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Malnutrition in Aging

Prevalence of malnutrition in the elderly is defined as a state of energy, protein or other specific nutrient deficiency is reported to occur frequently in elderly people, the prevalence, however, showing great variation from about zero to 65%. This observation can be partly explained by methodological problems in assessing malnutrition, but in particular by the enormous heterogeneity of the elderly population group. Old age includes a time span of more than 30 years, and a wide range of different life styles, physical and medical conditions, health and nutritional states. Among elderly up to about age 75 the prevalence of malnutrition is reported to be low (below 10%). The vast majority of these generally healthy elderly people living in their own homes, show marks of nutritional status in the normal range. Overweight is by far more prevalent than underweight (Hajjar et al, 2004).

A great number of studies in different countries confirm the high prevalence of under nutrition particularly in geriatric patients. Clinical anthropometric and biochemical signs of protein-calorie malnutrition as well as biochemical evidence of micronutrient deficiencies are frequently observed at hospital admission. Further weight loss and deterioration of nutritional status often occur during hospitalization. Interventions

When nutrition-related problems are identified they must be addressed in a timely manner. Following the Multifactorial origin of malnutrition in the elderly, multifaceted intervention is necessary. An individual plan of action has to be worked out based on the individual's physiologic and pathologic condition, aiming at the removal of underlying causes of malnutrition and at the increase of dietary intake. The elimination of reversible causes first of all needs the appropriate management of the underlying disease. Careful dental treatment, swallowing training, mobilization, avoidance of anorectic drugs or the provision of feeding assistance may also eliminate impediments to sufficient oral intake.

Nutritional therapy, as in younger patients, may include oral, enteral and parenteral measures. Concerning oral nutrition simple measures may contribute to an improved intake, e.g. care for calmness during meals and enough time to eat without interruptions, provision of palatable food rich in energy and nutrients, provision of multiple small feedings, provision of food in the right consistency that the patient is able to chew and to swallow, or avoidance of overly restrictive diets. Studies have shown that efforts to improve hospital food, nutritional care and meal environment can result in increased dietary intake. Best evidence, presently exists for the positive effects of oral liquid supplements. Several studies have documented improvements of dietary intake, nutritional status and outcome in geriatric patients by the use of these products. There are also clues that enteral nutrition - supplementary or complete - may positively affect nutritional status and outcome of elderly patients. But more research is required to identify patients who will actually benefit. As evidence from existing studies is altogether weak, well-designed, adequately powered studies are necessary to specify optimal strategies to improve intake, nutritional status and outcome of geriatric patients with malnutrition or at risk of ...