Elder Hunger: New Efforts To Combat Surprisingly Common Malnutrition Among Seniors

Jeff Kubina/Flickr

Jeff Kubina/Flickr

By Nell Lake

After her stroke, a 95-year-old woman in New York State found that she could no longer taste her food. She was also unable to feel hunger, so she didn’t know when she was supposed to eat. As a result, the woman began losing weight, grew weak and wasn’t getting the nutrients she needed.

Enter Meals on Wheels, a national home-delivered meals program established by the 1965 Older Americans Act. The woman (who asked that her name not be used) began receiving meals at her home five days a week. This, she says, helped her remember to eat regularly. Her weight improved, and so did her general health.

Malnutrition like hers is surprisingly common. Six percent of the elderly who live at home in the United States and in other developed countries are malnourished, according to a 2010 study in the Journal of the American Geriatric Society. The rate of elder malnutrition doubles among those in nursing homes — 14% according to the same study.

And rates skyrocket among elderly populations in rehabilitation facilities and hospitals: Various measures show an astonishing one third to one half of seniors are malnourished upon being admitted to the hospital.

“Malnutrition is a serious and under-recognized problem among older adults,” says Nancy Wellman, a nutritionist and instructor at Tuft University’s Friedman School of Nutrition Science and Policy.

It’s not a new problem. But growth in the elderly population, and concerns about healthcare costs, have helped renew efforts by nutritionists and other advocates to establish screenings for malnutrition in medical settings, and to improve interventions that can prevent or reverse the issue.

Nutrition Complexities

Most basically, malnutrition means not getting enough nutrients for optimal health. In older adults, the causes are complex, experts say. Illness, disability, social isolation, poverty — often a combination of these — can all contribute to malnutrition. An older person may become malnourished because she has trouble chewing or swallowing. The medications she takes may suppress appetite. She may be unable to get to a grocery store. She may live alone, be depressed, or simply be uninterested in eating.

It’s important to know, says Connie Bales, a dietician and faculty member at Duke University Medical Center, that obese and overweight seniors can be malnourished, too. Eating too many calories doesn’t necessarily mean you’re getting the right nutrients for maintaining muscle and bone. “One can be quite malnourished, yet not be skinny,” Bales says.

High Costs 

Whatever the cause, malnutrition leads to further trouble. It increases older adults’ risk of illness, frailty and infection. Malnourished people visit the doctor and are admitted to the hospital more often, have longer hospital stays and recover from surgery more slowly.

The association between malnutrition and hospitalization goes both ways, say Wellman and other experts: The sick are more likely to become malnourished, and the malnourished are more likely to get sick. Continue reading

More On ‘Sundowning,’ And The Agitation That Can Grip Seniors After Dark

(edward musiak/Flickr)

(edward musiak/Flickr)

Our post last week on “sundowning” — a syndrome in which seniors’ behavior changes dramatically after dark — generated an outpouring of stories from patients, caregivers and people working in hospitals, in hundreds of comments on Facebook.

Many brought up the fact that delirium and sundowning are related. While sundowning is thought to happen in elderly patients with advanced dementia, many people described seeing sundowning in others — like a relative after surgery. While experts aren’t sure how much sundown syndrome and delirium overlap, they agree that not everyone who gets confused at night is sundowning.

Delirium is very common and also gets worse at night. So the first time someone experiences delirium they should be checked for underlying and reversible causes like infections or mind-altering medications.

People also pointed out that sundowning can happen at home as well as in the hospital. For people with severe dementia like Alzheimer’s, this is especially true.

Some commenters referenced “The Visit,” a recently released horror movie where two children are visiting their elderly grandparents who exhibit erratic and violent behavior each night. I haven’t seen it myself, but it seems to be taking the concept to the extreme in the most frightening way possible.

Many of the stories on Facebook were particularly moving. We thought we’d share a few: Continue reading


‘Sundowning’: Why Hospital Staffs Dread Nightfall, And How To Help Seniors Avoid It

By Dr. David Scales

The elderly woman had been normal all day, my colleague told me, tolerating it well when a tube was placed in her bladder to measure her urine. But that evening, she was found wandering the hospital halls yelling in Italian, carrying her urine bag under her arm thinking it was her purse, traumatized that hospital staff were trying to take it away.

Another night in the hospital, a female Sri Lankan colleague saw an elderly man who was convinced she was a Nazi soldier. Reassurances and even a plea from the doctor — “How could I be a Nazi? I have brown skin!” — could not persuade him otherwise. The next day the patient was back to normal, incredulous when told about what transpired the night before.

An 80-year-old man — I’ll call him Bill — came to our emergency room after a fall. He seemed fine and his tests were negative, but his family wanted him admitted over night for observation. That evening, he began shouting out, repeatedly wanting to get up and walk to the bathroom (forgetting he had just gone). Our calming efforts only riled him up more.

This erratic nighttime behavior is called “sundowning.” Staff in hospitals and nursing homes always worry what will happen as twilight approaches. As the sun sets, many elderly patients can change drastically: They can become extremely confused, agitated, not know where they are, and even hallucinate. In other words, they exhibit signs of delirium, a confused state that can lead them to do things they otherwise wouldn’t.

Ulrich Joho/Flickr

Ulrich Joho/Flickr

Thankfully, not every elderly patient sundowns, but when one does, it can be emotionally traumatizing for everyone. To be confused or hallucinate, or to see a relative acting out in irrational ways, is frightening and destabilizing. Yet, sundowning seems to be extremely common. So, what is it? Why do people sundown? And what can you do to minimize the risk of sundowning in yourself or a close friend or relative?

Experts agree that confusion and agitation are more common in the evening and at night. But there is surprisingly little scientific consensus on what sundowning actually is.

The debate is in how much sundowning and delirium are related. Some experts think they’re the same thing, others separate but related entities.

It’s hard to study sundowning without a clear definition and diagnostic criteria. Experts can’t even be sure how often it happens. A recent review found a rate of anywhere from 2.4 percent to 66 percent. Continue reading

Prevention Expert: What I Wish You Knew About Not Falling Down

(Courtesy of the CDC)

(Courtesy of the CDC)

By Dr. Audrey M. Provenzano
Guest contributor

One word comes to mind when I think about Mr. H: grit.

I met him while he was in the hospital with pneumonia, the latest in a long string of hospitalizations after he broke his hip in a fall. I would see him in the halls with the physical therapist, gripping his walker, utterly absorbed in the work of lifting each foot and placing it back down.

Every morning on rounds, Mr. H would joke with us: “You’re going to throw me outta this place today, right, doc? Don’t pass go, just go home!” But beneath his humor lurked true sorrow, anger and frustration over his loss of independence. Before his fall, Mr. H had never stayed overnight in the hospital; he took only a few medicines for high blood pressure, and lived alone with his cat — a simple life he lost in a second, and yearned each day to get back.

Many of us harbor secret fears about growing older, and what many of us fear most is the loss of independence, a tragic and terrifying possibility. I’d suggest a very specific focus for those fears: falls. The most common but least talked-about reason that older adults like Mr. H lose their independence is falling down.

Here is what I most wish everyone knew about falls: They are are common, they can be devastating and, most importantly, falls are preventable.

Falls are common

Incredibly common. Thirty percent of adults over 65 fall each year. Because falls happen all the time, we don’t think about how dangerous they are. Unfortunately, one in five falls results in serious injuries, including broken bones.

Falls can be devastating

Mr. H’s story is the story of hundreds of thousands of older adults. A fall may lead to surgery, and sometimes that leads to complications, like pneumonia. Some older adults in this situation regain enough function to go back home; sadly, many do not, and one in three is still living in a nursing home a year later.

Even worse, these types of injuries often lead to declining health overall, and 20 percent of older adults who break a hip die within one year from the medical complications that frequently attend such devastating injuries.

Falls can be prevented

How? Six key recommendations, backed by the CDC, some obvious, some less so: Continue reading

Caregiver Nation: Snapshot Of 43 Million Americans Who Give Unpaid Care



By Marina Renton
CommonHealth intern

A high-stress job that requires a full-time commitment for no pay.

What kind of work fits that description? The answer should resonate with more than 43 million Americans: unpaid family caregiving.

As the population ages and more people need care, the ratio of available family caregivers to care recipients is declining, and efforts to support family caregivers are beginning to make headway in the political sphere.

Among those who need that support most: “higher-hour” caregivers, who spend more than 21 hours a week on caregiving, according to “Caregiving in the U.S. 2015,” a report released this summer by the National Alliance for Caregiving and the AARP Public Policy Institute.

Ask Massachusetts resident Diane Gwynne, 56. After her mother’s sudden death this past December, Gwynne found herself trying to balance her career and household responsibilities with caring for her 92-year-old father, who has dementia.

“I was so overwhelmed,” Gwynne said of when she first started caring for her father. “It was so sudden. I didn’t even know where to turn.”

Last year, Gwynne’s mother had an intuition that the Christmas of 2014 would be the family’s last. Gwynne’s mother was in her 80s and her father was seven years older, in his 90s. Both were feeling the effects of age.

“My mother said, ‘I want to put all the decorations up, because I think this is going to be our last year all together,’ ” Gwynne recalls. Her mother, it turned out, was unknowingly predicting her own death: She passed away just before the New Year.

Suddenly, her bereaved children found themselves managing the estate, taking their father to medical appointments, and making arrangements for his day-to-day care.

Caregivers By The Numbers

Caregiving in the U.S. 2015,” a report that comes out every few years and aims to profile the nation’s family caregivers, looks at the demographics of family caregivers, along with the emotional, physical and financial challenges they face.

Based on the results of online interviews with 1,248 adult caregivers who provide care to adults, the report offers a quantitative snapshot of the country’s caregivers. Among its findings:

• Approximately 43.5 million adults in the country have provided some form of unpaid care to an adult or child with special needs in the past year.

• About 39.8 million Americans have cared for an adult (over 18 years old), and 34.2 million an adult over 50, in the past year. In other words, about 18 percent of U.S. adults have shouldered some unpaid caregiving responsibilities in the past year.

• The average caregiver is a 49-year-old woman caring for a relative. (Eighty-five percent of caregivers look after a relative, 49 percent a parent or in-law.)

• Less than a third of unpaid caregivers retain some kind of paid help.

While she had helped out both her parents in recent years, it wasn’t until her mother’s death that Gwynne and her sister became the primary caregivers for their father.

Continue reading

Calcium, Vitamin D For Osteoporosis: Are Recommendations Skewed By Conflicts Of Interest?

A photo illustration shows over-the-counter calcium supplements. (Bebeto Matthews/AP)

A photo illustration shows over-the-counter calcium supplements. (Bebeto Matthews/AP)

By Marina Renton
CommonHealth Intern

Might commercial influences be driving the widespread recommendation of calcium and vitamin D supplementation for the prevention and treatment of osteoporosis?

That’s the conclusion of an analysis published in the journal BMJ, written by Andrew Grey and Mark Bolland, endocrinologists and associate professors at the University of Auckland.

The analysis — strongly refuted by organizations that advocate for osteoporosis research — further complicates the already contentious issue of whether it’s a good idea to take the supplements and if so, at what dosage.

The Supplement Conundrum

Women over 50 are most likely to develop osteoporosis, a bone disease affecting millions of Americans that results in bone weakness and increased risk of fracture. Calcium and vitamin D supplements are widely recommended to prevent and treat the condition.

“But as we point out, the considerable body of randomized trial evidence doesn’t support that practice,” Grey, the study’s co-author, wrote in an email.  “We wondered why practice hasn’t changed to reflect the evidence.”

To promote bone health, over half of older Americans take calcium and vitamin D supplements, which can be prescribed by a doctor or purchased over the counter, the authors write.

The Institute of Medicine (IOM) recommends adults take in 1,000 mg of calcium per day (1,200 for adults 70+ and women 51-70) and 600 IU (international units) of vitamin D — 800 IU for the 70+ set.

As of 2013, the U.S. Preventive Services Task Force does not recommend daily calcium and vitamin D supplementation for non-institutionalized postmenopausal women to prevent fractures. This, they note, is not necessarily inconsistent with the IOM’s recommendations, which do not specifically discuss fracture prevention.

The supplements have been standard clinical practice in preventing or treating osteoporosis in older adults since the early 2000s. Since then, however, studies have emerged to contest their effectiveness, according to the paper. Continue reading

Elderly And Drugged: Far More Psych Meds Prescribed To Old Than Young

Evidence suggests that anti-anxiety medications like Xanax increase the risk of falls in older adults, which can cause a cascade of problems. (johnofhammond/Flickr, with edits by WBUR)

Evidence suggests that anti-anxiety medications like Xanax increase the risk of falls in older adults, which can cause a cascade of problems. (johnofhammond/Flickr, with edits by WBUR)

By Nell Lake
Guest Contributor

Are we over-treating the elderly with psychiatric drugs?

That’s the natural question arising from a recent report that found adults over 65 are receiving psychotropic medications at twice the rate of younger adults. The study, published in this month’s Journal of the American Geriatrics Society, also found that elders are much less likely to get their mental health care from psychiatrists or to receive psychotherapy.

What’s the problem? First, psychotropic drugs generally pose greater risks to the elderly than they do to younger patients, and non-drug approaches, from therapy to meditation, may be as effective as psychotropic medications for some seniors’ mental disorders, without the risks.

The findings suggest that physicians and insurers should reassess psychotropic drug use among the elderly, says lead author Donovan Maust, a geriatric psychiatrist and assistant professor of psychiatry at the University of Michigan.

Maust’s team used 2007-2010 data from the CDC’s National Ambulatory Medical Care Survey and from the U.S. Census to compare the rates at which older and younger adults — those 65 and older, and those 18-64 — get prescribed psychotropic medications during outpatient doctors’ visits. After analyzing more than 100,000 of these doctor visits, and taking into account the fact that the younger population is much larger than the older one, the researchers found that older adults were much more likely to be prescribed psychiatric drugs for anxiety, depression and other mental health conditions. Researchers also found that these seniors were less likely to receive other types of non-drug treatment for their mental distress.

The importance of all this is fairly clear: The elderly population is booming, and seniors use the health care system more than any other demographic. So, finding safe, effective and appropriate treatments for their mental health problems is critical — for the well-being of a large swath of people, and as a policy matter.

Too Many Meds, And The Wrong Kind?

Psychotropic drugs pose both direct and indirect risks to the elderly: First, the drugs themselves can be dangerous. The American Geriatrics Society lists many psychotropic medications as potentially inappropriate for elderly patients. Continue reading

Happy 100 To You, And You — Centenarians Multiply, At Forefront Of Age Wave

Ethel Weiss, 100, dances with her daughter Anita Jamieson at the “Party Of The Century” at the Brookline Senior Center on Wednesday. (Jesse Costa/WBUR)

Ethel Weiss, 100, dances with her daughter Anita Jamieson at the “Party Of The Century” at the Brookline Senior Center on Wednesday. (Jesse Costa/WBUR)

It’s a rare milestone, to turn 100 — but not nearly as rare as it used to be.

This week in the town of Brookline, Massachusetts, the senior center hosted more than a dozen local centenarians for a “Party of the Century.” In the not-so-distant past — centenarian parties in 2002 and 2007 — party organizers had to reach out to centenarians from all of Greater Boston to gather a critical mass for a fete.

But now, the 99-and-over set has so grown that the party had to limit itself to just Brookline, says Ruthann Dobek, director of the Brookline Council on Aging. And if the numbers keep growing, she told the crowd, “we’re going to have to start it at 105 or 110 to be eligible.”

The centenarians are the leading edge of the fastest-growing sector of the population: people over 60. In this state, the population over 60 has grown 17 percent over just the last five years, and the over-60 cohort will soon outnumber people under 20 for the first time in history, says David Stevens, the executive director of the Massachusetts Association of Councils on Aging. Continue reading

Why To Exercise Today: To Promote Cognitive Health (It’s Official)

(Diabetes Care/Flickr)

(Diabetes Care/Flickr)

The venerable Institute of Medicine came out with a report this week on cognitive aging (yes, that means you…) and a few things that can help avert the inevitable. The panel’s No. 1 recommendation? “Be physically active.” Enough said.

To be clear, “cognitive aging is not a disease,” the report notes. “Instead, it is a process that occurs in every individual, beginning at birth and continuing throughout the life span.”

That process impacts the brain like no other body part, the authors say. And while the extent and quality of cognitive aging (read: decline) varies greatly, many older men and women will experience problems related to the speed at which they process information, the ability to problem-solve and make decisions and, of course, memory. (Lost keys, anyone?)

Putting a little silver lining on things, the IOM news release quotes the chairman of the committee, Dan G. Blazer, the J.P. Gibbons Professor of Psychiatry Emeritus at Duke University Medical Center, saying that “…wisdom and knowledge can increase with age, while memory and attention can decline.”

So what should we do about our aging brains? The report is clear:

· Be physically active.

· Reduce and manage cardiovascular disease risk factors, including high blood pressure, diabetes, and smoking.

· Regularly discuss and review health conditions and medications that might influence cognitive health with a health care professional. A number of medications can have a negative effect — temporary or long term –on cognitive function when used alone or in combination with other medication.

The committee also identifies additional actions for which there is some scientific evidence to suggest positive effects on cognitive health:

· Be socially and intellectually active, and continually seek opportunities to learn.

· Get adequate sleep and seek professional treatment for sleep disorders, if needed.

· Take steps to avoid a sudden acute decline in cognitive function, known as delirium, associated with medications or hospitalizations.

· Carefully evaluate products advertised to consumers to improve cognitive health, such as medications, nutritional supplements, and cognitive training.

Continue reading

Sexual Reality: The Checkup Podcast Debunks A Few Myths (Like Size And Age Matter…)

Possibly our juiciest segment yet, the latest installment of The Checkup podcast, our joint venture with Slate, takes on some sexual myths and offers a bit of reality.

We bring you surprises about penis size, stories of great sex over 70 and new insights on how both men and women are lied to about their sexuality. As we have in past segments, Carey and I offer our fresh take on research-based news that could brighten up your life below the waist. Check it out here:

And in case you missed our last episode, “Grossology” (including a look at the first stool bank in the nation and research on the benefits of “bacterial schmears” from a mother’s birth canal) — you can listen now.

And if you want to hear earlier episodes: “Scary Food Stories” includes the tale of a recovering sugar addict and offers sobering news to kale devotees. And “On The Brain” includes fascinating research on dyslexia, depression and how playing music may affect our minds.

Make sure to tune in next time, when we present: “High Anxiety,” an episode on the (arguably) most prevalent of mental health disorders.

Each week, The Checkup features a different topic — previous episodes focused on college mental health, sex problems, the Insanity workout and vaccine issues. If you listen and like it, won’t you please let our podcasting partner, Slate, know? You can email them at