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Spotting the Signs of Malnutrition in Your Loved One

Follow these steps to help prevent and address malnourishment concerns

spinner image one pea on a fork on a white plate
Julia Hiebaum / Alamy Stock Photo

Your once-husky dad has lost his appetite and four pants sizes. Your mom, a lifelong gourmet, has switched from French food to French fries and the kind of cereal she wouldn’t let you eat as a kid.

On the list of things that can go wrong, a small appetite or a taste for junk food seems minor and easily explained — even predictable. A decreased appetite is a frequent side effect of aging. When taste and smell get dull, the jacked-up flavors of processed food can become more appealing.

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In truth, either behavior can spawn a crisis: malnutrition. And because the outward signs are the same as problems associated with age — falling, anemia, slow healing and fragile bones — it can escape notice. Even healthy eaters who maintain weight can be running near empty because vitamin and mineral absorption decrease with age.

If you are concerned your loved one is underweight, undermined by diet, or possibly undernourished, you’ll want to consult an expert. And since health professionals can’t fix what they don’t know about, you’ll want to gather the information the doctor needs to help your loved one.

Preventing Malnutrition: Step by Step

Step 1. See a doctor

If you’ve noticed a change in your loved one’s appetite or weight, make an appointment with the healthcare provider for a nutritional evaluation.

 You may request:

  • A Nutritional Risk Screening (NRS) and a Mini Nutritional Assessment (MNA) to determine if the patient has or is at risk of malnutrition
  • Lab tests for nutrient absorption

Step 2. Consider possible reasons your loved one might be undernourished:

  • Anxiety
  • Alcoholism
  • Absorption of fewer nutrients
  • Medications (may upset digestion or nutrient absorption, or reduce appetite)
  • Chronic illness
  • Depression
  • Dementia
  • Dental issues
  • Difficulty swallowing
  • Loneliness
  • Mourning (the loss of a partner, friends, pet or their own stamina and independence)
  • Restricted diet  
  • Inability to afford adequate groceries
  • Sensitivity to a certain food group
  • Recent hospital stay
  • Unidentified physical issue

Step 3. Start a food journal for your loved one


  • All meals, snacks and drinks — including water and alcohol — and calories (before serving, measure each item; afterward, measure all that remains uneaten, using a calorie counting app)
  • Reaction to food or drink — such as gagging, choking, sneezing, stomach issues and headache
  • When and which medication is given
  • Number of cigarettes your loved one smoked, if any (cigarettes suppress appetite)
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Step 4. Talk it out

If your loved one is able, have a gentle, but upfront, conversation before the doctor’s visit. Include:

  • Your observations about appetite
  • Your loved one’s concerns and feelings
  • Your concerns
  • Suggestions, likes and dislikes
  • Permission to sit in on your loved one’s doctor’s appointments, if not already established

Step 5. Share your findings

Report the food journal and other concerns with your loved one’s medical team before the appointment by email or phone. This will give the doctor time to consider what you have to say.

Know your limitations:

  • As your loved one’s family caregiver, the medical provider may discuss your loved one’s treatment with you — unless your loved one has told the doctor that it may not be shared with others.
  • If your loved one has signed a Health Insurance Portability and Accountability Act (HIPAA) release, the doctor can discuss your loved one’s health with you.
  • Even if your loved one has told the doctor not to share medical information with others, the physician or medical assistant can listen to your report, questions and concerns by phone, in person or by email. They can use the information to better diagnose and treat the patient, but they cannot discuss diagnosis or medical information with you.

Step 6. Participate in appointments

If you are present during the appointment, your participation should depend on how well your loved one can carry and comprehend the conversation. Let your loved one take the lead. Your job is to:

  • Arrive with written questions
  • Take notes
  • Approach concerns with tact and empathy, and without judgment or emotion
  • Clarify questions and answers
  • Remember to let unwelcome orders come from the medical provider (doctors are more easily forgiven than relatives and friends)

Step 7. Ask a health professional:

  • How to improve appetite
  • If current prescriptions might be suppressing appetite
  • If a prescription change could spark appetite
  • If nutritional supplements are needed
  • About best foods for the patient
  • How to making food more palatable
  • About diagnosis and treatment
  •  For the name of a nutritionist or dietician specializing in geriatrics
  • About books, videos and websites for caregivers

Questions to ask if the issue is:

Depression and anxiety

Get recommendations for:

  • Drug therapy
  • Mental health therapists
  • Alternate or additional therapies
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Get recommendations for:

  • A therapist or group therapy
  • A local support group
  • An online support group
  • A visiting companion organization
  • A program that uses older volunteers
  • Adult day care
  • A visiting-pets program


Get recommendations for:

  • A therapist specializing in loss
  • Recommended reading
  • Local or online support group

Swallowing difficulties

Get recommendations for:

  • Recommended foods and diet
  • Thickening agents to add to liquid and soft foods

Alcohol abuse


  • History of alcohol or drug abuse
  • Specific caregiver instructions
  • Effect of abuse on other health issues — including diabetes, osteoporosis and liver disease
  • Increased sensitivity or decreased tolerance
  • Withdrawal
  • Sobriety programs for older people

Affording quality food

Get help:

  • Meals on Wheels America delivers low-cost or no-cost meals for people who meet the income requirement, as well as for those who can’t shop or cook. The meals are balanced and prepared in a professional, certified kitchen.
  • Many local faith-based organizations provide meals and groceries to older people.
  • If your loved one is disabled or over age 60 and cannot meet nutritional needs, research Supplemental Nutrition Assistance Program (SNAP) eligibility.

Food Services

Whether you’re caregiving from a distance or sharing a home with your loved one, technology and niche services can fill in as grocery shopper and chef. Some examples:

  • Instacart is one of many delivery services that will bring groceries to your door. A 10 percent service fee will appear on your bill, but you may choose to raise or lower the percentage. Instacart operates in most states, but may be available only in urban areas.
  • Consider joining the volunteer neighbors-helping-neighbors program known as the "village” movement. If your loved one needs a round trip to the grocery store or pharmacy, help is an online request away. Most villages charge an annual fee to cover overhead. There are more than 200 villages in the United States, with more coming.
  • There are more than a dozen companies that will ship healthy frozen meals created for older people. Options include vegan, vegetarian, gluten free, heart healthy, diabetic, low sodium, low carb, dairy free, and varied portions with macronutrients and more or less spice. A few to check: Silver CuisineHealthy ChefFresh n’ Lean.

Step 8. Check out Create a Plate

Find out how to put together meals that provide the nutrients an aging person needs. (It’s also ideal for caregivers of any age).

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