Take a close look at the oldest person in your family. A grandfather, a grandmother, a retired uncle or father, perhaps a neighbour who has lived in the same building for forty years. Now as you take a closer look, ask yourself: when did you last know for sure that they had eaten properly on a Friday afternoon? Consider looking at the fact that the older they get, the less they usually eat, hence, every bite and sip does matter as the consumption is less and the digestion is less efficient.

In Egypt, around 6.5 million people are aged 65 and older. Headlines rarely cover these people, and they do not feature much in the demographic campaigns of food security programmes. Now, think about the seriousness of the situation once an elder misses a meal, their portions shrink, and the nutritional quality of what they eat deteriorates. This rarely gets talked about until something wrong takes place.

Nutritional researchers call this Silent Hunger, a challenge that is harder to fix than it looks.

A Young Country and A Different Type of Hunger

By median age of around 25 years old, Egypt is considered one of the youngest countries in the world and the national dialogue and aims of the country on food and nutrition do reflect that.

Those that age beyond 65 do sometimes get hungry, however, that is not the problem, the problem is that their hunger is different. They experience something most of us in our youthful ages do not face. As the body gets older, it requires fewer calories overall, yet, the requirements for particular nutrients stay the same or even go up. This requires bits of wisdom and knowledge in feeding to give the older person less food but to make sure that they get more out of every bite once their appetite drops or their stomach absorbs less efficiently.

The anorexia of aging is the name that researchers gave to this gradual appetite decline which has nothing to do with dieting. This is a physiological shift that makes older people feel less hungry even when their bodies are running short of nutrients. Have you ever sat at the table with one of the elder members of the family and remembered how much they used to eat in comparison to how much they eat now? Do they eat far less? Well weak knees and joints are not the only thing that comes with old age, a loss of appetite does too. The gap between what an old person eats and what their body needs can widen up swiftly and become a life-threatening condition.

The Consequences of Inflation on the Older Budgets

Between 2022 and 2024, Egypt witnessed one of the highest inflation rates in its recent history which peaked at 38% in late 2023. This was not an issue that exclusively faced Egypt, rather, it was a global crisis. That being said, food prices rose at a very high pace, in July 2023 they were up 65% compared to the same month the previous year. Now let’s put ourselves in the shoes of a retired individual aged 65 in a low-income household who can barely afford the prices of bread, rice, cooking oil, and sugar.

For those elders on fixed pensions or even no income at all, this was not an inconvenience, instead, it was an excruciating challenge that changed the way they ate. When money gets tight in the household it is usually the old person who eats less quietly without saying anything so that the younger ones do not have to worry or complain. When the pot of lentil soup stretches across two days and meat gets swapped for cheaper starches, the problem gets serious.

The result of the above-mentioned is called hidden hunger by nutritionists. It is when a person eats but is chronically short on iron, calcium, vitamin B12, and vitamin D. The result of this shows later on as fatigue, weak bones, a decline in memory and an overall cognitive slowing; this physical fragility is often justified by the famous ‘’I am getting old’’. Getting old has its take on us, indeed, however, the lack of proper nutrition is preventable and the results do show once they eat properly.

Losing Some Muscle Mass: How Sarcopenia Can Visibly and Badly Affect Elders

Part of ageing includes losing muscle mass as we grow older. From around age 30 and as we age, we start to lose muscles somewhere between 1 and 2 percent per year. This is normal, however, if the protein intake is consistently low and when the vitamin D levels are deficient, the overall decline moves faster. This condition is called sarcopenia and if you want to see where you have witnessed it before knowing the terminology, take a look at these examples: falls become more likely, getting up from the chair is harder, climbing a ladder or taking the stairs is painful, and carrying the groceries gets harder. Have you heard any of your elder members of the family complain about that? If yes, then it is in many cases, sarcopenia.

Vitamin D is worth paying particular attention to in the Egyptian context. One of the main reasons for that is that despite living in one of the sunniest countries in the world, a percentage between 38% and 77% of older adults in Egypt have vitamin D levels below the threshold. What’s more, they often stay indoors and go out less in tandem with eating carb-rich foods that fill the stomach but do not fix the deficiency.

Loneliness and The Isolation that is Overlooked

Malnutrition in old age is not just about money or food access, loneliness plays a large role that many people often do not give enough attention to.

One of the traits of the Egyptian society is the extended family structures, the structure that once meant a grandmother always had someone cooking for her or checking on her. Yet, urbanisation, economic migration, and the cost of shared housing have scattered families across cities and an older person who once lived amidst a large number of family members may be left alone or with less care. They tend to cook less, eat less, and lose the motivation to prepare a proper meal that they could have shared with someone.

Research links social isolation consistently to poorer dietary habits and lower food intake in older adults. A person who stops eating well because they are lonely is just as malnourished as one who cannot afford food. The causes are different but the body does not care about the difference.

The Role of the EFB: When the Standard Food Box is Not Enough

Through the Monthly Feeding Programme, the Egyptian Food Bank (EFB) has worked with elderly beneficiaries for years and distributed food parcels on the basis of social assessments that identify the most vulnerable households which includes older adults living on their own.

This programme distinguishes and recognises that a standard food box is not enough, in other words, a food parcel designed for a working-age family does not address the nutritional gaps facing a 75-year-old woman with rheumatoid arthritis or osteoporosis, or a man in his eighties who is unable to chew hard foods.

Additionally, through the Vitamin D Programme, the EFB provides nutrient-enriched foods that target the deficiencies most common in older adults. This is done through evidence-based and scientific research that is carried out by researchers and nutritionists who tailor nutrients to tackle the vitamin D decline in older adults.

What’s more, is that the EFB understands that receiving food is one part of solving the problem, however, an older beneficiary who does not know how to prepare what they receive or lacks the ability to do it is still underserved. Thus, food delivery is paired with outreach and nutritional awareness that focuses on what to actually do with the food and not just to have it.

Therefore, once we look at it closely, it is apparent that silent hunger has a simple cure in theory: to be noticed. Practically speaking, this requires optimal resource mobilisation and the will to treat the elderly as a priority and not an afterthought, a work that the EFB has been doing for years.

 

 

 

 

 

 

 

 

 

References

1. UN Population Prospects United Nations, Department of Economic and Social Affairs, Population Division. World Population Prospects 2024: Summary of Results. New York: United Nations, 2024.

2. Global Hunger Index von Grebmer, Klaus, Jill Bernstein, Reshma Miriam, et al. 2022 Global Hunger Index: Food Systems Under Resilience and Local Solutions. Bonn: Welthungerhilfe; Dublin: Concern Worldwide, 2022.

3. Anorexia of Ageing Cox, Nicola J., Niamh Rice, S. J. Richardson, et al. "Anorexia of Aging: An International Assessment of Healthcare Providers' Knowledge and Practice Gaps." Journal of the Academy of Nutrition and Dietetics 119, no. 12 (December 2019): 2038–2044. https://doi.org/10.1016/j.jand.2019.04.015.

4. Egypt Inflation Data Central Bank of Egypt. Monthly Inflation Note: September 2023. Cairo: CBE, 2023. https://www.cbe.org.eg/en/monetary-policy/inflation.

5. Sarcopenia and Muscle Loss Bauer, Juergen M., et al. "Sarcopenia: A Review of Nutritional Treatment Approaches." Nutrients 13, no. 7 (2021): 2234. https://doi.org/10.3390/nu13072234.

6. Vitamin D in Egypt ALbuloshi, Thurayya, Ahmed M. Kamel, and Jeremy P. E. Spencer. "Factors Associated with Low Vitamin D Status among Older Adults." Nutrients 14, no. 16 (2022): 3342. https://doi.org/10.3390/nu14163342.

7. Malnutrition in Egyptian Hospitals Mohammed, Hebatullah O., Azza M. Hassan, Aya Mostafa, Mohamed S. Khater, Aisha Aboelfotoh, and Khaled M. Abd Elaziz. "Geriatric Nutritional Risk Index and Adverse Medical Outcomes among Egyptian Patients Admitted to a Geriatric Hospital: A Prospective Cohort Study." BMC Geriatrics 24, no. 62 (2024). https://doi.org/10.1186/s12877-024-04671-5.

8. Social Isolation and Diet Aljahdali, Abeer A., Muzi Na, and Cindy W. Leung. "Food Insecurity and Health-Related Quality of Life among a Nationally Representative Sample of Older Adults: Cross-Sectional Analysis." BMC Geriatrics 24, no. 132 (2024). https://doi.org/10.1186/s12877-024-04716-9.