Malnutrition in Older Adults: Protein, Strength & Ageing | Windback NZ

Eating Less, Losing More: The Overlooked Nutrition Risk in Later Life

Disclaimer: The information in this article is for general educational and wellness purposes only. It is not a substitute for professional medical or nutritional advice, diagnosis or treatment. Protein, energy, fibre and fluid requirements vary according to body weight, health, kidney function, medications, activity and individual tolerance. Always seek guidance from a qualified healthcare professional if you are concerned about unexplained weight loss, poor appetite, digestive changes, swallowing difficulties or declining strength.

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Malnutrition in Older Adults - The change may be almost invisible.

Breakfast becomes a piece of toast and a cup of tea. Lunch is skipped because there is little appetite, or no reason to prepare a meal for one. Dinner is smaller than it used to be, with half put aside for tomorrow.

Perhaps there are biscuits with afternoon tea, a sweet dessert after dinner or a milky drink before bed. Enough food may appear to be eaten, but the amount of protein, fibre and essential nutrients can still be surprisingly low.

None of these choices seems particularly concerning on its own. But repeated over weeks and months, eating a little less can gradually lead to the loss of something much more important than body weight. It can mean losing muscle, strength, energy and, eventually, some of the independence that makes everyday life possible.

Malnutrition is often associated with famine, severe illness or visible thinness. Yet it is also a significant and frequently overlooked issue among older people living in New Zealand.

Research suggests that around one in three older New Zealanders living independently may be at risk of malnutrition. The proportion becomes considerably higher among people entering hospital, rehabilitation or residential aged care. This does not mean that ageing inevitably leads to poor nutrition. It does mean that changes in appetite, food intake, mobility and personal circumstances deserve to be recognised and addressed earlier.

A hidden problem in our communities

Malnutrition develops when the body does not receive enough energy, protein or other essential nutrients to maintain health and normal physical function.

A person does not need to appear extremely thin to be affected. Someone can maintain a seemingly stable weight, or carry excess body weight, while still consuming too little protein and too few essential nutrients to preserve muscle, strength and resilience.

In a New Zealand study of older adults living in the community, 37% were identified as being at risk of malnutrition. Those at risk were also more likely to experience social and emotional loneliness and to have fewer sources of social support. An earlier Auckland study found that 31% of community-living older people were at high nutrition risk.

Among New Zealanders in their eighties, another study found that 49% of Māori and 38% of non-Māori participants were at high risk of malnutrition.

The figures become even more concerning when older people enter health and residential-care settings. One New Zealand study involving hospital, rehabilitation and residential-care patients found that 23% were already malnourished and a further 35% were at high risk.

A smaller study of older adults entering residential aged care found that 48% were malnourished and another 45% were at risk. As this was a relatively small study, it should not be treated as a national prevalence estimate. However, it illustrates how widespread nutrition problems can become by the time someone requires additional care. Behind every percentage is a person whose declining nutrition may have developed quietly and gradually.

Malnutrition and nutrition risk are not the same

When discussing these statistics, it is important to distinguish between being malnourished and being at risk of malnutrition.

A person identified as being at nutrition risk may not yet be clinically malnourished. However, screening may show that recent weight loss, reduced appetite, limited mobility, illness, difficulty preparing food or social circumstances are making inadequate nutrition more likely. Recognising this risk provides an opportunity to intervene before the person loses further weight, muscle or physical capability.

This is why it is more accurate to say that a large proportion of older people are malnourished or at risk of malnutrition, rather than suggesting that everyone identified through nutrition screening is already malnourished.

Why eating can become more difficult with age

It is easy to assume that older people simply need less food because they may be less physically active.

Energy requirements may decrease for some people, but the need for high-quality nutrition does not disappear. In fact, an older person often needs to obtain more nutritional value from a smaller amount of food.

Several physical changes can affect appetite and food intake. Taste and smell may become less sensitive, making familiar foods less appealing. Dental problems, dry mouth or poorly fitting dentures can make chewing uncomfortable. Difficulty swallowing may cause someone to avoid particular foods, take much longer to eat or become anxious around meals.

Pain, constipation, fatigue and medication side effects can also reduce appetite. Following a hospital stay, infection or operation, the body may require additional nourishment at precisely the time a person feels least interested in eating.

There can also be practical barriers. Carrying groceries, opening packaging, standing at the kitchen bench or preparing a complete meal may become difficult when strength, dexterity and mobility decline. But not every cause is physical.

When eating alone changes the meaning of a meal

For someone who has cooked for a partner or family for decades, eating alone can change the meaning of a meal. Food may no longer feel like an occasion. The motivation to shop, prepare a meal and sit down at the table can quietly fade.

A missed lunch may not always be about hunger. It may be connected to loneliness, grief, exhaustion, limited transport, financial pressure or simply feeling that cooking for one person is not worth the effort.

The New Zealand research linking nutrition risk with loneliness and limited social support reminds us that food is never only about nutrients. Meals can provide routine, companionship, pleasure and connection. When those elements disappear, appetite and food intake may decline with them.

Why nutrition matters for strength and independence

One of the most serious consequences of inadequate nutrition in later life is the loss of muscle.

Muscle naturally changes as we age, but inadequate food intake and inactivity can accelerate that process. A person may first notice difficulty getting out of a chair, carrying shopping, climbing stairs, walking the usual distance or recovering their balance.

These changes can easily be dismissed as an unavoidable part of ageing. Sometimes, however, they are signs that the body is losing the physical reserves it needs to remain strong.

Muscle is not important only for exercise. It supports balance, movement, glucose metabolism, recovery and the ability to perform everyday tasks independently. Poor nutrition has also been associated with frailty, falls, slower recovery, longer hospital stays and a greater need for support.

A systematic review involving more than 9,500 community-dwelling older adults found that those who were malnourished or at nutritional risk had a higher risk of falling than well-nourished older adults.

This is why nutrition in later life is about far more than reaching a particular number on the scales. It is about helping preserve the strength and physical capacity needed to participate in life.

How much protein does an older person need?

The standard adult protein recommendation is commonly stated as approximately 0.8 grams per kilogram of body weight each day. However, several expert groups consider this insufficient for supporting optimal muscle maintenance and physical function in later life.

The PROT-AGE Study Group recommends an average daily intake of approximately 1.0 to 1.2 grams of protein per kilogram of body weight for healthy adults over 65.

At this level, an approximate daily protein target would be:

50 kg body weight: 50 to 60 grams of protein
60 kg body weight: 60 to 72 grams of protein
70 kg body weight: 70 to 84 grams of protein
80 kg body weight: 80 to 96 grams of protein
90 kg body weight: 90 to 108 grams of protein

For example, a healthy older person weighing 75 kilograms may have an estimated target of approximately 75 to 90 grams of protein each day.

Older adults who are physically active, frail, recovering or living with an acute or chronic health condition may sometimes be advised to consume approximately 1.2 to 1.5 grams per kilogram. These higher targets should be individualised by an appropriate healthcare professional. People with significant kidney disease may require a different protein intake and should not increase protein without professional advice.

These figures are guides rather than prescriptions. Body weight alone cannot determine an individual’s needs. Appetite, muscle loss, activity, kidney function, digestive tolerance, wounds, medications and overall health must also be considered.

The protein paradox

Health New Zealand advises older adults to include a protein-rich food at every meal and notes that the body becomes less efficient at processing protein with age. Yet the need for more protein often arrives at exactly the time when appetite and meal size are declining.

A light breakfast of tea and toast may feel sufficient, but it contains very little protein. Soup can be warming and easy to eat, but a thin vegetable soup may not contain enough protein or energy to support someone who is already losing weight or strength.

Simply telling an older person to eat more does not solve the problem. A heavily loaded plate can be physically and psychologically overwhelming. The person may become full quickly, tire while eating, struggle to chew or lose interest before finishing the meal. For someone with a small appetite, increasing volume may be the least effective approach.

The more useful question is often: how can we provide more protein and nourishment in an amount the person can realistically manage?

What 100 grams of protein looks like in real life

A recommendation such as “aim for 100 grams of protein” can sound straightforward on paper. In real life, it can be remarkably difficult to achieve.

I experienced this personally while supporting my mother. Based on her body weight and nutritional needs, we were working towards approximately 100 grams of protein each day. That target was extremely difficult to reach through ordinary meals alone.

One egg generally provides around 5 to 7 grams of protein, depending on its size. Even four eggs may provide only around 20 to 28 grams of protein. Four eggs can already feel like a considerable amount of food for someone with a poor appetite, yet they may provide only around one-quarter of a 100-gram daily target.

We found that protein smoothies became an important and practical part of my mother’s routine. One serve of Mitchells Chocolate Bone Broth Protein provided approximately 25 grams of protein. Two smoothies contributed close to 50 grams, while four eggs added approximately another 20 grams. Together, that provided around 70 grams of protein without requiring several large meals.

Even then, we still needed to find approximately another 30 grams through yoghurt, milk, cheese, fish, chicken, soups or whatever else she felt able to manage that day.

That experience changed how I think about advice to “eat more protein”. The recommendation may be nutritionally appropriate, but it does not reflect the effort involved when appetite, taste, digestion, fatigue and the physical capacity to eat are all limited. A protein target is meaningful only if there is a realistic plan for helping the person reach it.

Protein should be spread across the day

Trying to consume most of the day’s protein at dinner can be difficult and may not be the most practical approach for maintaining muscle.

Research involving community-dwelling adults aged 65 to 74 in Auckland found that protein intake was unevenly distributed throughout the day. Breakfast and lunch were particularly likely to provide insufficient amounts, while much of the day’s protein was concentrated in the evening meal.

Spreading protein across breakfast, lunch, dinner and one or two snacks can make a daily target more achievable. For someone aiming for approximately 80 grams a day, a practical pattern might look like:

Breakfast: 20 grams
Lunch: 20 grams
Afternoon snack or smoothie: 15 to 20 grams
Dinner: 20 to 25 grams

This is only an example. Someone with a very small appetite may tolerate five or six smaller eating opportunities better than three traditional meals. The aim is not to force a rigid schedule. It is to avoid reaching the evening and discovering that most of the daily protein target is still unmet.

When ordinary meals are not enough

Whole foods should remain the foundation of a varied diet wherever possible. They provide protein alongside vitamins, minerals, fats, fibre and other useful nutrients. However, there are situations in which ordinary meals alone do not provide enough protein in a manageable volume.

Protein-enriched foods, smoothies and appropriate nutrition supplements can then be useful tools rather than signs of failure. Options may include:

Greek or high-protein yoghurt
Milk or soy milk
Eggs
Cottage cheese or soft cheese
Fish, chicken or tender meat in small portions
Tofu, lentils, beans or hummus
Nut and seed butters
Milk powder stirred into porridge, soup or mashed vegetables
Protein powder added to a smoothie or suitable food
Clinically prescribed oral nutrition drinks where appropriate

Health New Zealand notes that oral nutrition supplement drinks may be prescribed when an older person is losing weight or struggling to eat well.

Protein powders should not automatically replace meals or a varied diet. However, when chewing, appetite or meal volume is limiting intake, a well-chosen smoothie may provide meaningful protein in a form the person can actually consume. The appropriate product will depend on ingredients, protein type, sweetness, digestive tolerance, allergies, medications, kidney function and the person’s broader nutritional needs.

More protein is not helpful if it cannot be tolerated

It is tempting to treat nutrition like a mathematical problem: calculate the target, add more food and assume the problem is solved.

The human digestive system is not always that simple. An older person may become constipated if protein is increased while fluid, fibre, movement and overall food intake remain low. Another person may experience loose stools, bloating or urgency when introduced too quickly to large smoothies, concentrated nutrition drinks, lactose, certain sweeteners, large amounts of fat or unfamiliar ingredients. These symptoms should not be dismissed, but neither should they automatically be blamed on protein itself. Constipation and diarrhoea can have many causes, including:

Low fluid intake
Too little or too much fibre
Reduced movement
Medication side effects
Lactose intolerance
Artificial or sugar-alcohol sweeteners
Large servings of concentrated drinks
Infection or another underlying health condition
Faecal impaction, which can sometimes cause overflow diarrhoea

The solution may involve changing the serving size, ingredients, timing or concentration rather than abandoning nutritional support altogether. Smaller serves introduced gradually may be better tolerated. Some people manage yoghurt but not milk, or soy milk but not dairy. Others tolerate a protein drink when it is sipped slowly between meals rather than consumed quickly alongside food.

Persistent constipation, ongoing diarrhoea, abdominal pain, vomiting, dehydration, blood in the stool or an unexplained change in bowel habits requires medical assessment.

Every mouthful needs to do more

When appetite is limited, the goal is not necessarily to make the plate larger. It is to increase the nutritional value of the amount the person already feels able to eat. This is sometimes called food fortification.

Small changes may include:

Making porridge with milk or soy milk instead of water
Adding milk powder, yoghurt or nut butter to porridge
Serving eggs, cheese, fish or beans with toast
Adding shredded chicken, lentils, beans or cheese to soup
Stirring cheese, milk powder or olive oil into mashed vegetables
Adding Greek yoghurt to fruit or desserts
Using hummus, cottage cheese or nut butter as spreads
Choosing milky drinks or smoothies rather than relying only on tea
Offering nourishing snacks between meals

The best choices are not necessarily the foods with the most impressive nutrition label. They are foods the person enjoys, tolerates and can consume consistently.

The problem with filling up on sugar

Sweet foods have a legitimate place in an enjoyable diet. A favourite dessert, biscuit or piece of cake can provide pleasure, familiarity and additional energy for someone with a small appetite. The concern arises when sweet foods and drinks begin to replace more nourishing opportunities to eat.

Tea with biscuits may feel easier than preparing lunch. Custard, cake, juice or a sweetened drink may be readily accepted when meat, eggs or vegetables are refused. In residential care, familiar sweet foods may also be convenient to serve and more likely to be eaten. But providing calories is not the same as providing complete nourishment. A diet can contain adequate or even excessive sugar while remaining low in protein, fibre, vitamins and minerals.

Sweet foods may also reduce appetite for the next meal without making a meaningful contribution to muscle maintenance. Some sweet nutrition drinks provide useful protein and energy, but others are predominantly carbohydrate and should not be assumed to meet an older person’s full nutritional needs.

The answer is not to remove all sugar or deny someone the foods they enjoy. A better approach is to make sweet foods work harder nutritionally. Examples might include:

Greek yoghurt with fruit rather than fruit alone
Custard made with milk and enriched with milk powder
A smoothie containing protein, yoghurt or milk rather than juice alone
Nut butter on toast instead of jam alone
Cheese served with crackers and a small sweet item
A high-protein yoghurt or mousse as dessert

Pleasure matters, particularly in later life. But pleasure and nourishment do not have to be competing goals.

Residential care needs more than a menu

Residential care providers face genuine challenges. Residents may have dementia, swallowing difficulties, changing preferences, food allergies, cultural needs, limited dexterity, complex health conditions and widely different appetites.

Staffing, food costs, meal schedules and the need to prepare food safely for many people can make truly individualised nutrition difficult. Many care teams work hard to support residents. However, the high prevalence of malnutrition and nutrition risk shows that providing three meals a day is not, by itself, enough. A menu can appear balanced while an individual resident consumes only a small fraction of what is served.

The important questions are not only:

“Was a meal provided?”

They are also:

“How much did this person actually eat?”

“How much protein did they receive?”

“Are they losing weight or strength?”

“Can they chew, swallow and open the packaging?”

“Do they need encouragement or physical assistance?”

“Are bowel symptoms making them afraid to eat?”

“Are sweet foods displacing protein-rich foods?”

“Does the meal reflect what they genuinely enjoy and recognise?”

Research into residential care has noted that menu standards based mainly on food-group serving sizes may not adequately consider the energy and protein density of what residents actually consume. Nutrition support therefore requires more than designing a theoretically balanced menu. It requires observation, screening, individual planning and follow-up.

What good nutrition support should include

A practical nutrition plan for an older person should consider the whole person rather than focusing only on calories or body weight. Good support may include:

Regular weight monitoring where appropriate
Formal nutrition-risk screening
An individual protein and energy target
Observation of how much food is actually consumed
Protein offered throughout the day
Small, nutrient-dense meals and snacks
Foods matched to chewing and swallowing ability
Support with packaging, cutting and feeding where needed
Assessment of constipation, diarrhoea or other digestive symptoms
Adequate and accessible fluids
Respect for cultural preferences and familiar foods
Referral to a registered dietitian when risk is identified

A standard plate cannot meet every resident’s needs. Two people of the same age may require very different foods, textures, portions and levels of assistance.

Food is also social

Nutrition advice often focuses on what is placed on the plate. But where, how and with whom a meal is eaten can be just as important. Eating with another person may improve both appetite and enjoyment. A regular family lunch, a shared meal with a neighbour, a community dining programme or an unrushed dining room can help restore structure and connection. Rather than asking an older person, “Are you eating properly?”, it may be more helpful to ask:

“What did you enjoy eating today?”

“Which part of the meal was difficult?”

“Would a smaller portion feel easier?”

“Is there anything that has become difficult to chew or swallow?”

“Would you prefer to eat a little more often?”

These questions are gentler, more specific and often more revealing.

Supporting someone may involve more than leaving food in the fridge. They may need help opening containers, cutting food, reheating a meal or simply having someone sit with them while they eat.

Signs families should not ignore

Changes in nutrition can be subtle and may occur long before someone appears visibly unwell. Possible warning signs include:

Unintentional weight loss
Clothing, rings or dentures becoming loose
A noticeably smaller appetite
Frequently leaving meals unfinished
Increasing weakness or tiredness
Difficulty getting out of a chair
More frequent falls or a loss of balance
A fridge or pantry containing very little nourishing food
Relying mainly on tea, toast, biscuits or sweet foods
Difficulty chewing or swallowing
Loss of interest in shopping or cooking
Constipation or continuing loose stools
Slower recovery following illness or surgery
Becoming more withdrawn from family or shared meals
Struggling to carry groceries, open packaging or prepare food

Weight loss is not an inevitable or harmless part of ageing. Unexplained weight loss, ongoing poor appetite, swallowing difficulties or a noticeable decline in strength should be discussed with a GP or other qualified healthcare professional.

A registered dietitian can assess food intake, health conditions, protein needs, digestive tolerance and practical barriers, then recommend an approach suited to the individual.

What families can do

Nutrition problems can develop slowly, so regular contact and observation can make an important difference. Practical ways to support an older family member, friend or neighbour may include:

Sharing meals regularly rather than relying only on telephone check-ins
Helping with grocery shopping or arranging food delivery
Offering smaller portions of familiar, protein-rich foods
Keeping easy-to-open and easy-to-prepare foods available
Adding a protein-rich food to breakfast and lunch
Checking whether dental problems are making eating uncomfortable
Watching for changes in weight, clothing fit, energy and mobility
Noticing constipation, diarrhoea or avoidance of particular foods
Encouraging appropriate movement and resistance exercise
Seeking professional advice before weight loss becomes severe

It is also important to involve the person in decisions about their food. Meals should reflect what they enjoy, what is culturally familiar and what they feel able to manage.

Supporting nutrition should not mean removing independence or turning every meal into a medical task. It should help make eating easier, more enjoyable and more sustainable.

Nutrition and movement work together

Food provides the raw materials needed to maintain muscle, but muscle also needs to be used. Appropriate resistance exercise, balance activities and regular everyday movement can help support strength and physical function.

The right type and intensity of activity will vary. Someone who is frail, recovering, experiencing pain or having balance problems may benefit from advice from a physiotherapist, exercise professional or other qualified healthcare provider.

Nutrition and movement are most effective when considered together. Protein alone cannot replace activity, and exercise is much harder to sustain when the body is not adequately nourished.

Nourishing the life around the person

The subject of malnutrition can sound clinical, but the solutions are often deeply human. They may begin with noticing that someone’s clothes have become looser. Looking inside the fridge rather than assuming everything is fine. Bringing over a nourishing meal and staying to share it. Helping with transport, shopping or meal preparation. They may involve asking not only what a person is eating, but how much they are able to eat, whether it agrees with them and whether they have someone to eat with.

Healthy ageing is not supported through supplements or individual nutrients alone. It is shaped by regular nourishment, movement, connection, appropriate healthcare and the small routines that help a person remain involved in their own life.

As appetite changes, every mouthful becomes an opportunity to protect strength. Because in later life, adequate nutrition is not simply about adding years. It is about preserving the energy, mobility and independence needed to keep living those years well.

When to seek professional advice

Speak with a GP, registered dietitian or other qualified healthcare professional if you or someone you care for is experiencing:

Unexplained or continuing weight loss
Low iron may indicate an internal bleeding or cancer
Ongoing poor appetite
Difficulty chewing or swallowing
Coughing, choking or discomfort during meals
Increasing weakness or repeated falls
Difficulty shopping for or preparing food
Persistent constipation or diarrhoea
Slow recovery following an illness, injury or operation
A health condition that affects protein, fluid or dietary requirements

Sudden difficulty swallowing, choking, severe weakness, blood in the stool or signs of dehydration require prompt medical attention.

You can explore our Healthy Ageing collection, thoughtfully curated to support energy, mobility, muscle health and everyday vitality. You may also like to visit our Science & Wellness articles for more practical information about healthy ageing, nutrition, movement and wellbeing.

Conclusion: Older people cannot always simply eat more

Malnutrition in later life rarely begins with one dramatic event. More often, it develops through a series of small changes that are easy to overlook. A reduced appetite. A meal skipped here and there. Less energy for shopping and cooking. Difficulty chewing. Constipation. Loose stools. The loss of a partner. More time spent eating alone.

An older person may be offered enough food on paper and still receive too little nourishment in practice. They may not be able to finish a large meal. They may fill up on tea, biscuits or sweet foods because these are easy to consume. They may be given a protein target without any realistic way to achieve it.

The answer is not simply to place more food on the plate. It is to understand how much protein and energy the person needs, what they can comfortably consume, what their digestion will tolerate and what support they require at each meal.

Recognising nutrition risk early gives families, care providers and healthcare professionals the opportunity to help before the consequences become more difficult to reverse. Sometimes that support will require professional assessment and an individual nutrition plan. Sometimes it may begin with something much simpler. A small, nourishing meal that the person can actually eat, shared with someone who notices whether they do.

Featured products to help every mouthful do more

Whole foods should remain the foundation of a varied diet wherever possible. However, when appetite is limited or ordinary meals are not providing enough nourishment in a manageable volume, carefully chosen functional foods can help increase protein or energy without requiring a much larger meal.

Mitchells Nutrition Bone Broth Protein Chocolate 500 g – provides over 25 grams of protein per serve in a smooth chocolate flavour. This was the protein we used personally when trying to reach a challenging daily protein target, as it provided meaningful protein without requiring another large meal.
Mitchells Nutrition Bone Broth Protein Unflavoured 500 g – provides over 25 grams of protein per serve and contains no added flavours or sweeteners. Its neutral flavour makes it suitable for smoothies, soups, sauces, mashed vegetables and other sweet or savoury foods.
Nuzest Clean Lean Protein Smooth Vanilla 500 g – a plant-based pea protein providing all nine essential amino acids. It can be mixed into smoothies, yoghurt or porridge and offers an alternative for people avoiding dairy.
Mitchells Nutrition Bovine Collagen Peptides 200 g – an unflavoured, hydrolysed collagen powder sourced from New Zealand grass-fed cattle. It dissolves easily into coffee, tea, smoothies, yoghurt, oats and other foods, providing a simple way to add collagen protein without substantially increasing portion size.
Mitchells Nutrition Beef Tallow 450 g – a traditional cooking fat made from 100% grass-fed and finished New Zealand beef. It can be added to mashed vegetables, soups, roasting and savoury meals to increase energy density and flavour without adding a large volume of food.

Protein powders and collagen should complement a varied diet rather than replace complete meals. Collagen provides useful amino acids but is not considered a complete protein, so it is best used alongside foods or protein products that provide all essential amino acids.

Beef tallow adds concentrated dietary energy rather than protein. It may be useful when increasing calories is appropriate, but the amount should be tailored to the person’s appetite, digestive tolerance and overall health.

The most suitable option will depend on dietary preferences, allergies, swallowing ability, digestive tolerance, medications, kidney function and broader nutritional needs. Seek individual advice from a GP or registered dietitian where there is unexplained weight loss, frailty, kidney disease or difficulty eating.

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Sources and further reading

General information: Information in this article is for educational and general wellness purposes only and is not intended to diagnose, treat, cure or prevent any disease. Always seek professional advice regarding unexplained weight loss, poor appetite, swallowing problems, continuing bowel changes, frailty or changes in health. Supplements should not replace a balanced diet, regular movement, adequate rest, supportive relationships or appropriate medical care. Always read product labels and use supplements only as directed.