Having problems with your teeth can make you more likely to experience malnutrition. Trying to eat a healthy, well-balanced diet becomes much more difficult when teeth are weak, painful, loose or missing, or when dentures do not fit properly. In the United States, about half of older adults have lost many, if not all of their teeth.

Your nutrition can suffer if you have missing teeth, especially the back teeth that are needed for grinding up food. If you are unable to chew and grind your food well, you will avoid eating nutritious foods like fruits and vegetables. Instead, you are more likely to rely on soft, easy-to-swallow refined foods, such as white bread, potatoes, or puddings. Also, your diet will be much less varied. This increases the risk of being overweight or obese, and leads to higher salt intake and cholesterol levels. Lack of variation in your diet also means that it is harder to get important nutrients like vitamins and minerals.

A lack of B vitamins can lead to serious consequences for older adults. B vitamins include B6, B12, or folate (folic acid).

Vitamin B12

Older people are at increased risk of B12 deficiency. This is because they are more likely to have these certain risk factors:

• Poor nutrition
• Reduced ability to absorb nutrients even if nutrition is enough (this can be caused by not having enough stomach acid and digestive enzymes)
• History of surgery where part of the stomach or small intestine has been removed
• Taking antacids or other heartburn medicines long-term
• Long-term alcoholism

Make sure to tell your healthcare provider if you notice any of the following symptoms:

• Diarrhea or constipation
• Fatigue
• Loss of appetite
• Balance problems
• Shortness of breath, especially during exercise
• Poor concentration, confusion, even dementia in severe cases
• Depression
• Pale skin or gums (signs of anemia)
• Bleeding gums and red, swollen tongue
• Numbness or tingling in your hands and feet

One of the side effects of a lack of vitamin B12 is an anemia called “pernicious anemia.” Pernicious anemia occurs when your body has trouble absorbing vitamin B12, which then affects the production of red blood cells.   

Vitamin B6

Vitamin B6 is needed to keep your nerves functioning properly. You may have a deficiency of vitamin B6 if you are malnourished or have trouble absorbing nutrients.  B6 deficiencies are common in older adults. A B6 deficiency may cause:

• Tingling or numbness in feet and hands
• Fragile skin and mucous membranes
• Blood problems like anemia
• Possible higher risk of heart and circulation problems

Folic Acid (a B vitamin)

Folate is also known as folic acid. It is a B vitamin that appears to have a protective function against heart disease and cancer. It is found in many foods, especially artificially fortified foods, as well as dietary supplements. Folate keeps your cells healthy, and helps in the production of new red blood cells and in the prevention of cancer. It is considered important in keeping the heart and circulation healthy. This is because it keeps homocysteine, a heart disease risk factor, at healthy levels. Many things can lower your folate levels. Malnutrition, inability to absorb nutrients well, certain medications, kidney dialysis, liver disease, alcoholism, and other chronic diseases may lower your folate levels.

Folate deficiency can cause the following symptoms:

• High homocysteine levels (a risk factor for heart disease)
• Anemia (not enough red blood cells), causing pale skin
• Fatigue and weakness
• Diarrhea
• Poor appetite
• Weight loss
• Irritability, forgetfulness, and other unusual behaviors
• Headaches
• Sore tongue

When you are young, your body makes vitamin D in your skin whenever you are out in the sunshine. Vitamin D is also found in some foods, like milk and oily fish. However, older skin is not very efficient at producing vitamin D in response to sunlight. If your diet doesn’t have enough dairy products or fish oils, you may not have enough vitamin D in your body.

Low vitamin D levels are now common in the United States, particularly in northern states where the winters are long and sunshine is weaker. It is especially problematic for older people who do not go outside very much, and who are malnourished. If you are over 65 years of age, your healthcare provider may wish to order a blood test to check your vitamin D levels. Most guidelines recommend at least 800-1,000 IU (international units) of vitamin D every day for older adults.

One reason you need adequate vitamin D is that your bones cannot absorb calcium without it. This puts you at high risk of developing osteoporosis (fragile bones). Even with plenty of calcium in your diet, your bones may weaken as you age because of:

• a reduction in physical activity
• certain medications (such as steroids like prednisone)
• difficulty in absorbing dietary calcium from the digestive tract
• lower hormone levels, especially in women after menopause

You will want to make sure that your bones stay as strong as possible, so that you can avoid osteoporosis. Therefore, ask your healthcare provider if it would be helpful to take a blood test to check that your vitamin D blood levels are adequate. Get plenty of calcium from milk and other dairy products. Take a calcium supplement if your doctor thinks you are not getting a minimum of 1,200 milligrams of calcium per day.

Falling is the leading cause of fractures in older people. A broken hip can mean a long hospital stay in people over 65 years of age, and is often the reason people have to move into retirement homes or long-term care institutions.

Low vitamin D levels have been linked to an increased risk for falling. This may be due to weakened bones that can break easily, or from some other effect of vitamin D on brain function, nerve health, and muscle strength. Treating vitamin D deficiency with supplements may help reduce falls.

Researchers have found that people in lower social or economic situations have some predictable barriers to eating a healthy diet. These barriers include:

• Financial limits. Many fresh fruits, vegetables, and lean meats have high costs that can make it hard for lower-income people to afford them.
• Having trouble accessing transportation or having mobility problems. This can make it difficult to shop.
• Living in neighborhoods with stores that mainly sell foods that are high in calories, but do not provide enough nutrients (such as potato chips, sugary beverages and cereals, and refined sugary baked goods).
• Lack of education about nutrition.
• Poorer dental health.

As a result, older people in lower social and economic situations tend to have diets that are not as nutritious as they should be. Their diets tend to be high in fatty meat products, full-cream dairy products, fats, sugars, preservatives, potatoes, and cereals. Meanwhile, their intake of fresh fruits and vegetables, fish, and whole-grain baked goods may be low. They often have inadequate levels of nutrients that are essential for good health, such as calcium, iron, magnesium, folic acid, and other vitamins.

Learning about good nutrition can make up for some of the negative effects of social and economic limitations. A good nutritionist or dietitian will have information about how to find cheaper and more accessible food sources. They can also give you information about government programs like Food Stamps that can help.

Many ethnic and cultural groups have strong traditions and rituals that relate to food and food preparation. For example:

• Observant Jews and Muslims avoid eating meat from certain animals (such as pork). Some also will only eat meats from animals that are prepared according to religious rituals.
• Observant Muslims may avoid medications that contain gelatin or alcohol. They may also avoid anything that has come in contact with blood or a blood product.
• Observant Jews will not eat dairy products and meat at the same meal.
• Many Southeast Asians, such as Sikhs and Hindus, are vegetarians, or at least avoid beef.
• Fasting is an important ritual in many traditions, including Islam, Judaism, and Hinduism.
• There are many ethnic groups that tend to eat fewer fruits and vegetables (such as Cambodians and Alaskan Natives).
• Korean and Filipino diets tend to be extremely high in salt.
• Some ethnic groups, such as Haitian Americans, prefer to fast rather than eat unfamiliar foods when they are hospitalized.

If you or someone you care for is malnourished and prefers traditional foods, talk to your healthcare provider about food restrictions and preferences. A good dietitian or nutritionist will be able to come up with a healthy diet for you that fits your preferences and medical condition. 

Many people use medicines or remedies that are not part of the traditional medical treatment prescribed by their healthcare provider. These are called complementary or alternative treatments. Many older adults have tried an alternative remedy for a medical problem because they assume that these approaches are often effective, less expensive, and never harmful. These assumptions are not always correct.

Commonly used alternative remedies may include herbal medicines, large doses of vitamins, folk remedies, energy healing techniques (such as magnets or crystals), or homeopathy. Other approaches, such as acupuncture or chiropractic techniques, are also popular.

You must always tell your healthcare provider if you are using any of these products. Many of them can interact with or interfere with other medications, with serious or even life-threatening consequences. For example:

• Vitamin A in large doses can cause bone problems.
• Vitamin B6 in large doses can damage nerves.
• Many herbal remedies may be toxic. These can include kava kava (causes liver damage), licorice root (raises blood pressure), and gingko biloba (thins blood and may interfere with some heart medications).

Herbal remedies are not tested by the Food and Drug Administration (FDA, the government agency responsible for reviewing medications) in the same way that prescription medicines are tested. Therefore, some may have dangerous impurities in them. For example, some Ayurvedic remedies and folk remedies from the Caribbean have been found to be contaminated with poisonous heavy metals.The best way to reverse a lack of nutrients is to follow the recommendations you get from your healthcare provider, nutritionist, and/or dietitian.

Older adults with dementia are at extra risk for malnutrition because they are unlikely to be able to shop and cook for themselves. Even with a good caregiver, people with dementia need a lot of help actually finishing the food that is placed in front of them. This is because these patients may not be physically able to chew and swallow well. The situation is often complicated by the fact that many people with dementia do not like to accept help with eating. Also, they may be taking sedatives or other medications that interfere with appetite or taste. If someone is in a nursing home or long-term care facility, they are more likely to suffer from malnutrition, too.

Here are some approaches that may help in this situation:

• Consult a dietitian for information about appropriate foods and feeding techniques.
• Check with a pharmacist or healthcare provider about the medications the person is taking. Find out whether there are any adjustments that should be made to improve appetite and avoid drug-nutrient interactions.
• Make sure the older person is getting enough fluids and that their mouth is not too dry. Having them suck on candies or chew gum may be helpful.
• Check to see how much food the person leaves on the plate after a meal.
• Try to serve the person foods that they prefer.
• Make meals a pleasant social event by including friends or family when possible.
• Serve more frequent small meals instead of three large ones.

Offer nutritious snacks, including nutrient-rich drinks or protein bars.

Depression can lead to lack of appetite and malnutrition. Being malnourished can also bring on symptoms of depression. Many older adults take a variety of medicines and some of these may bring on a depressive mood.

If you are caring for an older adult who has become malnourished and is possibly depressed, check with a healthcare provider as soon as you can. (Also check in with a healthcare provider if you think you might be at risk of these conditions yourself.) The following approaches can be helpful:

• Work with a dietician or nutritionist to improve diet.
• Increasing physical activity or an exercise routine can improve appetite, improve social interactions (if exercising in a group), and lessen depressive moods.
• Try to make mealtimes an enjoyable social occasion, with satisfying foods in a pleasant setting.
• Check with a pharmacist or your healthcare provider about your medications. They may be able to stop or adjust prescriptions that might be contributing to lack of appetite or depressed mood.
• Discuss whether an antidepressant medication or counseling might be appropriate.
• Make sure you consume alcoholic beverages in moderation.

Malnutrition in older adults can lead to poor skin health. For example, there is a layer of fat under the skin that normally acts as a cushion against pressures from outside. When this cushion of fat disappears, an older person has a much higher risk of developing pressure sores or pressure ulcers. (This is especially the case for older adults who spend much of their time in a chair or bed.) These areas of skin breakdown and often resist healing.  

The poor skin health in malnutrition is partly a result of protein deficiency. This leads to a lack of materials in the body to repair unhealthy tissue. It can also be a response to lack of certain micronutrients such as vitamins B2 or vitamin C.

For some people, malnutrition may bring on diabetes (though how that happens is still not understood). Diabetes caused by malnutrition is found most often in the developing world, and most often affects people who were malnourished at a young age. However, it may also affect older adults who are suffering from malnutrition. This type of diabetes is most likely to require insulin to treat it, rather than using dietary control alone.

Even if you eat a fairly healthy diet, your chances of having a deficiency of vitamin D and potassium increase as you get older. Many older people have low vitamin D levels due to lack of exposure to the sun, aging skin, and the use of sunscreen. Older people who take diuretics (water pills) for high blood pressure may also lose a great deal of potassium in their urine, which can impact blood pressure. If you are also suffering from malnutrition, the result is an increased risk of high blood pressure (hypertension). The stress of being malnourished can also cause an increase in blood pressure.

High blood pressure raises your chance of developing heart disease. Therefore, making sure that you have sufficient vitamin D, potassium, magnesium ,and calcium will help you avoid heart problems.

If you lack some specific nutrients, particularly vitamins, it may damage your nerves. Here are some of the most well-known effects:

• A lack of thiamine (vitamin B1) damages the outer layer of nerves. This can lead to numbness and tingling in hands and feet within months of severe deficiency. This may also increase your risk of heart failure.
• Vitamin B 6 deficiency is linked to numbness and seizures.
• Vitamin B12 deficiency may also affect the outer layer of nerve cells, causing you to lose feeling and control in your hands and feet.
• In extreme cases, a lack of vitamins may cause a condition called burning-foot syndrome.

Researchers have found that physical activity has many benefits in older people, particularly if they are undernourished:

• It can increase your appetite.
• It can improve your brain function, which helps you nourish yourself in a more healthy way.
• It may strengthen muscles and bone.
• It may improve many other types of conditions, including type 2 diabetes, osteoporosis, arthritis, and psychological illnesses such as depression.