OPINION- All Texans can help reduce malnutrition among older adults

Published 6:37 am Saturday, October 9, 2021

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By Julia Jarrell, RDN, PMP, LD, president of Texas Academy of Nutrition and Dietetics

In Texas, which boasts more farms and ranches than any other state in America and is a leading producer of beef, chicken, vegetables, corn, wheat and dairy products, it may come as a surprise that nearly 20 percent of Texans over the age of 60 – about 800,000 people – struggle with food insecurity.

With the persistence of the pandemic, that number is likely higher, as many older Texans have remained isolated and family members have stayed away.

In recent years, Texas lawmakers and non-profit leaders have made excellent headway, as they work to improve the nutrition of Texas children through school nutrition programs and the Supplemental Nutrition Assistance Program (SNAP).

However, older Texans also face significant barriers to good nutrition, particularly if they live far away from a grocery store or have limited access to transportation.

Consider that nearly a quarter of our state’s 254 counties are considered “food deserts,” which means Texans in those areas have limited access to a grocery store or market where healthy, nutritious foods are available. Older Texans in rural areas or low-income urban neighborhoods are more likely to live in a food desert and are more likely to face other barriers to good health, including lower access to medical care and fewer food banks or food pantries. Moreover, at least one in four senior Texans who are eligible for SNAP benefits do not apply.

For dietitians and other healthcare professionals, these food insecurity numbers point to a deeply concerning but often-overlooked problem facing our state: malnutrition.

Malnutrition is defined as having unbalanced nutrition. Though someone can be malnourished even when they are overfed, most people use the term “malnutrition” interchangeably with “undernutrition,” caused by a lack of calories, protein or other nutrients. The human body relies on nutritious foods to fuel everyday functions and activities; without those nutrients, the body’s functions may begin to break down. In fact, malnutrition is linked to a number of chronic illnesses, including diabetes, kidney disease, cardiovascular disease and cancer and is most prevalent among the most vulnerable Texans, including minority populations, hospitalized patients and especially older adults.

Malnutrition, along with dehydration, can contribute to a decline in mental and cognitive functions, causing fatigue, confusion, anxiety and depression. Malnutrition contributes to falls and the development of life-threatening pressure sores, common and life-threatening problems for the senior population. Malnourished people are more likely to be hospitalized, experience longer hospital stays, have higher medical costs, and face a greater risk of death than those whose bodies are well nourished.

Malnutrition also is costly for the state of Texas and our healthcare system. Texas ranks third in the nation for the highest malnutrition-related costs, spending more than $1.2 billion annually due to worsened disease complications, increased length of hospital stays, and repeated readmissions associated with malnutrition.

What can be done to address malnutrition?

Healthcare professionals must be ever-diligent about screening for malnutrition and recognizing warning signs in their patients. Policymakers must work to ensure that malnourished patients have access to medical nutrition therapy and other interventional steps needed to restore their health. But you don’t have to be a healthcare professional or policymaker to intervene.

The Texas Health and Human Services Department’s Texercise program recently developed a robust set of bilingual resources geared toward helping older Texans, as well as the healthcare providers, caregivers and senior living professionals who care for them, recognize and take action to encourage healthy eating and prevent malnutrition. [https://www.hhs.texas.gov/services/health/wellness/texercise/healthy-eating] Meals on Wheels is also a tremendous resource, delivering daily nutritious meals to about 100,000 homebound Texans statewide each year.

With “Malnutrition Awareness Week” kicking off the month of October, it is a good time for all Texans to be part of the solution when it comes to preventing and addressing malnutrition among our elderly relatives, friends and neighbors. Check in with them regularly. Bring them meals. Offer to pick up food items they need when you run to the store. Your decision to be aware and show you care will be life changing.


  1. Texas Department of Agriculture, https://www.texasagriculture.gov/about/texasagstats.aspx
  2. America’s Health Rankings. Food Insecurity – Ages 60+ in Texas. 2020 [cited 2020 Jul 11]. https://www.americashealthrankings.org/explore/senior/measure/overall_sr_4/state/TX
  3. “Nutritional Assessment and Intervention to Prevent and Treat Malnutrition for Fall Risk Reduction in Elderly Populations.” American Journal of Lifestyle Medicine(2018). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6124993/
  4. “Old Age, Malnutrition, and Pressure Sores: An Ill-Fated Alliance.” The Journals of Gerontology(2004). https://academic.oup.com/biomedgerontology/article/59/4/M355/637767?login=true
  5. “Economic Burden of Disease-Associated Malnutrition at the State Level.” PLoS One(2016). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5031313/
  6. https://www.mealsonwheelstexas.org/impact/