Social & Community

Understanding the Causes of Poor Nutritional Health in Older Adults

Enjoying a meal with our family or friends is one of the most enjoyable, relaxing pleasures in life. But for many older adults, the loss of a spouse or social isolation often means eating alone — which usually means eating much less or skipping meals altogether. "Eating is a social activity, and we sometimes forget this," explains UAB Assistant Professor in the Division of Gerontology, Geriatrics, and Palliative Care Julie Locher, Ph.D. "A good deal of research shows that people who eat alone eat less than people who eat with others. For older adults, this can lead to under-nutrition, a decline in function and overall health, and a greater risk of illness." Research conducted by Dr. Locher and her colleagues at the UAB Center for Aging has focused on learning the most common reasons older adults under-eat. This information is important for caregivers, family members, and healthcare providers so they can recognize the risk factors for under-eating in older adults and take proactive steps to head off the cycle of poor nutrition before it begins.

"In our research, we found that older adults who are widowed are at greater risk for under-nutrition and under-eating than those who live with their spouse," explains Dr. Locher. For both widowed men and women, routinely eating meals alone after the loss of a spouse contributes to a decline in eating. The reason? A lack of social interaction during the meal is one important factor. "When you eat with others, you're talking and laughing — you have a natural opportunity to eat more because the socialization extends the meal." But other, sociological factors are also involved. "A woman cooks as a demonstration of love for her family. When her husband dies, she no longer views cooking as a labor of love — it becomes pure labor. So she's less likely to want to cook or eat." And when men are widowed, research has found their eating patterns become influenced by their self-image.

"Older men today weren't socialized to be feeders. They don't know how to cook or shop because these things are contrary to their identity of themselves," says Dr. Locher. As a result, men who have lost their spouse are at a greater risk for poor nutritional health.

A lack of social interaction during mealtimes – though an important factor – isn't the only trigger for under-eating in older adults. Research shows that illness also plays an important role, though not for the reason you may think. "We don't feel like eating when we're sick; but when we're better, we begin eating normally again," Dr. Locher says. "This isn't true for senior adults. Research indicates that after an illness, their food intake doesn't return to the level it was before they were sick," she explains. For older adults who suffer many successive illnesses, the negative impact on eating and nutrition can be profound. "That's why it's important for caregivers and family members to eat with older adults who have been ill, providing social support that will encourage them to eat more."

As with illness, hospitalization is another important risk factor that leads seniors to poor nutritional health. "But it's the social and environmental things that happen in the hospital – not the illness itself – that contribute to the problem," explains Dr. Locher. Lack of social interaction and frequent interruptions during mealtimes make eating well in the hospital difficult for older adults. "We're implementing a new program at UAB Hospital that will provide volunteers to offer physical assistance and social support to senior adults during mealtimes," adds Dr. Locher. "Programs that help provide extra support during mealtimes can help ensure that seniors receive proper nutrition when they're in the hospital."

Though under-nutrition among older adults is a serious problem with many contributing factors, Dr. Locher says much can be done in our own communities to improve the nutritional health of our seniors. "For all the groups we studied, a lack of adequate transportation was a problem in being able to shop for food or in getting to congregational meal sites at churches or community centers." She says providing seniors with affordable, accessible transportation is a key part of ensuring the nutritional health of our older population. "Also, we need to think about better nutritional follow-up and monitoring of seniors when they return home from a hospitalization," adds Dr. Locher. She also says that community, religious, and neighborhood organizations should continue to reach out to seniors who are socially isolated, giving them opportunities to share mealtimes with others. "We need to be proactive in ensuring the nutritional health of our seniors before the cycle of poor nutritional health begins."