Case Study: Malnutrition in an Older Adult
Patient Profile
Name: Margaret (pseudonym)
Age: 78
Living situation: At home with husband (primary carer, also ageing)
Medical history: Hypertension, osteoarthritis, recent respiratory infection
Medications: Antihypertensives, PRN analgesia
Presenting Concern
Margaret was referred by her GP following:
- Unintentional weight loss (~6 kg over 6 months)
- Ongoing fatigue
- Reduced appetite after a recent illness
Her husband noted: “She just doesn’t seem interested in food anymore.”
Anthropometric
- Weight loss >10% over 6 months
- BMI within “normal” range, but declining
Dietary Intake
- Skipping meals
- Small portions (toast, tea, occasional soup)
- Low protein and limited variety
Functional Changes
- Reduced strength (difficulty rising from chair)
- Increased fatigue
- Less engagement in usual activities
Clinical Indicators
- Mild iron deficiency
- Low vitamin D
- Recurrent minor infections post-illness
Contributing Factors
Margaret’s malnutrition was multifactorial:
- Reduced appetite following infection
- Early satiety and low meal volume
- Fatigue impacting meal preparation (both partners)
- Age-related muscle loss (sarcopenia)
- Subtle social factors — meals becoming less structured and less enjoyable
Importantly, there was no single cause — just a gradual drift.
Assessment Summary
Margaret meets criteria for disease-related malnutrition (chronic, low-grade inflammation) with:
- Significant unintentional weight loss
- Reduced intake
- Declining functional status
Intervention Plan
1. Nutrition Support
- Fortify meals (e.g. add milk powder, cheese, olive oil)
- Introduce small, frequent meals rather than large portions
- Emphasise protein at each eating opportunity
2. Practical Strategies
- Simplify meals (ready-made, frozen, or assisted prep)
- Encourage shared eating times to rebuild routine
- Consider community supports (e.g. meal services)
3. Micronutrient Repletion
- Iron and vitamin D supplementation as indicated
4. Functional Focus
- Gentle resistance-based activity (e.g. sit-to-stand exercises)
- Align nutrition with movement to support muscle maintenance
Outcomes (8–12 weeks)
- Weight stabilised, slight regain (~1–2 kg)
- Improved energy and participation in daily activities
- Increased protein intake and meal frequency
- Reduced fatigue reported by both Margaret and her husband
Clinical Reflection
This case highlights a common pattern:
- Malnutrition developing gradually, post-illness
- Occurring despite a “normal” BMI
- Driven as much by function and environment as by intake
Key Takeaway
In older adults, malnutrition often looks like:
“Eating a bit less, moving a bit less, and slowly becoming less themselves.”
- Early, practical nutrition support can meaningfully shift trajectory, particularly when it supports both the patient and the person preparing the meals.
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