A growing number of California’s oldest residents are dying of malnutrition, a trend that has been going on for years and has accelerated during the COVID pandemic.
Deaths attributed to malnutrition have more than doubled, from about 650 in 2018 to about 1,400 in 2022, according to preliminary death certificate data from the California Department of Public Health. The same trend has occurred nationwide, with malnutrition deaths more than doubling from around 9,300 deaths in 2018 to around 20,500 in 2022, according to the US Centers for Disease Control and Prevention. .
Malnutrition is particularly common among older people, especially those who are ill, on low income, housebound, or without reliable access to healthy food or medical services. It can result from an insufficient diet but also from bad eating habits that lead to nutritional deficiencies. Last year, the majority of deaths from malnutrition in California occurred among residents 85 and older.
Several experts said the covid shutdowns were likely cutting off access to healthy food. Because older people were most likely to die from covid, officials encouraged them to limit their exposure to others who might have the disease.
“People who were maybe depending on public transportation or others to get to the grocery store – suddenly they’re nervous about taking the bus,” said Lindsay ClarkSenior Vice President of Health Education and Advocacy at the Alliance for Aging Research, a nonprofit group in Washington, D.C. “That family member or friend who would have picked them up and taking them to the grocery store worries about having them in their car.”
Pandemic shutdowns have also hampered safety net programs that feed the elderly. For example, many adult daycare centers closedeliminating places where the elderly can go during the day as an alternative to nursing care. Dr. Louise Aronsongeriatrician and professor at the University of California, San Francisco, said seniors who have used the programs “can count on the food they get there as their best meal of the day.”
Malnutrition deaths rose in 2022 even as lockdowns eased. Experts said the persistence of the trend could be due to some of the older residents continuing to self-isolate.
Covid remains a grave danger to this demographic. About 5,400 Californians aged 85 and over died of covid last year, making it the fifth leading cause of death for this age group – responsible for more than twice as many deaths as diabetes, data shows. state preliminaries.
“For a lot of older people and people with disabilities, it’s not really over,” said Trinh Phan, who works from California for the nonprofit organization Justice in Aging. Phan said many older Californians are scared of covid, wondering, “Do I really want to risk this for myself given my own risk factors?”
While the number of deaths from malnutrition in California jumped during the pandemic, it had been rising for years. Some of that increase may be due to the overall aging of the population, experts said.
About 678,000 Californians are 85 or older, a number that has increased by about 59% from 2000 to 2021, according to census data.
Californians 85 or older accounted for nearly three in five deaths from malnutrition in the state last year. People aged 95 or older account for nearly one in five deaths from malnutrition, although only about one in 700 Californians are in this age group.
“Biologically, we eat less as we age,” Aronson said. “You are literally less hungry.”
Also, older people in particular have a slower metabolism and digestion than younger people. “When you eat less food overall, it’s hard to get all the nutrients you need,” she said.
Other factors beyond pandemic shutdowns and an aging population may be behind the sharp increase in reported malnutrition among the elderly. California’s malnutrition death rate per 100,000 among people age 85 or older rose precipitously around 2013, quintupled in 2019, and from there doubled during the pandemic.
Complicating the picture is the frequency with which malnutrition appears in conjunction with other illnesses. Older people are more vulnerable to diseases – such as heart failure, cancer, Alzheimer’s disease and depression – which can reduce their appetite and lead to malnutrition as a secondary cause of death.
Malnutrition was a contributing cause of 5,600 deaths in California in addition to the 1,400 deaths for which it was the leading underlying cause, according to interim CDC data. The number of deaths for which malnutrition was a secondary cause of death increased by approximately 1,700, or 43%, from 2018 to 2022.
“You may be admitted with diabetes, but at the same time you are also malnourished, and so malnutrition adds to your problems,” said Paul Brownprofessor at the University of California-Merced who co-presented papers on malnutrition in California at an American Public Health Association conference.
There is also increased pressure to recognize malnutrition. Two of the leading national nutritional science organizations released updated guidelines in 2012 to better standardize the diagnosis.
The highest malnutrition death rates among Californians aged 2020 to 2022 were in rural or semi-rural counties: Lake, Merced, Butte, Tuolumne and Sutter.
Brown said older residents living in rural counties often live in “food deserts,” which are areas that lack access to healthy foods.
Among large urban counties, Sacramento has had the highest rate of deaths from malnutrition among people age 65 or older from 2020 to 2022. County spokesperson Macy Obernuefemann said the health agency help control and manage chronic illnesses often accompanied by malnutrition, and that several programs help older people get the food they need.
Several programs in California seek to reduce malnutrition among the elderly. The state network of 33 regional agencies on aging often provide healthy meals to seniors, according to Sara Eisenberg, spokeswoman for the California Department of Aging. Organizations such as Meals on Wheels do it too. Agencies also routinely try to ensure seniors are enrolled in CalFresh, the state food assistance program for eligible low-income residents, Eisenberg said.
CalFresh Benefits increased end of 2021 27%, helping many seniors afford food. A bill in the legislature, SB 600, would increase CalFresh’s minimum benefit from $23 per month to $50. There is also a push to enlarge CalFresh benefits more undocumented immigrants, many of whom face food insecurity.
“I think there’s been really positive movement,” Phan said.
Demographic trends suggest that malnutrition will continue to be a problem. The number of Californians age 85 and older, the group most prone to malnutrition, is expected to increase by about 420,000, or 54 percent, from 2020 to 2030, according to projections by the state Department of Finance.
Phillip Reese is a data communications specialist and assistant professor of journalism at California State University-Sacramento.