderly, who often have multiple health conditions, take medications, and adhere to long-held beliefs and habits. For this reason, involving the individual and their family in designing a dietary plan is essential. Fostering open dialogue with healthcare professionals such as doctors, dietitians, and nutritionists is important to address challenges effectively.
Some practical recommendations include ensuring that meals are not skipped and that each dish provides a balanced distribution of nutrients. Meals should be appealing, served at the right temperature, varied in flavor (using spices and herbs), avoid monotony, and consider the dining environment—especially if the person has a poor appetite. Allowing sufficient time for meal consumption is also crucial, particularly for those with chewing or swallowing difficulties.
Other useful strategies include modifying food textures to reduce chewing effort, using specialized utensils and tableware for individuals with neurodegenerative diseases, and emphasizing the social aspect of eating—sharing meals with others is essential to stimulate appetite and improve the overall dining experience.
Food alone is insufficient to meet nutritional needs. Dietary supplements can be used first, followed by medical nutrition products (oral nutritional supplements, ONS), which should only be consumed under medical supervision. In severe cases, enteral or parenteral nutrition may be necessary 4.
Future advancements may lead to further specialization, with different disciplines providing enhanced tools to tackle malnutrition by understanding genetic and epigenetic factors, biomarkers, and bioactive molecules and leveraging patient screening and monitoring technologies. Today, we can begin by recognizing the fundamental role of nutrition in elderly care. Only through shared efforts and a multidisciplinary approach, we can offer long-term prospects for a good quality of life.
References
1 Rudnicka E, Napierała P, Podfigurna A, Męczekalski B, Smolarczyk R, Grymowicz M. The World Health Organization (WHO) approach to healthy ageing. Maturitas. 2020;139:6-11. doi:10.1016/j.maturitas.2020.05.018
2 Polimorbidità nell’anziano in Italia, ISTAT. Disponibile presso il sito https://www.istat.it/it/files/2021/07/Report-anziani-2019.pdf (ultimo accesso 23/01/2025)
3 Dent E, Wright ORL, Woo J, Hoogendijk EO. Malnutrition in older adults. Lancet. 2023;401(10380):951-966. doi:10.1016/S0140-6736(22)02612-5
4 Volkert D, Beck AM, Cederholm T, et al. ESPEN guideline on clinical nutrition and hydration in geriatrics. Clin Nutr. 2019;38(1):10-47. doi:10.1016/j.clnu.2018.05.024
Giulia Viroli
Researcher at University of Pavia
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